Making a Good First Impression Junior Doctors: Your Life in Their Hands

-Trauma...

-Give me another milligram.

-He's got a pulse. A strong pulse.

-Any pain up here?

-Tears...

-That's all right.

And intense pressure.

Changing the oxygen over.

Just another day on medicine's front line.

They're young.

They're untested.

This is my first patient ever.

And from their very first day, work is a matter of life and death.

-Don't let me die.

-We're not going to let you go anywhere.

For a junior doctor, fresh out of medical school,

it's time to put theory into practice.

No, I haven't.

We're following seven junior doctors

over their first three months on the job.

-Sharp scratch.

-Oooh!

It's all about the glamour. It's all about the bums.

Where there's a first time for everything.

I didn't really know what to do. It's having the confidence, isn't it?

And first impressions count.

I'm afraid I didn't get it first time either.

They will share their personal highs...

Every day you do make a little difference to someone and you get a kick out of that.

..and professional lows.

It's the first patient that I've had that's died.

They are - party animal Tom...

-We can pretend to be doctors.

-I think I've been doing that for the last week.

Arty Emily.

I want to have a pizza and I want to cry and I want to go to bed.

-Competitive Jen.

-I've worked for a long time for this. It needs to just happen now.

Young dad Tristan.

The balancing act between father and doctor will be a lot more difficult.

And second years...

Italian mountain medic Ed.

The first time I came to Liverpool and people started talking

to me on the bus, I thought they were foreign. I was pretty sure they weren't English.

Straight-talking Keira.

Sorry about that. I don't usually struggle with this.

And confident charmer Oli.

Keep looking straight up my nose. I saw you sneak a peek there.

They're working here, at the Royal Liverpool University Hospital,

in a city where men have the lowest life expectancy in England.

I get this wrong and I kill the patient.

And the highest number of alcohol-related illnesses.

Oh, dear. Feeling a bit sicky?

They've had five years of training.

But are the junior doctors really ready?

For this hospital, in this city.

It doesn't get any tougher.

Hey, they're here to look after you, lad. Give it a rest.

It's so exciting. Shall we go in?

Tom and Jen, friends from medical school,

are sharing this house with some of the other junior doctors.

This room will feel like home when I can no longer see the floor.

And thoughts of what lie ahead are never far away.

-Scared?

-Yeah, I'm terrified, actually.

-I keep getting butterflies in my tummy.

-Do you?

-Yes, when I think about it I do.

The others have arrived for dinner and in less than 24 hours,

they're all starting new jobs at one of the most demanding hospitals in the country.

-This is it, guys. Good luck.

-Cheers!

For Jen, Tom,

Tristan and Emily,

tomorrow will be their first day as qualified doctors.

I hope I don't just freeze in the middle of something where

everyone's looking at me and be like,

"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...

Oli has spent a year on the wards already

and knows how they're feeling.

I think I was beeping the medical registrar. "I've got this patient with this,"

and they're like, "Have you done this?" No. "Have you done this?" No.

Have you even done this? No. "Do that and come back." But then it becomes routine and it's fine.

Italian Ed has never worked in a UK hospital before

and he'll be straight in as a second year.

I am feeling a bit nervous.

Just being left alone with violent patients. That has never happened to me.

That's something that scares me a lot.

Everything that I've done before as a student has just become real,

because now is the time when I'm going to the doctor.

I'm going to be the person who is making the decisions

of the first-year junior doctor on the ward, which is massive.

It's much bigger than anything I've encountered before.

-I'm actually going to bed now. I'm shattered.

-OK. Night night.

-See you in the morning.

-See you in the morning.

-Make me a cup of tea?

I will.

I think there's a million and one things to make sure that you get

right on your first day.

It has everything from making sure that you look good with your seniors

and establishing the right attitude with the patients

and to make sure everybody's happy that you're there rather

than thinking that you're a massive pain,

just cos you don't know what you're doing.

ALARM BEEPS

Today is the day that thousands of junior doctors

across the country have been preparing for.

In Liverpool, first-day nerves are hitting home.

I feel like I'm living in a little bit of a dream, to be honest with you.

Nobody expects us to be, you know,

child prodigies the day we book on to the award.

-Bye-bye.

-Take care.

These are my first-year clothes.

I've been wearing them for the last year

and they can now go right in the bin.

Everything they've trained for begins here.

It's crunch time.

The enormity of what's about to happen has just suddenly

dawned on me.

Emily.

You bloody fool. You'll get us killed.

-I'm going to be the F2 on AMU for the next four months.

-Oh, right?

-Oliver.

I'm Emily, one of the F1s. I've just started today.

Welcome, everybody.

This will be an exciting four months for you.

A steep learning curve but you will learn a phenomenal amount when you're here.

Second-year Ed is starting in the Emergency Department

but the Italian junior doctor has never worked for the NHS and is

under extra pressure to figure out the British way of doing things.

What scares me at the moment is being able to actually

work in the system. Managing to fit in and implement the policies the hospital has.

