Work/Life Balance Junior Doctors: Your Life in Their Hands

This programme contains some strong language.

-Trauma...

-She's got a strong pulse.

-..tears...

-It's emotional.

-That's all right.

-..and intense pressure.

EQUIPMENT BEEPS Switching the oxygen over.

Just another day on medicine's front line.

They're young,

they're untested...

This is my first patient ever.

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

-Don't let me die.

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

For a junior doctor fresh out of medical school,

it's time to put theory into practice.

No, I haven't.

We're following seven junior doctors

over their first three months on the job...

-Sharp scratch.

-Ooh!

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

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

Aargh!

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

..and first impressions count.

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

First-years Tom, Emily, Jen, Tristan and Ed

have been on the wards now for six weeks.

OK? Yes.

Squeeze for me.

Second-years Kiera and Oli have 12 months' experience.

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

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

Hey, they're here to look after you, lad.

..where they're now starting to find that becoming a junior doctor

means making big sacrifices in their personal lives.

This has been one of the hardest points, even in our relationship.

I've been absolutely shattered cos I've been going to work every day

and going out every night, seeing my friends.

I feel like I need to start turning stuff down

and actually go to bed on time.

We've just got to get used to this new way of life. Make the best of it.

Since graduating from medical school

and beginning their careers in a busy hospital,

the junior doctors are finding that life is getting harder.

Six weeks in and the demands of being fully fledged doctors

are beginning to catch up with them.

I feel like I am just living in the hospital at the minute.

Stuff like doing the washing up, changing my bedsheets

and just stupid things like that just get completely thrown out

of the window, and I just feel like I need to sort my life out.

Long hours on the wards mean that achieving a work-life balance

is becoming increasingly tricky.

And in the house that some of them share, it's starting to show.

Tom's room is a shit tip.

Oh, my God, it really is so messy.

Half of Tom's dirty washing is in the gym.

Tom's room is pretty messy.

Dirty socks.

My room is pretty messy.

Dirty shirt.

I think if it was down to us to do the house,

it would be disgusting.

Dirty pants. Pyjama bottoms. And a jumper.

It has been really hard doing 12 hour days and working weekends

and things like that, and you just get really overwhelmed.

This bloody towel. It's Tom's shit everywhere.

The junior doctors may be struggling to look after themselves but at

the hospital, there's no shortage of patients who need their attention.

Is that for the same person or is that for a different person?

Different person.

It's early morning on the colorectal ward

and Emily is aiming to impress after being given a task

most junior doctors find notoriously tricky.

I'm just going to take it out for you.

It just might feel a bit uncomfortable.

If you want, you can cough.

One of her patients needs a new nasal tube after problems swallowing

meant his last one had to come out.

-Thank you.

-Right, then. Let's have a measure.

The tube will run up through the patient's nose

and all the way down into his stomach.

'It's not a painful procedure.'

It's uncomfortable having somebody put a tube up your nose but

he is a really nice gentleman and he knows why he needs it

so I don't think it's going to be too traumatic.

Emily may appear laidback about inserting a nasal tube but, on

a recent nightshift, Jen discovered it was anything but straightforward.

Aargh!

So, what we will do, once we have got you a pillow

and got you nice and comfy,

we'll get you to hold a bit of water in your mouth

and then this is going to go up your right nostril and then, when it is

sort of at the back of your throat, I'll just ask you to swallow.

-And then it will pop down into your belly.

-Just like that.

-Just easy.

Just like that. All right, then.

Emily is being supervised by registrar Femi Oshin

because the procedure can carry risks.

-He needs a bit of time to swallow.

-OK. All right, then?

So, pop your head a bit down towards your chest for me.

-That's lovely. You ready?

-Mm-hm.

OK, and swallow. Swallow.

Keep swallowing.

When you hit a bit of resistance,

you're hitting the back of the throat.

OK, keep swallowing.

It's possible the tube may enter the lungs rather than the stomach,

so it's crucial that Emily gets it right.

And a bit more. And swallow.

-Fantastic.

-Excellent. Well done.

And again.

It will take an X-ray of the man's chest to reveal

whether Emily has successfully reached the right target.

So, this is his chest X-ray

and this line here is the tube going into the tummy.

So, before, it was around here,

so I put it in a couple more centimetres so it is here.

Yeah, I am happy with that so I can go and get the nurse

and he can start getting fed.

Emily has got the difficult procedure right first time

and the improvement for her patient is immediate.

Oh, yeah. I couldn't do that before.

-Job done.

-Thank you.

-Thank you very much.

-Thank you.

-Well done, Emily.

-Thank you.

Yes, I think she did a very good job. She did very well. yeah.

-Are you going to come and help do breakfast?

-No, thank you.

No, thank you?

As if life as a junior doctor isn't demanding enough,

for first-year Tristan, it's even more of a challenge.

Lottie, are you going to have Lottie-brek for breakfast?

< Lottie-brek?

