0:00:02 > 0:00:03Trauma...
0:00:03 > 0:00:06- Got a pulse, got a strong pulse. - Any pain up here?
0:00:06 > 0:00:07..tears...
0:00:07 > 0:00:09That's all right.
0:00:09 > 0:00:11..and intense pressure.
0:00:11 > 0:00:13Changing the oxygen over.
0:00:15 > 0:00:18Just another day on medicine's front line.
0:00:22 > 0:00:24They're young, they're untested...
0:00:24 > 0:00:26This is my first patient ever.
0:00:26 > 0:00:31..and from their very first day, work is a matter of life and death.
0:00:31 > 0:00:33- Don't let me die.- I'm not going to let you go anywhere.
0:00:33 > 0:00:37For a junior doctor, fresh out of medical school,
0:00:37 > 0:00:40it's time to put theory into practice.
0:00:43 > 0:00:45No, I haven't.
0:00:45 > 0:00:50We're following seven junior doctors over their first three months on the job...
0:00:50 > 0:00:52- Sharp scratch.- Ohh!
0:00:52 > 0:00:54It's all about the glamour.
0:00:54 > 0:00:55It's all about the bums.
0:00:55 > 0:00:58..where there's a first time for everything...
0:00:58 > 0:01:03I didn't really know what to do. It's just having the confidence, isn't it?
0:01:04 > 0:01:06..and first impressions count.
0:01:06 > 0:01:10I'm afraid I didn't get it first time either.
0:01:11 > 0:01:14First years Tom, Emily,
0:01:14 > 0:01:16Jen, Tristan
0:01:16 > 0:01:19and Ed have been on the wards for just four weeks.
0:01:19 > 0:01:23For all intents and purposes, at the moment, he's actually having a heart attack.
0:01:23 > 0:01:26We're just going to put the morphine in now. You might feel a little bit dizzy.
0:01:26 > 0:01:30Second years Oli and Kiera have 12 months' experience.
0:01:30 > 0:01:31Breathing now.
0:01:31 > 0:01:34Don't need any more of them tonight, that'll do for me.
0:01:36 > 0:01:41They are working here, at the Royal Liverpool University Hospital.
0:01:41 > 0:01:43They're here to look after you.
0:01:43 > 0:01:45But can they handle the pressure of being doctors
0:01:45 > 0:01:48in one of Britain's booziest cities?
0:01:48 > 0:01:53You think of it as normal, sociable. Going out drinking with friends, people might have a few too many.
0:01:53 > 0:01:55But you see the real extreme end of it in hospital.
0:01:55 > 0:01:59I started drinking again the other night. Just loads of blood came out.
0:01:59 > 0:02:01I guess it's just one of those things
0:02:01 > 0:02:05of working in a city where there's lots of people who drink a lot of alcohol.
0:02:26 > 0:02:30It's the weekend in Liverpool, one of Britain's biggest party capitals.
0:02:30 > 0:02:34MUSIC: "This Is The Life" by Two Door Cinema Club
0:02:39 > 0:02:42But when lots of young people have one too many to drink,
0:02:42 > 0:02:45it's up to the junior doctors to pick up the pieces.
0:02:45 > 0:02:48SIREN WAILS
0:02:50 > 0:02:53Second year Kiera has just started a night shift
0:02:53 > 0:02:56in the hospital's emergency department.
0:02:58 > 0:03:01Working with A&E probably has changed the way I feel about going out
0:03:01 > 0:03:04and getting absolutely smashed,
0:03:04 > 0:03:06as maybe you would like to do as a student.
0:03:06 > 0:03:07It kind of upsets me a little bit
0:03:07 > 0:03:10because I've seen the really negative effects
0:03:10 > 0:03:12that can actually have.
0:03:12 > 0:03:13Hello, there.
0:03:13 > 0:03:17Kiera's first patient is no boozed up 20-something,
0:03:17 > 0:03:23but an evening spent sampling the city's nightlife has still ended in a trip to casualty.
0:03:23 > 0:03:28I had a couple of drinks, went into a bar, sitting on a stool,
0:03:28 > 0:03:32had a cocktail, but it must have gone down the wrong hole,
0:03:32 > 0:03:34and I took a fit of coughing.
0:03:34 > 0:03:37I felt light-headed as I coughed.
0:03:37 > 0:03:41- The next thing I know, I'm on the floor.- Dearie me. You poor thing.
0:03:41 > 0:03:43So you fell and you hit your face.
0:03:43 > 0:03:47The next thing I remember is I woke up and there were people around me
0:03:47 > 0:03:51and there was somebody wiping the blood from me and I couldn't move.
0:03:51 > 0:03:53Then I could move and I was all right.
0:03:53 > 0:03:55I think you've broken your nose there.
0:03:55 > 0:03:57Oh, God.
0:03:57 > 0:04:01Got a bit of a cut there as well. Been in the wars, eh?
0:04:01 > 0:04:03Did myself a bit of damage there, didn't I?
0:04:03 > 0:04:05You've done a proper job of it, haven't you?
0:04:05 > 0:04:10But it's not just a broken nose that's concerning the patient.
0:04:10 > 0:04:15The thing that is getting me is these sensations in me hands.
0:04:15 > 0:04:19Extremely painful pins and needles which are shooting up from my fingers
0:04:19 > 0:04:22into my hands, and it's very painful indeed.
0:04:22 > 0:04:25Medical alarm bells ring for the junior doctor.
0:04:25 > 0:04:29If you've hurt something in your neck, it might be causing you pain in your hands,
0:04:29 > 0:04:34so we might need to get a bit of an X-ray of the neck, OK?
0:04:34 > 0:04:36Can you just tell me...?
0:04:36 > 0:04:39The tingly sensations could be a sign of a serious spinal injury.
0:04:39 > 0:04:41It's extremely painful.
0:04:41 > 0:04:43- On the back here? - Yes, very sensitive.
0:04:43 > 0:04:46- Very sensitive for me to touch there. - It's very sensitive there, yes.
0:04:46 > 0:04:50Very sensitive here and here, OK.
0:04:50 > 0:04:54I think we probably need to get some sort of imaging on your neck
0:04:54 > 0:04:57before I can assess you any further, OK?
0:05:04 > 0:05:07With the scan over and the patient back in the bay,
0:05:07 > 0:05:10Kiera can get on with the job of fixing his face.
0:05:10 > 0:05:13I'm going to just pop a bit of local in that head
0:05:13 > 0:05:17and put a couple of stitches in that, get you looking beautiful again, OK?
0:05:17 > 0:05:20- HE LAUGHS - Cheers, thanks!
0:05:23 > 0:05:25OK, this is when the sharp, stingy bit is coming up now.
0:05:25 > 0:05:27You might not like this bit.
0:05:27 > 0:05:28Oh, God, OK.
0:05:28 > 0:05:31Right. Just going to go for it.
0:05:31 > 0:05:33Just go for it.
0:05:33 > 0:05:35OK, sharp scratch coming up.
0:05:41 > 0:05:44- That wasn't too bad.- You'll start to notice it will be numbing soon.
0:05:48 > 0:05:51You'll be pleased to know that everyone winds me up
0:05:51 > 0:05:53for being a bit of a perfectionist with this.
0:05:53 > 0:05:57- Probably what you'd want, I'd imagine.- I couldn't care less.
0:05:57 > 0:05:59Oh, fine, then!
0:05:59 > 0:06:01You're going to do a good job.
0:06:01 > 0:06:04It's an ugly face anyway.
0:06:04 > 0:06:08Aww. Beauty is in the eye of the beholder, as they say.
0:06:08 > 0:06:11Just going to have a little look inside now.
0:06:11 > 0:06:14We've given it a good wash out so it actually feels OK.
0:06:14 > 0:06:16- Can you feel any of this? - No, you're all right.
0:06:16 > 0:06:19Great. All right, sir.
0:06:21 > 0:06:23Is the nose broken, is it?
0:06:23 > 0:06:24Yes, your nose is broken.
0:06:24 > 0:06:29I'm just closing up the skin on it now,
0:06:29 > 0:06:32because it reduces the risk of infection
0:06:32 > 0:06:35and it stops a lot of the bleeding that is going on.
0:06:39 > 0:06:44You're going to have quite a nice black eye from this, sir.
0:06:44 > 0:06:46One to show off down the pub.
0:06:48 > 0:06:51Wounds, battle scars.
0:06:51 > 0:06:54Perfectionist Kiera has stitching down to a fine art.
0:06:55 > 0:06:57He's got a new nose.
0:06:57 > 0:07:02But potentially there is a much bigger problem to deal with.
0:07:02 > 0:07:04Got the results of his scan back
0:07:04 > 0:07:07and we think he's had a small fracture to one of the vertebra in his neck
0:07:07 > 0:07:12which is probably explaining the horrible sensation he is getting in his hands.
0:07:12 > 0:07:15So, essentially, orthopaedics are going to take over care
0:07:15 > 0:07:20of his fractured neck and we'll see where we go from there.