It's not the only thing about his new job that's worrying him.

The main fear about today is that I haven't seen an X-ray in six months

so I really need to get up to reading these things again.

It's so easy to miss out obvious things when you don't practise them.

Ed will be starting off with a 10-hour shift

in one of the country's busiest emergency departments.

For a junior doctor with no experience of working in a British hospital,

there'll be nowhere to hide.

People see me as the guy who is always either studying or climbing.

Knowing the risks involved does not stop me

very much from taking the risks.

Being calm is something that I try to do in any situation.

-My friends say that I am a bit of a perfectionist.

-Perfect.

The job I'm doing at the moment is doctor in a little town

up the top of a mountain.

Around 2,000 people live in the area.

I'm the only doctor around there so I deal with everything.

That can be from first aid to just a simple prescription.

Martine and I have been together for four years.

She's ready to take the chance and move over to the UK.

-To fast understanding of Liverpudlians.

-To Liverpudlians.

I don't know so much about the NHS, that's for sure.

I haven't been working in the UK and I'm looking forward to seeing

how well I adapt to the situation because at the moment, I'm an outsider.

With Ed, he's going to find this quite an eye-opener.

It's very different to what he experienced working in the mountains

in a small village with very little support.

Left wrist has gone, fracture broken.

Possible dislocation of the right shoulder.

Whereas here he will see inner-city medicine

with lots of problems

with smoking and drinking and drug taking.

I'm sure he'll learn very quickly.

Give him a loud call and when he responds, just bring him through to here.

It's crunch time for Ed.

He's got his first patient, a man who's come in with a knee injury.

-So do you want to tell me what happened?

-I stepped off the van.

-My knee twisted.

-Yeah. OK. No problems before that?

-No.

-No problems in the knee?

-OK.

Ed must perform an immediate examination.

The ligament here is very tough and very thick. Does that hurt if I let press there?

-That's sore there.

-OK?

But he's not sure what to do next.

This is my first patient ever here, so I don't know exactly what to do.

I don't know anything about this, this is my first day here.

So you'd probably be better speaking to one of these wonderful senior doctors.

With his patient waiting, Ed finally goes to find senior consultant

Doctor Demnitz, who confirms an x-ray is needed.

But Ed's got a confession to make.

I'm not very good at examination of the knee.

Orthopaedics in general is something I need to work up on a bit.

-But I did...

-We can work on that.

The x-ray is booked in, but will Ed be able to understand the results?

-The request is there, they'll call you.

-All right.

-OK.

Like Ed, also starting her second year in the emergency department

is Keira, and her patient has undergone a terrifying ordeal.

-What's been going on?

-Basically, I was assaulted.

A young man has come into hospital after being beaten up.

Still fearing for his safety, he has asked not to be identified.

Well, cos they couldn't actually do more damage to my face,

-they were kicking me everywhere.

-So, where were you hit and/or punched?

On my left side and my right side and my arm.

And your arm? OK.

-Any blurring or double vision?

-No.

As the man has suffered serious head injuries,

Keira must perform a thorough examination.

How many fingers am I holding up?

Two.

And examine some of his other injuries.

-Any pain there?

-No.

-You've probably bruised some ribs

but they don't feel like they're broken, you've obviously had

a bit of a smack.

Is your nose all right as well?

Is it a bit swollen?

-No. Oh...

-HE WINCES

-Yeah?

-Yeah.

So the most important thing now is to get you

in for your scan of your head, OK?

His scan is clear, but the patient must be stitched up.

I'm going to have to pop a bit of numbing stuff in now.

It won't be the most comfortable thing when I'm injecting it,

but the pain will soon go away. OK?

-How's that?

-OK.

As bad as you thought it was going to be?

To be honest, I'm kind of used to pain anyway.

PAINED MOANING FROM NEARBY BED

Maybe you could have a word with this gentleman across the road, eh?

People are often very reticent about what details

they give about alleged assaults and I tend not to really ask.

If people aren't going to tell me, then I tend not to ask.

-Sorry. That a bit sore?

-Yeah.

-HE WINCES

Sorry, love.

I'll do some plastic surgery on you, eh?

Sorted.

After three stitches, she's all done.

Thank you.

All right, love.

Oh, God, did you just smack your head on that? Are you OK?

-You didn't smack where you...?

-No. It got me there.

It's the kind of case that Keira is expecting more of

while in the emergency department.

Certainly we are getting a fair number of shootings

and stabbings and stuff that come in.

Problems with living in a big, inner-city area.

Tristan is starting work on Gerontology,

which specialises in dealing with elderly patients.

Just squeeze my fingers as tight as you can.

But he's the first of the junior doctors to go on call,

so he could end up having to assist in any urgent cases

on any ward, at any time.

One of his next patients is a man who needs a rectal examination.

It'll be the first one Tristan has done

since qualifying as a doctor.

Starting off as a medical student, yeah, it's something

that you don't want to do.

