Dealing with Addiction Junior Doctors: Your Life in Their Hands


Dealing with Addiction

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Trauma...

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-Got a pulse, got a strong pulse.

-Any pain up here?

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..tears...

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That's all right.

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..and intense pressure.

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Changing the oxygen over.

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Just another day on medicine's front line.

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They're young, they're untested...

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This is my first patient ever.

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

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-Don't let me die.

-I'm not going to let you go anywhere.

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For a junior doctor, fresh out of medical school,

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it's time to put theory into practice.

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No, I haven't.

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We're following seven junior doctors over their first three months on the job...

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-Sharp scratch.

-Ohh!

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It's all about the glamour.

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It's all about the bums.

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..where there's a first time for everything...

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

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..and first impressions count.

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

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First years Tom, Emily,

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Jen, Tristan

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and Ed have been on the wards for just four weeks.

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For all intents and purposes, at the moment, he's actually having a heart attack.

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We're just going to put the morphine in now. You might feel a little bit dizzy.

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Second years Oli and Kiera have 12 months' experience.

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Breathing now.

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Don't need any more of them tonight, that'll do for me.

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They are working here, at the Royal Liverpool University Hospital.

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They're here to look after you.

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But can they handle the pressure of being doctors

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in one of Britain's booziest cities?

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You think of it as normal, sociable. Going out drinking with friends, people might have a few too many.

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But you see the real extreme end of it in hospital.

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I started drinking again the other night. Just loads of blood came out.

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I guess it's just one of those things

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of working in a city where there's lots of people who drink a lot of alcohol.

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It's the weekend in Liverpool, one of Britain's biggest party capitals.

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MUSIC: "This Is The Life" by Two Door Cinema Club

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But when lots of young people have one too many to drink,

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it's up to the junior doctors to pick up the pieces.

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SIREN WAILS

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Second year Kiera has just started a night shift

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in the hospital's emergency department.

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Working with A&E probably has changed the way I feel about going out

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and getting absolutely smashed,

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as maybe you would like to do as a student.

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It kind of upsets me a little bit

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because I've seen the really negative effects

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that can actually have.

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Hello, there.

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Kiera's first patient is no boozed up 20-something,

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but an evening spent sampling the city's nightlife has still ended in a trip to casualty.

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I had a couple of drinks, went into a bar, sitting on a stool,

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had a cocktail, but it must have gone down the wrong hole,

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and I took a fit of coughing.

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I felt light-headed as I coughed.

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-The next thing I know, I'm on the floor.

-Dearie me. You poor thing.

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So you fell and you hit your face.

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The next thing I remember is I woke up and there were people around me

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and there was somebody wiping the blood from me and I couldn't move.

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Then I could move and I was all right.

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I think you've broken your nose there.

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Oh, God.

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Got a bit of a cut there as well. Been in the wars, eh?

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Did myself a bit of damage there, didn't I?

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You've done a proper job of it, haven't you?

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But it's not just a broken nose that's concerning the patient.

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The thing that is getting me is these sensations in me hands.

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Extremely painful pins and needles which are shooting up from my fingers

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into my hands, and it's very painful indeed.

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Medical alarm bells ring for the junior doctor.

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If you've hurt something in your neck, it might be causing you pain in your hands,

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so we might need to get a bit of an X-ray of the neck, OK?

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Can you just tell me...?

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The tingly sensations could be a sign of a serious spinal injury.

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It's extremely painful.

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-On the back here?

-Yes, very sensitive.

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-Very sensitive for me to touch there.

-It's very sensitive there, yes.

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Very sensitive here and here, OK.

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I think we probably need to get some sort of imaging on your neck

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before I can assess you any further, OK?

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With the scan over and the patient back in the bay,

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Kiera can get on with the job of fixing his face.

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I'm going to just pop a bit of local in that head

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and put a couple of stitches in that, get you looking beautiful again, OK?

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-HE LAUGHS

-Cheers, thanks!

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OK, this is when the sharp, stingy bit is coming up now.

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You might not like this bit.

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Oh, God, OK.

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Right. Just going to go for it.

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Just go for it.

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OK, sharp scratch coming up.

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-That wasn't too bad.

-You'll start to notice it will be numbing soon.

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You'll be pleased to know that everyone winds me up

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for being a bit of a perfectionist with this.

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-Probably what you'd want, I'd imagine.

-I couldn't care less.

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Oh, fine, then!

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You're going to do a good job.

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It's an ugly face anyway.

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Aww. Beauty is in the eye of the beholder, as they say.

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Just going to have a little look inside now.

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We've given it a good wash out so it actually feels OK.

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-Can you feel any of this?

-No, you're all right.

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Great. All right, sir.

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Is the nose broken, is it?

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Yes, your nose is broken.

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I'm just closing up the skin on it now,

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because it reduces the risk of infection

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and it stops a lot of the bleeding that is going on.

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You're going to have quite a nice black eye from this, sir.

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One to show off down the pub.

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Wounds, battle scars.

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Perfectionist Kiera has stitching down to a fine art.

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He's got a new nose.

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But potentially there is a much bigger problem to deal with.

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Got the results of his scan back

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and we think he's had a small fracture to one of the vertebra in his neck

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which is probably explaining the horrible sensation he is getting in his hands.

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So, essentially, orthopaedics are going to take over care

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of his fractured neck and we'll see where we go from there.

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Despite the patient's prognosis,

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he remains upbeat about the treatment Kiera has given him.

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Wonderful service.

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Thank you. It's nice to hear that.

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It's not always echoed by most people.

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As Liverpool recovers from a weekend of partying,

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junior doctors Emily and Jen

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are gearing up for a week of birthday celebrations,

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as they'll both turn 25. Emily's comes first.

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Oh, wow!

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It looks quite nice.

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Well impressed.

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Dear Dr Phipps, happy birthday, hope you have a wonderful Thursday,

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and I'll see you at weekend, love, Jamie.

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I think I will be keeping it quiet.

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Why?!

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-I can't be bothered.

-Are you not a birthday fan?

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I don't mind birthdays, I just don't think everybody on the ward needs...

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But there's little time to open presents,

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as Emily needs to put in a shift at the hospital.

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And as it's her birthday,

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she's hoping to avoid any of the more unpleasant procedures.

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I'm not putting my fingers up anyone's bum, it's my birthday.

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That's my plan.

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The news of Emily's 25th birthday has reached the wards.

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Ah!

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-ALL:

-# Happy birthday to you!

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# Happy birthday to you! #

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-Can I have a hug?

-Happy birthday!

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Thank you.

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But the birthday celebrations have to go on hold,

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as Emily has patients in need of surgery to see.

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86-year-old Joe has been admitted to the ward

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to have a growth removed from his bowel.

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So, symptoms-wise,

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have you noticed any yellowing in your eyes at all?

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-No!

-Bit of a weird question, isn't it?! No?

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The only thing I do when I get out of bed - shower, shave.

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I don't look in the mirror and say, "He's gorgeous, him!"

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You should do!

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He's going into theatre today,

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and Emily needs to do his pre-op assessment.

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Are you allergic to any medication?

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No.

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-How are your waterworks? Any burning or stinging?