0:07:20 > 0:07:22Despite the patient's prognosis,
0:07:22 > 0:07:26he remains upbeat about the treatment Kiera has given him.
0:07:26 > 0:07:28Wonderful service.
0:07:28 > 0:07:31Thank you. It's nice to hear that.
0:07:31 > 0:07:33It's not always echoed by most people.
0:07:40 > 0:07:43As Liverpool recovers from a weekend of partying,
0:07:43 > 0:07:45junior doctors Emily and Jen
0:07:45 > 0:07:49are gearing up for a week of birthday celebrations,
0:07:49 > 0:07:52as they'll both turn 25. Emily's comes first.
0:07:52 > 0:07:53Oh, wow!
0:07:53 > 0:07:55It looks quite nice.
0:07:55 > 0:07:57Well impressed.
0:07:57 > 0:08:00Dear Dr Phipps, happy birthday, hope you have a wonderful Thursday,
0:08:00 > 0:08:03and I'll see you at weekend, love, Jamie.
0:08:05 > 0:08:06I think I will be keeping it quiet.
0:08:06 > 0:08:08Why?!
0:08:08 > 0:08:11- I can't be bothered. - Are you not a birthday fan?
0:08:11 > 0:08:14I don't mind birthdays, I just don't think everybody on the ward needs...
0:08:14 > 0:08:18But there's little time to open presents,
0:08:18 > 0:08:21as Emily needs to put in a shift at the hospital.
0:08:21 > 0:08:24And as it's her birthday,
0:08:24 > 0:08:27she's hoping to avoid any of the more unpleasant procedures.
0:08:27 > 0:08:31I'm not putting my fingers up anyone's bum, it's my birthday.
0:08:31 > 0:08:32That's my plan.
0:08:32 > 0:08:37The news of Emily's 25th birthday has reached the wards.
0:08:37 > 0:08:39Ah!
0:08:39 > 0:08:42- ALL:- # Happy birthday to you!
0:08:42 > 0:08:46# Happy birthday to you! #
0:08:46 > 0:08:48- Can I have a hug?- Happy birthday!
0:08:48 > 0:08:51Thank you.
0:08:52 > 0:08:55But the birthday celebrations have to go on hold,
0:08:55 > 0:08:59as Emily has patients in need of surgery to see.
0:08:59 > 0:09:0186-year-old Joe has been admitted to the ward
0:09:01 > 0:09:04to have a growth removed from his bowel.
0:09:04 > 0:09:07So, symptoms-wise,
0:09:07 > 0:09:10have you noticed any yellowing in your eyes at all?
0:09:10 > 0:09:14- No!- Bit of a weird question, isn't it?! No?
0:09:14 > 0:09:18The only thing I do when I get out of bed - shower, shave.
0:09:18 > 0:09:22I don't look in the mirror and say, "He's gorgeous, him!"
0:09:22 > 0:09:25You should do!
0:09:26 > 0:09:27He's going into theatre today,
0:09:27 > 0:09:30and Emily needs to do his pre-op assessment.
0:09:30 > 0:09:32Are you allergic to any medication?
0:09:32 > 0:09:34No.
0:09:34 > 0:09:37- How are your waterworks? Any burning or stinging?- No problem.
0:09:39 > 0:09:41Can you lift your top up for me?
0:09:42 > 0:09:46- Nothing to hide!- No tattoos.- No.
0:09:46 > 0:09:49OK. Can I listen to your back as well?
0:09:49 > 0:09:51Nice deep breathe for me.
0:09:51 > 0:09:54I feel there is something there.
0:09:54 > 0:09:57- It's the only part of my body where I feel there is something.- Mmm.
0:09:59 > 0:10:02I think you're doing very well.
0:10:02 > 0:10:07So what'll happen is one of the registrars, one of the senior doctors,
0:10:07 > 0:10:10will explain everything and answer any questions you have.
0:10:12 > 0:10:15Oh, we'll see what we can do.
0:10:18 > 0:10:22Emily's been offered the opportunity to observe Joe's surgery,
0:10:22 > 0:10:25but she has opted to clear a backlog of work on the ward instead.
0:10:25 > 0:10:29While some junior doctors would jump at the chance,
0:10:29 > 0:10:32birthday girl Emily is clear about her future direction,
0:10:32 > 0:10:36and surgery is not what she wants to specialise in.
0:10:36 > 0:10:39I passed out a couple of times in surgery as a student!
0:10:39 > 0:10:40It's really hot and sweaty
0:10:40 > 0:10:43and you can't go for a wee, you can't have any lunch.
0:10:44 > 0:10:47They have this thing called the diathermy
0:10:47 > 0:10:51which kind of burns the tissue and stuff so it seals,
0:10:51 > 0:10:53and it just smells like a barbeque but not in a nice way.
0:10:53 > 0:10:56I'm vegetarian as well so it's just not that nice!
0:10:58 > 0:11:02I have an issue with flesh. It's just a bit too fleshy, I think, for me.
0:11:02 > 0:11:06But despite her issues with surgery, Emily still feels that choosing
0:11:06 > 0:11:09to work her first three months on a surgical ward
0:11:09 > 0:11:12has been a worthwhile learning experience.
0:11:12 > 0:11:16I'm not passionate about the act of surgery itself.
0:11:16 > 0:11:19I really enjoy the patients and the clinical problems they have.
0:11:19 > 0:11:23So I feel like I'm still being really useful staying on the ward.
0:11:25 > 0:11:28With the patient's operation successfully completed,
0:11:28 > 0:11:30Emily's senior, Femi Oshin, takes some time
0:11:30 > 0:11:35to catch up on her progress so far, and discuss her future direction.
0:11:35 > 0:11:37Some people have no idea what they want to do
0:11:37 > 0:11:39until the very last minute, whereas some people
0:11:39 > 0:11:43are like, "I want to be a surgeon," from about six. It's weird.
0:11:43 > 0:11:44Have you had any thoughts
0:11:44 > 0:11:47on what you'd like to specialise in in the future?
0:11:47 > 0:11:50Can we tempt you with surgery, perhaps?
0:11:50 > 0:11:52Maybe not surgery yet.
0:11:52 > 0:11:55Maybe I'll change my mind at some point, but at the minute
0:11:55 > 0:11:58- I want to do public health with an infectious diseases focus.- OK.
0:11:58 > 0:12:01You have to do whatever you find interesting,
0:12:01 > 0:12:04otherwise you'll very quickly find
0:12:04 > 0:12:07that you don't enjoy yourself any more,
0:12:07 > 0:12:08and people drop out.
0:12:08 > 0:12:11I think my mind's pretty much made up about what I want to do.
0:12:11 > 0:12:14But I'm not saying I'm walking around, grumpy, thinking, "Why am I doing this?"
0:12:14 > 0:12:17Because, like I say, there's so much you can get out of a job,
0:12:17 > 0:12:21it's not all about thinking, "This is what I want to do for the rest of my life."
0:12:21 > 0:12:23Every job's a learning experience, so I'm getting loads from it,
0:12:23 > 0:12:25even though it's not what I want to do.
0:12:28 > 0:12:31While Emily contemplates her future,
0:12:31 > 0:12:36over on the acute medical unit Ed and Oli are on the morning ward round,
0:12:36 > 0:12:39where they are dealing with Liverpool's all too familiar problem -
0:12:39 > 0:12:42alcohol-related illness.
0:12:48 > 0:12:51The Royal Liverpool University Hospital deals with
0:12:51 > 0:12:55the highest number of alcohol-related cases in England.
0:12:55 > 0:12:58It's really sad when you see young people who have come in
0:12:58 > 0:13:04and they've got liver problems or, essentially, incurable diseases because of alcohol.
0:13:05 > 0:13:10It's worlds apart from Ed's last job in an Italian mountain village.
0:13:10 > 0:13:14Of course, I mean, I don't want to pass the city off as a city of alcoholics,
0:13:14 > 0:13:15because it's not true.
0:13:15 > 0:13:18Unfortunately, it's just an important problem
0:13:18 > 0:13:22and you've got to learn how to deal with it as best as possible.
0:13:22 > 0:13:25Because of his inexperience of working in the NHS,
0:13:25 > 0:13:28he'll be closely supervised by Dr Khan,
0:13:28 > 0:13:32who's keen to see what Ed knows about chronic liver disease.
0:13:33 > 0:13:35How long have you been drinking for?
0:13:35 > 0:13:38- For about five years. - How much do you drink?
0:13:38 > 0:13:40Approximately a litre and half of vodka.
0:13:40 > 0:13:42A litre and half a day.
0:13:42 > 0:13:45Dr Khan wants Ed to examine a patient
0:13:45 > 0:13:47who's showing some of the classic signs.
0:13:47 > 0:13:50- Can I have a feel of your tummy? - Yes.- Thank you.
0:13:50 > 0:13:53Just tell me if there's any pain.
0:13:55 > 0:13:58Yeah. All there's sore.