As father to toddler Lottie, he needs to juggle his role as a doctor

each day with his one as a dad.

'Obviously, I have to get myself ready

'and then also Lottie will need nappy changing, clothes changing.

'She will probably want to play with something or do

'something in the morning to keep herself entertained or

'sometimes she is running around my legs as I try to do her breakfast.

'Oh, and then there is feeding her breakfast and making our breakfast.'

Lottie, here is your breakfast.

So, yeah, it adds a lot more little steps,

but you just build it into your routine.

Tristan's life is about to become even harder over the next few weeks.

After dropping Lottie at nursery, he's off to the hospital.

He's volunteered to do extra shifts on top of his normal hours

and will also be working the next two weekends.

'I'm on call this weekend.

'It's Friday morning so I'm doing my day job today until five

'and then five till ten, I'll be on call,

'and then nine till ten Saturday, nine till ten Sunday

'and then back in work on Monday.

'Yeah, it should be quite a long one.'

But that's OK. It's what I signed up for.

With a young family to support, Tristan has good reason

for signing up for all the extra work.

I think it is safe to say that we are in a lot of debt, in terms

of the fact that we have got not one student loan but two each.

So I am looking forward to pay day.

It's going to be nice to start chipping away at the debt.

'I feel really happy that I will be earning money that will help

'sustain Jenna and Lottie, my wife and my daughter.'

I think that's like a real privilege.

It makes me feel good that I'll be allowing them

to live the life that they would like to, comfortably.

Day one of his long run of shifts

and he's straight into the thick of it.

BEEPING

Just got a crash bleep.

Being on call means that he can be bleeped to attend

emergencies in other parts of the hospital at any time.

Said to go to A&E Resus urgently.

Day two and there are also procedures

on his own ward of gerontology which need doing.

Is it OK if I take this canula out?

Sorry, I'm just going to take the dressing off. OK?

-Hi, Marge.

-What would you like to talk about?

I just wanted to get an update of what has been going on.

Marjorie is in the hospital after losing feeling in her hands.

-As you said, you've been having these problems with your arms.

-Yes.

We did the scan of your neck

and there is a little bit of narrowing in your spine at the top.

So you have your vertebra,

which are the bones that make up your spine,

and at one or two levels, the nerves that are coming out

and the cord are slightly compressed where they shouldn't be.

But we will talk to the neurologist and neurosurgeons, like I said,

-and get it sorted. Is that OK?

-That's good news. Yes, thank you.

Right, well, I'll see you later and give you an update. See you later.

Tristan's plain-talking manner is proving to be popular with patients.

Tristan puts everything easily...

in words, you know, that you understand.

And all the time he is talking to you, he is also holding your hand.

You know, you feel at ease. He's lovely. He really is lovely. Yeah.

I love him to bits.

Over in the Acute Medical Unit, Ed is also looking to make

a good impression on his patients.

Hello.

An elderly man is having trouble breathing and it's the Italian

medic's job to take a sample of fluid surrounding his lungs.

Use this side because there is more space here.

This patient has got a particularly large collection

of fluid in the pleural space.

So, all this black stuff...

-Is fluid.

-..is fluid, yeah.

And the top is towards the skin.

'I'm going to do it and I have an

'excellent mentor who will help me out, so I'm sure it will be OK

'and it will be an excellent learning opportunity.'

The untested doctor will need to be precise

if he's to avoid puncturing the patient's lung.

There is still air in there. There we go.

So, you're going to have a little stab.

There you go.

-OK, sir?

-Yes. You can come again, you can.

Ed's patient is responding well to his positive approach

but after giving him a local anaesthetic, the junior doctor

must now use a much larger needle to finish the job.

Just go straight in, slightly inclined. You need to do that.

Yeah, straight in. Very good. Keep sucking as you're going in. OK, yeah.

Is it OK, sir?

Obviously, if there was a bigger needle...

Keep the pressure there.

I want you to take the syringe off.

As you take the syringe off, I want you to put your thumb on the needle.

OK.

That's lovely. That's fine.

Could you please make a humming noise, sir?

-HE HUMS

-That's lovely.

The procedure has been a success for both patient and junior doctor.

OK, sir, we can position you back. Was that all right?

-That was fine, thank you.

-OK, that's good.

Ed has managed to extract two full syringes of fluid

and leaves behind one satisfied patient.

I thought he was excellent. I told him so, didn't I?

He was excellent. They've got to learn.

If they don't learn, they're never going to be able to do the job

and we've all got to learn, whatever we're doing, haven't we?

It's been a productive day for Ed.

But all the hours he's been spending in the hospital means

that his home life with girlfriend Martina has been put on hold.

I think that with any job, it is very difficult to strike

a good balance between home and work, but this is fine. I mean,

this is my job, so that's the priority.

As a couple, we are missing, of course, the routine

we were having in Italy.

We have just got to get used to this new way of life.

Make the best of it.

