0:00:02 > 0:00:04Trauma...
0:00:04 > 0:00:06- She's got a pulse, she's got a strong pulse.- Any pain up here?
0:00:06 > 0:00:07..tears...
0:00:07 > 0:00:09HE BREAKS DOWN
0:00:09 > 0:00:11..and intense pressure.
0:00:11 > 0:00:13Changing the oxygen over.
0:00:16 > 0:00:19Just another day on medicine's frontline.
0:00:21 > 0:00:23They're young.
0:00:23 > 0:00:24They're untested.
0:00:24 > 0:00:27This is my first patient ever.
0:00:27 > 0:00:31And from their very first day, work is a matter of life and death.
0:00:31 > 0:00:35- Don't let me die!- We're not going to let you go anywhere.
0:00:35 > 0:00:37For a junior doctor fresh out of medical school,
0:00:37 > 0:00:40it's time to put theory into practice.
0:00:42 > 0:00:44No, I haven't.
0:00:44 > 0:00:46We are following seven junior doctors
0:00:46 > 0:00:49over their first three months on the job...
0:00:49 > 0:00:51- Sharp scratch.- Ewww!
0:00:51 > 0:00:54It's all about the glamour. It's all about the bums.
0:00:56 > 0:00:59..where there is a first time for everything.
0:00:59 > 0:01:01I didn't really know what to do.
0:01:01 > 0:01:04It's having the confidence, isn't it?
0:01:04 > 0:01:06And first impressions count.
0:01:06 > 0:01:09I'm afraid I didn't get it first time, either.
0:01:12 > 0:01:14First-years Tom, Emily,
0:01:14 > 0:01:17Jen, Tristan, and Ed,
0:01:17 > 0:01:20have been on the wards for just two months.
0:01:20 > 0:01:22OK, and swallow.
0:01:22 > 0:01:24- Can I have a tap on your back?- Yes.
0:01:24 > 0:01:26Could you please make a humming noise.
0:01:26 > 0:01:32Second-years Ollie and Kiera have been in the job 12 months.
0:01:32 > 0:01:34When I press in here, is that sore?
0:01:34 > 0:01:37And now there's Malawian doctor, Carol,
0:01:37 > 0:01:41who is hoping to get a full-time position working in A&E.
0:01:41 > 0:01:43No cough, no chest pain?
0:01:44 > 0:01:48They're working here at the Royal Liverpool University Hospital.
0:01:49 > 0:01:53They're here to look after you, lad! Give it a rest.
0:01:53 > 0:01:55They're learning lots on the job
0:01:55 > 0:01:58but are realising there's plenty that medical school
0:01:58 > 0:02:00could never have prepared them for...
0:02:00 > 0:02:01I think that's cardiology.
0:02:01 > 0:02:03Your guess is as good as mine, I'm afraid.
0:02:03 > 0:02:06..and that dealing with the critically ill and dying
0:02:06 > 0:02:08is going to take its toll.
0:02:08 > 0:02:11I'm not used to this kind of thing, happening in my life everyday,
0:02:11 > 0:02:12but I'm OK.
0:02:32 > 0:02:37Late nights and long days are now a reality for all the junior doctors.
0:02:37 > 0:02:38With a million patients
0:02:38 > 0:02:42passing through the doors of the hospital every year,
0:02:42 > 0:02:44making it as a medic takes skill and stamina.
0:02:44 > 0:02:48We were warned before we became juniors
0:02:48 > 0:02:52that we'd be signing up for a few long stints.
0:02:56 > 0:02:58It's been a long night.
0:02:58 > 0:03:01I feel that I want to get home because I'm a bit tired.
0:03:01 > 0:03:03SHE YAWNS Sorry!
0:03:03 > 0:03:07I want to cry little bit, I'm so tired.
0:03:07 > 0:03:10For Emily, in particular, getting used to the long hours
0:03:10 > 0:03:14working around the clock has been an uphill struggle.
0:03:14 > 0:03:18So, lady on 8X just...
0:03:18 > 0:03:21YAWN OBSCURES SPEECH
0:03:21 > 0:03:24So, I just came to check on her.