0:13:58 > 0:14:01What are the other signs you'd find in the tummy in such a patient?
0:14:01 > 0:14:06Well, I would expect to find tenderness
0:14:06 > 0:14:07around the liver area.
0:14:07 > 0:14:10So what happens to the liver?
0:14:12 > 0:14:16In the long term, it can go towards cirrhosis
0:14:16 > 0:14:18and in that case, it gets harder.
0:14:20 > 0:14:22Ed's holding up to scrutiny,
0:14:22 > 0:14:25but there's an obvious clue in the diagnosis of the patient's condition
0:14:25 > 0:14:27that Dr Khan thinks he's overlooked.
0:14:28 > 0:14:30What are spider naevi?
0:14:30 > 0:14:33Spider naevi are another sign typical of alcohol intake,
0:14:33 > 0:14:37depending if they are vascular abnormalities...
0:14:37 > 0:14:38Has she got any?
0:14:40 > 0:14:42That's one.
0:14:42 > 0:14:44That's...
0:14:44 > 0:14:45That one is.
0:14:47 > 0:14:51- That, to me, looks like... - Not that one?
0:14:53 > 0:14:56With people from Liverpool twice as likely to die
0:14:56 > 0:15:00from an alcohol-related condition as those from the rest of the UK,
0:15:00 > 0:15:04it's an issue that Ed's going to have to grips with.
0:15:04 > 0:15:07'I really need to get into revising
0:15:07 > 0:15:11'serious complications of alcohol intake,'
0:15:11 > 0:15:12because I know a bit,
0:15:12 > 0:15:15but I must be more proficient than that
0:15:15 > 0:15:17because it's such an important issue here.
0:15:17 > 0:15:19Thank you.
0:15:19 > 0:15:24I find it very sad, because after a certain point,
0:15:24 > 0:15:26it's just difficult to get your health back.
0:15:32 > 0:15:36With their shifts over, Ed and some of the other junior doctors
0:15:36 > 0:15:39are back at the house with a surprise for Emily.
0:15:39 > 0:15:44- ALL:- # Happy birthday, dear Emily
0:15:44 > 0:15:47# Happy birthday to you! #
0:15:47 > 0:15:49Aww!
0:15:49 > 0:15:52You know you're old when your cake feels like an inferno.
0:15:52 > 0:15:54Oh, my God, that's amazing.
0:15:56 > 0:15:58- Oh, shit! - ALL LAUGH
0:15:58 > 0:16:00That was hair on fire!
0:16:01 > 0:16:04Oli nearly got his fireman on there!
0:16:04 > 0:16:08- About to pour beer on it! - One more, Emily, then your wish.
0:16:08 > 0:16:11But the surprises don't stop there.
0:16:11 > 0:16:13So, Emily, since you're now 25,
0:16:13 > 0:16:17I have a rhyme that I've written that is quite appropriate for the moment.
0:16:17 > 0:16:20It's a bit grim and it's about the menopause.
0:16:20 > 0:16:23Hot flush, open the doors
0:16:23 > 0:16:26Make way for the menopause
0:16:26 > 0:16:28If you thought PMT was bad
0:16:28 > 0:16:31Found yourself flustered and mad
0:16:31 > 0:16:34Just wait till this one takes its toll
0:16:34 > 0:16:36You see red and heads will roll
0:16:36 > 0:16:39If only your oestrogen would come back
0:16:39 > 0:16:41Your ever drooping once-hot rack
0:16:41 > 0:16:45But fear not, you are still strong
0:16:45 > 0:16:47It's just the change and won't last long
0:16:47 > 0:16:50Of life, you still have much, much more
0:16:50 > 0:16:52You're still all woman, hear you roar.
0:16:52 > 0:16:54Thank you very much.
0:16:54 > 0:16:59'I feel like I have just grown up in the last few weeks,'
0:16:59 > 0:17:00and it's such a surreal feeling,
0:17:00 > 0:17:04kind of being independent and having so much responsibility
0:17:04 > 0:17:06and not quite knowing what to do with it.
0:17:08 > 0:17:10- Happy birthday! - ALL: Happy birthday!
0:17:10 > 0:17:14As Emily celebrates a birthday night in,
0:17:14 > 0:17:16back at the hospital,
0:17:16 > 0:17:20Tristan's shift is only just starting on the acute medical ward.
0:17:20 > 0:17:24The patient's stable, it's just that I think that she's got a large left-sided haemothorax.
0:17:24 > 0:17:28As part of the night team, he'll be on the front line
0:17:28 > 0:17:31for any emergency bleeps across the hospital.
0:17:32 > 0:17:36Being on the crash bleep is a mixture of apprehension and excitement.
0:17:36 > 0:17:38I mean, obviously whoever you're going to see is going to be ill,
0:17:38 > 0:17:40which is very bad for them.
0:17:40 > 0:17:42You sort of hope that you can rely on your training
0:17:42 > 0:17:44to remember everything you're supposed to do.
0:17:44 > 0:17:48Tristan is coping with the pressure of being a junior doctor,
0:17:48 > 0:17:51but he has a lot more than his patients to juggle.
0:17:54 > 0:17:57I'm married to Jenna. We've been married almost six years,
0:17:57 > 0:18:00and we have a daughter called Lottie
0:18:00 > 0:18:01and she's almost two years old.
0:18:01 > 0:18:03Uh-oh! Watch out for the tickly trees!
0:18:03 > 0:18:06Uh-oh! Uh-oh! Watch out! Watch out! Watch out!
0:18:06 > 0:18:11Time with Lottie is very important to him.
0:18:14 > 0:18:17Now starting to actually work as a junior doctor,
0:18:17 > 0:18:24the balancing act between father and doctor will be a lot more difficult.
0:18:24 > 0:18:27I'll be missing Lottie and Jenna a lot.
0:18:29 > 0:18:32My greatest fear about being a doctor would be
0:18:32 > 0:18:38'making a mistake or missing something that's really important.'
0:18:38 > 0:18:40There's going to be a sharp scratch, OK?
0:18:40 > 0:18:41Try and stay as still as possible. Ready?
0:18:41 > 0:18:43'It is a big responsibility'
0:18:43 > 0:18:47to be in the position to give people medicines
0:18:47 > 0:18:52which have side effects, both predictable and unpredictable,
0:18:52 > 0:18:54or to do procedures,
0:18:54 > 0:18:58and even minor things can have rare but serious consequences.
0:18:58 > 0:19:02So we're just going to use the local anaesthetic first. Is that all right?
0:19:03 > 0:19:06If I didn't know a risk and something happened to a patient,
0:19:06 > 0:19:10I think I'd feel very guilty that I exposed them to that.
0:19:16 > 0:19:18Tonight Tristan must face his fear
0:19:18 > 0:19:20of dealing with seriously ill patients.
0:19:22 > 0:19:26It's not long before he's called to another alcohol-related casualty.
0:19:28 > 0:19:32Sounds like you've been having a horrible time. You feeling rough?
0:19:32 > 0:19:35I keep getting blood in the back of my mouth.
0:19:35 > 0:19:37Did you tell the doctor that before?
0:19:37 > 0:19:39Yeah.
0:19:39 > 0:19:40I'm getting frightened now.
0:19:42 > 0:19:43I'm scared I'm going to die.
0:19:43 > 0:19:46- Is that just because you feel so rough?- Uh-huh.
0:19:51 > 0:19:53You're in hospital, so you're in the right place.
0:19:53 > 0:19:57The man admits to drinking a bottle of vodka a day
0:19:57 > 0:19:58and he is now vomiting blood.
0:19:58 > 0:20:00Little scratch.
0:20:00 > 0:20:02Ah!
0:20:02 > 0:20:04Right, we've got a sample of blood.
0:20:04 > 0:20:07I'll go and get this analysed
0:20:07 > 0:20:10so we can see how you're doing, cos what we want to make sure
0:20:10 > 0:20:13is that your blood is not too acid or too alkaline.
0:20:13 > 0:20:14I'm so frightened.
0:20:14 > 0:20:16Don't let me die, doctor, please.
0:20:16 > 0:20:19- Sorry?- Don't let me die.
0:20:19 > 0:20:22We're just sorting you out right now. We've given you some anti-sickness.
0:20:22 > 0:20:26We're going to get you some fluids. We'll give you some antibiotics
0:20:26 > 0:20:29- and I'm sending these blood tests off as well.- I'm frightened.
0:20:29 > 0:20:33We're not going to let you go anywhere.
0:20:33 > 0:20:36I'll let the doctor that's been looking after you
0:20:36 > 0:20:40know you're still having some pain and that you're really worried. OK?
0:20:40 > 0:20:41See you later.
0:20:41 > 0:20:44The results of the man's blood tests have come back
0:20:44 > 0:20:46and Tristan's concerned.
0:20:46 > 0:20:50He reports his findings to the registrar, Dr Abraham.
0:20:50 > 0:20:53- Can I just mention something to you? Is that all right?- Yeah.
0:20:53 > 0:20:57His pH is 7.3. He's quite sick, I think.