He spends the majority of his time in the hospital

and when he is not in the hospital he is sat in his studio, typing,

thinking, studying, doing courses and tests.

My lullaby is the click, click, click of the computer.

Click, click, click, click...

So that is just explanatory on how hard he works and sometimes I just

look at the clock and it's 1am and I am like,

"Edward, what the...? I mean, come to bed."

Tonight, Ed has the chance to make it up to Martina.

With a relatively early finish at the hospital,

he's taking her for a curry.

We never have a meal out.

Never have a meal out so, yes, we are happy

and we are really looking forward

even to just spend some time,

the two of us, in a different setting. It's nice.

It's things that a couple might like to do.

With Martina spending so little time with Ed lately, tonight gives

her the chance to find out how he's coping with life at the hospital.

How do you find the new ward? People?

Do you think you're getting around the system now?

Do you think you're getting better, understanding how things work?

Well, I mean, the system itself is much more understandable to me.

Do you think you're doing things that are up your street

and you are able to do them? Or are they too easy, too difficult?

No, they are fine.

I wish I had a bit more time to see new patients

and a little bit of time to read up on what to do if I don't know.

I mean, do you still get the feedback you had asked...from supervisors?

People tell me if I do something wrong.

-Do you like the people you're working with?

-Oh, yeah, the team is great.

-I really like it.

-That's very good, you know.

I think I, basically, didn't encounter anybody

in the Acute Medicine Unit

-that I disliked or did not get on with.

-Really?

That is so good, Edward. To a bright career for both of us.

And some peace.

It's the beginning of a new day in the hospital and one of Britain's

busiest emergency departments is already full to capacity.

Second-year Kiera is dealing with Barry,

a patient who's come in to the department with severe leg pain.

The green man was on the traffic light and I walked across the road

but the car came up, and he mustn't have seen me and he just hit me.

Do you know what sort of speed it was that he hit you at?

And he hit you from this side, did he?

Barry was able to walk away from the accident

but a few hours later, he began to feel the full effects.

This has blown up, has it, since?

Do you want to swing your leg up onto the bed for me?

I need to have a little look at it.

Do you usually walk with a crutch or do you walk normally?

I just normally walk normally, like.

Right, you have got a big swelling of it. Are you all right?

Are you happy for me to have a little feel of it or would you rather

-have some more painkillers first?

-If you like.

-Right.

Can you bend it up for me? Just gently. Really sore?

Yeah. I'll bet. How far can you bend it up?

That's it? Yeah. OK.

I won't poke too much if you're sore.

Any pain up here? Sorry.

-It's really sore, isn't it?

-Honest to God, it's fucking killing.

With Barry in obvious pain, Kiera has a decision to make -

push on or put the examination on hold?

His knee is really, really painful and quite swollen at the moment

so I'm just going to give him a few more painkillers

before I examine it any further.

It is still quite a strong pain reaction from him

and it's a bit mean to poke or prod it any more.

It's a dilemma that all junior doctors must get to grips with -

knowing when to treat a patient and when to give them space.

Unfortunately for Barry, his time out is coming to an end.

I can't see any fractures within the femur.

There is nothing broken on the X-ray, which is good.

But that doesn't mean that you haven't damaged something else.

With the painkillers kicking in,

it's time for Kiera to finish what she started.

That is hurting, that, man.

Can I sit on your foot?

Are you having a laugh?

Fucking hell!

-I just need to...

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

Barry, I just need to really gently examine something, OK? I'll be quick.

Well done.

Any pain around here?

It's a good job I don't hit women, you know.

You wouldn't be able to catch me, mate.

Though no bones are broken, Kiera believes Barry may have

damaged his ligaments and will need further treatment.

But for now, a splint should allow him to go home.

You're like Cinderella, aren't you? A glass slipper.

That's enough of that, thank you very much, young man.

Grateful to the second-year junior doctor for all her help,

Barry's keen that other patients also show their appreciation.

SHOUTING

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

He will come back in to see

one of our orthopaedic specialists next week.

And they will order whatever tests and stuff are necessary

and give him advice from there. He was a bit of a character, bless him.

Those doctors are here to treat you. Treat them with respect, kid.

Dealing with seriously ill patients is an everyday occurrence

for staff in the busy emergency room.

This is medicine on the frontline.

Alcohol and drug cases are the norm and new doctors must adapt quickly.

-How much do you usually drink?

-About eight or nine...

Is that in a day?

-OK.

-A day, yeah.

In terms of what drugs you took, do you remember?

Were they tablets, were they liquid? Do you remember anything?

The newest recruit to this busy department is Carol,

a second-year medic from Malawi.

He is alert, he is comfortable but he's definitely jaundiced.

She's hoping to fill the gap left by Ed after

he was dropped down a year and moved to the Acute Medical Unit.

What do we call that? It is a semilunar shape.

-What do we call them now?

-In English?

-In English.

-Yeah, it begins with an M.

-Yeah.

-No.

-The meniscus.

-meniscus, yeah.

