0:00:02 > 0:00:04Trauma...
0:00:04 > 0:00:07- He's got a pulse, a strong pulse. - Any pain up here?
0:00:07 > 0:00:10Tears...
0:00:10 > 0:00:13and intense pressure.
0:00:13 > 0:00:14Changing the oxygen over.
0:00:14 > 0:00:19Just another day on medicine's front line.
0:00:23 > 0:00:26They're young,
0:00:26 > 0:00:27they're untested...
0:00:27 > 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 > 0:00:50We're following seven junior doctors over their first three months
0:00:50 > 0:00:51on the job...
0:00:51 > 0:00:53Sharp scratch.
0:00:53 > 0:00:56It's all about the glamour. It's all about the bums.
0:00:56 > 0:00:59Where there's a first time for everything...
0:01:00 > 0:01:02I didn't really know what to do.
0:01:02 > 0:01:05It's having the confidence, isn't it?
0:01:05 > 0:01:07And first impressions count.
0:01:07 > 0:01:12I'm afraid I didn't get it first time either.
0:01:12 > 0:01:16First years Tom, Emily, Jen, Ed and Tristan
0:01:16 > 0:01:19have been finding their feet for the last two weeks.
0:01:19 > 0:01:22I'm really sorry about that, just that's not gone in.
0:01:24 > 0:01:28Second years Keira and Oli have 12 months' experience.
0:01:28 > 0:01:31He called me a toerag. I can handle being called a toerag.
0:01:31 > 0:01:33I have been called a lot worse before.
0:01:33 > 0:01:37Now they're finding out how tough life on the wards can really be.
0:01:37 > 0:01:40I really don't like it when it causes discomfort
0:01:40 > 0:01:42but you've got to do it.
0:01:42 > 0:01:43And that being a doctor
0:01:43 > 0:01:48is one of the most emotionally demanding jobs in the world.
0:01:48 > 0:01:49I hope I can get over crying
0:01:49 > 0:01:53but I hope I always feel a little bit for them.
0:01:55 > 0:01:59They're working here, at the Royal Liverpool University Hospital,
0:01:59 > 0:02:02but are the junior doctors really ready?
0:02:02 > 0:02:06For this hospital, in this city, it doesn't get any tougher.
0:02:08 > 0:02:11They're here to look after you, lad! Give it a rest!
0:02:26 > 0:02:29It's Saturday and across Liverpool,
0:02:29 > 0:02:32thousands of people are gearing up to head into the city.
0:02:36 > 0:02:38Junior doctor Jen is getting ready too,
0:02:38 > 0:02:40for her first ever night shift.
0:02:40 > 0:02:43And after a successful start to hospital life,
0:02:43 > 0:02:47she can't wait to step up to her latest challenge.
0:02:47 > 0:02:53I'm massively jealous that Tom has got to do some of the exciting stuff
0:02:53 > 0:02:59like cardiac arrest calls, treating really unwell patients first.
0:02:59 > 0:03:03I wanted to do it because I'm competitive.
0:03:03 > 0:03:07But I know my nights are coming this weekend so I'll have to see
0:03:07 > 0:03:10if I can beat him in the number of lives I can save in one night.
0:03:10 > 0:03:13We'll have a tally chart in the kitchen.
0:03:16 > 0:03:19Jen's only been a doctor for two weeks
0:03:19 > 0:03:21but with fewer senior staff around,
0:03:21 > 0:03:23tonight she's facing the daunting prospect
0:03:23 > 0:03:26of being the only junior doctor working across five wards.
0:03:29 > 0:03:33The nights are the scary part because you're on your own.
0:03:33 > 0:03:38And it's all the sick people in the surgical wards in the hospital
0:03:38 > 0:03:43so that's something I've never done before on my own.
0:03:47 > 0:03:49Jen's first patient, a man who's suffering
0:03:49 > 0:03:54from a seriously inflamed pancreas, puts her right in at the deep end.
0:03:54 > 0:03:57Is he in pain? Is that what I've been called for?
0:03:57 > 0:04:02- He's in agony. He's sweating. - OK.- He's doubled over in pain.
0:04:02 > 0:04:04He's had IV paracetamol and he's had oral tramadol.
0:04:04 > 0:04:10OK, what's his obs like at the moment? I'll get his chart.
0:04:11 > 0:04:13Hi, I'm, Jen I'm one of the doctors.
0:04:13 > 0:04:17I'm just going to have a feel of your tummy if that's OK.
0:04:17 > 0:04:19Jen wants to give him morphine
0:04:19 > 0:04:22but it's a procedure that she's only ever watched someone more senior do.
0:04:22 > 0:04:25He's in quite a lot of pain, isn't he?
0:04:25 > 0:04:28How do we feel about IV morphine, if I give it?
0:04:28 > 0:04:31I can give it.
0:04:31 > 0:04:35It's now down to Jen to inject the man
0:04:35 > 0:04:39so she can get the pain relieving drug into his system quickly.
0:04:39 > 0:04:42I think I'll do that because he's in quite a lot of pain,
0:04:42 > 0:04:46I'll give him some oral morphine, PRN.
0:04:47 > 0:04:51I've never given IV morphine before.
0:04:53 > 0:04:56On my own, I've never given it on my own, I've given it with somebody.
0:04:56 > 0:04:58I've seen it done.
0:05:05 > 0:05:08Getting the dose wrong can have fatal consequences,
0:05:08 > 0:05:12so Jen must be sure she is using the right amount.
0:05:12 > 0:05:14Sign here.
0:05:19 > 0:05:21We just put this in 10 mills normally, do we?
0:05:21 > 0:05:23Yes. 10 mills.
0:05:23 > 0:05:26All right, thanks very much.
0:05:26 > 0:05:28With the patient in so much pain,
0:05:28 > 0:05:32Jen needs to get the morphine into his system as quickly as possible.
0:05:34 > 0:05:38Do you just want to lie down, I'll give you something to stop the pain.
0:05:41 > 0:05:43We're just going to put the morphine in now.
0:05:43 > 0:05:44You might feel a little bit dizzy.
0:05:44 > 0:05:47We're just going to put it through really slowly.
0:05:53 > 0:05:56Is that helping the pain at all?
0:05:56 > 0:06:01- Not yet.- Not yet, OK.
0:06:01 > 0:06:05Is it easing your pain at all? It's starting to, good.
0:06:05 > 0:06:08I'm just going to go with a little bit more.
0:06:10 > 0:06:12Feeling a little bit better?
0:06:17 > 0:06:20You're obviously in a lot of pain.
0:06:20 > 0:06:22You might feel a little bit sleepy.
0:06:23 > 0:06:28Success, and Jen's pleased with how the procedure has gone.
0:06:28 > 0:06:31I just looked at him and he was in a lot of pain.
0:06:31 > 0:06:34And as you saw,
0:06:34 > 0:06:38when you give IV it just goes away.
0:06:38 > 0:06:41You can literally see the pain leaving him which is nice.
0:06:45 > 0:06:48With the patient now comfortable and out of pain,
0:06:48 > 0:06:51it's time for Jen to move on to her next case,
0:06:51 > 0:06:55and it's another new experience for the first year junior doctor.
0:06:55 > 0:07:00We're going to A&E to meet Andrea, my SHO,
0:07:00 > 0:07:04to put in an NG tube,
0:07:04 > 0:07:10which is a tube which goes in the nose and in to the stomach.
0:07:10 > 0:07:12Fitting a nasal tube takes technique and skill
0:07:12 > 0:07:16so she'll be assessed throughout by senior doctor Andrea Sheel,
0:07:16 > 0:07:17who has some words of advice.
0:07:48 > 0:07:51Hello, you all right?
0:07:51 > 0:07:56- Have you got a preference on which side?- This one.
0:07:56 > 0:07:59And you know just to swallow when it's going down
0:07:59 > 0:08:01in case it just...so give it a swallow, OK?
0:08:01 > 0:08:03For me to give it a swallow?
0:08:03 > 0:08:06Yeah, when it goes into the back, just give it a little swallow.
0:08:06 > 0:08:07When you feel it tickling.
0:08:20 > 0:08:22That's it, and swallow.
0:08:22 > 0:08:27HE COUGHS PAINFULLY
0:08:27 > 0:08:28The patient's coughing,
0:08:28 > 0:08:31which means the tube has gone down the wrong hole.