0:20:57 > 0:21:00Tristan's discovered the patient's blood is too acidic,
0:21:00 > 0:21:02which can be fatal.
0:21:02 > 0:21:05He's shaking, but I think he might be withdrawing as well.
0:21:05 > 0:21:11So whether that's from infection or alcohol withdrawal, I don't know.
0:21:11 > 0:21:14I don't know if he is septic.
0:21:14 > 0:21:16I don't know if... Yeah, it's here.
0:21:20 > 0:21:21Anti-sickness, please.
0:21:21 > 0:21:24The only way we can get anti-sickness into you
0:21:24 > 0:21:27without you throwing it straight back up would be to get an IV cannula.
0:21:27 > 0:21:28In the interim,
0:21:28 > 0:21:31I'll see if we can give you an injection for the sickness.
0:21:31 > 0:21:33- OK.- And I'll be right back.
0:21:33 > 0:21:35'He's being sick all the time.
0:21:35 > 0:21:38'He's throwing up some sort of half-digested blood.'
0:21:38 > 0:21:40We need to get IV access
0:21:40 > 0:21:42so that we can give him anti-sickness, pain relief,
0:21:42 > 0:21:46antibiotics - the whole lot, really.
0:21:46 > 0:21:48And that all hinges, really, on finding a good vein
0:21:48 > 0:21:50and getting a cannula in.
0:21:51 > 0:21:56'When dealing with the sort of patients that come in with alcohol problems,
0:21:56 > 0:22:01'it's easy to slip into the attitude that they're a hassle.'
0:22:02 > 0:22:05But a lot of the people who have these sorts of problems
0:22:05 > 0:22:07have been in terrible situations.
0:22:08 > 0:22:11Tristan's shift should have ended an hour ago
0:22:11 > 0:22:14but he's pressing on and fitting a fresh cannula
0:22:14 > 0:22:17so the patient can get the life-saving drugs he needs.
0:22:17 > 0:22:20Please bring your arm around here.
0:22:20 > 0:22:24And Tristan's late finish hasn't gone unnoticed by his senior.
0:22:24 > 0:22:27Thanks very much for that, Tristan. I'm glad you were here.
0:22:27 > 0:22:29'Quite impressed, really.'
0:22:29 > 0:22:31I only realised half an hour ago
0:22:31 > 0:22:34that he stayed an extra hour and a half
0:22:34 > 0:22:37to get all the other follow-ups done as well,
0:22:37 > 0:22:40in terms of investigations and procedures,
0:22:40 > 0:22:41so that is impressive, yeah.
0:22:43 > 0:22:46Being an inner-city hospital,
0:22:46 > 0:22:52and one with certain social problems that are quite rife in Liverpool,
0:22:52 > 0:22:56you get to see a lot of sick people,
0:22:56 > 0:22:57which is obviously a terrible thing
0:22:57 > 0:23:01but really important to learn from, so you can deal with those problems.
0:23:01 > 0:23:04SIREN WAILS
0:23:09 > 0:23:11A new day,
0:23:11 > 0:23:15and not all of the junior doctors are dealing with alcohol cases.
0:23:16 > 0:23:19For first-year Tom on the cardiology ward,
0:23:19 > 0:23:21it's another day, another vein.
0:23:21 > 0:23:22See you in a bit.
0:23:25 > 0:23:28His next patient has recently had surgery
0:23:28 > 0:23:30and he needs to fit a cannula.
0:23:30 > 0:23:34He's found needle work trickier than most, but a month into the job,
0:23:34 > 0:23:37he's hoping that this time it goes without a hitch.
0:23:37 > 0:23:40How long has that been in there for?
0:23:40 > 0:23:42I think Friday night or Saturday.
0:23:42 > 0:23:44You'll have to have another one in
0:23:44 > 0:23:46cos we have to give you the antibiotics.
0:23:46 > 0:23:48But from the outset, it's becoming clear
0:23:48 > 0:23:52that Tom is the one being examined, and not the patient.
0:23:52 > 0:23:56So you like giving banter out but you don't like taking it, do you?
0:23:56 > 0:23:59- What do you mean?- Ah. I do fortunes.
0:23:59 > 0:24:01- You do fortunes?- Yeah.
0:24:01 > 0:24:04I've never met anybody who reads fortunes before.
0:24:04 > 0:24:05- Do you really?- That's how I know.
0:24:05 > 0:24:08Cos you go dead shy when you're out, don't you,
0:24:08 > 0:24:11- having a little banter with all the lads?- Put it in this one here.
0:24:11 > 0:24:14- I've done a few of the nurses in here as well.- Have you?- Yeah.
0:24:15 > 0:24:17How do you...?
0:24:17 > 0:24:20"How do I know," you were going to say then, weren't you?
0:24:20 > 0:24:23I know, yeah. I just shouldn't have asked, should I?
0:24:23 > 0:24:25THEY LAUGH
0:24:25 > 0:24:29- So you're enjoying being a doctor? - So far, so good, yeah.- Good.
0:24:29 > 0:24:31I'm just only starting to feel like one now.
0:24:31 > 0:24:35- Cos you'll go far, you know. - Do you think so?- Yeah.
0:24:35 > 0:24:37You want to keep your vein in one place.
0:24:37 > 0:24:39Just, obviously, it's a sharp scratch.
0:24:39 > 0:24:43- And we're in. Quick and painless. - What?- I said quick and painless.
0:24:43 > 0:24:46- Yeah?- You're like, "Yeah(!)" - You need to let go sometimes.
0:24:46 > 0:24:48TOM LAUGHS
0:24:48 > 0:24:51- You're reading my fortune while I'm taking your blood.- Yeah.
0:24:51 > 0:24:53There's something quite poetic about that.
0:24:53 > 0:24:56I can feel that going through you - that's what I'm like.
0:24:56 > 0:24:59See? You're shaking now. That's cos I'm telling you bits, isn't it?
0:25:01 > 0:25:02There we go, got it in.
0:25:02 > 0:25:04I'm right, though, aren't I?
0:25:04 > 0:25:06I... You're freaking me out!
0:25:09 > 0:25:11- OK, that's all sorted. - Thank you very much.
0:25:11 > 0:25:14I'll stick a little date on it so we know when it went in
0:25:14 > 0:25:17- and I'll stick this down with tape like last time.- Thank you.
0:25:17 > 0:25:20- That's everything.- See, now, you never hurt me like the other ones.
0:25:20 > 0:25:23- You're saying all the right things, aren't you?- Yeah.
0:25:23 > 0:25:26So don't forget what I said.
0:25:26 > 0:25:28I won't. Nice to see you.
0:25:28 > 0:25:30- Thank you, and you.- Take care.
0:25:30 > 0:25:31Luckily for Tom,
0:25:31 > 0:25:35the psychic predictions didn't distract him from the job...
0:25:35 > 0:25:38and he's got a new fan in Cindy.
0:25:40 > 0:25:42Usually they hurt me, and it didn't hurt at all
0:25:42 > 0:25:44and he's just put a new one in
0:25:44 > 0:25:48and I can't believe I've just had that done without, "Aargh!"
0:25:48 > 0:25:50or screaming or anything. He was so gentle.
0:25:50 > 0:25:52He's a fun guy,
0:25:52 > 0:25:55but if a woman was to approach him
0:25:55 > 0:25:58and say, "Come on, let's have a dance," he'll run a mile.
0:25:58 > 0:26:00Do you get what I mean?
0:26:00 > 0:26:02He's a bit funny, and he's a bit...
0:26:02 > 0:26:06He's... What's that word? He's very preserved.
0:26:06 > 0:26:08He doesn't show his emotions.
0:26:08 > 0:26:10It's the first time I've ever had my fortune told
0:26:10 > 0:26:12by a patient or by anybody.
0:26:12 > 0:26:16Apparently, outside of hospital, I'm a very quiet person.
0:26:16 > 0:26:18And this is news to me.
0:26:18 > 0:26:20He knows I'm right, really.
0:26:22 > 0:26:26With Tom's golden future in medicine written in the stars,
0:26:26 > 0:26:30over on upper GI, Jen's predicting a tricky start to her day.
0:26:31 > 0:26:33She's been called to an elderly woman
0:26:33 > 0:26:36who needs a catheter fitting to her bladder.
0:26:36 > 0:26:39It's really difficult
0:26:39 > 0:26:42to actually tell which hole it's going in.
0:26:42 > 0:26:46It's the first time that the usually unflappable Jen
0:26:46 > 0:26:49has tried this procedure on a female patient.
0:26:51 > 0:26:53WOMAN LAUGHS
0:26:53 > 0:26:56Do you know how many times I've done that?
0:27:08 > 0:27:11I'm just going to go and get another catheter, OK?
0:27:12 > 0:27:14So far, no success.
0:27:17 > 0:27:19I think it might have been in the wrong hole.
0:27:19 > 0:27:21It's definitely trickier than a male!