-No problem.

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Can you lift your top up for me?

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-Nothing to hide!

-No tattoos.

-No.

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OK. Can I listen to your back as well?

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Nice deep breathe for me.

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I feel there is something there.

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-It's the only part of my body where I feel there is something.

-Mmm.

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I think you're doing very well.

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So what'll happen is one of the registrars, one of the senior doctors,

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will explain everything and answer any questions you have.

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Oh, we'll see what we can do.

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Emily's been offered the opportunity to observe Joe's surgery,

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but she has opted to clear a backlog of work on the ward instead.

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While some junior doctors would jump at the chance,

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birthday girl Emily is clear about her future direction,

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and surgery is not what she wants to specialise in.

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I passed out a couple of times in surgery as a student!

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It's really hot and sweaty

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and you can't go for a wee, you can't have any lunch.

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They have this thing called the diathermy

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which kind of burns the tissue and stuff so it seals,

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and it just smells like a barbeque but not in a nice way.

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I'm vegetarian as well so it's just not that nice!

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I have an issue with flesh. It's just a bit too fleshy, I think, for me.

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But despite her issues with surgery, Emily still feels that choosing

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to work her first three months on a surgical ward

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has been a worthwhile learning experience.

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I'm not passionate about the act of surgery itself.

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I really enjoy the patients and the clinical problems they have.

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So I feel like I'm still being really useful staying on the ward.

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With the patient's operation successfully completed,

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Emily's senior, Femi Oshin, takes some time

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to catch up on her progress so far, and discuss her future direction.

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Some people have no idea what they want to do

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until the very last minute, whereas some people

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are like, "I want to be a surgeon," from about six. It's weird.

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Have you had any thoughts

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on what you'd like to specialise in in the future?

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Can we tempt you with surgery, perhaps?

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Maybe not surgery yet.

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Maybe I'll change my mind at some point, but at the minute

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-I want to do public health with an infectious diseases focus.

-OK.

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You have to do whatever you find interesting,

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otherwise you'll very quickly find

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that you don't enjoy yourself any more,

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and people drop out.

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I think my mind's pretty much made up about what I want to do.

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But I'm not saying I'm walking around, grumpy, thinking, "Why am I doing this?"

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Because, like I say, there's so much you can get out of a job,

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it's not all about thinking, "This is what I want to do for the rest of my life."

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Every job's a learning experience, so I'm getting loads from it,

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even though it's not what I want to do.

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While Emily contemplates her future,

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over on the acute medical unit Ed and Oli are on the morning ward round,

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where they are dealing with Liverpool's all too familiar problem -

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alcohol-related illness.

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The Royal Liverpool University Hospital deals with

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the highest number of alcohol-related cases in England.

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It's really sad when you see young people who have come in

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and they've got liver problems or, essentially, incurable diseases because of alcohol.

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It's worlds apart from Ed's last job in an Italian mountain village.

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Of course, I mean, I don't want to pass the city off as a city of alcoholics,

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because it's not true.

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Unfortunately, it's just an important problem

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and you've got to learn how to deal with it as best as possible.

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Because of his inexperience of working in the NHS,

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he'll be closely supervised by Dr Khan,

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who's keen to see what Ed knows about chronic liver disease.

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How long have you been drinking for?

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-For about five years.

-How much do you drink?

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Approximately a litre and half of vodka.

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A litre and half a day.

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Dr Khan wants Ed to examine a patient

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who's showing some of the classic signs.

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-Can I have a feel of your tummy?

-Yes.

-Thank you.

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Just tell me if there's any pain.

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Yeah. All there's sore.

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What are the other signs you'd find in the tummy in such a patient?

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Well, I would expect to find tenderness

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around the liver area.

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So what happens to the liver?

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In the long term, it can go towards cirrhosis

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and in that case, it gets harder.

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Ed's holding up to scrutiny,

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but there's an obvious clue in the diagnosis of the patient's condition

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that Dr Khan thinks he's overlooked.

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What are spider naevi?

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Spider naevi are another sign typical of alcohol intake,

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depending if they are vascular abnormalities...

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Has she got any?

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That's one.

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That's...

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That one is.

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-That, to me, looks like...

-Not that one?

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With people from Liverpool twice as likely to die

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from an alcohol-related condition as those from the rest of the UK,

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it's an issue that Ed's going to have to grips with.

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'I really need to get into revising

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'serious complications of alcohol intake,'

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because I know a bit,

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but I must be more proficient than that

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because it's such an important issue here.

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Thank you.

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I find it very sad, because after a certain point,

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it's just difficult to get your health back.

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With their shifts over, Ed and some of the other junior doctors

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are back at the house with a surprise for Emily.

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-ALL:

-# Happy birthday, dear Emily

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# Happy birthday to you! #

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Aww!

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You know you're old when your cake feels like an inferno.

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Oh, my God, that's amazing.

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-Oh, shit!

-ALL LAUGH

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That was hair on fire!

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Oli nearly got his fireman on there!

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-About to pour beer on it!

-One more, Emily, then your wish.

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But the surprises don't stop there.

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So, Emily, since you're now 25,

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I have a rhyme that I've written that is quite appropriate for the moment.

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It's a bit grim and it's about the menopause.

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Hot flush, open the doors

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Make way for the menopause

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If you thought PMT was bad

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Found yourself flustered and mad

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Just wait till this one takes its toll

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You see red and heads will roll

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If only your oestrogen would come back

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Your ever drooping once-hot rack

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But fear not, you are still strong

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It's just the change and won't last long

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Of life, you still have much, much more

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You're still all woman, hear you roar.

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Thank you very much.

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'I feel like I have just grown up in the last few weeks,'

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and it's such a surreal feeling,

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kind of being independent and having so much responsibility

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and not quite knowing what to do with it.

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-Happy birthday!

-ALL: Happy birthday!

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As Emily celebrates a birthday night in,

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back at the hospital,

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Tristan's shift is only just starting on the acute medical ward.

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The patient's stable, it's just that I think that she's got a large left-sided haemothorax.

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As part of the night team, he'll be on the front line

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for any emergency bleeps across the hospital.

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Being on the crash bleep is a mixture of apprehension and excitement.

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I mean, obviously whoever you're going to see is going to be ill,

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which is very bad for them.

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You sort of hope that you can rely on your training

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to remember everything you're supposed to do.

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Tristan is coping with the pressure of being a junior doctor,

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but he has a lot more than his patients to juggle.

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I'm married to Jenna. We've been married almost six years,

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and we have a daughter called Lottie

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and she's almost two years old.

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Uh-oh! Watch out for the tickly trees!

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Uh-oh! Uh-oh! Watch out! Watch out! Watch out!

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Time with Lottie is very important to him.

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Now starting to actually work as a junior doctor,

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

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I'll be missing Lottie and Jenna a lot.

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My greatest fear about being a doctor would be

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'making a mistake or missing something that's really important.'

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There's going to be a sharp scratch, OK?

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Try and stay as still as possible. Ready?

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'It is a big responsibility'

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to be in the position to give people medicines

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which have side effects, both predictable and unpredictable,

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or to do procedures,

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and even minor things can have rare but serious consequences.