0:08:31 > 0:08:35Just pull it out a little bit, sorry about that.
0:08:37 > 0:08:40Just catch your breath for a sec.
0:08:45 > 0:08:47You're all right, it's coming out.
0:08:47 > 0:08:49Deep breaths in and out.
0:08:49 > 0:08:54With the patient panicking, Jen's senior steps in to release it.
0:08:54 > 0:08:59That's it, just have a breath for a minute.
0:08:59 > 0:09:02And when Jen has another go, this time she gets it right.
0:09:04 > 0:09:09If you want to stop, tap on the bed and we'll give you a break.
0:09:09 > 0:09:13All doctors should have this done to them at least once.
0:09:13 > 0:09:15You will feel a lot better.
0:09:15 > 0:09:17With the tube correctly in place,
0:09:17 > 0:09:20the contents of the patient's stomach are finally released,
0:09:20 > 0:09:23providing him with instant relief.
0:09:23 > 0:09:27It's making you feel better, is it?
0:09:27 > 0:09:31Jen may have finally mastered her first nasal tube procedure,
0:09:31 > 0:09:33but she's in no mood to celebrate.
0:09:33 > 0:09:36I think it's just because I didn't know what to do
0:09:36 > 0:09:40when he was panicking, that's all.
0:09:40 > 0:09:42It's just having the confidence, isn't it?
0:09:48 > 0:09:50Every time you don't succeed in something,
0:09:50 > 0:09:53especially when your bosses are around or your seniors are around,
0:09:53 > 0:09:57you do take it a bit personally. I can remember what it's like.
0:09:57 > 0:10:00The thing is we've all done it, we've all been there.
0:10:00 > 0:10:04It's one of those procedures that you just have to have
0:10:04 > 0:10:05a lot of practice in.
0:10:05 > 0:10:09Jenny did really well there. It's just that it was a bit tricky.
0:10:13 > 0:10:16MUSIC: "Taste It" by Jake Bugg
0:10:25 > 0:10:29Back at the house, and Jen's nightshift is finally over,
0:10:29 > 0:10:31but she's still thinking about how she handled
0:10:31 > 0:10:33the difficult nasal tube procedure.
0:10:33 > 0:10:37I'm not really sure whether it was the patient being anxious
0:10:37 > 0:10:42or my inexperience that meant that I found it quite difficult to get down.
0:10:45 > 0:10:48I really don't like it when it causes discomfort
0:10:48 > 0:10:52but you've got to do it. Poor guy. He was in a lot of pain.
0:10:52 > 0:10:54It was nice to see the relief afterwards.
0:11:11 > 0:11:15As a junior doctor, grappling with needles is a big part of the job.
0:11:15 > 0:11:19- Sharp scratch.- Sharp scratch. - Sharp scratch.
0:11:19 > 0:11:20And on the acute medical ward,
0:11:20 > 0:11:24first year Tom has had his fair share of tricky veins.
0:11:24 > 0:11:27- Did they get it first time last time?- No.- Didn't they?!
0:11:27 > 0:11:31I'm afraid I didn't get it first time either.
0:11:33 > 0:11:37In some patients it's difficult to get intravenous access at all.
0:11:37 > 0:11:39That's basically what just happened to me!
0:11:39 > 0:11:42- Is it good?- No.
0:11:44 > 0:11:47I'm sorry.
0:11:47 > 0:11:49You're going to feel a sharp scratch on your hand.
0:11:49 > 0:11:53I couldn't literally feel any kind of vein I could put it in.
0:11:56 > 0:12:00Tom's next patient is a man who has come in complaining of dizziness.
0:12:00 > 0:12:03Tingling in my legs, tingling in my arms.
0:12:03 > 0:12:06Just feeling disorientated, couldn't see properly.
0:12:06 > 0:12:09- Did you have any visual problems? - Yeah.- What happened?
0:12:09 > 0:12:13Basically, it's black spots but things are just rotating.
0:12:13 > 0:12:15- In your eyes?- In my vision.
0:12:15 > 0:12:19Pins and needles in the legs and the arms.
0:12:19 > 0:12:23To find out what's wrong, Tom will need to do a blood test.
0:12:23 > 0:12:28It's an opportunity to succeed where he's previously failed.
0:12:28 > 0:12:31Are we locked in forever?
0:12:31 > 0:12:36But, first, Tom has another obstacle to overcome.
0:12:45 > 0:12:48I unlocked it and then I locked it!
0:12:52 > 0:12:55OK, sharp scratch.
0:12:55 > 0:12:57He starts with the wrist.
0:12:57 > 0:13:00First time I've actually had it taken from my wrist.
0:13:00 > 0:13:04Where do they normally take it from? Up here? I'll go from there then.
0:13:08 > 0:13:11In the right place for when a thing goes wrong.
0:13:11 > 0:13:14There's not many things can go wrong with this at least.
0:13:14 > 0:13:18They're not putting me in charge of doing hip replacements just yet.
0:13:18 > 0:13:20Sharp scratch.
0:13:20 > 0:13:23He then tries the arm.
0:13:23 > 0:13:28- Taken anything?- Sorry.
0:13:28 > 0:13:31- No.- OK, don't worry!
0:13:31 > 0:13:33Don't worry, just crack on.
0:13:33 > 0:13:39I'm going to go down here and use a different needle as well.
0:13:39 > 0:13:41Tom needs to have another go,
0:13:41 > 0:13:45but he's running out of veins in all the usual places.
0:13:48 > 0:13:52Finally, third time lucky.
0:13:56 > 0:13:59- This one's working.- Yay.- Yay.
0:13:59 > 0:14:02Done. Cheers, dude.
0:14:05 > 0:14:09The patient is one step closer to a diagnosis,
0:14:09 > 0:14:13but as a doctor, Tom should be able to hit the target much quicker.
0:14:13 > 0:14:16And he knows it.
0:14:17 > 0:14:20Yeah, I'll be particularly pleased to see the back of those, I think.
0:14:20 > 0:14:21After the three attempts!
0:14:21 > 0:14:23It's about as many times as I've ever had
0:14:23 > 0:14:27to get blood out of somebody and it wasn't particularly challenging.
0:14:30 > 0:14:32At the end of a long day,
0:14:32 > 0:14:35Tom gets a chance to put his feet up with housemate Emily.
0:14:35 > 0:14:37Can I tell you about my day? It wasn't too busy -
0:14:37 > 0:14:41Friday busy which is busier than normal but not bad for a Friday.
0:14:41 > 0:14:45Tonight, Tom's planning to relax by having some friends round,
0:14:45 > 0:14:46but Emily can't be there.
0:14:46 > 0:14:50I can't believe you've organised a party when I'm on a night shift.
0:14:50 > 0:14:54It was bank holiday weekend, Emily, it wasn't aimed at you.
0:14:54 > 0:14:58We'll have another one when you're not on night shift, don't worry.
0:14:58 > 0:15:00Well, I'd better go get ready for my night shift.
0:15:00 > 0:15:01You get ready for your party.
0:15:01 > 0:15:02Awww. Give me a hug.
0:15:03 > 0:15:06I'm sorry you're working when we're having a party.
0:15:06 > 0:15:07Me too.
0:15:07 > 0:15:09Mmm.
0:15:11 > 0:15:13Not only is Emily missing the party,
0:15:13 > 0:15:15but the moment she's been dreading
0:15:15 > 0:15:17since she became a junior doctor has arrived -
0:15:17 > 0:15:20the start of a gruelling 12-hour night shift.
0:15:20 > 0:15:27I am feeling mildly grumpy that I'm in hospital overnight.
0:15:27 > 0:15:30From what I've heard from other people, it's either going to be,
0:15:30 > 0:15:33like, really dramatic and manic and exciting and interesting,
0:15:33 > 0:15:37or it's going to be a couple of jobs, and then twiddling my thumbs.
0:15:37 > 0:15:39And I haven't decided which one I prefer.
0:15:39 > 0:15:43At the moment I'm kind of leaning towards the quiet, twiddling thumbs.
0:15:43 > 0:15:46On the wards, Emily wants a quiet life.
0:15:46 > 0:15:50Outside the hospital, she's anything but a thumb-twiddler.
0:15:56 > 0:16:00I'm one of these people that I need hobbies to go to outside of work,
0:16:00 > 0:16:02otherwise I'll just sit down and sleep.