0:27:21 > 0:27:25Just bash the males in. Not literally, of course, but...
0:27:25 > 0:27:27They haven't got any size 12s.
0:27:27 > 0:27:29The nurse is really good, though.
0:27:29 > 0:27:32She's hoping that a different size catheter is the answer.
0:27:32 > 0:27:34Push it in as much as you...
0:27:34 > 0:27:36No, it's not going in.
0:27:36 > 0:27:39- It's OK, don't worry. - You're fine, don't worry.
0:27:39 > 0:27:42Yep. We're there!
0:27:48 > 0:27:50Finally, success!
0:27:50 > 0:27:52Like every junior doctor,
0:27:52 > 0:27:55Jen's realising she's still got a lot to learn.
0:27:56 > 0:28:00I think as each day passes, you do start to grow in confidence
0:28:00 > 0:28:02in the tasks that you're used to doing every day.
0:28:02 > 0:28:04But all the time,
0:28:04 > 0:28:07you meet new challenges that you've never done before.
0:28:07 > 0:28:10So I've been doing this job for a month now
0:28:10 > 0:28:12and I've never done a female catheter
0:28:12 > 0:28:16so it would have made no difference if I'd done it on day one or day 30.
0:28:23 > 0:28:26After his run of late shifts on call,
0:28:26 > 0:28:30Tristan is back to the day job on his usual ward of gerontology,
0:28:30 > 0:28:33which specialises in care of the elderly.
0:28:33 > 0:28:36Having impressed his seniors over the past few weeks,
0:28:36 > 0:28:38Tristan's been given the responsibility
0:28:38 > 0:28:40of leading his own ward round.
0:28:40 > 0:28:42I'm feeling pretty good this morning.
0:28:42 > 0:28:45We're just about to start the ward round, which I'll be taking today.
0:28:45 > 0:28:49I'm the only one from the team here this morning, so...
0:28:49 > 0:28:51Yeah, the pressure's on.
0:28:52 > 0:28:54All ward rounds in the hospital start at 9am
0:28:54 > 0:28:57and must be wrapped up by midday,
0:28:57 > 0:28:59so it will be a race against the clock for Tristan
0:28:59 > 0:29:02to get through all his patients.
0:29:02 > 0:29:04It's due to start in about five minutes
0:29:04 > 0:29:06so I'm just trying to get everything organised
0:29:06 > 0:29:09so I can just have my head in one place.
0:29:09 > 0:29:11It's 9am,
0:29:11 > 0:29:13and Tristan starts bang on time.
0:29:13 > 0:29:15Looking good.
0:29:15 > 0:29:17But there's a technical hitch.
0:29:20 > 0:29:21Computer's not working. Good start.
0:29:23 > 0:29:25I'm just waiting for the computer to load up.
0:29:30 > 0:29:32What's the time?
0:29:32 > 0:29:33We're 15 minutes behind already.
0:29:39 > 0:29:42Finally, he's on his way.
0:29:42 > 0:29:44SIGN CLATTERS
0:29:46 > 0:29:50Careful, there's a Wet Floor sign here. Looks dry.
0:29:52 > 0:29:54It's not been the best start,
0:29:54 > 0:29:56but he could still make up the time
0:29:56 > 0:30:00- if he could just stop the small talk.- Hi.
0:30:00 > 0:30:01Hello, Bridie. Morning, Edith.
0:30:01 > 0:30:03That's amazing, Mary.
0:30:03 > 0:30:05It got pride of place, then?
0:30:05 > 0:30:08Oh, gosh! I've got a hole in my trousers.
0:30:08 > 0:30:09I've got to sort that out.
0:30:12 > 0:30:15How do you feel you're doing?
0:30:15 > 0:30:19Do you feel like it's a little bit easier to talk?
0:30:19 > 0:30:21INDISTINCT SPEECH
0:30:21 > 0:30:23Sorry?
0:30:25 > 0:30:28INDISTINCT SPEECH
0:30:33 > 0:30:36With just 20 minutes until the midday deadline,
0:30:36 > 0:30:38Tristan's still optimistic.
0:30:38 > 0:30:42Yep, we've seen several patients so far on the ward round. It's 11:45.
0:30:42 > 0:30:45So obviously slower than the consultants would do it
0:30:45 > 0:30:47but I think we're not doing horrendously so far.
0:30:47 > 0:30:50I don't know. What do you think?
0:30:50 > 0:30:53You're doing well. Still a long way to go.
0:30:55 > 0:30:58I think that's code for, "It could be worse."
0:31:05 > 0:31:09Finally, Tristan finishes his ward round -
0:31:09 > 0:31:11an hour and a half late.
0:31:11 > 0:31:16And his timekeeping has not gone unnoticed by his senior, Dr Scott.
0:31:16 > 0:31:18Tristan did well running his own ward round.
0:31:18 > 0:31:21I think if I would identify any one area for him
0:31:21 > 0:31:24that he'll need to work on,
0:31:24 > 0:31:27it will be the amount of time it takes him to do the ward round.
0:31:27 > 0:31:30"So confirm arrangements for...
0:31:32 > 0:31:35"..district nurses
0:31:35 > 0:31:37"and package of care."
0:31:37 > 0:31:40He took longer than the actual session lasted.
0:31:40 > 0:31:43His introspectiveness, I think, is what slows him down,
0:31:43 > 0:31:45as well as a certain lack of experience,
0:31:45 > 0:31:47but as he trains and as he gets more confident,
0:31:47 > 0:31:49he'll come up to speed very quickly.
0:31:49 > 0:31:51Right, well, thank you so much
0:31:51 > 0:31:54and I'll keep you updated, OK?
0:31:54 > 0:31:56See you later.
0:31:57 > 0:32:01It wasn't a stressful thing to do but I knew there would be a lot of work
0:32:01 > 0:32:05and time would inevitably pass faster than I was hoping
0:32:05 > 0:32:08and, you know, it's important to get everything right for the patients.
0:32:08 > 0:32:10It is a good experience doing a ward round
0:32:10 > 0:32:14because you really have to think for yourself. You can't switch off
0:32:14 > 0:32:17and just let some of your seniors give you a list of things to do
0:32:17 > 0:32:19and do that. At the end of the day,
0:32:19 > 0:32:21you actually have to make some decisions.
0:32:27 > 0:32:30Back at the house, Jen's having a day off from the daily grind
0:32:30 > 0:32:33of ward rounds, catheters and cannulas.
0:32:36 > 0:32:39Like Emily, it's her birthday this week
0:32:39 > 0:32:41and she's expecting some very special visitors.
0:32:41 > 0:32:43DOORBELL RINGS
0:32:43 > 0:32:47Mum and Dad, Chris and Christine, have driven over from Manchester
0:32:47 > 0:32:49and they come bearing gifts.
0:32:49 > 0:32:51Hello. You all right?
0:32:51 > 0:32:54- Happy birthday.- Happy birthday.
0:32:54 > 0:32:56- This is a big card.- That's my choice.
0:32:59 > 0:33:01Oh, God! It's awful!
0:33:01 > 0:33:02'I am close to my mum and dad.'
0:33:02 > 0:33:05All my birthday cards this year
0:33:05 > 0:33:09are going to be addressed to Dr Jen or Dr Jennifer
0:33:09 > 0:33:11or whatever they want to call me!
0:33:11 > 0:33:14'So, yeah, I think they're pretty proud of me.'
0:33:14 > 0:33:15JEN LAUGHS
0:33:15 > 0:33:17When I saw that card, I thought,
0:33:17 > 0:33:21"That's the worst card I've seen in my life, so I have to buy it!"
0:33:21 > 0:33:26It is probably the best worst card I have ever seen.
0:33:26 > 0:33:29On her seventh birthday, she got a nurse's outfit
0:33:29 > 0:33:31and she said, "I want to be nurse when I'm older."
0:33:31 > 0:33:33I said, "Why don't you want to be a doctor?"
0:33:33 > 0:33:36- So from point on, she wants to be a doctor.- Yeah.
0:33:36 > 0:33:39And she's never given up the determination from the age of seven.
0:33:39 > 0:33:42Now she is a doctor at 25.
0:33:42 > 0:33:45So she sticks to what she says she's going to do.
0:33:45 > 0:33:46- Yeah, yeah.- She always has done.
0:33:52 > 0:33:53Back at the hospital,
0:33:53 > 0:33:58and so far, it's been a steady day for Oli in the acute medical unit.
0:33:58 > 0:34:01Yeah, it's been quite a nice, relaxed day.
0:34:01 > 0:34:03Did a ward round, had some jobs to do, did them,
0:34:03 > 0:34:06had some really nice teaching at lunchtime, which was nice,
0:34:06 > 0:34:09and then, this afternoon, just tying up loose ends.
0:34:09 > 0:34:11I'm bored! There's nothing to do.
0:34:14 > 0:34:18But the peace is soon shattered with an emergency crash bleep.
0:34:21 > 0:34:22ALARM BLEEPS
0:34:22 > 0:34:24Whose patient is it?