I don't think anyone particularly likes doing them,

but, to me, it's just another part and parcel, comes with the job.

Hey. Back again.

I'll just pull the curtains round.

So, just for the time being,

if you could just roll over to your left-hand side and lie on your left.

OK.

I'll just explain what's going to happen.

So, if you lie on your left-hand side like you're doing.

And we'll just pull your trousers down slightly.

And I'll just inspect and area

and I'll need to insert a gloved finger to just check the area.

-And then it'll be over very quickly. Is that all right?

-Yeah, go on.

You tell me if it's painful.

We'll just pull your things down now, is that OK?

Yeah, go on.

'We're worried that he's a had a bleed from his intestines.'

It's not very pleasant for the patient, but it's obviously important.

Right.

Finger going in now.

OK, that's all over.

Right, you can pull your things up.

'It really depends on the patient,'

how much they're really freaked out by having a rectal exam.

Some people, it's the worst thing in the world.

Some people, they know it's just medical and they get on with it.

Some people have had so many

because they come in with the sort of thing that they know

it's going to happen already before you've even broached the topic.

-Everything was fine on that. There was nothing abnormal.

-OK-doke.

OK.

While Tristan gets to grips with his first patient,

Jen, Tom and Emily are settling into their new jobs.

Hello. My name is Emily.

-What's your name?

-Anna.

-Anna. Hiya. I'm one of the new F1s.

I don't know where anything is,

do you know where the forms are for biochemistry?

I have a lot to do on my first day.

I have a list as long as my arm. Probably longer, actually.

Technically supposed to leave at four o'clock

but I don't think I'll get out of here probably before about eight.

After an hour, Ed is still dealing with his first case.

Just being shockingly slow with this patient,

it was a stupid thing, he's been here an hour.

Could have been done in half an hour, but anyway. First patient, so.

The x-ray results are back in, but he isn't sure how to interpret them.

He has to look for senior consultant Doctor Demnitz to help him out.

I'm sorry to pester you, I just want to send this poor guy home.

But Doctor Demnitz wants to know what Ed learnt in Italy

and puts him to the test.

Can you remember what sits inside the knee joint,

just to the side here?

There are a couple of spongy pads that sit there.

That would be cartilage.

OK, what particular cartilage?

-Articular cartilage?

-No, what particular? What do we call that?

It's a semi-lunar shape.

-Half-moon shape.

-Ah, the...

What do you call them now in English?

-Begins with an M.

-Yeah. Erm...

God, oh...

-Nah, no.

-OK. The menisci.

-Menisci, yeah. Thank you.

There's no sign of a fracture, which is good news for the patient

who is finally discharged with just a twisted knee.

But has the morning so far been good news for Ed?

Junior doctors at this level have got a lot to learn.

And the only way we can help them

along with that is to supervise them because everything they see,

they're not the kind of things they've come across before.

-All right.

-Cheers.

-Take care. Goodbye.

But Ed's not happy with how things have gone with his very first patient.

This is all new.

I just need to settle down and understand how things work here.

'There are definitely loads of things I've got to get better at

'in this environment.'

The first day on the wards is over

and the junior doctors head for home.

We'll have a nice relaxing evening and probably have a glass of wine

and a bit of a chill between us.

Then on with it tomorrow with a little more confidence, hopefully.

'It was daunting to be a doctor on the ward,

'for people to come up to me and say,'

"Doctor, can you do this?" And I was there thinking, "Wow. Um...

"You want my opinion? I mean, I could give it to you.

"I certainly have an opinion because I've had the training, but you want it?"

People definitely gave me some compliments on my shoes,

which is nice, rather than my medical prowess, which was fine.

I am so glad to be home. It's been a long day. How was your day?

Fairly uneventful but that's probably a good thing, like,

I literally just did... Hello.

-Hello. How was your day?

-I'm very tired.

Are you? Em's just telling us about hers. Go on, Em.

I did stuff today, but nothing exciting.

Like, literally just loads of paperwork.

Have you had loads of paperwork to do as well?

-No, I just got all the first years to do it instead.

-Oh, nice.

-Yeah.

-I spent half my day on your ward today.

-I know.

-It was nice seeing you.

-The feeling was not mutual!

After a difficult first day,

Ed is back home with his girlfriend, Martina.

He's very scared to make mistakes.

That's the first thing. The second thing is that he really needs

to get used to the system.

The fact that there are a huge amount of things

I don't know about means that there are many things I've got to learn

and work on, and I'm going to have to fix that as soon as possible.

It's a new day and on Upper Gastro Intestinal, the stomach ward,

first year Jen is looking after a 72-year-old patient.

He's concerned that the medicine he's been taking

is upsetting his stomach.

-When did you start that?

-Beginning of last week.

-And why was that?

-They gave me the runs.

She changed them over to them and they done the opposite.

You stopped taking these tablets

-because they were causing you to get a bit blocked?

-Yes.

But Jen's not so sure it's the tablets.