0:16:02 > 0:16:06I'm also creative. I love the arts.
0:16:06 > 0:16:09I'm not a competitive person at all.
0:16:09 > 0:16:11I'm not bothered about being top of the pile.
0:16:12 > 0:16:16I would describe myself as optimistic
0:16:16 > 0:16:19and positive and emotional.
0:16:19 > 0:16:21I do cry quite easily.
0:16:21 > 0:16:22I need to learn to toughen up,
0:16:22 > 0:16:25otherwise I'm just not going to cope with the job.
0:16:27 > 0:16:29I still have this thought in the back of my mind of,
0:16:29 > 0:16:30"What if I'm not good enough?
0:16:30 > 0:16:32"What if I don't even get through the year?"
0:16:32 > 0:16:34That's something that really terrifies me.
0:16:34 > 0:16:36CHEERING
0:16:36 > 0:16:39I'm really worried about night shifts. I'm not a night person.
0:16:39 > 0:16:41Everybody knows when you're tired,
0:16:41 > 0:16:42you're going to make more mistakes,
0:16:42 > 0:16:45and that's something that's really worrying me,
0:16:45 > 0:16:47because I'm just not in a position to make mistakes.
0:16:50 > 0:16:52PHONE RINGS
0:16:53 > 0:16:54Hello, 8A?
0:16:56 > 0:16:58Oh, sorry, 5A.
0:16:58 > 0:17:00She's not tired yet,
0:17:00 > 0:17:04but Emily's already finding simple tasks more challenging than usual.
0:17:04 > 0:17:06Hello, 5A?
0:17:06 > 0:17:08On nights, junior doctors need to take calls
0:17:08 > 0:17:10from anywhere in the hospital.
0:17:10 > 0:17:11Hello, 8A?
0:17:11 > 0:17:14Trouble is, Emily's not on her usual ward -
0:17:14 > 0:17:17and she keeps forgetting where she is.
0:17:17 > 0:17:19Oh, sorry, I mean 5... oh, OK.
0:17:21 > 0:17:22I got the name of the ward wrong.
0:17:24 > 0:17:25You're so efficient!
0:17:25 > 0:17:26Am I?
0:17:26 > 0:17:28I was being sarcastic.
0:17:28 > 0:17:30THEY LAUGH
0:17:30 > 0:17:32When she finally remembers what ward she's on,
0:17:32 > 0:17:35Emily goes to see her first patient.
0:17:35 > 0:17:38How you feeling in yourself at the moment?
0:17:38 > 0:17:41- Still sore.- Still really sore in your tummy?- Yeah.- OK.
0:17:41 > 0:17:43And you've not opened your bowels in a week, I hear?
0:17:43 > 0:17:47The woman has a pressing problem - she's extremely constipated.
0:17:47 > 0:17:49Is it worse when I press in or when I let go?
0:17:49 > 0:17:53When you press in. What did the X-ray show?
0:17:53 > 0:17:57The X-ray showed absolutely loads of poo.
0:17:57 > 0:18:00It must feel horrendous. Her stomach's out here.
0:18:00 > 0:18:04She must just feel so uncomfortable. Bless her.
0:18:04 > 0:18:06That's all poo.
0:18:06 > 0:18:09I think she's got something called adhesion,
0:18:09 > 0:18:12so, like, due to previous surgery or inflammation of the bowel,
0:18:12 > 0:18:15it all just sticks together and it's all horrible.
0:18:15 > 0:18:19Emily decides to do a rectal examination.
0:18:19 > 0:18:21It's her first one since she qualified as a doctor,
0:18:21 > 0:18:24and doing it on a nightshift, where there's fewer seniors around
0:18:24 > 0:18:26to supervise, is an added pressure.
0:18:26 > 0:18:28With the problem you've got,
0:18:28 > 0:18:30it's really important that I examine your back passage as well.
0:18:30 > 0:18:32- OK.- So it might be a little bit uncomfortable,
0:18:32 > 0:18:34but it'll be really quick,
0:18:34 > 0:18:37- and it'll let us know what's going on really well.- OK.
0:18:37 > 0:18:39- Is that OK with you?- Yeah, OK.
0:18:40 > 0:18:42You just have to put a finger in
0:18:42 > 0:18:46and just make sure there's no blood or any poo in the rectum.
0:18:46 > 0:18:48Emily knows if she can relax the patient,
0:18:48 > 0:18:50it'll be easier for both of them.
0:18:54 > 0:18:56All right. I'm going in now.
0:18:59 > 0:19:01Just squeeze for me. OK.
0:19:01 > 0:19:03Is that sore at all? Brilliant.
0:19:03 > 0:19:05Well done.
0:19:05 > 0:19:07Thankfully the rectal went smoothly,
0:19:07 > 0:19:11and Emily's hoping that the rest of her night is uneventful.
0:19:12 > 0:19:14It's all about the glamour.
0:19:14 > 0:19:16It's all about the bums, isn't it, surgery?
0:19:18 > 0:19:20# Have you tried the soca
0:19:20 > 0:19:22# Let's lift the beat all over
0:19:22 > 0:19:23# Dance all night
0:19:23 > 0:19:26# With me till the morning light... #
0:19:26 > 0:19:30Back at the house, Tom's party is getting into full swing.
0:19:30 > 0:19:33# Dance with me, dance with me
0:19:33 > 0:19:36# All night... #
0:19:36 > 0:19:38But at the hospital,
0:19:38 > 0:19:41Emily's making the most of a quiet night on the wards instead.
0:19:43 > 0:19:44# All night, all night
0:19:46 > 0:19:47# All night
0:19:47 > 0:19:49# Dance with me, dance with me... #
0:19:50 > 0:19:54Junior doctors working on-call night shifts are allowed
0:19:54 > 0:19:5620-minute breaks every four hours.
0:19:56 > 0:19:59Luckily for Emily, they can use this time to nap.
0:19:59 > 0:20:03And that's something she intends to take full advantage of.
0:20:03 > 0:20:08# Today I don't feel like doing anything
0:20:08 > 0:20:12# I just want to lay in my bed... #
0:20:14 > 0:20:17Have you had a nap? Have you had a rest?
0:20:17 > 0:20:18No, not yet.
0:20:18 > 0:20:22I've been working really hard, and I'm really tired.
0:20:22 > 0:20:24LAUGHS
0:20:24 > 0:20:28# I'm going to kick my feet up, then stare at the fan
0:20:28 > 0:20:31# Turn the TV on, throw my hand in my pants
0:20:31 > 0:20:35# Nobody's going to tell me I can't #
0:20:35 > 0:20:41It's 8am, and Emily's night shift has finally come to an end.
0:20:41 > 0:20:45I hate working nights and it's been really tiring,
0:20:45 > 0:20:50and I feel like I'm not here and I'm a bit zombied,
0:20:50 > 0:20:55so it's just not nice trying to think when your brain's like cotton wool.
0:20:55 > 0:20:56It's just not pleasant.
0:21:00 > 0:21:02As Emily finally gets to go home...
0:21:05 > 0:21:09..Ed's arriving for his first day on his new ward of acute medicine.
0:21:11 > 0:21:14The Italian medic has had a difficult start
0:21:14 > 0:21:17to life in a British hospital.
0:21:17 > 0:21:20He started off as a second year in the emergency department,
0:21:20 > 0:21:23but he struggled with some basic medical procedures.
0:21:27 > 0:21:29It's been a while.
0:21:31 > 0:21:34So he agreed to leave, and redo his first year
0:21:34 > 0:21:37in another, less demanding department.
0:21:37 > 0:21:41Speaking to colleagues, it's quite obvious that it would be
0:21:41 > 0:21:44unfair on him and also on patients in particular
0:21:44 > 0:21:46to allow him to carry on.
0:21:46 > 0:21:49There was also another dramatic turn of events
0:21:49 > 0:21:52when he received the news that his father was seriously ill
0:21:52 > 0:21:56and he needed to leave the country immediately to visit him.
0:21:56 > 0:21:59They said, "Please take one week off and go and see your family."
0:21:59 > 0:22:06I did and, well, my girlfriend and I got a plane Saturday morning
0:22:06 > 0:22:10and unfortunately we arrived in Paris and my father had just passed away.
0:22:15 > 0:22:18Now he's back and more determined than ever
0:22:18 > 0:22:19to get his career on track.