0:34:27 > 0:34:31The man, a heavy drinker, is having a seizure.
0:34:35 > 0:34:38- Are you all right to set up a BR... a BM on him?- Yeah.- Cheers.
0:34:40 > 0:34:41For second-year Oli,
0:34:41 > 0:34:45patients like this have become commonplace on the wards...
0:34:45 > 0:34:49'He's a chap who's known to have alcohol withdrawal seizures.'
0:34:49 > 0:34:52I'm just having a look at his latest blood results.
0:34:52 > 0:34:56..and he's fast becoming an old hand at treating them.
0:34:56 > 0:34:58Last lot of Librium was at 12 o'clock.
0:35:00 > 0:35:02We give him Librium straight into his veins, which is
0:35:02 > 0:35:06something you give to alcoholics to help them when they're withdrawing.
0:35:06 > 0:35:09Keep a close eye on him, do some more blood tests,
0:35:09 > 0:35:11and just see how he gets on, really.
0:35:11 > 0:35:16The negative affects of alcohol cost the NHS £164 million every year.
0:35:16 > 0:35:18Yeah, they've gone to find it, yeah.
0:35:18 > 0:35:21A sobering thought for any new junior doctor
0:35:21 > 0:35:26experiencing the dark side of the demon drink for the very first time.
0:35:26 > 0:35:28It puts a lot of pressure on the doctors,
0:35:28 > 0:35:32particularly trying to manage people who are very drunk.
0:35:32 > 0:35:37As a junior doctor, not really being exposed to those pressures before,
0:35:37 > 0:35:39it can be quite difficult for them.
0:35:41 > 0:35:44I suppose it's a side of alcohol that a lot of people don't see
0:35:44 > 0:35:47unless you work in a hospital. You know, you think of it as normal,
0:35:47 > 0:35:50being sociable, going out with friends, having a drink.
0:35:50 > 0:35:53People might have a few too many, but this was...
0:35:53 > 0:35:56I think you see the real extreme end of it in hospital
0:35:56 > 0:35:58and there are physiological effects
0:35:58 > 0:36:00that perhaps the general public don't see very often.
0:36:00 > 0:36:02And it can be quite shocking at first
0:36:02 > 0:36:05but I think you get used to it after a while. We see quite a lot.
0:36:05 > 0:36:08We see so much of it, it's like...
0:36:08 > 0:36:09It just becomes quite common.
0:36:12 > 0:36:15In a way, it's sad that it's happening so much
0:36:15 > 0:36:17but that's just the nature of where this hospital is
0:36:17 > 0:36:19and some of the surrounding areas.
0:36:19 > 0:36:21People living in socio-economic deprivation,
0:36:21 > 0:36:25who probably have nothing else in their lives, they turn to drink
0:36:25 > 0:36:29and it's like... It's an addiction, like anything else, it's a disease
0:36:29 > 0:36:33and we treat it like any other disease -
0:36:33 > 0:36:36just patch them up and help them along their way.
0:36:38 > 0:36:41As Oli deals with the after-effects
0:36:41 > 0:36:43of the city's high rates of alcohol abuse,
0:36:43 > 0:36:48first-year Ed is dealing with a very different kind of medical case.
0:36:48 > 0:36:51He's about to face one of his toughest tests yet
0:36:51 > 0:36:54and perform a tricky medical procedure called a lumbar puncture
0:36:54 > 0:36:56for the first time.
0:36:56 > 0:37:00We're going to ward 7B,
0:37:00 > 0:37:03where this patient has been transferred,
0:37:03 > 0:37:05and we're going to do the lumbar puncture there.
0:37:07 > 0:37:11Ed's keen to show senior medics that he has the right clinical skills,
0:37:11 > 0:37:16so this opportunity is a big deal for the Italian junior doctor.
0:37:16 > 0:37:18She's here. I think she's here.
0:37:18 > 0:37:22He's had a lot to prove since, in his very first week in the hospital,
0:37:22 > 0:37:24he was asked to leave the emergency department
0:37:24 > 0:37:26as a second-year junior doctor
0:37:26 > 0:37:29and become a first-year in the acute medical unit.
0:37:30 > 0:37:33'I'm not completely glad the fact that I was moved back'
0:37:33 > 0:37:38from Foundation Two in A&E to Foundation One training.
0:37:38 > 0:37:42'But I'm really glad of how things turned out in the end.
0:37:42 > 0:37:45'It's been steady and positive.'
0:37:45 > 0:37:47It's been good since then.
0:37:47 > 0:37:49Yeah, I think his confidence was initially knocked
0:37:49 > 0:37:50cos he'd started in A&E
0:37:50 > 0:37:53and he had to be moved to the acute medicine unit.
0:37:53 > 0:37:57But I think, as time has gone along, he's been supervised closely,
0:37:57 > 0:37:59we've given him more and more responsibility
0:37:59 > 0:38:00and I think he's relished it.
0:38:03 > 0:38:07The procedure Ed will do today involves drawing fluid
0:38:07 > 0:38:09that surrounds the patient's brain.
0:38:09 > 0:38:14I have an aneurysm. From the veins in me brain.
0:38:15 > 0:38:18And they want to know whether it's bleeding.
0:38:18 > 0:38:22I've been getting violent headaches.
0:38:22 > 0:38:24Have you got plenty of gauze and...?
0:38:24 > 0:38:26What this test will determine
0:38:26 > 0:38:30is whether any vessels in the patient's brain have burst.
0:38:30 > 0:38:34Are you able to bend your legs as much as you can?
0:38:34 > 0:38:38It's an invasive procedure so Ed will need a steady hand.
0:38:40 > 0:38:44Before he starts, Dr Ahmed offers some important words of advice.
0:38:50 > 0:38:53And then when you withdraw, you actually infiltrate.
0:38:53 > 0:38:57So you've created a space and you're putting the needle in.
0:39:00 > 0:39:01Erm, no, I haven't.
0:39:05 > 0:39:07But I will absolutely do my best.
0:39:16 > 0:39:18He's prepped and ready to drain the fluid.
0:39:20 > 0:39:22- Is it OK?- Yes.
0:39:29 > 0:39:30Yup.
0:39:38 > 0:39:40- Is it OK?- Yes.
0:39:44 > 0:39:45We're getting there, eh?
0:39:48 > 0:39:50Ed has extracted the fluid he needs...
0:39:54 > 0:39:56..which will now need to go off for further tests.
0:39:58 > 0:40:03- Any pain at the moment?- No. - OK. We're getting there, eh?
0:40:03 > 0:40:06It's been a textbook procedure for Ed.
0:40:06 > 0:40:07And all that's left to do now is inform
0:40:07 > 0:40:10the patient of the potential side effects.
0:40:10 > 0:40:13Now, you may experience a bit of headache.
0:40:15 > 0:40:17That's a good point.
0:40:17 > 0:40:21But it may vary a bit in its... kind of headache.
0:40:21 > 0:40:25It's... A common complication of this procedure is headache,
0:40:25 > 0:40:28so let's not worry about it at the moment.
0:40:42 > 0:40:44- Thank you very much.- No problem.
0:40:44 > 0:40:48It's a small slip-up, but Dr Ahmed's still pleased.
0:40:48 > 0:40:51It was obvious he was still learning
0:40:51 > 0:40:56but he did the procedure well and he got the fluid in the first attempt.
0:40:56 > 0:41:00I am sure if he does more procedures, he will become more confident.
0:41:00 > 0:41:02It went well and the patient is quite happy.
0:41:02 > 0:41:04He was quite confident, wasn't he?
0:41:04 > 0:41:07Well, I knew there could be complications
0:41:07 > 0:41:11and one of them is that you can become paralysed,
0:41:11 > 0:41:15so he had to know exactly where to go.
0:41:15 > 0:41:18Successfully completing the lumbar puncture
0:41:18 > 0:41:21has given Ed a boost of confidence.
0:41:21 > 0:41:24It's rather an invasive procedure so, you know,
0:41:24 > 0:41:28it's something that you learn going through your career
0:41:28 > 0:41:32and, yeah, it was good. It ticks a box, a very important one, so I'm happy about that.
0:41:32 > 0:41:37And he's keen so share the good news with fellow junior doctor Oli.
0:41:37 > 0:41:41No, she was fine, and in the end, she also told me that it wasn't painful.
0:41:41 > 0:41:43No worries. Is that the first one you've done?
0:41:43 > 0:41:45That was the first one, yes.
0:41:45 > 0:41:46It's good that you got to do it.
0:41:46 > 0:41:50- Will you be confident doing it on your own next time?- Well, I'll try!
0:41:50 > 0:41:54- Well, have a nice afternoon. - See you later, man.- Bye-bye.
0:41:56 > 0:41:59Very pleased for Ed. It's fantastic. Really good news.
0:41:59 > 0:42:02Glad he got it and glad it went without a hitch. Fantastic.
0:42:02 > 0:42:06There are continuously moments when I have self-doubts
0:42:06 > 0:42:09that my knowledge is not up to what I would like it to be.