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So we're just going to use the local anaesthetic first. Is that all right?

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If I didn't know a risk and something happened to a patient,

0:19:030:19:06

I think I'd feel very guilty that I exposed them to that.

0:19:060:19:10

Tonight Tristan must face his fear

0:19:160:19:18

of dealing with seriously ill patients.

0:19:180:19:20

It's not long before he's called to another alcohol-related casualty.

0:19:220:19:26

Sounds like you've been having a horrible time. You feeling rough?

0:19:280:19:32

I keep getting blood in the back of my mouth.

0:19:320:19:35

Did you tell the doctor that before?

0:19:350:19:37

Yeah.

0:19:370:19:39

I'm getting frightened now.

0:19:390:19:40

I'm scared I'm going to die.

0:19:420:19:43

-Is that just because you feel so rough?

-Uh-huh.

0:19:430:19:46

You're in hospital, so you're in the right place.

0:19:510:19:53

The man admits to drinking a bottle of vodka a day

0:19:530:19:57

and he is now vomiting blood.

0:19:570:19:58

Little scratch.

0:19:580:20:00

Ah!

0:20:000:20:02

Right, we've got a sample of blood.

0:20:020:20:04

I'll go and get this analysed

0:20:040:20:07

so we can see how you're doing, cos what we want to make sure

0:20:070:20:10

is that your blood is not too acid or too alkaline.

0:20:100:20:13

I'm so frightened.

0:20:130:20:14

Don't let me die, doctor, please.

0:20:140:20:16

-Sorry?

-Don't let me die.

0:20:160:20:19

We're just sorting you out right now. We've given you some anti-sickness.

0:20:190:20:22

We're going to get you some fluids. We'll give you some antibiotics

0:20:220:20:26

-and I'm sending these blood tests off as well.

-I'm frightened.

0:20:260:20:29

We're not going to let you go anywhere.

0:20:290:20:33

I'll let the doctor that's been looking after you

0:20:330:20:36

know you're still having some pain and that you're really worried. OK?

0:20:360:20:40

See you later.

0:20:400:20:41

The results of the man's blood tests have come back

0:20:410:20:44

and Tristan's concerned.

0:20:440:20:46

He reports his findings to the registrar, Dr Abraham.

0:20:460:20:50

-Can I just mention something to you? Is that all right?

-Yeah.

0:20:500:20:53

His pH is 7.3. He's quite sick, I think.

0:20:530:20:57

Tristan's discovered the patient's blood is too acidic,

0:20:570:21:00

which can be fatal.

0:21:000:21:02

He's shaking, but I think he might be withdrawing as well.

0:21:020:21:05

So whether that's from infection or alcohol withdrawal, I don't know.

0:21:050:21:11

I don't know if he is septic.

0:21:110:21:14

I don't know if... Yeah, it's here.

0:21:140:21:16

Anti-sickness, please.

0:21:200:21:21

The only way we can get anti-sickness into you

0:21:210:21:24

without you throwing it straight back up would be to get an IV cannula.

0:21:240:21:27

In the interim,

0:21:270:21:28

I'll see if we can give you an injection for the sickness.

0:21:280:21:31

-OK.

-And I'll be right back.

0:21:310:21:33

'He's being sick all the time.

0:21:330:21:35

'He's throwing up some sort of half-digested blood.'

0:21:350:21:38

We need to get IV access

0:21:380:21:40

so that we can give him anti-sickness, pain relief,

0:21:400:21:42

antibiotics - the whole lot, really.

0:21:420:21:46

And that all hinges, really, on finding a good vein

0:21:460:21:48

and getting a cannula in.

0:21:480:21:50

'When dealing with the sort of patients that come in with alcohol problems,

0:21:510:21:56

'it's easy to slip into the attitude that they're a hassle.'

0:21:560:22:01

But a lot of the people who have these sorts of problems

0:22:020:22:05

have been in terrible situations.

0:22:050:22:07

Tristan's shift should have ended an hour ago

0:22:080:22:11

but he's pressing on and fitting a fresh cannula

0:22:110:22:14

so the patient can get the life-saving drugs he needs.

0:22:140:22:17

Please bring your arm around here.

0:22:170:22:20

And Tristan's late finish hasn't gone unnoticed by his senior.

0:22:200:22:24

Thanks very much for that, Tristan. I'm glad you were here.

0:22:240:22:27

'Quite impressed, really.'

0:22:270:22:29

I only realised half an hour ago

0:22:290:22:31

that he stayed an extra hour and a half

0:22:310:22:34

to get all the other follow-ups done as well,

0:22:340:22:37

in terms of investigations and procedures,

0:22:370:22:40

so that is impressive, yeah.

0:22:400:22:41

Being an inner-city hospital,

0:22:430:22:46

and one with certain social problems that are quite rife in Liverpool,

0:22:460:22:52

you get to see a lot of sick people,

0:22:520:22:56

which is obviously a terrible thing

0:22:560:22:57

but really important to learn from, so you can deal with those problems.

0:22:570:23:01

SIREN WAILS

0:23:010:23:04

A new day,

0:23:090:23:11

and not all of the junior doctors are dealing with alcohol cases.

0:23:110:23:15

For first-year Tom on the cardiology ward,

0:23:160:23:19

it's another day, another vein.

0:23:190:23:21

See you in a bit.

0:23:210:23:22

His next patient has recently had surgery

0:23:250:23:28

and he needs to fit a cannula.

0:23:280:23:30

He's found needle work trickier than most, but a month into the job,

0:23:300:23:34

he's hoping that this time it goes without a hitch.

0:23:340:23:37

How long has that been in there for?

0:23:370:23:40

I think Friday night or Saturday.

0:23:400:23:42

You'll have to have another one in

0:23:420:23:44

cos we have to give you the antibiotics.

0:23:440:23:46

But from the outset, it's becoming clear

0:23:460:23:48

that Tom is the one being examined, and not the patient.

0:23:480:23:52

So you like giving banter out but you don't like taking it, do you?

0:23:520:23:56

-What do you mean?

-Ah. I do fortunes.

0:23:560:23:59

-You do fortunes?

-Yeah.

0:23:590:24:01

I've never met anybody who reads fortunes before.

0:24:010:24:04

-Do you really?

-That's how I know.

0:24:040:24:05

Cos you go dead shy when you're out, don't you,

0:24:050:24:08

-having a little banter with all the lads?

-Put it in this one here.

0:24:080:24:11

-I've done a few of the nurses in here as well.

-Have you?

-Yeah.

0:24:110:24:14

How do you...?

0:24:150:24:17

"How do I know," you were going to say then, weren't you?

0:24:170:24:20

I know, yeah. I just shouldn't have asked, should I?

0:24:200:24:23

THEY LAUGH

0:24:230:24:25

-So you're enjoying being a doctor?

-So far, so good, yeah.

-Good.

0:24:250:24:29

I'm just only starting to feel like one now.

0:24:290:24:31

-Cos you'll go far, you know.

-Do you think so?

-Yeah.

0:24:310:24:35

You want to keep your vein in one place.

0:24:350:24:37

Just, obviously, it's a sharp scratch.