0:22:22 > 0:22:24- Do I just follow you?- Yes.- OK.
0:22:27 > 0:22:29His day starts with a ward round.
0:22:29 > 0:22:32And Consultant Dr Osman uses a patient's results
0:22:32 > 0:22:34to test Ed's knowledge.
0:22:36 > 0:22:40She's a lady who came in feeling unwell.
0:22:41 > 0:22:42She's 86.
0:22:42 > 0:22:45- This might be old changes.- Yeah. - They might be new changes.
0:22:45 > 0:22:46So what will you do?
0:22:46 > 0:22:50Ed studied medicine for seven years in Italy, but, under pressure,
0:22:50 > 0:22:53he's finding it difficult to come up with the answers.
0:22:53 > 0:22:55Yeah, I don't know the measurements.
0:22:55 > 0:22:58- Normally it's less than 14.- OK.
0:23:00 > 0:23:01You have to know that.
0:23:01 > 0:23:05- So you go and read about that, that will be very useful.- Yeah.
0:23:05 > 0:23:07- But you'll see this patient now.- OK.
0:23:10 > 0:23:13Dr Osman needs to know that his new starter has enough experience
0:23:13 > 0:23:15to cut it in a big hospital,
0:23:15 > 0:23:19so he asks Ed some questions about his training in Italy.
0:23:26 > 0:23:27Unfortunately not.
0:23:29 > 0:23:31No, I've never worked in a hospital.
0:23:31 > 0:23:33I've seen outpatients and GP patients,
0:23:33 > 0:23:34but I've never worked in a hospital,
0:23:34 > 0:23:36so I'm getting to see all the patients now that
0:23:36 > 0:23:38I haven't seen in my previous job.
0:23:38 > 0:23:41I haven't been treating patients with...
0:23:43 > 0:23:46I've been working in a little mountain village in Italy
0:23:46 > 0:23:48and seeing patients during nights and weekends
0:23:48 > 0:23:49when the GP was not available.
0:23:50 > 0:23:52That's all.
0:23:52 > 0:23:54I haven't worked in a hospital yet.
0:23:58 > 0:24:01Ed's beginning to realise that even though he's qualified,
0:24:01 > 0:24:04his studying days are far from over.
0:24:04 > 0:24:08I was just caught, er, taken aback by one question
0:24:08 > 0:24:12which I should have answered straight away
0:24:12 > 0:24:15and to which I actually know the answer
0:24:15 > 0:24:18but for some reason, I just didn't tell him.
0:24:18 > 0:24:22Anyway, I just need to convert the stuff I know into practice.
0:24:22 > 0:24:24Nothing else, and that annoys me a bit,
0:24:24 > 0:24:28because it's all stuff I have studied and knew well,
0:24:28 > 0:24:31but never used in practice.
0:24:31 > 0:24:33when you don't do things, you forget about them.
0:24:38 > 0:24:40After a testing time on the night shift,
0:24:40 > 0:24:43Jen's back on days and it's the busiest week of the month
0:24:43 > 0:24:47as her ward fills up with new surgical admissions.
0:24:47 > 0:24:49We've gone from about ten to about...
0:24:51 > 0:24:54..30, maybe, over the weekend,
0:24:54 > 0:24:56so quite a lot.
0:24:57 > 0:24:59ECGs...
0:24:59 > 0:25:03She's particularly concerned about one of the new arrivals.
0:25:03 > 0:25:05- Are you looking after Mr Flusk?- I am.
0:25:05 > 0:25:07- Has he had an ECG yet?- No, not yet.
0:25:07 > 0:25:10OK, shall we do this ECG, and then I'll go and do his gases?
0:25:10 > 0:25:12- I'll see if he's finished with it now.- Thank you.
0:25:14 > 0:25:1783 year old Thomas Flusk has just had emergency surgery
0:25:17 > 0:25:21to remove his appendix. The surgery was a success,
0:25:21 > 0:25:24but he's now having difficulty breathing.
0:25:24 > 0:25:27And Jen is determined to get to the bottom of why.
0:25:27 > 0:25:30He probably has a chest infection because he's post-op,
0:25:30 > 0:25:33and that's the most likely cause,
0:25:33 > 0:25:35but, you know, there's other things.
0:25:35 > 0:25:37If he's very, very hypoxic,
0:25:37 > 0:25:40which means he's got very low blood oxygen levels,
0:25:40 > 0:25:42that can be a sign of a clot on his lungs.
0:25:42 > 0:25:47The first thing Jen does is order an ECG to check his heart,
0:25:47 > 0:25:49but she also needs to test his blood.
0:25:49 > 0:25:50How are you feeling?
0:25:54 > 0:25:56Yeah. I'll sort you out.
0:26:00 > 0:26:03But for a junior doctor, getting to the root
0:26:03 > 0:26:05of a complex problem isn't always straightforward.
0:26:05 > 0:26:08The further you go with medicine,
0:26:08 > 0:26:11the more you realise you don't know anything.
0:26:11 > 0:26:15So, yeah, it might look like I remember a lot,
0:26:15 > 0:26:18but there's an awful lot I don't remember as well.
0:26:18 > 0:26:21The most important thing for a junior doctor is to recognise
0:26:21 > 0:26:25when something is wrong, but not necessarily what it is,
0:26:25 > 0:26:28because that's the years later that you'll find out.
0:26:31 > 0:26:34Would I be able to sit you up just to listen to the back of your chest?
0:26:34 > 0:26:36- Yeah.- Thank you.
0:26:36 > 0:26:37Deep breath in.
0:26:46 > 0:26:49When Jen finally gets to check Mr Flusk's blood tests,
0:26:49 > 0:26:51they confirm that something is wrong,
0:26:51 > 0:26:54but don't reveal precisely what.
0:26:54 > 0:27:00He's on 40% oxygen, and his pO2's 8.7.
0:27:05 > 0:27:07So she sends him off to radiology.
0:27:07 > 0:27:10If, as Jen suspects, he does have an infection,
0:27:10 > 0:27:13then it will show up on his chest X-ray.
0:27:14 > 0:27:17Because the X-rays go straight on my computer, I get to see them
0:27:17 > 0:27:20almost immediately, so he's still down, he's not back yet,
0:27:20 > 0:27:21but I've seen his X-ray.
0:27:21 > 0:27:24I can see that he's actually got fluid on his lungs,
0:27:24 > 0:27:27probably means that it's not a chest infection.
0:27:27 > 0:27:29It's more likely to be this problem with his heart,
0:27:29 > 0:27:31which is quite common in someone his age.
0:27:31 > 0:27:34Now that Jen has finally established what's causing
0:27:34 > 0:27:37his shortness of breath, she can plan his treatment.
0:27:37 > 0:27:40I'm just putting some medication through and then
0:27:40 > 0:27:44I'm going to come and repeat his bloods just to see what's going on.
0:27:44 > 0:27:46Hopefully it'll all be improving and going the right way.
0:27:48 > 0:27:52You can't say you're not getting looked after, can you?
0:27:52 > 0:27:54It's another case ticked off for Jen,
0:27:54 > 0:27:58and she can now update her senior house officer with her findings.
0:27:58 > 0:27:59Has he had an ECG?
0:27:59 > 0:28:01Yeah, his ECG.
0:28:01 > 0:28:03I know if I tell Jen to do something, it'll be done,
0:28:03 > 0:28:06it'll be done quickly and it'll be done to a high standard,
0:28:06 > 0:28:09and I won't have to go back and double check
0:28:09 > 0:28:11that it's been done properly.
0:28:11 > 0:28:12It's really nice to see the progress.
0:28:12 > 0:28:15Whereas with the first take, it would be, "This has happened?
0:28:15 > 0:28:18"What do I do?" Now it's, "This has happened.
0:28:18 > 0:28:21"I've seen the patient, I've done this, I've done this.
0:28:21 > 0:28:25"Is that OK?" And I go, "Yeah, that's great. You don't need me."
0:28:25 > 0:28:30The way Jen's handled this case has demonstrated just how far
0:28:30 > 0:28:34the first year junior doctor has come in a short space of time.
0:28:34 > 0:28:38I'm a lot more confident in dealing with things like that
0:28:38 > 0:28:40than I was when I first started.
0:28:40 > 0:28:44It's satisfying that we've found a problem,
0:28:44 > 0:28:48treated him for it and he looks a bit better.