She goes to ask for advice from a senior and discovers that

the patient's recently been diagnosed with bowel cancer.

He put the symptoms that he was having down to the medication.

But we know that that's not the case.

And it's down to the fact that he's most likely got bowel cancer.

While the patient knows of his condition, he hasn't told his family

and is reluctant to accept the full extent of his illness.

More than likely that his family aren't completely aware.

They might have an idea but they need to be told properly

what's going to happen.

With the patient unwilling to tell them himself,

Jen is faced with doing what every junior doctor dreads -

breaking bad news to a patient's family.

So she's called her senior house officer, Andrea Sheel, for support.

She's on her way up, be about ten minutes.

So she's asked if you guys don't mind hanging on. Is that OK?

-Just so you know what's going on and you get an update.

-OK.

I do feel quite bad sitting in, like, metres away from them,

knowing the diagnosis and prognosis and not giving them any information,

so it's quite difficult.

But they're aware that my senior's coming and that she'll explain it

to them, so I think they're quite happy with that.

PHONE RINGS

Luckily for Jen, it's not a situation she needs to face alone.

It is a hard first experience for any junior doctor.

That was quite a tough conversation.

It's the worst part of the job, isn't it?

-Maybe, sometimes I think I'm a bit too blunt.

-No, I thought you were...

-Otherwise you can end up beating around the bush...

-I thought you were so nice to them,

I honestly do, it's heartbreaking.

The worst sort of thing about it is the relatives.

I think that this is when everybody's stood around the bed

and all they want is good news

and you've not got any to give them, that's when it's quite hard.

You can't brush it under the carpet, can you?

You've just got to focus and carry on. That's all you can do.

It's going to be a lot for Jen to take in.

But I specifically wanted her to be involved in that situation,

because I think the sooner you get used to it,

dealing with situations like that, the better.

Obviously it's upsetting for everybody involved

and I think she's dealt with it really well so far.

Back at the house, and second year Keira has some advice for Jen

on handling difficult situations with patients.

I suppose throughout medical school, empathy's really drilled into you.

And so when you see families

and stuff coming in and you naturally empathise with them

and think, "What would I be like in that position

"if that was my family member?"

And it's very difficult not to become very caught up in that

and emotional amongst them.

Do I cry? Do I not cry? How would the patient's family react?

Would they think I was sort of taking it away from their family,

would they like the fact that I was emotional?

I don't think it's a good idea to cry,

it looks like you're out of control and you're the one person

in that situation that they need to be in control.

I've sat down with families of patients who I've known very well

and had a little cry and a little hug with them

and some people think that would be overstepping the mark

but it was entirely appropriate in the situation at the time.

-It's about the situation, isn't it?

-Yeah.

While the others carry on talking,

Tom has to leave for his first night shift.

And with fewer senior staff around, it's a huge responsibility

for any junior doctor to take on.

I'm feeling quite nervous actually

because there's slightly less support.

The major teams are still all in place as they are in the daytime,

but I think it's a good opportunity to show what I can do, I guess.

'Having fun and being a bit silly is really big part of who I am.'

Can you please try it on?

'I love just being a big kid when I'm outside of hospital.'

-Are you ready?

-Are you ready?

-Who lives in a pineapple under the sea?

-Tom does, Tom does.

I'm definitely a people person. I really enjoy making new friends

and at times have probably been a little bit of an attention seeker.

Hello, how are you? Nice to see you.

'I'm a little bit needy.'

I can't be on my own for an afternoon or an evening,

I always have to call my friends up and drag them round for a DVD.

'I find my humour funny. Quite a few of my friends find it funny.

'I don't know if they're laughing with me or at me.'

As long as they're laughing, I guess it's good enough.

APPLAUSE

'The thing that daunts me about starting as a junior doctor'

is actually doing my first on-call night shift.

I will see cardiac arrests

and be part of the team that manage those kind of situations.

It's crunch time.

His first night shift and Tom's worst fears come true.

He's just received his first crash bleep to attend a patient

in the Acute Medical Unit.

He needs to get there as quickly as possible

because the patient's taken a suspected overdose.

But finding his way around the many wards of the hospital

for the first time is tricky.

Where's the AMU? Which way to AMU?

Sorry, I've got a crash call to AMU. Which way is it?

OK, thanks.

Thank you.

-Did she arrest?

-She had a VT. She had a VT. She came around.

When he arrives, everything is under control

and he is sent back to the wards.

All right, cool. See you in a bit.

But 20 minutes later, he's called to the Heart Emergency Centre.

Oh, actually, it's that way.

I keep going the wrong way.

The patient's been moved there to be monitored.

Hello.

Tom must take a blood sample and fit a cannula.

There's a medication we have to give that you have to give through a really wide needle.

It's particularly tricky to get wider needles in -

you have to find the right size vein

And it's fallen on my shoulders cos, unfortunately, the person

who tried before wasn't unsuccessful, which... no pressure.

I understand I've got to pop something into your arm.