0:03:24 > 0:03:26Oh, dear.
0:03:26 > 0:03:29BLEEPER ALERT
0:03:29 > 0:03:31Just put my toast on.
0:03:31 > 0:03:36The exhausted junior doctor has been working for 11 consecutive shifts.
0:03:36 > 0:03:37I'll set my alarm.
0:03:42 > 0:03:45Later today, she will be catching a train to her mum's
0:03:45 > 0:03:47for a much-needed break.
0:03:47 > 0:03:50So, she's hoping for a quiet Friday on the ward.
0:03:52 > 0:03:54But working in an inner-city hospital,
0:03:54 > 0:03:56you don't always get what you wish for.
0:04:04 > 0:04:06One of Emily's patients, a prisoner,
0:04:06 > 0:04:08has been admitted with a knife wound,
0:04:08 > 0:04:11but somehow he's slipped his prison guards.
0:04:12 > 0:04:15Very busy, not finished ward round yet, midday.
0:04:15 > 0:04:18One of our patients was stabbed, had a chest drain put in,
0:04:18 > 0:04:22he's ripped it out and he's on the roof and the police are here.
0:04:22 > 0:04:25So, we are waiting for him to get brought down so we can assess him.
0:04:25 > 0:04:26With the fugitive on the run,
0:04:26 > 0:04:31any chance of Emily making her train on time hangs in the balance.
0:04:31 > 0:04:33You don't get prisoners escaping off the ward every day
0:04:33 > 0:04:35and I am sure on a normal day
0:04:35 > 0:04:37it would be quite a novelty and exciting,
0:04:37 > 0:04:40but today I really need to get on.
0:04:45 > 0:04:49Word has spread quickly and excitement is near fever-pitch.
0:04:49 > 0:04:54We believe the convict is still in the ventilation system.
0:04:58 > 0:05:01I would be worried about him if I didn't have 60 other patients,
0:05:01 > 0:05:03so at the minute he is just annoying me.
0:05:06 > 0:05:10I've been reliably informed it's one of Emily's patients.
0:05:10 > 0:05:12Emily's patient?
0:05:12 > 0:05:13I don't think I'd ever seen a patient
0:05:13 > 0:05:15with that amount of security.
0:05:15 > 0:05:17I didn't think she was that bad a doctor!
0:05:17 > 0:05:20There's no need to jump out of the hospital.
0:05:21 > 0:05:23No patient is an inconvenience,
0:05:23 > 0:05:27but I think some are more challenging than others.
0:05:27 > 0:05:29With the end of her shift approaching,
0:05:29 > 0:05:30Emily has lots to get done
0:05:30 > 0:05:33if she is to leave on time and catch her train.
0:05:43 > 0:05:46There isn't a class on how to treat an escaped convict
0:05:46 > 0:05:47at medical school.
0:05:47 > 0:05:51Just like there isn't one on how to read a consultant's handwriting.
0:05:51 > 0:05:53How can I do this?
0:05:53 > 0:05:57Italian medic Ed has come up against this age-old problem
0:05:57 > 0:05:59and has turned to Ollie for help.
0:05:59 > 0:06:01Confusion, I think that's cardiology.
0:06:03 > 0:06:06I'm not used to this writing.
0:06:06 > 0:06:08So, it's a cardiology problem.
0:06:10 > 0:06:12- It's either cardiology or gerontology.- I don't know.
0:06:12 > 0:06:17- It could be gerontology, cardiology. - It could be any ology!
0:06:17 > 0:06:20Your guess is as good as mine, I'm afraid.
0:06:20 > 0:06:23We've all felt his pain, trying to decipher some ancient runes
0:06:23 > 0:06:26that have been scribbled across the page
0:06:26 > 0:06:28by some professor or consultant.
0:06:28 > 0:06:31I think the more senior you get, the worse your writing gets!
0:06:31 > 0:06:33Can you tell me something more about this?
0:06:33 > 0:06:37Ask Hannah.
0:06:37 > 0:06:41Yeah, because I just can't do this.
0:06:41 > 0:06:46I don't want to put through a random referral and follow-up with who?