Carol's on a trial run after moving to the UK

to be with her husband, a consultant at the hospital.

Can you just put them... Hold them out? Let's have a look.

She's only observing

but she's already had an eye-opening introduction to the department.

I have never seen a patient who has overdosed with drugs

before in Malawi.

The most I've seen is just alcohol intoxication,

but not recreational drugs, so this is very new, very different.

One of Carol's first patients

is a man who has a history of heavy drinking.

Can you tell me a little bit more about the blood in the stools?

-Have you been vomiting at all? Have you been vomiting any...?

-No, no.

That's stopped. I used to vomit all the time. I'm on...

He's come into the emergency room

because he's bleeding from his bottom.

Is this the first time it happened, this problem,

where you're bleeding from the back passage? Any fevers?

Carol needs to find out more about his symptoms

but he has a complicated medical history.

Any tummy pain?

I've been eating more... and it seems to be just stuck.

OK.

No cough, no chest pain?

-Yeah, I've got quite a cough at the moment.

-OK.

But, then again, I've been smoking the last few weeks.

And no headaches?

I've packed in smoking. Very bad headaches. I am on Propranolol.

Mr Gribbin, you said you had a similar episode last week.

Sorry, what it is, one of the tablets I am on...

OK, I will move a bit closer. Can you hear me OK now?

It's making me go a bit like my ears are full of water.

How much do you drink?

At the moment, I am probably on about a litre,

-half a litre a day. I was on three or four.

-Of what?

Well, cider, beer.

At least 5 to 7%. But I have stopped spirits.

I haven't had spirits since...

So you just take beer. Is that one to half a litre in a day?

In a day, normally. It takes the edge off the tablets.

-OK. Do you work?

-No.

God, no.

-I wish I did, obviously. But at the moment, no.

-OK.

As part of Carol's trial period, senior consultant Dr Jaffe

wants to test her on what she's concluded about the patient.

..necrotising pancreatitis.

I suspect, because of his history of alcohol, it is probably a virus.

Yeah. What do we call that?

-Haemorrhoids.

-Haemorrhoids.

First-degree, second-degree, third-degree haemorrhoids.

So, he has got piles, which are bleeding because his poo's hard.

-OK.

-Is that right?

-Most likely.

-Most likely. Go and see him?

-Yeah.

With a potential future in the hospital, Carol heads to the house

after her shift to find out what she's letting herself in for.

-Hi, welcome.

-It's Tom, is it?

-It is. Nice to meet you. How's it going?

-Nice to meet you too.

-Come in. Oli's just in the room on the right.

Just the kitchen.

It's an opportunity to meet the other junior doctors

and get the lowdown on life in Liverpool.

-Hi.

-This is Carol. Carol, Emily.

-Hello, Emily. Nice to meet you.

It's also a chance for the doctors to find out

what it's like being a medic in Malawi.

Is it completely different in Malawi?

Gosh, yes, it is very different. It is so different.

It's not like here, where you have got patient attendants,

you've got nursing staff, you've got registrars.

We are so thin on the ground.

Have you been here a lot, then? Been to the UK loads of times?

Yeah, I have visited about three or four times before eventually

-coming over.

-Presumably, Liverpool.

-Yes, yeah, yeah. Liverpool.

I've got my husband here.

So, has he moved over with you?

No, he has been here... Oh, very nice.

He has been living and working here for a while now.

-Is he a doctor too?

-Yeah.

-So, you know the area quite well, then?

-No. Getting used to it.

-We'll have to take you out...

-That would be great, yes.

-Get to see the Liverpool life.

-Yeah, that'd be really good.

Someone told me that Liverpool women,

they have to wear short skirts and have to have a man with

-a tattoo, and then you know they're from Liverpool. Is that true?

-Yes.

-Is that true?

-I'm not saying anything.

'Cardiac arrest Ward 5b. Urgent.'

See you later.

Tristan is in the middle of a demanding run of shifts.

Matt, can you put my bag in that locker room?

He's a young father to two-year-old Lottie, but being in the hospital so much

means he's spending little time at home.

The worst thing about the job so far, I think, is not seeing Lottie and Jenna as much as I'd like.

To be honest, I think Lottie is suffering a little bit because I'm not around.

She just seems a little bit more anxious, so I feel really bad about that.

In an effort to see more of his girls, he's invited them

to have a quick lunch with him in the doctors' mess.

-Boo!

-Oh look, there he is!

-Come on in!

Quick! Secret entrance. Hi. You OK?

-It's my daddy.

-Your daddy? You OK? Hello. Shall we go in?

-My rice cake.

-Your rice cake? There's pizza available and you're going for a rice cake.

You sure she's related to me?

I've really got to go, Jen.

-Will you be OK to...

-Give Daddy a kiss and a cuddle.

-See you.

-Shall we have a family squeeze? Ready, steady... Squidge.

-Squidge. See you.

It was really nice to see Jenna and Lottie. A nice break in the day.