0:24:370:24:39

-And we're in. Quick and painless.

-What?

-I said quick and painless.

0:24:390:24:43

-Yeah?

-You're like, "Yeah(!)"

-You need to let go sometimes.

0:24:430:24:46

TOM LAUGHS

0:24:460:24:48

-You're reading my fortune while I'm taking your blood.

-Yeah.

0:24:480:24:51

There's something quite poetic about that.

0:24:510:24:53

I can feel that going through you - that's what I'm like.

0:24:530:24:56

See? You're shaking now. That's cos I'm telling you bits, isn't it?

0:24:560:24:59

There we go, got it in.

0:25:010:25:02

I'm right, though, aren't I?

0:25:020:25:04

I... You're freaking me out!

0:25:040:25:06

-OK, that's all sorted.

-Thank you very much.

0:25:090:25:11

I'll stick a little date on it so we know when it went in

0:25:110:25:14

-and I'll stick this down with tape like last time.

-Thank you.

0:25:140:25:17

-That's everything.

-See, now, you never hurt me like the other ones.

0:25:170:25:20

-You're saying all the right things, aren't you?

-Yeah.

0:25:200:25:23

So don't forget what I said.

0:25:230:25:26

I won't. Nice to see you.

0:25:260:25:28

-Thank you, and you.

-Take care.

0:25:280:25:30

Luckily for Tom,

0:25:300:25:31

the psychic predictions didn't distract him from the job...

0:25:310:25:35

and he's got a new fan in Cindy.

0:25:350:25:38

Usually they hurt me, and it didn't hurt at all

0:25:400:25:42

and he's just put a new one in

0:25:420:25:44

and I can't believe I've just had that done without, "Aargh!"

0:25:440:25:48

or screaming or anything. He was so gentle.

0:25:480:25:50

He's a fun guy,

0:25:500:25:52

but if a woman was to approach him

0:25:520:25:55

and say, "Come on, let's have a dance," he'll run a mile.

0:25:550:25:58

Do you get what I mean?

0:25:580:26:00

He's a bit funny, and he's a bit...

0:26:000:26:02

He's... What's that word? He's very preserved.

0:26:020:26:06

He doesn't show his emotions.

0:26:060:26:08

It's the first time I've ever had my fortune told

0:26:080:26:10

by a patient or by anybody.

0:26:100:26:12

Apparently, outside of hospital, I'm a very quiet person.

0:26:120:26:16

And this is news to me.

0:26:160:26:18

He knows I'm right, really.

0:26:180:26:20

With Tom's golden future in medicine written in the stars,

0:26:220:26:26

over on upper GI, Jen's predicting a tricky start to her day.

0:26:260:26:30

She's been called to an elderly woman

0:26:310:26:33

who needs a catheter fitting to her bladder.

0:26:330:26:36

It's really difficult

0:26:360:26:39

to actually tell which hole it's going in.

0:26:390:26:42

It's the first time that the usually unflappable Jen

0:26:420:26:46

has tried this procedure on a female patient.

0:26:460:26:49

WOMAN LAUGHS

0:26:510:26:53

Do you know how many times I've done that?

0:26:530:26:56

I'm just going to go and get another catheter, OK?

0:27:080:27:11

So far, no success.

0:27:120:27:14

I think it might have been in the wrong hole.

0:27:170:27:19

It's definitely trickier than a male!

0:27:190:27:21

Just bash the males in. Not literally, of course, but...

0:27:210:27:25

They haven't got any size 12s.

0:27:250:27:27

The nurse is really good, though.

0:27:270:27:29

She's hoping that a different size catheter is the answer.

0:27:290:27:32

Push it in as much as you...

0:27:320:27:34

No, it's not going in.

0:27:340:27:36

-It's OK, don't worry.

-You're fine, don't worry.

0:27:360:27:39

Yep. We're there!

0:27:390:27:42

Finally, success!

0:27:480:27:50

Like every junior doctor,

0:27:500:27:52

Jen's realising she's still got a lot to learn.

0:27:520:27:55

I think as each day passes, you do start to grow in confidence

0:27:560:28:00

in the tasks that you're used to doing every day.

0:28:000:28:02

But all the time,

0:28:020:28:04

you meet new challenges that you've never done before.

0:28:040:28:07

So I've been doing this job for a month now

0:28:070:28:10

and I've never done a female catheter

0:28:100:28:12

so it would have made no difference if I'd done it on day one or day 30.

0:28:120:28:16

After his run of late shifts on call,

0:28:230:28:26

Tristan is back to the day job on his usual ward of gerontology,

0:28:260:28:30

which specialises in care of the elderly.

0:28:300:28:33

Having impressed his seniors over the past few weeks,

0:28:330:28:36

Tristan's been given the responsibility

0:28:360:28:38

of leading his own ward round.

0:28:380:28:40

I'm feeling pretty good this morning.

0:28:400:28:42

We're just about to start the ward round, which I'll be taking today.

0:28:420:28:45

I'm the only one from the team here this morning, so...

0:28:450:28:49

Yeah, the pressure's on.

0:28:490:28:51

All ward rounds in the hospital start at 9am

0:28:520:28:54

and must be wrapped up by midday,

0:28:540:28:57

so it will be a race against the clock for Tristan

0:28:570:28:59

to get through all his patients.

0:28:590:29:02

It's due to start in about five minutes

0:29:020:29:04

so I'm just trying to get everything organised

0:29:040:29:06

so I can just have my head in one place.

0:29:060:29:09

It's 9am,

0:29:090:29:11

and Tristan starts bang on time.

0:29:110:29:13

Looking good.

0:29:130:29:15

But there's a technical hitch.

0:29:150:29:17

Computer's not working. Good start.

0:29:200:29:21

I'm just waiting for the computer to load up.

0:29:230:29:25

What's the time?

0:29:300:29:32

We're 15 minutes behind already.

0:29:320:29:33

Finally, he's on his way.

0:29:390:29:42

SIGN CLATTERS

0:29:420:29:44

Careful, there's a Wet Floor sign here. Looks dry.

0:29:460:29:50

It's not been the best start,

0:29:520:29:54

but he could still make up the time

0:29:540:29:56

-if he could just stop the small talk.

-Hi.

0:29:560:30:00

Hello, Bridie. Morning, Edith.

0:30:000:30:01

That's amazing, Mary.

0:30:010:30:03

It got pride of place, then?

0:30:030:30:05

Oh, gosh! I've got a hole in my trousers.

0:30:050:30:08

I've got to sort that out.

0:30:080:30:09

How do you feel you're doing?

0:30:120:30:15

Do you feel like it's a little bit easier to talk?

0:30:150:30:19

INDISTINCT SPEECH

0:30:190:30:21

Sorry?

0:30:210:30:23

INDISTINCT SPEECH

0:30:250:30:28

With just 20 minutes until the midday deadline,

0:30:330:30:36

Tristan's still optimistic.

0:30:360:30:38

Yep, we've seen several patients so far on the ward round. It's 11:45.

0:30:380:30:42

So obviously slower than the consultants would do it

0:30:420:30:45

but I think we're not doing horrendously so far.

0:30:450:30:47

I don't know. What do you think?