0:42:11 > 0:42:15Now I feel I am starting to help the team.
0:42:15 > 0:42:18I can see that people are giving me more responsibilities now.
0:42:31 > 0:42:34While Ed's belief in his medical abilities is growing,
0:42:34 > 0:42:39first year Tom is feeling a little nervous about his next challenge.
0:42:39 > 0:42:40Little bit scared.
0:42:40 > 0:42:44All junior doctors are expected to do presentations
0:42:44 > 0:42:46as part of their training.
0:42:46 > 0:42:51Today, Tom will be giving a talk on pacemakers to the hospital's top consultants.
0:42:51 > 0:42:54I think that, considering there's consultants there,
0:42:54 > 0:42:58it's going to be tricky to be able to keep up with the pace,
0:42:58 > 0:43:01in terms of what they can do and what they know.
0:43:01 > 0:43:06If he succeeds, he will prove he has a firm grasp of cardiology.
0:43:08 > 0:43:10Hoping nobody turns up so I can go home!
0:43:14 > 0:43:16Morning.
0:43:16 > 0:43:20Today, Dr Saltissi, one of the most respected consultants
0:43:20 > 0:43:23at Liverpool Royal, has a front-row seat.
0:43:23 > 0:43:26Tom will have to speak for ten minutes.
0:43:26 > 0:43:29Thanks for coming. This is my case presentation
0:43:29 > 0:43:33with kind of teaching notes on permanent pacemakers,
0:43:33 > 0:43:35and I've entitled it Keeping The Pace Up,
0:43:35 > 0:43:39and it's even more of a pun, as you'll see during the presentation.
0:43:39 > 0:43:43The primary role of the pacemaker is to basically maintain a heart rate
0:43:43 > 0:43:46which is adequate for function.
0:43:46 > 0:43:50This is a case I saw - a patient who came in with chest pain.
0:43:50 > 0:43:54He was 69 years old, usually fit and healthy, he's a runner. He hill-climbs as well.
0:43:54 > 0:43:59But the grilling Tom was dreading starts almost immediately.
0:43:59 > 0:44:01Before you go on any further, is there any association
0:44:01 > 0:44:05between somebody who is a hill runner and an athlete
0:44:05 > 0:44:09and a diagnosis of sinoatrial disorder?
0:44:13 > 0:44:16If you're really athletic, you can get carotid hypersensitivity,
0:44:16 > 0:44:18which can decrease the heart rate.
0:44:21 > 0:44:26- Right, sorry, on you go.- This is the ECG just pre-pacemaker insertion.
0:44:26 > 0:44:29It's obviously...er, areg... irregular.
0:44:29 > 0:44:33Yeah, it's the irre...irreg... Ugh! The irregularity of it.
0:44:33 > 0:44:36I'm trying to think... HE MUMBLES
0:44:39 > 0:44:41Well, there's not a lot abnormal there, is there?
0:44:41 > 0:44:46It's basically a sinus bradycardia with a supraventricular ectopic beat there,
0:44:46 > 0:44:49and you've got partial right bundle branch block,
0:44:49 > 0:44:52you've got a slight fragmentation of the complexes,
0:44:52 > 0:44:56but I don't see anything else on there, unless anybody else can see anything?
0:44:56 > 0:44:59What are the sort of mechanical things that can go wrong?
0:44:59 > 0:45:02What about the lead itself? I mean, will it always stay where it is?
0:45:02 > 0:45:05- Erm...- Well, in pericarditis, what sound do you get?
0:45:05 > 0:45:07Just trying to think. I don't know.
0:45:07 > 0:45:10- Did you read up about pacemaker syndrome?- No.
0:45:10 > 0:45:14- What are you going to be doing tonight? - Reading up about pacemaker syndrome!
0:45:16 > 0:45:20Can Tom pull it back in the closing minutes?
0:45:20 > 0:45:23So what's your take-home message from this particular case?
0:45:23 > 0:45:25Erm, in terms of...
0:45:25 > 0:45:28OK, so indications for pacing, for bradycardia,
0:45:28 > 0:45:32symptomatic bradycardia, is where the symptoms correlate with the bradycardic episode itself.
0:45:32 > 0:45:36Usually transvenous will be the next option - again, a temporary option.
0:45:36 > 0:45:40The pacemaker's outside of the body but the electrodes are put through the veins to pace the heart.
0:45:40 > 0:45:42And, finally, permanent pacing.
0:45:42 > 0:45:44- Thank you. It was a good presentation.- Thank you.
0:45:44 > 0:45:48You brought up some interesting points and stimulated our discussion.
0:45:48 > 0:45:49- Thanks very much.- Thank you.
0:45:56 > 0:45:58He needs to speak more slowly.
0:45:58 > 0:46:01He needs to project his voice better.
0:46:01 > 0:46:04There were some important areas in there that he didn't really grasp.
0:46:04 > 0:46:07I was really nervous and I think that one of the problems I have
0:46:07 > 0:46:10when I'm really nervous is I end up speaking really, really quickly,
0:46:10 > 0:46:13and I felt myself doing it at times and I tried to slow down.
0:46:13 > 0:46:14You survived!
0:46:14 > 0:46:17Obviously, there are quite a few things in there
0:46:17 > 0:46:19that one would want to improve upon.
0:46:19 > 0:46:23And he will improve as time goes by. But he's junior, this was one of his first presentations.
0:46:23 > 0:46:27I think he did reasonably well. I think he can be pleased with that.
0:46:31 > 0:46:34It's the end of another busy week for the junior doctors,
0:46:34 > 0:46:38and the day of Jen and Emily's joint birthday party.
0:46:38 > 0:46:41- I'm going to wear a dress that I bought.- Mmm!
0:46:41 > 0:46:42And sparkly shoes!
0:46:45 > 0:46:48And it's time off from playing the part of a professional.
0:46:55 > 0:46:57I've had enough!
0:46:57 > 0:46:59LAUGHTER
0:47:00 > 0:47:02Let's decorate!
0:47:02 > 0:47:03Hold this up while I blow.
0:47:07 > 0:47:11I think it's really important to have a life outside medicine.
0:47:11 > 0:47:15It's very easy to get sucked in to the role of, "I am a doctor 24/7."
0:47:15 > 0:47:16Oh, that's nice.
0:47:16 > 0:47:20- Ooh, that's quite strong. - It's not that strong.
0:47:20 > 0:47:21Booze!
0:47:21 > 0:47:24- Feel like a witch.- That's really...
0:47:25 > 0:47:27I really quite like that.
0:47:34 > 0:47:38One person who will miss out on the party is second year Kiera.
0:47:40 > 0:47:44She's back on nights in the emergency department.
0:47:44 > 0:47:47Hello, there. Hello. Mr Mitchell?
0:47:51 > 0:47:56Kiera's senior, consultant Kate Clark, has asked her to deal with
0:47:56 > 0:47:59an urgent case of a man who's been admitted with chest pains.
0:48:01 > 0:48:04It's much more likely to be some, you know,
0:48:04 > 0:48:08lung-related type of pain than anything else.
0:48:08 > 0:48:11So do a gas, get his ECG and chest X-ray done.
0:48:11 > 0:48:14- And then we're going to see whether or not he needs a D-dimer.- Lovely.
0:48:14 > 0:48:17Will do, that's great. Thank you.
0:48:17 > 0:48:20Junior doctors in their second year are expected to be able
0:48:20 > 0:48:22to diagnose patients.
0:48:22 > 0:48:25So what's brought you in today?
0:48:25 > 0:48:27Every time I breathe, I'm getting pains up here.
0:48:27 > 0:48:30- Pains there?- At the back.
0:48:30 > 0:48:33- OK, and no pain at the front of the chest?- No.
0:48:33 > 0:48:36OK, fine. How long that been going on for?
0:48:36 > 0:48:39All day today, since I got up this morning.
0:48:39 > 0:48:42- If you take a big breath in, does that hurt?- Yes.- OK.
0:48:42 > 0:48:45Have you ever had anything like this in the past before?
0:48:45 > 0:48:48- Only when I had a blood clot in me lung.- OK.- That was the only time.
0:48:48 > 0:48:50And what caused that?
0:48:50 > 0:48:51Pneumonia.
0:48:51 > 0:48:54Kiera will need to investigate further,
0:48:54 > 0:48:56as clots on the lungs can be fatal.
0:48:56 > 0:48:59- See you in a bit, sir.- OK.
0:48:59 > 0:49:03A 42-year-old gentleman whose past history...
0:49:03 > 0:49:05He's had a clot on his lung.
0:49:05 > 0:49:10He's come in with a pain that he describes as worse when he breathes in.
0:49:10 > 0:49:14That's a typical pain you expect with people who have perhaps a clot on the lung.
0:49:14 > 0:49:16That's the most important thing to rule out
0:49:16 > 0:49:19because, obviously, it's quite a serious thing if he does have that.