It's been a bit difficult. You can definitely see it at home, sort of.

The dishes are piling up slightly higher each day.

-Hello again.

-Hello.

-I'm just going to pull the curtains round, if it's OK.

-I just need to ask you some questions.

-OK.

One of his favourite patients, Marjorie, has added to her problems

by slipping when she got out of bed in the hospital.

-You know you had that fall on Saturday?

-Yes.

-Um...

I don't know what happened. I don't remember falling.

I don't remember anything about it.

-OK.

-I only know now that I've got one breast bigger than the other.

It's all I know. And it's huge.

Tristan takes a look at an X-ray of Marjorie's chest,

and he's concerned at what he sees.

So this is the X-ray.

The darker areas here are the lungs and this should be...

the heart outline would be roughly there.

You should be able to see lung tissue all around.

But obviously, all of this is fluid.

And you can tell it's fluid because you have a meniscus,

the curving of the fluid coming round

the bottom of the lung there.

Um...just like you get in a glass of water.

This is very dangerous if it's not treated.

But it's the end of a long shift for Tristan

and he now has a decision to make.

He could hand the patient over to another doctor to treat,

or stay and see it through.

I don't think I'd be happy going home tonight,

having just sort of left the equivalent of a Post-It note

somewhere to make sure that she gets checked out, so I want to get the plan in place.

He decides to stay,

so he can take some sample fluid from the swollen area.

-It's going to be a sharp scratch, OK?

-OK.

Try and stay still as possible. Ready?

The needle coming out now. Well done.

Staying behind to help means that it's another late finish for Tristan.

I'm looking forward to going home and seeing Jenna and Lottie.

It's a bit later than I'd like so, you know,

I'm not going to see much of Lottie before she has to go to bed

but I have to make the most of it.

The junior doctors may no longer be in medical school,

but that doesn't mean they've seen the back of the classroom.

Today, Ed will be taking part in an advanced life-support course.

He's playing catch-up with the other first-year junior doctors,

who have already qualified to deal with emergency situations in the hospital.

If, today, I get my certificate for the advanced life-support course,

it shows that I've been qualified

and trained to give support to work in the team

that will take care of a patient during cardiac arrest.

I'm pretty excited about the day

because it's something that I've wanted to do for a long time

and I get the opportunity to do it today.

It's a milestone in my training. So, yes, it is an important day.

It's a necessary part of a doctor's training.

It just works towards being a better practitioner, I suppose.

OK, so I would ask Jack if he can hear me, so...

"Jack, can you hear me?"

GURGLING

-OK. So the airway is not clear.

-OK.

So the first thing I'm going to do is try...

The course will give him the qualification he needs to be part of the hospital crash team.

'I'm doing this course because I want to be

'competent in the unfortunate but not so unlikely

'situation of being called at the bed of an acutely ill patient.

'I just want to know what to do.'

Well, 75 could be his denture just fell off.

-Very often it comes back on. Can you see anything?

-I can't see anything.

Right, what else could be in there?

'I'll be able to bridge the time between the advanced team

'arrives and the first call for help is issued.' So, measure the...

-I'm always keeping the head tilted, because otherwise his airway...

-Excellent, yes.

Ed's only got a few hours of training before he'll be

given a tough exam, designed to test if he's ready to take on

the responsibility of dealing with emergency crash calls on the wards.

There is no pulse and there's no sign, OK?

'I'm feeling a bit nervous, of course.

'You're always a bit nervous before an examination, but I'm also looking forward to it very much.'

So, for the last time, you give 300, 300.

After some final revision, Ed's big moment has finally arrived.

This is the final exam, yes.

Let's hope in a decent scenario or I'll fail miserably and murder my patient and my career.

Ed's given a life-threatening scenario which

he might attend as part of the crash team.

And he's a 25-year-old young man with asthma

and he's become acutely short of breath.

OK. All right. Um...

Charlie, hello, can you hear me?

-So he's trying to talk to you but he's really struggling to get his breath.

-OK.

And he's stopped breathing and there's no palpable pulse.

OK, all right, so... this is a cardiac arrest.

-Could you please call the crash team and I will start the CPR.

-Yep.

-Thank you.

We need to do an immediate decompression and that would be a...

Yes, so tell me how you would do that.

Well, mid-clavicle line. Second intercostal space.

BEEPING

Everybody is clear. I'm going to give him a shock. OK.

OK, he's starting to breathe and he's got a palpable pulse.

-He's got a palpable pulse. OK.

-If you wouldn't mind stepping outside.

We'll call you back in very soon, so don't go anywhere.

It's an anxious few minutes while Ed waits for his test results.

Difficult. That was a difficult case.

I didn't do that very well, unfortunately.

We hadn't tried an asthma case earlier and they just are difficult.

-Right, congratulations.

-Oh, thank you.

You passed your crash test. We thought you did very well.

Positive feedback for you was that you asked for intubation

early on for your patient, so...

OK. That's good, thank you.