0:30:470:30:50

You're doing well. Still a long way to go.

0:30:500:30:53

I think that's code for, "It could be worse."

0:30:550:30:58

Finally, Tristan finishes his ward round -

0:31:050:31:09

an hour and a half late.

0:31:090:31:11

And his timekeeping has not gone unnoticed by his senior, Dr Scott.

0:31:110:31:16

Tristan did well running his own ward round.

0:31:160:31:18

I think if I would identify any one area for him

0:31:180:31:21

that he'll need to work on,

0:31:210:31:24

it will be the amount of time it takes him to do the ward round.

0:31:240:31:27

"So confirm arrangements for...

0:31:270:31:30

"..district nurses

0:31:320:31:35

"and package of care."

0:31:350:31:37

He took longer than the actual session lasted.

0:31:370:31:40

His introspectiveness, I think, is what slows him down,

0:31:400:31:43

as well as a certain lack of experience,

0:31:430:31:45

but as he trains and as he gets more confident,

0:31:450:31:47

he'll come up to speed very quickly.

0:31:470:31:49

Right, well, thank you so much

0:31:490:31:51

and I'll keep you updated, OK?

0:31:510:31:54

See you later.

0:31:540:31:56

It wasn't a stressful thing to do but I knew there would be a lot of work

0:31:570:32:01

and time would inevitably pass faster than I was hoping

0:32:010:32:05

and, you know, it's important to get everything right for the patients.

0:32:050:32:08

It is a good experience doing a ward round

0:32:080:32:10

because you really have to think for yourself. You can't switch off

0:32:100:32:14

and just let some of your seniors give you a list of things to do

0:32:140:32:17

and do that. At the end of the day,

0:32:170:32:19

you actually have to make some decisions.

0:32:190:32:21

Back at the house, Jen's having a day off from the daily grind

0:32:270:32:30

of ward rounds, catheters and cannulas.

0:32:300:32:33

Like Emily, it's her birthday this week

0:32:360:32:39

and she's expecting some very special visitors.

0:32:390:32:41

DOORBELL RINGS

0:32:410:32:43

Mum and Dad, Chris and Christine, have driven over from Manchester

0:32:430:32:47

and they come bearing gifts.

0:32:470:32:49

Hello. You all right?

0:32:490:32:51

-Happy birthday.

-Happy birthday.

0:32:510:32:54

-This is a big card.

-That's my choice.

0:32:540:32:56

Oh, God! It's awful!

0:32:590:33:01

'I am close to my mum and dad.'

0:33:010:33:02

All my birthday cards this year

0:33:020:33:05

are going to be addressed to Dr Jen or Dr Jennifer

0:33:050:33:09

or whatever they want to call me!

0:33:090:33:11

'So, yeah, I think they're pretty proud of me.'

0:33:110:33:14

JEN LAUGHS

0:33:140:33:15

When I saw that card, I thought,

0:33:150:33:17

"That's the worst card I've seen in my life, so I have to buy it!"

0:33:170:33:21

It is probably the best worst card I have ever seen.

0:33:210:33:26

On her seventh birthday, she got a nurse's outfit

0:33:260:33:29

and she said, "I want to be nurse when I'm older."

0:33:290:33:31

I said, "Why don't you want to be a doctor?"

0:33:310:33:33

-So from point on, she wants to be a doctor.

-Yeah.

0:33:330:33:36

And she's never given up the determination from the age of seven.

0:33:360:33:39

Now she is a doctor at 25.

0:33:390:33:42

So she sticks to what she says she's going to do.

0:33:420:33:45

-Yeah, yeah.

-She always has done.

0:33:450:33:46

Back at the hospital,

0:33:520:33:53

and so far, it's been a steady day for Oli in the acute medical unit.

0:33:530:33:58

Yeah, it's been quite a nice, relaxed day.

0:33:580:34:01

Did a ward round, had some jobs to do, did them,

0:34:010:34:03

had some really nice teaching at lunchtime, which was nice,

0:34:030:34:06

and then, this afternoon, just tying up loose ends.

0:34:060:34:09

I'm bored! There's nothing to do.

0:34:090:34:11

But the peace is soon shattered with an emergency crash bleep.

0:34:140:34:18

ALARM BLEEPS

0:34:210:34:22

Whose patient is it?

0:34:220:34:24

The man, a heavy drinker, is having a seizure.

0:34:270:34:31

-Are you all right to set up a BR... a BM on him?

-Yeah.

-Cheers.

0:34:350:34:38

For second-year Oli,

0:34:400:34:41

patients like this have become commonplace on the wards...

0:34:410:34:45

'He's a chap who's known to have alcohol withdrawal seizures.'

0:34:450:34:49

I'm just having a look at his latest blood results.

0:34:490:34:52

..and he's fast becoming an old hand at treating them.

0:34:520:34:56

Last lot of Librium was at 12 o'clock.

0:34:560:34:58

We give him Librium straight into his veins, which is

0:35:000:35:02

something you give to alcoholics to help them when they're withdrawing.

0:35:020:35:06

Keep a close eye on him, do some more blood tests,

0:35:060:35:09

and just see how he gets on, really.

0:35:090:35:11

The negative affects of alcohol cost the NHS £164 million every year.

0:35:110:35:16

Yeah, they've gone to find it, yeah.

0:35:160:35:18

A sobering thought for any new junior doctor

0:35:180:35:21

experiencing the dark side of the demon drink for the very first time.

0:35:210:35:26

It puts a lot of pressure on the doctors,

0:35:260:35:28

particularly trying to manage people who are very drunk.

0:35:280:35:32

As a junior doctor, not really being exposed to those pressures before,

0:35:320:35:37

it can be quite difficult for them.

0:35:370:35:39

I suppose it's a side of alcohol that a lot of people don't see

0:35:410:35:44

unless you work in a hospital. You know, you think of it as normal,

0:35:440:35:47

being sociable, going out with friends, having a drink.

0:35:470:35:50

People might have a few too many, but this was...

0:35:500:35:53

I think you see the real extreme end of it in hospital

0:35:530:35:56

and there are physiological effects

0:35:560:35:58

that perhaps the general public don't see very often.

0:35:580:36:00

And it can be quite shocking at first

0:36:000:36:02

but I think you get used to it after a while. We see quite a lot.

0:36:020:36:05

We see so much of it, it's like...

0:36:050:36:08

It just becomes quite common.

0:36:080:36:09

In a way, it's sad that it's happening so much

0:36:120:36:15

but that's just the nature of where this hospital is

0:36:150:36:17

and some of the surrounding areas.

0:36:170:36:19

People living in socio-economic deprivation,

0:36:190:36:21

who probably have nothing else in their lives, they turn to drink

0:36:210:36:25

and it's like... It's an addiction, like anything else, it's a disease

0:36:250:36:29

and we treat it like any other disease -

0:36:290:36:33

just patch them up and help them along their way.

0:36:330:36:36

As Oli deals with the after-effects

0:36:380:36:41

of the city's high rates of alcohol abuse,

0:36:410:36:43

first-year Ed is dealing with a very different kind of medical case.