Have you been told?

I've got to pop a needle into your arm

so we can give you medication. Is that OK? All right.

My name's Tom, I'm one of the junior doctors here.

Do you want to look the other way?

We're in anyway, we're in, we're in.

Oh, sorry. Oh!

Just give me one second. Oh, I'm sorry.

OK.

Try not to move your arm, try not to move your arm.

I'm really sorry, but that's not gone in.

I'll tell you what, I'll get one of the other people to come and do it.

OK? Would you be happier with that?

I'm sorry.

Unfortunately, after two unsuccessful attempts,

I've decided that it's probably better

I call somebody who's got more experience in putting them in

than me. I don't want to keep putting it in if I'll be unsuccessful.

It's not fair.

Tom reports back to the senior doctor.

I tried twice, none successfully.

If they need it done then they need it done,

-so you need to get over the...

-OK.

-Cos if they're unwell,

if you need to try ten times, you try ten times.

-Would you mind trying...?

-I'll do the line if you try the ABG.

-OK.

Sure. Ideal.

She's told me that she's happy to try and pop this needle in,

but in the meantime she wants me

to take another sample of blood from this girl's wrist.

She just said, "You're going to have to get it done,"

so I'm going to try and get on with that now.

It's a difficult situation for any new doctor.

The good news is that one of the senior doctors is going to come

pop that thing in your arm and she'll do it quickly.

The other news is that I've got to take a sample from here, all right?

And it's really important that we do it cos you've been really unwell.

It's one of the most important tests we do

but it doesn't feel very much. I'm sorry.

Is that all right?

And once we've got these things in,

you should be able to have a bit of sleep.

We need to get it done, that's all.

Keep losing your pulse.

I want to make sure I've got it before I go in.

I'm sorry.

Got it. That's the good news, is that I've got it.

That won't happen again now. OK?

Success.

I don't feel like there's anything I did wrong

I don't feel like I didn't contribute my fair part.

I just feel like at that stage of real tiredness,

I found it really demanding intellectually as well as physically.

-I'm just dreaming about my bed.

-(LAUGHS)

While Tom gets some sleep, it's the start of a run of day shifts

for second year Oli on the Acute Medical Unit.

-Right , keep looking straight at my nose. I saw you sneak a peek there.

-(SHE LAUGHS)

-You can't cheat.

He's proving to be a natural when it comes to charming his patients.

Sharp scratch.

-Didn't feel that.

-Good.

-I'll keep my job after all.

-(SHE LAUGHS)

If you can get a rapport with them and crack a few jokes,

it's nice to be able to interact with them and put them at ease.

I think that's one of the most important things you can do.

We don't want to get ahead of ourselves and start saying

-it's this or that till we've got all the information.

-Oh, no.

A very nice chap. I felt at ease with him. A nice bedside manner. (LAUGHS)

But it's not just the patients who have been won over.

I think he is quite popular with the nurses, yes.

CHATTER LAUGHTER

SHE LAUGHS

I'm probably old enough to be his mum, so it's no good for me.

A new day and a new patient,

who's about to put Oli's charm to the test.

She's come into hospital suffering from breathing difficulties.

-Julie Hancock?

-Yes.

I've got your repeat prescriptions here somewhere. here we go.

-Has there been...

-(SHE COUGHS)

Sounds nasty, doesn't it.

So how far could you walk now without getting short of breath?

-I mean, can you walk any distance?

-No.

Have you had any chest pain at all?

-I have had chest pain.

-OK, tell me about that.

It's been up here and then it's been down here.

-So on the left side up here and down here.

-Yeah.

And this wheeze I can hear, that's normal for you, is it?

-Well, on a good day.

-On a good day. OK.

The shortness of breath is a long-term thing with you.

-I've got emphysema.

-You've got emphysema.

-How often do you use the nebulisers at home.

-From time to time.

When was the last time you used one?

Last night.

I jumped up early this morning to get to my doctor's.

-Do you smoke at all?

-Yes.

-How many d you smoke?

-Between five and seven a day.

Have you always smoked that much?

-I used to smoke about 50 a day.

-OK.

-How long did you smoke 50 a day for?

-I started to smoke from the age of nine or ten.

-So probably about 40 years.

-Yes.

Oli needs to examine her to see if the problem is anything other than her emphysema.

SHE INHALES DEEPLY

Is this the normal size for your tummy or is this blown up a bit?

Let's have a look at your ankles.

-Sorry. Where is the pain on your chest.

-Round my kidney parts.

Is it painful if I press there?

Ow!

Have you ever had a blood test taken from the wrist before?

-It's painful.

-Yeah.

-Is it all right if I come back and do one of those on you?

-No.

-If I ask very nicely?

-I've had one of them done and it's very painful.

I'll bring the stuff back ready to do it and we'll have a look and see what your pulse is.

If it hurts, you can punch me.

All right?

-Fantastic. Stick here, I'll everybody back in a minute.

-All right.