She just told me very simply that I'd got 88%, so that was pretty good and I'm happy.

Yeah. Very happy.

Ed's girlfriend Martina has arrived to celebrate the news that he

can now take his place alongside the other junior doctors

saving lives in the hospital.

That's very good. I'm very proud of him. Very happy.

Also being assessed this week is second-year Oli.

He's due to take the first part of a Royal College of Physicians diploma -

a qualification that will set him on the path to becoming a consultant.

But he's not feeling too confident.

It's a tricky one with this exam.

Because, like, previous exams, I've always sort of known that

I could probably pass it if I put in a certain amount of effort.

You just have to put in the extra effort to get a good result.

This is just a pass/fail exam and it's quite difficult to pass.

It's quite common for a lot of people to fail it maybe the first or second time.

If Oli fails, it won't just be his pride that's damaged.

Yeah, it costs 400 quid. This is one of three parts.

First part is £400, then I think it gets a little bit steeper each time.

So if I fail, that's sort of 400 quid down the drain,

which would be a disaster.

The exam may be playing on his mind

but Oli still has a list of patients to get through.

He's on the morning ward round with consultant Dr Dyack.

Had a dizzy episode yesterday morning about eight o'clock.

And she fell after going to the toilet. So let's go and talk to her.

-She's not hypoxic, particularly.

-These are actually all right.

92-year-old Lillian Harrison can't remember

anything about the fall she had yesterday.

Dr Dyack and Oli are concerned about her memory loss.

Mrs Harrison? My name is Dr Dyack. I'm one of the consultants.

This is Dr Harris. Did you have a fall yesterday?

-Not that I remember.

-Did you collapse?

-I'm in fine health.

-Good.

-Do you know where you are at the moment?

-Yes, the Royal.

-And what year is it?

-Oh...

I haven't the faintest idea. Is it...

I'm not going to tell lies. I don't know, to be quite honest.

-It's all right. It's 2012.

-Oh, yes.

OK, you ready? Going for a scan.

May see you on the way back.

Lillian will need a scan of her heart to determine the cause of the fall.

And is there an MSU result on that?

But when Dr Dyack and Oli get the results of some of the patient's

other tests, concerns are raised about a bigger problem.

It's one of the SHOs here from AMU.

We have a patient who is put in for a V/Q scan.

OK, great.

I saw that it been put through as a normal request but we want

to sort of change it to urgent.

When Lillian gets back to the ward,

Oli needs to test her mental faculties.

These are just silly questions.

If you could just play along with it and answer them as best as you can.

Can you repeat a sentence after me? "No ifs, ands or buts."

-No ifs, ands or buts.

-Very good, well done.

-Now can you take seven away from 100?

-93.

-Very good. OK.

What I'm going to get you to do, just follow a command.

So take the index finger from your right hand,

place it onto your nose and then onto your left ear.

-Perfect. Done.

-Yes.

-All right?

-I've enjoyed it.

I'll leave you in peace to get a bit of rest, OK?

She's a great character, yes. Not bad for 92.

Her memory may be slowly improving but when the scan results come back,

the doctors' fears are confirmed.

-She has a suspected blood clot on her lung.

-Lillian Harrison. V/Q.

-High probability.

-You're joking?

-No.

-Right. Glad we did that.

-Yes.

It's down to Oli to deliver the news.

You've had your scan.

-Yes.

-And the scan suggests that there may be a clot on your lungs.

-Yes.

OK? In all likelihood, you are going to be with us for a couple of days.

I know. It's not what you wanted to hear, is it?

If it's got to be, it's got to be.

It does have to be, unfortunately.

-It's no good doing half a job.

-I agree, yes.

-You're boss.

-OK, you're boss. Don't worry.

-Thanks for explaining it.

Yes, no worries. See you later, Lil.

OK. And there was me thinking I was going home for tonight. Never mind.

What has to be, will be.

She was a really lovely patient. And really good fun.

Definitely miss her on tomorrow's ward round.

She obviously brightened up a few people's day in there.

MRCP is, what, a third or something?

About a third of people pass MRCP, yes.

With Oli's shift over,

back at the house, the other junior doctors are quizzing him about

his Royal College of Physicians exam and its notoriously low pass rate.

How many hours of revision have you been doing a day?

Because you get some study leave, don't you?

I have been doing... I don't know. A few questions a day.

I've not been doing as long as I should do. Let's be honest.

Revising is boring and I hate it.

I would rather be doing a million other things.

I'd rather tidy my room. I'd rather cook for myself.

I'd rather clean my clothes.

I'd rather dust this house of cobwebs than revise.

-Were you like that in medical school?

-A bit of a last-minute man, yes.

If I just open the book and left it on my chest,

like that, it will probably get absorbed into me somehow.

I just hate it. There's nothing worse on earth than sitting down

and trying to read dry, dry books.

Do you not get, like, into it after you've started and you get going a bit?

No, not even a little bit.

It's nice to see yourself getting better, obviously.