0:36:430:36:48

He's about to face one of his toughest tests yet

0:36:480:36:51

and perform a tricky medical procedure called a lumbar puncture

0:36:510:36:54

for the first time.

0:36:540:36:56

We're going to ward 7B,

0:36:560:37:00

where this patient has been transferred,

0:37:000:37:03

and we're going to do the lumbar puncture there.

0:37:030:37:05

Ed's keen to show senior medics that he has the right clinical skills,

0:37:070:37:11

so this opportunity is a big deal for the Italian junior doctor.

0:37:110:37:16

She's here. I think she's here.

0:37:160:37:18

He's had a lot to prove since, in his very first week in the hospital,

0:37:180:37:22

he was asked to leave the emergency department

0:37:220:37:24

as a second-year junior doctor

0:37:240:37:26

and become a first-year in the acute medical unit.

0:37:260:37:29

'I'm not completely glad the fact that I was moved back'

0:37:300:37:33

from Foundation Two in A&E to Foundation One training.

0:37:330:37:38

'But I'm really glad of how things turned out in the end.

0:37:380:37:42

'It's been steady and positive.'

0:37:420:37:45

It's been good since then.

0:37:450:37:47

Yeah, I think his confidence was initially knocked

0:37:470:37:49

cos he'd started in A&E

0:37:490:37:50

and he had to be moved to the acute medicine unit.

0:37:500:37:53

But I think, as time has gone along, he's been supervised closely,

0:37:530:37:57

we've given him more and more responsibility

0:37:570:37:59

and I think he's relished it.

0:37:590:38:00

The procedure Ed will do today involves drawing fluid

0:38:030:38:07

that surrounds the patient's brain.

0:38:070:38:09

I have an aneurysm. From the veins in me brain.

0:38:090:38:14

And they want to know whether it's bleeding.

0:38:150:38:18

I've been getting violent headaches.

0:38:180:38:22

Have you got plenty of gauze and...?

0:38:220:38:24

What this test will determine

0:38:240:38:26

is whether any vessels in the patient's brain have burst.

0:38:260:38:30

Are you able to bend your legs as much as you can?

0:38:300:38:34

It's an invasive procedure so Ed will need a steady hand.

0:38:340:38:38

Before he starts, Dr Ahmed offers some important words of advice.

0:38:400:38:44

And then when you withdraw, you actually infiltrate.

0:38:500:38:53

So you've created a space and you're putting the needle in.

0:38:530:38:57

Erm, no, I haven't.

0:39:000:39:01

But I will absolutely do my best.

0:39:050:39:07

He's prepped and ready to drain the fluid.

0:39:160:39:18

-Is it OK?

-Yes.

0:39:200:39:22

Yup.

0:39:290:39:30

-Is it OK?

-Yes.

0:39:380:39:40

We're getting there, eh?

0:39:440:39:45

Ed has extracted the fluid he needs...

0:39:480:39:50

..which will now need to go off for further tests.

0:39:540:39:56

-Any pain at the moment?

-No.

-OK. We're getting there, eh?

0:39:580:40:03

It's been a textbook procedure for Ed.

0:40:030:40:06

And all that's left to do now is inform

0:40:060:40:07

the patient of the potential side effects.

0:40:070:40:10

Now, you may experience a bit of headache.

0:40:100:40:13

That's a good point.

0:40:150:40:17

But it may vary a bit in its... kind of headache.

0:40:170:40:21

It's... A common complication of this procedure is headache,

0:40:210:40:25

so let's not worry about it at the moment.

0:40:250:40:28

-Thank you very much.

-No problem.

0:40:420:40:44

It's a small slip-up, but Dr Ahmed's still pleased.

0:40:440:40:48

It was obvious he was still learning

0:40:480:40:51

but he did the procedure well and he got the fluid in the first attempt.

0:40:510:40:56

I am sure if he does more procedures, he will become more confident.

0:40:560:41:00

It went well and the patient is quite happy.

0:41:000:41:02

He was quite confident, wasn't he?

0:41:020:41:04

Well, I knew there could be complications

0:41:040:41:07

and one of them is that you can become paralysed,

0:41:070:41:11

so he had to know exactly where to go.

0:41:110:41:15

Successfully completing the lumbar puncture

0:41:150:41:18

has given Ed a boost of confidence.

0:41:180:41:21

It's rather an invasive procedure so, you know,

0:41:210:41:24

it's something that you learn going through your career

0:41:240:41:28

and, yeah, it was good. It ticks a box, a very important one, so I'm happy about that.

0:41:280:41:32

And he's keen so share the good news with fellow junior doctor Oli.

0:41:320:41:37

No, she was fine, and in the end, she also told me that it wasn't painful.

0:41:370:41:41

No worries. Is that the first one you've done?

0:41:410:41:43

That was the first one, yes.

0:41:430:41:45

It's good that you got to do it.

0:41:450:41:46

-Will you be confident doing it on your own next time?

-Well, I'll try!

0:41:460:41:50

-Well, have a nice afternoon.

-See you later, man.

-Bye-bye.

0:41:500:41:54

Very pleased for Ed. It's fantastic. Really good news.

0:41:560:41:59

Glad he got it and glad it went without a hitch. Fantastic.

0:41:590:42:02

There are continuously moments when I have self-doubts

0:42:020:42:06

that my knowledge is not up to what I would like it to be.

0:42:060:42:09

Now I feel I am starting to help the team.

0:42:110:42:15

I can see that people are giving me more responsibilities now.

0:42:150:42:18

While Ed's belief in his medical abilities is growing,

0:42:310:42:34

first year Tom is feeling a little nervous about his next challenge.

0:42:340:42:39

Little bit scared.

0:42:390:42:40

All junior doctors are expected to do presentations

0:42:400:42:44

as part of their training.

0:42:440:42:46

Today, Tom will be giving a talk on pacemakers to the hospital's top consultants.

0:42:460:42:51

I think that, considering there's consultants there,

0:42:510:42:54

it's going to be tricky to be able to keep up with the pace,

0:42:540:42:58

in terms of what they can do and what they know.

0:42:580:43:01

If he succeeds, he will prove he has a firm grasp of cardiology.

0:43:010:43:06

Hoping nobody turns up so I can go home!

0:43:080:43:10

Morning.

0:43:140:43:16

Today, Dr Saltissi, one of the most respected consultants

0:43:160:43:20

at Liverpool Royal, has a front-row seat.

0:43:200:43:23

Tom will have to speak for ten minutes.

0:43:230:43:26

Thanks for coming. This is my case presentation

0:43:260:43:29

with kind of teaching notes on permanent pacemakers,

0:43:290:43:33

and I've entitled it Keeping The Pace Up,

0:43:330:43:35

and it's even more of a pun, as you'll see during the presentation.

0:43:350:43:39

The primary role of the pacemaker is to basically maintain a heart rate

0:43:390:43:43

which is adequate for function.

0:43:430:43:46

This is a case I saw - a patient who came in with chest pain.

0:43:460:43:50

He was 69 years old, usually fit and healthy, he's a runner. He hill-climbs as well.

0:43:500:43:54

But the grilling Tom was dreading starts almost immediately.