Oli needs to take some blood from the artery in her wrist to measure her blood gases,

a test that's carried out when a patient is struggling to breathe.

It's an arterial sample from the wrist,

which it sounds like she's had before and didn't like.

It's often a bit more difficult from there, so...

we'll see how that goes.

It's not the first time he's performed this procedure,

-but he knows it's not going to be easy.

-Right.

And so does she.

Ready? Sharp scratch.

SHE GROANS

Argh!

Ah!

SHE GROANS

-All done. Put some pressure on there for me.

-SHE GROANS

-You toerag!

-Sorry?

-You toerag!

-Toerag! (LAUGHS)

You didn't punch me, anyway.

-No, I'm not that type of person.

-OK. Fair enough.

Not good at all. It really hurts.

SHE GROANS

Nice doctor. Toerag.

I can handle being called a toerag, I've been called a lot worse.

With the worst over for all involved,

the blood is analysed and Julie is sent home with the all clear.

Some people just aren't a fan of needles.

I think that one, because of the angle that you go in at

and the fact you're doing it from the wrist, people tend to like it a lot less.

And it's a chance for Oli to retreat to the safety of his paperwork.

Probably get through the whole lot in about, I don't know,

six or seven years, so might as well get started now.

While second year Oli is taking everything in his stride,... Tom is still finding his feet.

It's his second night shift and he's only 3 hours in when his crash bleep goes off.

BLEEPING

He's been called to the Haematology Ward where a patient is in cardiac arrest.

It's kind of exciting. "Oh, gosh! I've got a bleep!"

You get this naive excitement.

BLEEPING

You go into situations where there's a real-life patient on the bed with chest compressions going on,

which are immensely important to keep the heart pumping blood,

but at the same time to see it in real life it's quite hard hitting.

BLEEPING

It was very daunting, unlike anything I'd experienced.

Even though I've seen cardiac arrests in hospital before, I didn't feel responsible before.

And although I've had a lot of training in how to manage them

when you see it for the first time it's kind of scary.

BLEEPING

We went on for 20 minutes of resuscitation before it was decided

that the situation the patient was in wouldn't really be recoverable

in spite of the best efforts of the team.

-So it was called.

-The man didn't survive.

Very sadly the patient's 15-year-old daughter who was on her own on the ward is being informed now.

It's been a hard shift for Tom.

Two emergency calls in total does have a toll on a person,

especially somebody who's new and just coming into the role.

He will be physically exhausted by that

because you're using every sort of emotion.

And Tom and all the other junior doctors

will probably have to cope with that.

Back home after his shift, Tom is still thinking about the patient who died.

He only had one relative, his 15-year-old daughter, she was on her own.

-Oh, my God!

-So that was horrible.

That's really sad.

-And it does sit in your head.

-Especially cos it's someone you wouldn't expect to just die.

I didn't think about while I was seeing other patients, you focus on other stuff,

but it's when you're not focusing that you think about it again.

-Yeah.

-And it just kind of gets you. Even when I took five minutes later to have my sandwich,

-I was, like, "It's really sad."

-It is sad, yeah.

-I don't think anyone really gets used to that. It's sad all round.

-Yeah.

It's the following morning and Ed is starting his second shift in the Emergency Department.

He's feeling the pressure of being a new doctor in a new country.

It's proving a bit difficult.

I've got to get the hang of... how thorough certain things are here

rather than what I've been taught.

There's more at stake today that just the health of the patients.

After a shaky start on his first shift, Ed's seniors are going to be monitoring him closely.

Within our department, we're providing them with 24 hour senior supervision and support,

but they are expected to see patients from the offset on their own.

Now, having not worked within the UK,

Edward is finding that difficult because he's unaware of the systems and the treatments in place.

Ed's next case is a man who seems to be disorientated and confused.

Can you close your eyes, please. No, you. Like this.

Eyes closed.

No, no. If you can close your eyes.

Keep both closed. Both closed! That was good.

OK, keep them both closed.

I've got a confused patient. He's not able to tell me where he lives, what he does, why he's here.

He doesn't know where he is, but he is able to perform simple tasks.

Unsure of his next move, Ed goes to Dr Raj for help.

-Have you gone through each nerve.

-No, I haven't.

Right. So do a full neurological examination.

-Saying he can speak and his eyes are OK doesn't mean his neurological exam is normal.

-OK.

-Yeah?

-OK.

I would probably ask you to follow me during the first examination is that OK?

-You should be able to do a neurological examination.

-It's been a while.

-Let's go and do a neurological examination.

-That would be nice.

Dr Raj will have to show Ed how to do the examination himself.

It's a blow for Ed as it is a procedure

that a second year junior doctor should be able to perform unsupervised.

-You have completed your training in medicine?

-Yes.

Then you should be able to do a basic examination.

He's come in with a neurological problem. Confusion is a neurological problem.

So he needs a neurological examination.

And when you do a neurological examination,

you can 't test some nerves and not others in a neurological examination.