But it is tedious and it is a slog.

It is boring, but you have to do it.

With only 24 hours to go until the exam, Oli is knuckling down

to some revision, powered by his own unique choice of fuel.

They're amazing when you come back after a night out.

When you're revising, you just sort of get urges.

You have to satisfy those urges, otherwise you can't revise.

It's a bit like... I think it's probably what being pregnant is like.

That's why I've got chocolate and pickled cucumbers and beer.

And then I can revise. Otherwise, it would be useless.

As both time and beer begin to run out, there's little more that

Oli can do before tomorrow's test.

Yeah, I think you get a standard feeling before all exams,

isn't it, when you think "Oh, I could have done a bit more."

If only I had revised this and this.

And your brain comes up with a million things you wish you'd had to look over, so...

best not to listen to that, though, because you're going to panic

and never sleep, and do even worse in the exam, so...

It's about 10.50 now, so I will go to bed fairly soon-ish.

Thing is, I get up really late, cos I'm lazy, when I'm revising,

so it means I won't be able to sleep very easily, so...

I don't know.

I will have to be a bit tired tomorrow but I'll be able to live with that.

After it's all done, that's it.

Clean clothes, I'll have a shower. I'll shave off the exam beard. I'll be a new man.

The next morning, and Oli's big day has finally arrived.

Come on, taxi.

The exam that he's sitting will last six hours.

While Oli sweats it out in the exam room, on the wards,

the other junior doctors are dealing with their own pressures.

On the colorectal ward, Emily's patient,

who she fitted a nasal tube to earlier in the week, has collapsed.

Staff who arrive on the scene first manage to get him

back into bed, but it's up to first-year Emily to try

and get to the bottom of why he fell.

-How are you feeling?

-Not so bad.

-Any weakness in your legs at all?

Do you feel like you can't move them at all? No? Good.

Would we be able to get a lying and standing blood pressure on him?

-Standing one as well?

-When he's feeling up to it.

-Are you all right?

-For what?

-Do you think you could stand up for a minute?

-Oh, yes. No problem.

Just so I can check your blood pressure.

He's just fallen over so we're just assessing him to make sure

there's nothing serious going on that could have caused his fall.

Emily has arranged for the patient to have an ECG

a test that will identify any problems he may have with his heart.

Are you all right? Marvellous.

The results are in, but will Emily understand them?

So an ECG is like a tracing of the electrical, um...

activity in your heart and I just find them really hard to understand.

If I show you one, like...

just working out what that means is just ridiculous.

Emily calls a senior doctor to discuss what

she thinks the ECG results mean.

I've got Mr Stanley's ECG.

Mr Stanley, who fell over.

He's got an irregular arrhythmia and I think he's in atrial flutter.

Yes.

Um...62.

But her senior thinks the results reveal something different.

Oh. What is it? I suppose you can't tell without seeing it.

Oh... I'm not sure. I can't really tell.

Emily has interpreted the results incorrectly.

For the junior doctor, it's another important lesson learnt on the job.

I thought he was in atrial flutter,

but he was actually in atrial fibrillation.

And James is really good.

He taught me the difference between the two so I know next time.

He's going to do some more teaching this afternoon.

Oli's exam is finally over, but he's unsure

whether his last-minute revision has done the trick.

It's difficult to say with that exam

whether the revision paid off,

because maybe three or four things that I revised over the past couple of days

actually came up and maybe that'll make the difference,

but otherwise, it was pot luck, really.

Oli can now head into town for some well-deserved time out.

And he's not the only one looking to escape

the pressures of life as a medic.

Tonight, Emily's getting in touch with her arty side at a life-drawing class.

I definitely really wanted to study art.

I've done, like, art courses most summers and when I was at uni,

I did lots of art.

This is the first time I've ever been able to do life drawing

since I started work, so it's really nice to get back into it.

I think that when you're life drawing,

there's a lot more focus on kind of lighting and shadow and line,

rather than kind of bones to be fixed or blood vessels to be severed, and things like that,

so it's completely different.

I have appalling knowledge of anatomy.

Don't ask me what any muscles are.

I think that I'm quite...

I kind of bring the emotional, creative side of me onto the wards, in a way,

because, I don't know, I'm more into the social side of medicine

than the scientific side of medicine.

I really enjoy patient interaction, kind of involving

patients in the decision-making rather than reading my textbooks,

so I think that you can definitely bring the two things together.

I don't think the two things are totally distinct.

It's been a welcome break from the wards,

but with a long shift in the morning, Emily is wondering

whether she's getting the balance right between work and play.

I really try to make sure that that side of work hasn't had

an impact on my social life, but I think

because of that, I've been absolutely shattered,

because I've been going to work every day,

then going out every night, seeing my friends

and doing different things every night, so I feel

I need to start turning stuff down and actually going to bed on time.

Oli's Royal College of Physicians exam results have been posted online this morning.

If he passes, he'll have taken another step towards moving up

the medical career ladder.