0:28:48 > 0:28:50He's still got a bit of a way to go...
0:28:52 > 0:28:55..and we'll see him on the ward round tomorrow and see how he is.
0:29:01 > 0:29:04After a busy day on the wards,
0:29:04 > 0:29:09the junior doctors finally get a chance to relax together,
0:29:09 > 0:29:10ahead of a night out for Emily.
0:29:10 > 0:29:12Emily, who you going on a date with tonight?
0:29:12 > 0:29:14I'm not going on a date with anyone, Olly.
0:29:14 > 0:29:15Oh, God, you are. Don't lie.
0:29:15 > 0:29:16She so is.
0:29:16 > 0:29:20- I'm not.- Face tells it all. - She's done her eyelashes.
0:29:20 > 0:29:21I haven't. They're real.
0:29:21 > 0:29:24They're perfect. You've separated them all.
0:29:24 > 0:29:25I have.
0:29:25 > 0:29:28Date. Stinks of date.
0:29:28 > 0:29:30Is he cooking you a nice vegetarian meal?
0:29:30 > 0:29:32Oh this is so embarrassing
0:29:32 > 0:29:34Or is he going to cook you up a meat feast?
0:29:34 > 0:29:37LAUGHTER
0:29:37 > 0:29:39Have you got any pre-date nerves?
0:29:39 > 0:29:40No, because I'm not going on a date.
0:29:40 > 0:29:42And, one more question.
0:29:44 > 0:29:47If it all goes tits up, how are you going to get home?
0:29:47 > 0:29:48I've got a car.
0:29:48 > 0:29:50Oh, are you not drinking?
0:29:50 > 0:29:53No, it's a school night. Don't drink on a school night.
0:29:53 > 0:29:54- Sensible.- Well, you do.
0:29:56 > 0:29:58You old tanker.
0:29:59 > 0:30:01What you trying to do?
0:30:01 > 0:30:02I don't know.
0:30:02 > 0:30:04I'm never going to get a job or a boyfriend.
0:30:04 > 0:30:06LAUGHTER
0:30:13 > 0:30:14It's a new day at the hospital.
0:30:17 > 0:30:20And in the Heart Emergency Centre, Tom has been asked to treat
0:30:20 > 0:30:24a patient who came into A&E with chest pains.
0:30:24 > 0:30:25- So it's Mr Flynn?- Yes.
0:30:25 > 0:30:27Hi, Mr Flynn. My name is Tom.
0:30:28 > 0:30:32Mr Flynn has previously had a heart attack and a heart bypass,
0:30:32 > 0:30:35and since then, he's suffered from angina.
0:30:35 > 0:30:37Do you just want to just describe it to me?
0:30:37 > 0:30:40Well, it's just a very heavy pain in my chest and, er...
0:30:40 > 0:30:41Like a crushing kind of pain?
0:30:41 > 0:30:44- Yeah.- Has it been happening at rest, this chest pain?
0:30:44 > 0:30:45Just happened now, yeah.
0:30:45 > 0:30:48OK. So you take your GTN spray under your tongue?
0:30:48 > 0:30:51- Yeah.- And you took two squirts of it, do you?
0:30:51 > 0:30:53- Yeah.- And it's still taken 25 minutes to work?
0:30:53 > 0:30:54- Yeah.- OK.
0:30:54 > 0:30:58Tom begins to suspect something is seriously wrong.
0:30:58 > 0:31:00- You feeling clammy and sweaty?- Yeah.
0:31:00 > 0:31:02- Do you feel like that now? - I do, yes.
0:31:02 > 0:31:04- You do. - I'm really sweating now, though.
0:31:04 > 0:31:06- Are you?- Yes.
0:31:06 > 0:31:09- Tell you what, I'll just... - Really uncomfortable.
0:31:09 > 0:31:11You're uncomfortable?
0:31:11 > 0:31:13Hang on, just give me two minutes.
0:31:13 > 0:31:16Tom quickly alerts the team to the emergency.
0:31:19 > 0:31:21This is a man who came in with unstable angina,
0:31:21 > 0:31:24and for all intents and purposes, he is having a heart attack, so...
0:31:24 > 0:31:27this is his ECG now, so we're going to get inside and get it done.
0:31:27 > 0:31:28Thank you very much.
0:31:30 > 0:31:34He's getting some morphine and having his ECG now.
0:31:34 > 0:31:36He's also sweaty and clammy and really grey.
0:31:36 > 0:31:38- FEMALE DOCTOR:- Oh, really? - Yeah.
0:31:47 > 0:31:49Has the blood pressure changed?
0:31:49 > 0:31:51Guys, his blood pressure is dropping.
0:31:53 > 0:31:55If the man is having a heart attack,
0:31:55 > 0:31:57a drop in blood pressure could be fatal.
0:31:57 > 0:31:59I need to get another cannula in for fluids
0:31:59 > 0:32:02if his blood pressure is dropping.
0:32:02 > 0:32:05Tom needs to fit a cannula, but the clock is ticking.
0:32:05 > 0:32:07And this time, there is no margin for error.
0:32:23 > 0:32:25Sorry.
0:32:25 > 0:32:27Tom fails with his first attempt.
0:32:27 > 0:32:31And the patient's blood pressure is still dropping, meaning his veins
0:32:31 > 0:32:33are getting thinner by the second.
0:32:33 > 0:32:36He needs to fit the cannula now.
0:32:36 > 0:32:38You just relax your hand and let me move it around a bit.
0:32:43 > 0:32:46Yep, that one's in. Can I get, er...the flush?
0:32:46 > 0:32:50The cannula's in, much to everyone's relief.
0:32:50 > 0:32:52And the team manage to stabilise the patient.
0:32:52 > 0:32:54Had we left him, there's every chance
0:32:54 > 0:32:56he could have had a full-blown heart attack.
0:32:56 > 0:32:59No-one could say whether or not we prevented it. No-one could say that.
0:32:59 > 0:33:02But what is important was that we reacted quickly and, you know,
0:33:02 > 0:33:05we've just got to monitor him now to see what happened during that time.
0:33:05 > 0:33:07Over the next 12 hours we should get
0:33:07 > 0:33:10a better picture of what's just happened. So we'll see.
0:33:16 > 0:33:20Now that Emily's off nights, she's back on her own ward
0:33:20 > 0:33:25doing what she loves most - building relationships with her patients.
0:33:25 > 0:33:27- You feeling better today? - Oh, a lot better.
0:33:27 > 0:33:28Are you? Good, good.
0:33:28 > 0:33:30Must be tea time!
0:33:30 > 0:33:33SHE LAUGHS For the vampires!
0:33:33 > 0:33:35You're doing brilliantly. Well done.
0:33:35 > 0:33:38And since she started as a junior doctor,
0:33:38 > 0:33:42Emily's favourite patient has been 83 year-old Doris.
0:33:42 > 0:33:45You're in the wars a bit, aren't you, Doris?
0:33:45 > 0:33:47You're bloodless. I've taken it all.
0:33:51 > 0:33:55I really like Doris, because she's so lovely. That's her, really.
0:33:55 > 0:33:57She's just so nice to everybody.
0:33:57 > 0:34:00She always seems really happy, no matter what's going on.
0:34:00 > 0:34:03She's never got a bad word about anyone. So she's just lovely.
0:34:03 > 0:34:06But Doris isn't responding to treatment,
0:34:06 > 0:34:08and her condition has become critical.
0:34:11 > 0:34:15Why does her temperature go up and down like that?
0:34:15 > 0:34:18Doris' family and doctors now need to plan
0:34:18 > 0:34:22the best possible care for her in the last days of her life.
0:34:22 > 0:34:25I think the end outcome is that she's going to die.
0:34:25 > 0:34:27OK.
0:34:27 > 0:34:29So it's more of a pragmatic decision in terms of,
0:34:29 > 0:34:32what is the end of her life going to be like?
0:34:32 > 0:34:34End of life care.
0:34:34 > 0:34:37Are we going to make the end of her life comfortable?
0:34:37 > 0:34:39So for Doris, there's a difference between
0:34:39 > 0:34:44stopping all her medications and just carrying on,
0:34:44 > 0:34:45but not doing anything else.
0:34:45 > 0:34:49The point is that we're not escalating her care.
0:34:51 > 0:34:55All the treatment we're giving her isn't making her better.