Yeah?

You all right, love?

It has become clear to Dr Raj and the hospital

that there is a big difference between what Ed has been taught in Italy

and what the department expects of him.

Speaking to colleagues it's quite obvious that it would be unfair on him and on patients in particular

to allow him to carry on seeing those patients

when we feel he would be out of his depth.

With the priority being patient welfare and making sure Ed gets the training and support he needs,

the department has come to a difficult decision.

It was apparent from day one that we were having to spend a lot of time with Ed

and we've made the decision

that I'm going to be taking him off the rota.

-Goodbye.

-See you.

-Goodbye.

It would be unsafe to allow him to carry on seeing those patients from the offset on his own

without providing him with some extra training.

Back home, and Ed's coming to terms with the news that his time in the Emergency Department is over.

Dr Raj seems very to the point immediately,

not a wasted word or anything like that.

He's very quick in what he does and I can see he's an outstanding doctor.

You can see some things about people in three days,

but you can't possibly evaluate six years of medical training

and six months of work... in two days.

I don't think that's possible.

You can have all the experience you want to but people can have good days, bad days.

Give them a week at least. A week is not too much.

The hospital have decided that Ed should be moved from front-line medicine

and redo his first year in a department where he can get intensive training and supervision.

This means Ed will have to become a first year junior doctor again.

I had a fleeting image of myself saying, "OK, never mind about this,

then I'll just go back to my job in the mountains in Italy."

But, of course, you are in the thick of emotion and you've just been told

you're going to be moved to another department and your training will last one year longer.

But I need to stay here.

I've got a job, it's fine. I'll do my best to just get on top of it.

It's a turn of events that Ed could never have predicted.

But there's more bad news to deal with.

Ed's father, who has been unwell for a while, has taken a turn for the worse

and Ed must leave the country immediately to see him.

Back at the hospital, it's business as usual.

On the colo-rectal ward, which specialises in looking after patients with bowel conditions,

Emily is dealing with her first case.

It's quite busy. Lots to do today.

So I'm just going to try and get some blood off this woman.

But it's the kind of blood sample that needs to be sent to the lab packed in ice

and first Emily needs to find the ice machine.

It's a massive faff cos they're on the fifth floor

and all the ice machines are broken, so I've got to go to the ninth floor to find one.

About half my day is spent running around looking for something.

-I need to find some ice.

-It's down the other end. There's an ice machine -

Right the other end? Thank you.

Knowing where everything is is a problem when you're starting any new job.

Every ward is laid out differently,

so whenever you go onto a new ward you have to learn where everything is.

Hiya. Have you got any ice I can have, please.

I don't work here. I'm guessing that's the ice machine.

Oh, wicked. Thank you.

How do I work it.

SHE LAUGHS

Do I have to press a button?

Oh!

Finally, she can take the sample.

She needs blood from the patient's wrist

to record the levels of oxygen and carbon dioxide in her body.

Sorry, that was more of a faff than I thought it would be.

Feeling better today?

-A lot better.

-Are you? Good. Good.

Taking blood from a patient is one thing she feels confident about.

All through medical school I worked as a phlebotomist, which gave me loads of practice at taking blood.

A phlebotomist is somebody who takes blood for a living.

So it's made me not too scared of doing it as a doctor, which is quite helpful I think.

OK. Sharp scratch.

-Marvellous!

-OK.

-Easy.

-Easy-peasy.

But if the blood isn't analysed within 60 minutes of being taken,

the sample will be ruined and Emily must start again from scratch.

Hello, I'm trying to get a porter to 5B to take an ABG for me. Is that possible, please.

Got an hour. The clock's ticking.

Happy she's done a good job, Emily leaves the sample waiting for collection.

But with the ice slowly melting, will it make it on time?

Junior doctor Jen is spending her first three months on a surgical ward.

She's up for the challenge and wants to be the best.

Hold that.

My life motto is "work hard, play hard".

I've wanted to be a doctor for as long as I can remember.

I definitely consider myself a competitive person.

There's nothing I love more than a challenge

or the opportunity to beat somebody.

I love going shopping, getting new makeup,

I like having my hair done. So there is a side of me that's a bit of a girl as well.

My mates are really important to me.

On a night out, I like to have a few drinks.

ALL: Cheers!

I think every medic is familiar with the bars and clubs in Liverpool.

Medicine is very much the priority in my life.

My greatest fear with starting work

is that I'm not gonna be as good as I expect to be.

Jen's only been on the ward for a few days, but her assertive and confident nature is shining through.

Organisation's definitely the key to this job.

You do then list. You sort it out. You've pulled it out!

OK, you can go back to your bed now, you're not attached to that any more. Yeah.

I'm not a bossy person. Let's get a cannula in, let's put a bag of saline up.

If something needs doing, I want to make sure it's done.

Bring them in in a minute, I'm just gonna get the blood results up.

Her dream job is to work in surgery and she's keen to get some hands-on experience.