0:49:19 > 0:49:23Certainly, I'm concerned enough that I want to rule this out,
0:49:23 > 0:49:26because if we miss it, then it's quite a big thing to miss.
0:49:26 > 0:49:28How are you doing?
0:49:28 > 0:49:33We're going to keep you in to do a scan just to check that it's not...
0:49:33 > 0:49:36- Overnight, or...? - It'll be overnight, yeah.
0:49:36 > 0:49:39- As we wait for the scan. - Can't I have the...?
0:49:39 > 0:49:43Can't they just discharge me till tomorrow?
0:49:43 > 0:49:46- I'm thinking of me mother, you see. - Yeah.
0:49:46 > 0:49:49- Have you got anyone else at home who can look after your mother? - Not at the moment, no.
0:49:49 > 0:49:52I'd be very unhappy about you going, really.
0:49:52 > 0:49:57I could...try and arrange something. I don't know, you see.
0:49:57 > 0:49:59Well, I tell you what,
0:49:59 > 0:50:03let me take your bloods and get your chest X-ray under way
0:50:03 > 0:50:06and we'll have a little discussion about what we'll do after that.
0:50:06 > 0:50:09Have a little think about what you can do. OK?
0:50:09 > 0:50:13- What's up?- Er... - You look a bit worried.
0:50:13 > 0:50:15Erm... I just don't like needles.
0:50:15 > 0:50:16- You don't like needles?- No.
0:50:16 > 0:50:22- OK. You know that's probably what we're going to have to come and do now?- Yeah.
0:50:22 > 0:50:24OK, I'll be very gentle with you.
0:50:24 > 0:50:27Every junior doctor must learn how to handle nervous patients
0:50:27 > 0:50:29and Kiera's about to be tested.
0:50:29 > 0:50:33I'd use a smaller needle than most, so...
0:50:33 > 0:50:35SHE CHUCKLES
0:50:40 > 0:50:42Every doctor says the same.
0:50:42 > 0:50:45- What's that?- "Only a little scratch."
0:50:53 > 0:50:56That's it. That's the worst of it done now.
0:50:56 > 0:50:57Well done.
0:50:57 > 0:51:00- You all right?- Yeah.
0:51:00 > 0:51:03- Wasn't too bad, was it?- No.
0:51:03 > 0:51:06- Just like eating a bag of chips. - SHE CHUCKLES
0:51:06 > 0:51:10Kiera needs to act quickly to complete taking all
0:51:10 > 0:51:12the samples she needs.
0:51:12 > 0:51:15OK, again, sharp scratch coming up.
0:51:20 > 0:51:25But as the patient gets increasingly anxious, she's under pressure.
0:51:29 > 0:51:31Sorry.
0:51:32 > 0:51:33Nearly done.
0:51:44 > 0:51:45Sorry.
0:51:47 > 0:51:49Struggling to get it on you.
0:51:52 > 0:51:54Let's have a little breather for a bit.
0:51:54 > 0:51:56HE MURMURS
0:52:01 > 0:52:04Sorry about that. I don't usually struggle with this.
0:52:04 > 0:52:06You must have deep ones.
0:52:06 > 0:52:08It's crucial she completes the tests.
0:52:08 > 0:52:11But can she persuade the patient to keep the faith?
0:52:11 > 0:52:14Do you want me to have a go on the other arm?
0:52:14 > 0:52:15No.
0:52:16 > 0:52:18Take a breather.
0:52:21 > 0:52:24- Oh, just keep on going. - Yeah?- Yeah.- OK.
0:52:24 > 0:52:26Sorry about that.
0:52:30 > 0:52:33What do you reckon, this arm or the other one?
0:52:33 > 0:52:35Don't know.
0:52:35 > 0:52:36Take your pick.
0:52:36 > 0:52:39Finally, success, as Kiera eventually manages
0:52:39 > 0:52:43to get the vital blood sample from the reluctant patient.
0:52:43 > 0:52:46All done. Right, press really hard on there for me
0:52:46 > 0:52:49for about five minutes. Really, really hard.
0:52:49 > 0:52:50Hard as you can. Well done.
0:52:52 > 0:52:53Sorry about that.
0:52:53 > 0:52:55Glad to see the back of me, eh?
0:52:55 > 0:52:58Oh, it's just the needles. I really don't like needles.
0:52:58 > 0:53:00Hopefully that's it now. All right.
0:53:00 > 0:53:02If someone is scared of needles,
0:53:02 > 0:53:05it's weighing up the risks versus benefits of them
0:53:05 > 0:53:08having the injection or the blood test.
0:53:08 > 0:53:10And he's absolutely got to have the blood test,
0:53:10 > 0:53:12because if it is what we think it is,
0:53:12 > 0:53:14then he potentially could be very poorly.
0:53:16 > 0:53:19An hour later, with the test results complete,
0:53:19 > 0:53:22Kiera's diagnostic hunch seems to be correct.
0:53:22 > 0:53:26It's probably most likely that he has actually got a clot on the lungs,
0:53:26 > 0:53:28so we've given him the treatment for that.
0:53:28 > 0:53:31There was discussion with him as to whether he's going to stay in,
0:53:31 > 0:53:35but he's chosen the sensible option and arranged for someone to look after his mum,
0:53:35 > 0:53:37so he will stay in tonight, which I'm glad about!
0:53:39 > 0:53:42There is quite a big difference between first year
0:53:42 > 0:53:45and second year. I would say maybe the big thing
0:53:45 > 0:53:48is there's quite a large step up in responsibility
0:53:48 > 0:53:51and there's quite a lot more expected of you.
0:53:51 > 0:53:54I feel as though I have the responsibility for taking
0:53:54 > 0:53:56a lot of decisions, and it's quite a scary thing,
0:53:56 > 0:54:00so, yeah, I do feel like a proper doctor!
0:54:04 > 0:54:07While Kiera's embracing her inner medic,
0:54:07 > 0:54:10the rest of the junior doctors are happy to finally
0:54:10 > 0:54:13let their hair down at Emily and Jen's joint birthday bash.
0:54:13 > 0:54:17We've decorated the house now. Just getting my clothes ready.
0:54:17 > 0:54:21I've got my most eclectic shirt on for our tropical theme party.
0:54:21 > 0:54:25Yeah, all we need now is the... the hordes!
0:54:30 > 0:54:31Do you feel old now you're 25?
0:54:31 > 0:54:34I actually feel younger. I was thinking about this.
0:54:34 > 0:54:38When you're in med school, I think it was partly that that made me feel really old, like,
0:54:38 > 0:54:40getting older in the year. Now we're, like, junior doctors...
0:54:40 > 0:54:44- You actually feel younger.- I feel younger. Because I'm just walking
0:54:44 > 0:54:45around the ward like, "I know nothing!"
0:54:45 > 0:54:49I know what you mean, but then you think, "God Almighty, 25."
0:54:49 > 0:54:53That's like slap bang in the middle of your 20s.
0:54:53 > 0:54:56Before we know it, it'll be 30.
0:54:57 > 0:55:03It is weird, though, when you think about how long ago we were starting work, like, six weeks ago,
0:55:03 > 0:55:06how different we were back then to now.
0:55:18 > 0:55:21ALL: Happy birthday!
0:55:21 > 0:55:23- Quarter of a century.- Oh, shut up!
0:55:27 > 0:55:30I don't really think we reflect our home personalities when we're at work.
0:55:30 > 0:55:31We have to focus on our job.
0:55:33 > 0:55:36We all love to have a laugh and giggle and be silly.
0:55:47 > 0:55:48Next week on Junior Doctors...
0:55:48 > 0:55:52Bloody towel. It's Tom's shit everywhere.
0:55:52 > 0:55:54..long hours on the wards
0:55:54 > 0:55:57are starting to impact on lives outside the hospital.
0:55:57 > 0:56:00To be honest, I think Lottie's suffering a little bit
0:56:00 > 0:56:01because I'm not around.
0:56:01 > 0:56:04She just seems a little bit more anxious.
0:56:04 > 0:56:06Any pain up here? Sorry.
0:56:06 > 0:56:10Kiera's powers of persuasion are put to the test in the emergency department.
0:56:10 > 0:56:13- Just need to...- Can you just put it down for us, please?!
0:56:13 > 0:56:18It's exam nerves for Ed when he goes on an advanced life saver course.
0:56:18 > 0:56:20Charlie? Hello. Can you hear me?
0:56:20 > 0:56:24This is the final exam. I'm just hoping for a decent scenario -
0:56:24 > 0:56:28not fail miserably, murder my patient and end my career.
0:56:28 > 0:56:31Come on, taxi.
0:56:31 > 0:56:36And Oli faces one of the toughest exams a junior doctor can do.
0:56:36 > 0:56:39The book I'm revising from, it feels like it is that big sometimes.
0:56:39 > 0:56:41There's so much, I don't even know where to begin.
0:56:41 > 0:56:44I've got a lot to try and fit into my head.
0:57:00 > 0:57:03Subtitles by Red Bee Media Ltd