0:34:55 > 0:34:57It's a natural part of life, is death,
0:34:57 > 0:35:01and it's something that is sort of...
0:35:01 > 0:35:03you have to work out when it's a priority
0:35:03 > 0:35:05to make sure that somebody's comfortable,
0:35:05 > 0:35:06rather than trying to treat them.
0:35:12 > 0:35:17A few days later, Emily has to deal with the news that Doris has died.
0:35:17 > 0:35:21And she has chance to reflect on the decisions made about her final days.
0:35:23 > 0:35:26Doris and her family were really prepared for her to die.
0:35:26 > 0:35:30They all thought it was the best thing for her to pass away peacefully
0:35:30 > 0:35:33rather than struggling on with active treatment.
0:35:33 > 0:35:35So I'm really happy with how it happened.
0:35:35 > 0:35:37I feel that she had a really dignified death,
0:35:37 > 0:35:40and she passed away peacefully and comfortably.
0:35:43 > 0:35:47Emily must do one last thing for Doris - register her death.
0:35:47 > 0:35:50It's a difficult job for any junior doctor
0:35:50 > 0:35:53at the beginning of their career.
0:35:53 > 0:35:56I'm not looking forward to seeing her after she's passed away.
0:35:56 > 0:35:58I think it's...
0:35:58 > 0:36:01I just don't know how I'm going to react to it, really.
0:36:01 > 0:36:04But I'm glad that it's me who's got to come and say goodbye to her,
0:36:04 > 0:36:08because I feel like we've got to know her really well
0:36:08 > 0:36:10and it's quite important to me
0:36:10 > 0:36:12that we kind of finish off the whole process
0:36:12 > 0:36:14and close the book on it.
0:36:24 > 0:36:28Emily isn't the only doctor struggling to deal with death.
0:36:28 > 0:36:32First year Tristan works on a ward where all the patients are elderly.
0:36:32 > 0:36:35The dilemma of when to stop escalating the care
0:36:35 > 0:36:37of those who are at the end of their lives
0:36:37 > 0:36:41is an issue of some debate, and one he'll regularly face.
0:36:41 > 0:36:44I think there's already been a couple of patients
0:36:44 > 0:36:46where the senior doctors have, um...
0:36:46 > 0:36:50I guess diagnosed dying,
0:36:50 > 0:36:54and I found it really hard to adjust to that.
0:36:54 > 0:36:57Sort of saying, "This is what we've been able to do,
0:36:57 > 0:36:59"It hasn't worked, and...
0:36:59 > 0:37:02"this is just the natural progression of things."
0:37:02 > 0:37:07Tristan's come for some advice from his senior, Dr Scott,
0:37:07 > 0:37:10about when to make the call to accept that a patient is dying.
0:37:12 > 0:37:17We sort of made the decision to only provide supportive treatment,
0:37:17 > 0:37:19so that they can have a more comfortable and dignified time
0:37:19 > 0:37:22and the family can have that precious time with them
0:37:22 > 0:37:23before they died.
0:37:23 > 0:37:26I don't know, I felt it was really difficult.
0:37:26 > 0:37:29That's exactly the way you should be feeling at the minute.
0:37:29 > 0:37:31You have this kind of conflict
0:37:31 > 0:37:33between what you have been trained to do,
0:37:33 > 0:37:36which is to make people better and get them home,
0:37:36 > 0:37:39versus actually then encountering the reality.
0:37:39 > 0:37:42What you're learning now is not so much the science of being a doctor,
0:37:42 > 0:37:44but the art of being a doctor.
0:37:44 > 0:37:46'The fact that he's actually thinking about that'
0:37:46 > 0:37:49and coming to talk to me about that at this early stage,
0:37:49 > 0:37:50I think, is a very good sign.
0:37:50 > 0:37:53There will come a point in anybody who's severely ill
0:37:53 > 0:37:54where if you've got to the stage
0:37:54 > 0:37:56where treatment's not working,
0:37:56 > 0:37:58you've got to make a judgement.
0:37:58 > 0:38:00Your patient relies on you to do that.
0:38:00 > 0:38:02Your patient's family relies on you to do that.
0:38:02 > 0:38:05But if you're worth your salt as a doctor,
0:38:05 > 0:38:08you will then go away and you will probably agonise over that.
0:38:13 > 0:38:15The junior doctors are learning to deal
0:38:15 > 0:38:17with the emotional challenges of the job.
0:38:17 > 0:38:19And after five years of hard study,
0:38:19 > 0:38:22one of the rewards is just round the corner.
0:38:22 > 0:38:24Payday.
0:38:24 > 0:38:27I can't really process the idea of having money at the moment.
0:38:27 > 0:38:28It seems so alien.
0:38:28 > 0:38:34The starting salary for a first year junior doctor is £22,500.
0:38:34 > 0:38:37And their first slice of it can't come quick enough.
0:38:37 > 0:38:41Because they're all skint, and resorting to desperate measures.
0:38:41 > 0:38:43This one went off on the 10th of August.
0:38:43 > 0:38:45- Can I have it still?- What?
0:38:45 > 0:38:49Lentil mousakka. It might be all right?
0:38:49 > 0:38:51Yeah, you kill the bacteria, don't you, when you heat it up?
0:38:51 > 0:38:54Yeah. It's not got meat in or anything that can go wormy, has it?
0:38:54 > 0:38:56I'm so excited about getting paid now.
0:38:56 > 0:38:59I didn't genuinely think payday would be such a big deal to me
0:38:59 > 0:39:02until I became the poorest person I know.
0:39:02 > 0:39:04And now, that's why we're having stir fry,
0:39:04 > 0:39:07because this entire meal probably cost me about 5 quid.
0:39:07 > 0:39:10As the first years enjoy a budget stir fry,
0:39:10 > 0:39:12the only thing second year, Oli,
0:39:12 > 0:39:15will be eating tonight is hospital catering.
0:39:15 > 0:39:17He's about to start a run of night shifts,
0:39:17 > 0:39:20so he'll be putting his social life on hold.
0:39:21 > 0:39:24I went and saw some of my friends before nights,
0:39:24 > 0:39:27and we were just sitting around, playing a bit of FIFA,
0:39:27 > 0:39:28and I was thinking, "Ugh!
0:39:28 > 0:39:31"That would be a lovely way to spend this weekend."
0:39:34 > 0:39:37A few beers with some friends.
0:39:37 > 0:39:39But instead, I will be with the fine residents
0:39:39 > 0:39:43of the Royal Liverpool and Broadgreen University Hospital.
0:39:52 > 0:39:54Being the on-call medic on nights
0:39:54 > 0:39:57is a tough test for any new junior doctor,
0:39:57 > 0:40:00but for laidback Oli, a night shift is all in a day's work.
0:40:05 > 0:40:09So I was brought up in Reading. Went to school there.
0:40:09 > 0:40:13I'm the first in my immediate family to go to university.
0:40:13 > 0:40:15He was quite young, eight or nine,
0:40:15 > 0:40:17when we were at the dinner table one night and he said,
0:40:17 > 0:40:19"I'd really love to be a doctor when I'm older."
0:40:19 > 0:40:21And we all kind of laughed and said,
0:40:21 > 0:40:23"Oh, that would be a really good idea!"
0:40:23 > 0:40:26He worked hard. I think he played hard too.
0:40:30 > 0:40:32How would I describe myself?
0:40:32 > 0:40:35I'm probably a secretly competitive person.
0:40:35 > 0:40:38Although, I don't know, my friends might say it's not so secret.
0:40:38 > 0:40:40Smart, sleepy.
0:40:40 > 0:40:43I'd go for lazy!
0:40:43 > 0:40:46I'm quite a laidback person. I don't let things get on top of me.
0:40:46 > 0:40:48I try not to get stressed out too much.
0:40:48 > 0:40:51The chances of getting your full ten hours of sleep
0:40:51 > 0:40:54is highly unlikely, so I tend to make up for it with, yeah,
0:40:54 > 0:40:58napping in the evening or during the day, if I can get away with it.
0:41:00 > 0:41:02When you start off, it's all a bit new
0:41:02 > 0:41:05and you're not quite sure how to handle it and you worry a bit.
0:41:05 > 0:41:08- Is that the first one you've done? - Yeah, that was the first one, yeah.