-I wanna do anaesthetics.

-Do you?

Will I be able to get involved a bit? That'd be cool!

Going into surgery would be exciting cos I like to do hands-on things,

given the practical element of the job.

I'm a surgical house officer. This is the first year on and you don't often get into theatre,

but, yeah, excited.

Getting into surgery in your first week is unusual for a junior doctor,

but Jen's impressed her bosses enough to make it happen after only a few days.

Jen's fitted in really well in the team.

She seems to have a level of maturity above her age I'd say.

She's just taken it all in her stride, really.

Hiya. I'm going into Mr Hartley's theatre.

-Which theatre is she in?

-Theatre 6.

Consultant Surgeon Mr Hartley is in charge of today's procedure.

Increasingly, it's almost like a privilege to be allowed

to come into a theatre and be exposed to what goes on up here.

The patient is having stomach surgery to control acid reflux

and his stomach needs to be repositioned to cover part of his oesophagus.

Jen's first task is to insert the patient's cannula.

This one?

Yeah, just there.

Yeah.

Thank you.

So the leaky valve, the one that doesn't work, is just here.

-Right.

-So that's the bit we're going to repair.

Mr Hartley wants to see if Jen's been paying attention in medical school.

Suppose we thought, "Where's the needle?! We don't know where it is!"

What might you try to do to find a lost needle?

-Get an X-ray?

-Yeah, just X-ray the patient.

Very impressed.

Jenny, what do you think? Have you seen one of those before?

-No, I haven't.

-Yeah.

Pretty amazing.

-Thanks very much. Bye!

-Thanks a lot.

Jen's on a high from her first surgical experience as a junior doctor.

I've really, really enjoyed surgery.

And I have definitely noticed... the buzz from surgery.

I understand why people enjoy it and want to do it as a career.

Back on colo-rectal and Emily has a long list of patients to see and bloods to take.

It's over 30 minutes since she left her ice sample on another ward

and she's needs to check it's been taken to the lab.

I'm just going down and back to B5 to check that ABG's gone off,

because I'm paranoid it's still sat in the side.

When Emily returns to the ward, her worst fears are confirmed.

(GASPS)

Why?!

Can I still send that?

-It's all right to send.

-Are you sure?

Yeah. Send a porter.

This is so ridiculous!

It's enough for laid-back Emily to lose her cool.

BLEEPING

It's annoying that if you ask someone to do a job for you it doesn't get done.

Especially with something that has a time limit on it

like a blood test that you can't really leave hanging around.

Hello. I rang half an hour ago for a porter to pick an ABG up, do you know where they are?

I think from now on, I'm actually going to stand with the blood and not go anywhere.

Oh, it's melting!

Are you gonna take it up to them?

No, cos I don't have time to take it up.

It'd take you five minutes.

-Getting up there and getting it analysed, five minutes.

-You think?

Save the patient getting stabbed again.

All right. If it takes me any longer, I'm blaming you.

All right.

-Oh, will you tell the porter when he comes.

-All right.

The Junior Doctors have made it through the week and Tom's in the mood to party.

It's Friday!

-Oh, my God!

-Cham-pagne!

SHE LAUGHS

Whoo!

-Cheers, everyone!

-Here's to Friday and the weekend.

-I was the last one home... for once.

-For once!

I'm starting to feel relieved because everything's starting to fall into place.

I've got two or three patients I have world-class banter with.

I'm happy. I feel like I'm in my niche now.

-ALL CHEER

-While Tristan spends some well deserved time with his family,

over at the house, some of the other junior doctors are gearing up for a big night out.

After a long week, I'm actually letting my hair down.

I feel like I've learnt so much in the first two weeks,

imagine what I'll be like after I've done six months.

I feel like I'm progressing,

which is a really nice feeling, rather that like I'm floundering.

HE LAUGHS

Everyone's going through stressful times and there are bad days and times when you get exhausted.

And everyone knows that and is in the same position, so everything pulls together.

Doctors are a really good support system for each other.

I definitely think I've earned this night out.

-You've worked so hard this week.

-I'm beyond tired.

-Hmm.

I think the biggest thing you learn is how to work as a team.

You have to work like a well-oiled machine.

That's a big thing I've taken away from the first couple of weeks.

It's been physically challenging,

it's been intellectually challenging and very emotionally challenging too.

At the end of this week I don't feel like I'm, fooling anyone when I tell them I'm a doctor.

Night.

Next week on Junior Doctors.

-Argh!

-Unflappable Jen tackles a tricky procedure on her first nightshift.

I didn't really know what to do when he was panicking.

Tom has another stab at perfecting his needle technique.

Don't worry. Just crack on.

I'll be particularly pleased to see the back of those after the three attempts.

And Emily feels the pressure when she's the first doctor on the scene of a cardiac arrest.

The senior doctor said, "Right, does everyone agree this is futile?"

I hope that I get over crying,

but I hope that I always feel a little bit for them.

Subtitles by Red Bee Media Ltd