Fail, and he'll have spent £400 with nothing to show for it.

I passed.

No, I wasn't really expecting that.

When I came out the exam, I wasn't sure, so...

It's a relief, more than anything.

That is good. I'm happy. Not a waste of £400.

Tristan has been working hard to support his young family

by taking on extra shifts.

Today marks the end of a long stint, which has involved working

two weekends on top of his regular hours.

All sitting down? It might be a little bit tricky for them.

'It's been hard, especially when he's been getting home at about 11pm,'

so she'll see him for an hour in the morning and that's it, and when it comes to

dinner time and bedtime, she's kind of looking at me, like, where's Daddy? What's going on?

Daddy is going to take you to nursery and give you a big squeeze.

Daddy's at work and he's helping people and things like that.

It reminds me why he's doing it. He is doing it for us.

But obviously, at the end of the day, I'm really tired.

It's getting pretty difficult. I think this has been one of hardest points, even in our relationship.

But Jenna and Lottie still have one final shift to wait before he's back home.

OK? Right. Sorted.

In the hospital, the junior doctor is on a ward round

and finally has some good news to pass on to his patient, Marjorie.

Hi, Marge. Sorry to interrupt your tea.

I just wanted to let you know that that blood test we did,

it showed that the potassium, which is what we were most

-interested in, has come back to normal on its own.

-So I can go home?

Exactly. It can be this evening or tomorrow morning.

-Is that OK?

-Fine.

The swelling from her fall in the hospital has gone down

and her original problem of lost feeling in her hands has eased.

Going home is the news that she'd been hoping for

but it seems Marjorie will miss her favourite junior doctor.

Well, what can you say about Tristan? He's the doctor, isn't he? THE doctor.

I think he's smashing. I really do.

I think everybody feels the same way, as well.

He's lovely, isn't he?

I could take him home with me, couldn't I, really?

Marjorie's not the only one leaving the hospital.

It's been a long time coming but, at last, Tristan can finally head home

for a day off with Jenna and Lottie.

LOTTIE SQUEALS

-Lottie! Hey, can I have a cuddle?

-Give Daddy a cuddle.

-Do you want to be thrown in the air?

-Yes.

His long stint at the hospital has been a sharp reminder

of the demands that the job can place on a junior doctor.

I do feel like a few...

over the last couple of weeks,

a lot of the things that have been happening in Jenna and Lottie's life

have almost just been...

on this parallel track to mine that I can't quite sort of keep hold of,

so it's a bit of a shame in that regard.

I'm looking forward to, after this,

having a couple of days to really focus and spend time with them.

The junior doctors have made it to the end of another tough week in the hospital.

Most of them are meeting up at the house, and Tristan is bringing

Lottie and Jenna to see everyone for the first time.

Hello! Come in.

-And how old are you now?

-Three.

-No. Not quite three.

-This many. How many is that?

-Two.

-That's right.

We're having a party.

What a lovely party. Oh, wow! This is so nice to come to come home to.

So many nights, I just finish late.

Um... Awesome.

Nice to see you.

I don't know how you do it. I can barely feed myself.

I couldn't even imagine. I've eaten Doritos for tea.

And then I'm going to have a glass of wine later.

And in the mornings, I take her to nursery,

-but it's only a few minutes out of the day.

-I think it's like anything.

If you want it enough, you can do both.

I think I'm going to have to plough everything into my career

because that's what I have at the moment.

You know, because that's what I want to do at the moment, you know.

If I was, like, desperate to have a kid, I'd think of a different career path.

I do want to have kids at some point, but I'm not really bothered

-if it's somewhere in my 30s, to be an old mum.

-Daddy.

-Yes?

I want to adopt a baby. I don't like the idea of pregnancy.

We see what Tristan does because we do it too.

I do just think, "How?" I come home after a day, like, "Ugh!"

Every ounce of effort just melts into the sofa when you sit down.

But for you guys, you just carry on and you just keep it going. I...

I don't know. I don't know if I'd have it in me. I think it's amazing.

It sets us apart NOW

because we're just one of the few people who are juniors with kids,

but it's not like we're the only people in the world who have kids.

-It really hard but it's worth it.

-Can we have a baby?

-No.

Next week on Junior Doctors...

-I think that's "cardiology".

-I'm not used to this writing.

What they don't teach you in medical school...

I think the more senior you get, the worse your writing gets.

Sharp scratch.

A visitor to the Emergency Room puts Kiera's knowledge to the test.

Are you all right, sir? What's wrong there, sir?

Can be quite a potentially dangerous problem so we need to get onto it quite quickly and make sure he's OK.

Jen is hit hard by the loss of her first patient.

I'm not used to this kind of thing happening in my life every day, but I'm OK.

And an escaped prisoner causes chaos at the hospital.

So we believe that the convict is

still in the ventilation system.

I've never seen anything like this. This is bonkers, absolutely bonkers.

It's all kicking off out here.

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