0:41:08 > 0:41:11'But as time goes on, you begin to take it more in your stride
0:41:11 > 0:41:13'and, you know, you still take it seriously,'
0:41:13 > 0:41:16but it becomes a bit more routine and easier to deal with.
0:41:16 > 0:41:20ALARM SOUNDS
0:41:20 > 0:41:22You're often thrown in at the deep end
0:41:22 > 0:41:24and you're just expected to be able
0:41:24 > 0:41:27to deal with these really difficult situations at times, yeah.
0:41:31 > 0:41:33ALARM SOUNDS Where is it?
0:41:33 > 0:41:36Straight away, Oli's called into action.
0:41:36 > 0:41:37It's an emergency.
0:41:39 > 0:41:41This floor's fine.
0:41:41 > 0:41:43But it turns out to be a false alarm.
0:41:46 > 0:41:49The routine tasks Oli faces on a nightshift
0:41:49 > 0:41:52all need to be done during demanding 12-hour stints.
0:41:52 > 0:41:55Something of a struggle for a man who likes his sleep.
0:41:55 > 0:41:58You do, occasionally, when you're walking round on wards,
0:41:58 > 0:41:59you see an empty bed, and you're like,
0:41:59 > 0:42:01"Mmm, I could sleep the shit out of you!"
0:42:01 > 0:42:03But then, you're not allowed.
0:42:03 > 0:42:04So you just carry on working!
0:42:05 > 0:42:07But night shifts are unpredictable.
0:42:07 > 0:42:10And unfortunately for Oli, it's never long
0:42:10 > 0:42:12before there's another challenge to deal with.
0:42:16 > 0:42:18Yet again, it's a crash bleep.
0:42:18 > 0:42:19And this one is for real.
0:42:23 > 0:42:25'When the call comes through, you forget how tired you are.
0:42:25 > 0:42:27'Adrenalin pumps and you just run there.
0:42:27 > 0:42:29'You're just focusing so much on what's going on
0:42:29 > 0:42:31'that you don't notice how tired you are.'
0:42:31 > 0:42:325A. We'll go through 5X.
0:42:34 > 0:42:36Arriving at the scene of the emergency,
0:42:36 > 0:42:39Oli finds nurses working on an elderly woman
0:42:39 > 0:42:42who has stopped breathing.
0:42:42 > 0:42:43Is there an output?
0:42:47 > 0:42:50She's got a pulse. She's got a strong pulse. Good output.
0:42:54 > 0:42:57What's going in? Is that just normal fluids, or is there any antibiotics?
0:42:57 > 0:43:00- No, dextrose.- Dextrose?
0:43:00 > 0:43:03Yeah, could we get a glucose?
0:43:03 > 0:43:05Oli takes charge of the team
0:43:05 > 0:43:09and they soon manage to stabilise the patient.
0:43:09 > 0:43:10She's breathing now.
0:43:13 > 0:43:16Just get the stats monitor on.
0:43:19 > 0:43:21Have we got a drug card around here at all?
0:43:24 > 0:43:27With the patient beginning to recover,
0:43:27 > 0:43:30the situation no longer seems as bad as first feared.
0:43:32 > 0:43:36It's not a cardiac arrest, but it is somebody who's maybe had a fit.
0:43:37 > 0:43:40Sounds like they're known to have seizures, so...
0:43:42 > 0:43:44Don't need any more of them tonight. That'll do for me!
0:43:44 > 0:43:47One crash call per night is enough, I think.
0:43:51 > 0:43:54Oli's made it to the end of his shift.
0:43:55 > 0:43:58But just when he thought it was safe to go home...
0:44:00 > 0:44:02..there's another crash bleep.
0:44:03 > 0:44:05And it's on Emily's ward.
0:44:06 > 0:44:09What's going on?
0:44:09 > 0:44:12She's been on shift for less than an hour,
0:44:12 > 0:44:15but one of her patients is in cardiac arrest.
0:44:15 > 0:44:16Does anyone know about this patient?
0:44:19 > 0:44:21As the on-call medic,
0:44:21 > 0:44:23second year, Oli, is needed to assist at the scene.
0:44:25 > 0:44:28Could I get one of you two to get me an Ambu bag and a mask, please?
0:44:37 > 0:44:39Is there a pulse?
0:44:45 > 0:44:47Is there...I'll get gas.
0:44:48 > 0:44:53Despite the teams' efforts, the man is showing no signs of improvement.
0:44:57 > 0:44:59As Oli takes some blood,
0:44:59 > 0:45:02Emily continues chest compressions on her patient.
0:45:11 > 0:45:14Nothing seems to be working.
0:45:14 > 0:45:16And as the monitor shows no signs of a heartbeat,
0:45:16 > 0:45:21the doctor in charge has a difficult decision to make.
0:45:28 > 0:45:33As the team tries one last time to restart the man's heart,
0:45:33 > 0:45:35Emily does another round of compressions.
0:45:48 > 0:45:52The team pause, to check whether the monitor shows the patient's
0:45:52 > 0:45:56heart has started working on its own again.
0:45:58 > 0:46:01But there's still no change.
0:46:47 > 0:46:51It's been a tragic end to an otherwise routine night shift
0:46:51 > 0:46:53for Oli.
0:46:53 > 0:46:56It was unexpected, a bit of a shock,
0:46:56 > 0:47:00bit of a downer to the night shift, to be honest.
0:47:00 > 0:47:04For Emily, it's the second of her patients to die this week.
0:47:04 > 0:47:08It's always much harder when it's your own patients.
0:47:08 > 0:47:11She has a day job to get on with as well, so I don't think
0:47:11 > 0:47:13she'll let it affect her too much.
0:47:15 > 0:47:17I think maybe wait until you get home,
0:47:17 > 0:47:20then let the emotional side...have a think about that,
0:47:20 > 0:47:22otherwise, you can't get on with your day, can you?
0:47:27 > 0:47:31Emily was the first doctor on the scene when her patient
0:47:31 > 0:47:33went into cardiac arrest,
0:47:33 > 0:47:36and she's reliving the events with Tristan and Jen.
0:47:36 > 0:47:39I hate being the first person there.
0:47:39 > 0:47:41I hate it so much.
0:47:41 > 0:47:43And I did not know what I was doing.
0:47:47 > 0:47:49How long were you on your own for?
0:47:49 > 0:47:52I wasn't really on my own, I had the nurses with me,
0:47:52 > 0:47:54but I feel like I needed somebody
0:47:54 > 0:47:57very senior and calm just to direct everything,
0:47:57 > 0:47:59cos we were all rushing about,
0:47:59 > 0:48:02trying to get oxygen and start compressions
0:48:02 > 0:48:05and start timing.
0:48:05 > 0:48:09I didn't know how to organise it, I wasn't organising it well.
0:48:09 > 0:48:14You did the best you could do at the time, which is all anyone can expect of you.
0:48:14 > 0:48:17Sounds like you did a really good job.
0:48:17 > 0:48:20But Tristan's words are cold comfort to Emily.
0:48:20 > 0:48:25When the senior doctor said, "Does everybody agree
0:48:25 > 0:48:27"that this is futile?"
0:48:27 > 0:48:31Then everybody took a step back
0:48:31 > 0:48:33and he was just laying there and got really pale
0:48:33 > 0:48:36and his eyes were open and he wasn't breathing,
0:48:36 > 0:48:38and I had to check on his chest that he was breathing'
0:48:41 > 0:48:44Do you think it will ever get easier?
0:48:44 > 0:48:45I hope it doesn't, in a way.
0:48:45 > 0:48:48I don't want to get blase about crashes.
0:48:48 > 0:48:54I hope that I get over crying, that I stop crying.
0:48:54 > 0:48:57But I hope that I always feel a little bit for them.
0:49:06 > 0:49:08After a shaky start yesterday,
0:49:08 > 0:49:11Ed's back for another shift on the Acute Medical Ward.
0:49:11 > 0:49:15He trained in Italy, so his lack of practical experience of working in a
0:49:15 > 0:49:20British hospital means the learning curve has been that bit steeper.
0:49:20 > 0:49:22He's in B2.
0:49:22 > 0:49:24He's ready in B2?
0:49:24 > 0:49:27You go round the corner.
0:49:28 > 0:49:30OK.
0:49:31 > 0:49:35His first job is treating a patient with a severe headache.