0:43:540:43:59

Before you go on any further, is there any association

0:43:590:44:01

between somebody who is a hill runner and an athlete

0:44:010:44:05

and a diagnosis of sinoatrial disorder?

0:44:050:44:09

If you're really athletic, you can get carotid hypersensitivity,

0:44:130:44:16

which can decrease the heart rate.

0:44:160:44:18

-Right, sorry, on you go.

-This is the ECG just pre-pacemaker insertion.

0:44:210:44:26

It's obviously...er, areg... irregular.

0:44:260:44:29

Yeah, it's the irre...irreg... Ugh! The irregularity of it.

0:44:290:44:33

I'm trying to think... HE MUMBLES

0:44:330:44:36

Well, there's not a lot abnormal there, is there?

0:44:390:44:41

It's basically a sinus bradycardia with a supraventricular ectopic beat there,

0:44:410:44:46

and you've got partial right bundle branch block,

0:44:460:44:49

you've got a slight fragmentation of the complexes,

0:44:490:44:52

but I don't see anything else on there, unless anybody else can see anything?

0:44:520:44:56

What are the sort of mechanical things that can go wrong?

0:44:560:44:59

What about the lead itself? I mean, will it always stay where it is?

0:44:590:45:02

-Erm...

-Well, in pericarditis, what sound do you get?

0:45:020:45:05

Just trying to think. I don't know.

0:45:050:45:07

-Did you read up about pacemaker syndrome?

-No.

0:45:070:45:10

-What are you going to be doing tonight?

-Reading up about pacemaker syndrome!

0:45:100:45:14

Can Tom pull it back in the closing minutes?

0:45:160:45:20

So what's your take-home message from this particular case?

0:45:200:45:23

Erm, in terms of...

0:45:230:45:25

OK, so indications for pacing, for bradycardia,

0:45:250:45:28

symptomatic bradycardia, is where the symptoms correlate with the bradycardic episode itself.

0:45:280:45:32

Usually transvenous will be the next option - again, a temporary option.

0:45:320:45:36

The pacemaker's outside of the body but the electrodes are put through the veins to pace the heart.

0:45:360:45:40

And, finally, permanent pacing.

0:45:400:45:42

-Thank you. It was a good presentation.

-Thank you.

0:45:420:45:44

You brought up some interesting points and stimulated our discussion.

0:45:440:45:48

-Thanks very much.

-Thank you.

0:45:480:45:49

He needs to speak more slowly.

0:45:560:45:58

He needs to project his voice better.

0:45:580:46:01

There were some important areas in there that he didn't really grasp.

0:46:010:46:04

I was really nervous and I think that one of the problems I have

0:46:040:46:07

when I'm really nervous is I end up speaking really, really quickly,

0:46:070:46:10

and I felt myself doing it at times and I tried to slow down.

0:46:100:46:13

You survived!

0:46:130:46:14

Obviously, there are quite a few things in there

0:46:140:46:17

that one would want to improve upon.

0:46:170:46:19

And he will improve as time goes by. But he's junior, this was one of his first presentations.

0:46:190:46:23

I think he did reasonably well. I think he can be pleased with that.

0:46:230:46:27

It's the end of another busy week for the junior doctors,

0:46:310:46:34

and the day of Jen and Emily's joint birthday party.

0:46:340:46:38

-I'm going to wear a dress that I bought.

-Mmm!

0:46:380:46:41

And sparkly shoes!

0:46:410:46:42

And it's time off from playing the part of a professional.

0:46:450:46:48

I've had enough!

0:46:550:46:57

LAUGHTER

0:46:570:46:59

Let's decorate!

0:47:000:47:02

Hold this up while I blow.

0:47:020:47:03

I think it's really important to have a life outside medicine.

0:47:070:47:11

It's very easy to get sucked in to the role of, "I am a doctor 24/7."

0:47:110:47:15

Oh, that's nice.

0:47:150:47:16

-Ooh, that's quite strong.

-It's not that strong.

0:47:160:47:20

Booze!

0:47:200:47:21

-Feel like a witch.

-That's really...

0:47:210:47:24

I really quite like that.

0:47:250:47:27

One person who will miss out on the party is second year Kiera.

0:47:340:47:38

She's back on nights in the emergency department.

0:47:400:47:44

Hello, there. Hello. Mr Mitchell?

0:47:440:47:47

Kiera's senior, consultant Kate Clark, has asked her to deal with

0:47:510:47:56

an urgent case of a man who's been admitted with chest pains.

0:47:560:47:59

It's much more likely to be some, you know,

0:48:010:48:04

lung-related type of pain than anything else.

0:48:040:48:08

So do a gas, get his ECG and chest X-ray done.

0:48:080:48:11

-And then we're going to see whether or not he needs a D-dimer.

-Lovely.

0:48:110:48:14

Will do, that's great. Thank you.

0:48:140:48:17

Junior doctors in their second year are expected to be able

0:48:170:48:20

to diagnose patients.

0:48:200:48:22

So what's brought you in today?

0:48:220:48:25

Every time I breathe, I'm getting pains up here.

0:48:250:48:27

-Pains there?

-At the back.

0:48:270:48:30

-OK, and no pain at the front of the chest?

-No.

0:48:300:48:33

OK, fine. How long that been going on for?

0:48:330:48:36

All day today, since I got up this morning.

0:48:360:48:39

-If you take a big breath in, does that hurt?

-Yes.

-OK.

0:48:390:48:42

Have you ever had anything like this in the past before?

0:48:420:48:45

-Only when I had a blood clot in me lung.

-OK.

-That was the only time.

0:48:450:48:48

And what caused that?

0:48:480:48:50

Pneumonia.

0:48:500:48:51

Kiera will need to investigate further,

0:48:510:48:54

as clots on the lungs can be fatal.

0:48:540:48:56

-See you in a bit, sir.

-OK.

0:48:560:48:59

A 42-year-old gentleman whose past history...

0:48:590:49:03

He's had a clot on his lung.

0:49:030:49:05

He's come in with a pain that he describes as worse when he breathes in.

0:49:050:49:10

That's a typical pain you expect with people who have perhaps a clot on the lung.

0:49:100:49:14

That's the most important thing to rule out

0:49:140:49:16

because, obviously, it's quite a serious thing if he does have that.

0:49:160:49:19

Certainly, I'm concerned enough that I want to rule this out,

0:49:190:49:23

because if we miss it, then it's quite a big thing to miss.

0:49:230:49:26

How are you doing?

0:49:260:49:28

We're going to keep you in to do a scan just to check that it's not...

0:49:280:49:33

-Overnight, or...?

-It'll be overnight, yeah.

0:49:330:49:36

-As we wait for the scan.

-Can't I have the...?

0:49:360:49:39

Can't they just discharge me till tomorrow?

0:49:390:49:43

-I'm thinking of me mother, you see.

-Yeah.

0:49:430:49:46

-Have you got anyone else at home who can look after your mother?

-Not at the moment, no.

0:49:460:49:49

I'd be very unhappy about you going, really.

0:49:490:49:52

I could...try and arrange something. I don't know, you see.

0:49:520:49:57

Well, I tell you what,

0:49:570:49:59

let me take your bloods and get your chest X-ray under way

0:49:590:50:03

and we'll have a little discussion about what we'll do after that.

0:50:030:50:06

Have a little think about what you can do. OK?

0:50:060:50:09

-What's up?

-Er...

-You look a bit worried.

0:50:090:50:13

Erm... I just don't like needles.

0:50:130:50:15

-You don't like needles?

-No.

0:50:150:50:16

-OK. You know that's probably what we're going to have to come and do now?

-Yeah.

0:50:160:50:22

OK, I'll be very gentle with you.

0:50:220:50:24

Every junior doctor must learn how to handle nervous patients

0:50:240:50:27

and Kiera's about to be tested.

0:50:270:50:29

I'd use a smaller needle than most, so...

0:50:290:50:33

SHE CHUCKLES

0:50:330:50:35

Every doctor says the same.

0:50:400:50:42

-What's that?

-"Only a little scratch."

0:50:420:50:45

That's it. That's the worst of it done now.

0:50:530:50:56

Well done.

0:50:560:50:57

-You all right?

-Yeah.

0:50:570:51:00

-Wasn't too bad, was it?

-No.

0:51:000:51:03

-Just like eating a bag of chips.

-SHE CHUCKLES

0:51:030:51:06

Kiera needs to act quickly to complete taking all

0:51:060:51:10

the samples she needs.

0:51:100:51:12

OK, again, sharp scratch coming up.

0:51:120:51:15

But as the patient gets increasingly anxious, she's under pressure.

0:51:200:51:25

Sorry.

0:51:290:51:31

Nearly done.

0:51:320:51:33

Sorry.

0:51:440:51:45

Struggling to get it on you.

0:51:470:51:49

Let's have a little breather for a bit.

0:51:520:51:54

HE MURMURS

0:51:540:51:56

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

0:52:010:52:04

You must have deep ones.

0:52:040:52:06

It's crucial she completes the tests.

0:52:060:52:08

But can she persuade the patient to keep the faith?

0:52:080:52:11

Do you want me to have a go on the other arm?

0:52:110:52:14

No.

0:52:140:52:15

Take a breather.

0:52:160:52:18

-Oh, just keep on going.

-Yeah?

-Yeah.

-OK.

0:52:210:52:24

Sorry about that.

0:52:240:52:26

What do you reckon, this arm or the other one?

0:52:300:52:33

Don't know.

0:52:330:52:35

Take your pick.

0:52:350:52:36

Finally, success, as Kiera eventually manages

0:52:360:52:39

to get the vital blood sample from the reluctant patient.

0:52:390:52:43

All done. Right, press really hard on there for me

0:52:430:52:46

for about five minutes. Really, really hard.

0:52:460:52:49

Hard as you can. Well done.

0:52:490:52:50

Sorry about that.

0:52:520:52:53

Glad to see the back of me, eh?

0:52:530:52:55

Oh, it's just the needles. I really don't like needles.

0:52:550:52:58

Hopefully that's it now. All right.

0:52:580:53:00

If someone is scared of needles,

0:53:000:53:02

it's weighing up the risks versus benefits of them

0:53:020:53:05

having the injection or the blood test.

0:53:050:53:08

And he's absolutely got to have the blood test,

0:53:080:53:10

because if it is what we think it is,

0:53:100:53:12

then he potentially could be very poorly.

0:53:120:53:14

An hour later, with the test results complete,

0:53:160:53:19

Kiera's diagnostic hunch seems to be correct.

0:53:190:53:22

It's probably most likely that he has actually got a clot on the lungs,

0:53:220:53:26

so we've given him the treatment for that.

0:53:260:53:28

There was discussion with him as to whether he's going to stay in,

0:53:280:53:31

but he's chosen the sensible option and arranged for someone to look after his mum,

0:53:310:53:35

so he will stay in tonight, which I'm glad about!

0:53:350:53:37

There is quite a big difference between first year

0:53:390:53:42

and second year. I would say maybe the big thing

0:53:420:53:45

is there's quite a large step up in responsibility

0:53:450:53:48

and there's quite a lot more expected of you.

0:53:480:53:51

I feel as though I have the responsibility for taking

0:53:510:53:54

a lot of decisions, and it's quite a scary thing,

0:53:540:53:56

so, yeah, I do feel like a proper doctor!

0:53:560:54:00

While Kiera's embracing her inner medic,

0:54:040:54:07

the rest of the junior doctors are happy to finally

0:54:070:54:10

let their hair down at Emily and Jen's joint birthday bash.

0:54:100:54:13

We've decorated the house now. Just getting my clothes ready.

0:54:130:54:17

I've got my most eclectic shirt on for our tropical theme party.

0:54:170:54:21

Yeah, all we need now is the... the hordes!

0:54:210:54:25

Do you feel old now you're 25?

0:54:300:54:31

I actually feel younger. I was thinking about this.

0:54:310:54:34

When you're in med school, I think it was partly that that made me feel really old, like,

0:54:340:54:38

getting older in the year. Now we're, like, junior doctors...

0:54:380:54:40

-You actually feel younger.

-I feel younger. Because I'm just walking

0:54:400:54:44

around the ward like, "I know nothing!"

0:54:440:54:45

I know what you mean, but then you think, "God Almighty, 25."

0:54:450:54:49

That's like slap bang in the middle of your 20s.

0:54:490:54:53

Before we know it, it'll be 30.

0:54:530:54:56

It is weird, though, when you think about how long ago we were starting work, like, six weeks ago,

0:54:570:55:03

how different we were back then to now.

0:55:030:55:06

ALL: Happy birthday!

0:55:180:55:21

-Quarter of a century.

-Oh, shut up!

0:55:210:55:23

I don't really think we reflect our home personalities when we're at work.

0:55:270:55:30

We have to focus on our job.

0:55:300:55:31

We all love to have a laugh and giggle and be silly.

0:55:330:55:36

Next week on Junior Doctors...

0:55:470:55:48

Bloody towel. It's Tom's shit everywhere.

0:55:480:55:52

..long hours on the wards

0:55:520:55:54

are starting to impact on lives outside the hospital.

0:55:540:55:57

To be honest, I think Lottie's suffering a little bit

0:55:570:56:00

because I'm not around.

0:56:000:56:01

She just seems a little bit more anxious.

0:56:010:56:04

Any pain up here? Sorry.

0:56:040:56:06

Kiera's powers of persuasion are put to the test in the emergency department.

0:56:060:56:10

-Just need to...

-Can you just put it down for us, please?!

0:56:100:56:13

It's exam nerves for Ed when he goes on an advanced life saver course.

0:56:130:56:18

Charlie? Hello. Can you hear me?

0:56:180:56:20

This is the final exam. I'm just hoping for a decent scenario -

0:56:200:56:24

not fail miserably, murder my patient and end my career.

0:56:240:56:28

Come on, taxi.

0:56:280:56:31

And Oli faces one of the toughest exams a junior doctor can do.

0:56:310:56:36

The book I'm revising from, it feels like it is that big sometimes.

0:56:360:56:39

There's so much, I don't even know where to begin.

0:56:390:56:41

I've got a lot to try and fit into my head.

0:56:410:56:44

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0:57:000:57:03

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