0:49:35 > 0:49:38- Do you feel anything at the back of your eyes?- A bit, yeah.
0:49:38 > 0:49:41The man suffers from migraines, but Ed must rule out anything
0:49:41 > 0:49:45more serious by doing a neurological examination.
0:49:45 > 0:49:47Can you give me some qualities of this pain?
0:49:47 > 0:49:51Is it throbbing? Is it continuous?
0:49:51 > 0:49:53Does it come and go during the day?
0:49:53 > 0:49:55Do you have peaks?
0:49:55 > 0:49:58It just throbs up there.
0:49:58 > 0:50:02- It's been throbbing ever since yesterday?- Since yesterday, yeah.
0:50:02 > 0:50:05I saw you marked your pain from zero to ten
0:50:05 > 0:50:06around ten.
0:50:06 > 0:50:09- That must be very painful. - Yeah, it was very painful.
0:50:09 > 0:50:11How is it now?
0:50:11 > 0:50:13It's subsiding a little bit but it's still there.
0:50:13 > 0:50:15Still throbbing, OK.
0:50:16 > 0:50:18For Ed, there's a lot riding on this.
0:50:18 > 0:50:22His last neurological examination was one of the reasons
0:50:22 > 0:50:25he left the emergency department.
0:50:25 > 0:50:27So he can't afford to get it wrong.
0:50:28 > 0:50:30If you could please follow the pen.
0:50:34 > 0:50:36Look at my hands. OK.
0:50:36 > 0:50:38- Say, "Ah".- Ah.
0:50:41 > 0:50:42Can you feel?
0:50:44 > 0:50:48The examination requires Ed's full concentration.
0:50:48 > 0:50:50And there's a lot to tick off his mental checklist.
0:50:50 > 0:50:53Can you stick out your tongue?
0:50:53 > 0:50:55Lift up your shoulders against my force.
0:50:55 > 0:50:58Grab my hands as firmly as you can.
0:51:00 > 0:51:02Right.
0:51:02 > 0:51:05Erm...
0:51:05 > 0:51:09That, I think, is...perfectly fine.
0:51:11 > 0:51:13Look at me again.
0:51:13 > 0:51:17Your right eye does seem redder than your left eye,
0:51:17 > 0:51:23so that also makes me think more towards
0:51:23 > 0:51:25some kinds of migraine.
0:51:26 > 0:51:30I've had a migraine before and it's nothing like it.
0:51:30 > 0:51:34I've never had flashing lights in my vision.
0:51:34 > 0:51:38The patient is unsure of the diagnosis, so Ed gets a senior
0:51:38 > 0:51:43doctor to do a second assessment, which confirms he's got it right.
0:51:45 > 0:51:48- SENIOR DOCTOR:- Your blood tests have all come back normal.
0:51:48 > 0:51:49Good, good.
0:51:49 > 0:51:52It sounds like a migraine.
0:51:52 > 0:51:55We went over the history of the patient
0:51:55 > 0:51:59and the clinical examination and it was confirmed what I'd found,
0:51:59 > 0:52:03so it looks like I didn't miss out anything relevant,
0:52:03 > 0:52:06so that's good.
0:52:06 > 0:52:09Now he's got the backing of his seniors,
0:52:09 > 0:52:12Ed goes to discharge the patient.
0:52:12 > 0:52:15But he's got fed up of waiting, and has gone home.
0:52:15 > 0:52:18There's nothing much I can do about that. He's gone,
0:52:18 > 0:52:20he decided to go, he goes.
0:52:20 > 0:52:23After a bumpy start to life as a junior doctor in Liverpool,
0:52:23 > 0:52:26Italian Ed's finally tasted success.
0:52:26 > 0:52:30Just in time for a catch up with his mentor, Dr Pickles.
0:52:30 > 0:52:33You are going in the right direction and that's encouraging.
0:52:33 > 0:52:37Certainly when you've presented cases to me, I've been pleased
0:52:37 > 0:52:40with your initial diagnosis, your management plan, your examination.
0:52:40 > 0:52:44- Obviously...- There's loads of space for improvement.- Absolutely.
0:52:44 > 0:52:48At least I know I'm not working in a bad way.
0:52:53 > 0:52:55I think this is a culture shock to him.
0:52:55 > 0:52:57My understanding is that he
0:52:57 > 0:53:02was pretty much the only doctor in a rural area
0:53:02 > 0:53:05and didn't get too much hands-on experience.
0:53:05 > 0:53:07I think coming to a hospital as big as the Royal,
0:53:07 > 0:53:10where you've got such a vast turnover
0:53:10 > 0:53:16of patients, where you're expected to see a lot of patients quickly,
0:53:16 > 0:53:21to do a lot of things in a short period of time.
0:53:21 > 0:53:26It's going to be so hard for him, but he'll get there.
0:53:26 > 0:53:28It's been a challenging week,
0:53:28 > 0:53:33and Ed's relieved that Dr Pickles has ended it on a positive note.
0:53:33 > 0:53:35All in all, I'm feeling a bit worn out
0:53:35 > 0:53:38because it has been a long and busy day.
0:53:38 > 0:53:43Certainly I've gained a little bit of confidence at least from my meeting.
0:53:43 > 0:53:46I'm not worried about confidence,
0:53:46 > 0:53:50I'm just worried about working in the right direction
0:53:50 > 0:53:54and doing things as I should be doing them at my level,
0:53:54 > 0:53:58and that seems to be OK.
0:53:58 > 0:54:00Plenty of space for improvement.
0:54:00 > 0:54:04Ed's not the only junior doctor feeling upbeat.
0:54:04 > 0:54:08They've all made it through their first stressful month on the wards.
0:54:08 > 0:54:11And the moment they've all been waiting for has finally arrived.
0:54:11 > 0:54:14- It's payday!- It's payday! - It's payday!
0:54:14 > 0:54:17ALL: It's payday!
0:54:17 > 0:54:20And after all their years of training, there can be only
0:54:20 > 0:54:26one way to mark such a milestone - cocktails.
0:54:26 > 0:54:30Happy payday, guys. Happy payday!
0:54:30 > 0:54:32Almost the first bit of gratification.
0:54:32 > 0:54:36You've just got paid. "Oh, good.
0:54:39 > 0:54:41"It's a job, I'm settled, I've had my first pay cheque.
0:54:41 > 0:54:44"I feel a little bit established." It's nice!
0:54:45 > 0:54:47It's really nice.
0:54:47 > 0:54:49We've been working for a month now,
0:54:49 > 0:54:51so it's nice to see some money in the bank
0:54:51 > 0:54:53and stop scrimping and saving for the time being.
0:54:56 > 0:54:59I need a handbag,
0:54:59 > 0:55:01some clothes, some new shoes,
0:55:01 > 0:55:05a bike, and I'm going to take my nan up some dinner.
0:55:05 > 0:55:07- SHE LAUGHS - Cos she's helped me through uni.
0:55:10 > 0:55:13The best thing about payday is being independent.
0:55:13 > 0:55:17I want to buy my mum flowers because she's supported me for ages
0:55:17 > 0:55:20and now we can sever the cord and cut the standing order.
0:55:20 > 0:55:23I can actually look after myself now.
0:55:33 > 0:55:35Next week, on Junior Doctors...
0:55:35 > 0:55:37can they handle the pressure of being doctors
0:55:37 > 0:55:40in one of Britain's booziest cities?
0:55:40 > 0:55:42You think of it as normal, going out with friends,
0:55:42 > 0:55:45but you see the real extreme end of it in hospital.
0:55:49 > 0:55:53It's a race against the clock for Tristan
0:55:53 > 0:55:56as he takes on his very first ward round.
0:55:56 > 0:55:5915 minutes behind already.
0:56:01 > 0:56:03You can't switch off and let your seniors
0:56:03 > 0:56:05give you a list of things to do.
0:56:07 > 0:56:09You have to make some decisions.
0:56:09 > 0:56:14And Tom comes under fire in his very first presentation to senior consultants.
0:56:14 > 0:56:17It's obviously irregular.
0:56:17 > 0:56:21It's the irreg-, irreg-, irregularity of it.
0:56:21 > 0:56:24There was no doubt I was going to get grilled when I was doing it.
0:56:24 > 0:56:27There's no doubt I wouldn't get everything right.
0:56:43 > 0:56:46Subtitles by Red Bee Media Ltd