0:06:46 > 0:06:48Giving up on the undecipherable notes,
0:06:48 > 0:06:51Ed has been tasked with the job of getting blood from a patient
0:06:51 > 0:06:54with weak veins and a serious phobia of needles.
0:06:57 > 0:07:00Is that OK if we can take some bloods from you?
0:07:00 > 0:07:04Yeah, I'm feeling around. Pump your hand a bit.
0:07:07 > 0:07:11Let's just have a look. I don't want to stab you many times.
0:07:12 > 0:07:16There's really not much here. I will have a look on this side as well,
0:07:16 > 0:07:18then we will just decide.
0:07:18 > 0:07:22Ed calls in some assistance to help calm the patient's nerves.
0:07:22 > 0:07:23Someone's already tried here.
0:07:27 > 0:07:31- I would say... - That looks like a vein.- Yeah.
0:07:33 > 0:07:36It's your best bet so far.
0:07:38 > 0:07:42There's absolutely nothing there. There's no blood at all.
0:07:42 > 0:07:46OK, we will try this one. Seems like there's something there.
0:07:48 > 0:07:50Just keep it nice and still.
0:07:50 > 0:07:52Ed is having no luck finding a vein.
0:07:52 > 0:07:55The patient is getting increasingly agitated.
0:07:55 > 0:08:01- Don't move this hand, please. Don't. Stop it.- Stop moving this hand.
0:08:01 > 0:08:04- Don't move it any more. - Just keep your hand still.
0:08:04 > 0:08:06Keep your hand still.
0:08:06 > 0:08:08Shall we have another go?
0:08:12 > 0:08:15Right, I'm going to try this one again. You must keep still.
0:08:15 > 0:08:17Otherwise the needle goes out.
0:08:21 > 0:08:25Nice and still, nice and still. Nearly done.
0:08:25 > 0:08:29- She moved around and it went out the other side.- Just relax.
0:08:33 > 0:08:38Nope, I'm sorry. There's no way I can get a cannular in there.
0:08:38 > 0:08:42If somebody else wants to try, but I definitely can't. I've looked.
0:08:44 > 0:08:47A frustrated Ed beats a hasty retreat.
0:08:50 > 0:08:52Meanwhile, back on colorectal...
0:08:52 > 0:08:55- I haven't finished the ward round yet.- You're kidding me!
0:08:55 > 0:08:59Emily's day is also showing no signs of improvement.
0:09:04 > 0:09:07She is still hoping to get out on time
0:09:07 > 0:09:09so she can make it to her parents for supper,
0:09:09 > 0:09:11but with her prisoner patient still hiding
0:09:11 > 0:09:15and a mountain of work to complete, it's not looking likely.
0:09:15 > 0:09:19I've got a lady who's got an exacerbation of CUPD.
0:09:19 > 0:09:22I've totally forgotten what CUPD stands for!
0:09:22 > 0:09:24There's bloods to take...
0:09:24 > 0:09:27- I'm not convinced there's anything there.- No.
0:09:27 > 0:09:31- Do you mind if I go in the back of your hand?- No.- Is that all right?
0:09:31 > 0:09:32..and patients to please...
0:09:32 > 0:09:35Don't move. I'm being quite rude, aren't I?
0:09:35 > 0:09:39- ..but none of it is going to plan. - You're trickier than you look!
0:09:39 > 0:09:41We're having a bad day today, aren't we?
0:09:41 > 0:09:42Argh!
0:09:42 > 0:09:45Does that hurt? Going to need a stiff drink after this.
0:09:45 > 0:09:46As the afternoon draws on,
0:09:46 > 0:09:52news of the escaped prisoner has reached the local news stations.
0:09:52 > 0:09:54'A prisoner who was due to undergo surgery
0:09:54 > 0:09:55'at the Royal Liverpool Hospital
0:09:55 > 0:09:58'has been recaptured after escaping from his guards.
0:09:58 > 0:10:02'He was caught around two hours later.'
0:10:02 > 0:10:05So, I've had to assess him.
0:10:05 > 0:10:11I think he's just done his lung in again. We need another X-ray on him.
0:10:11 > 0:10:14It's two o'clock and I've not finished my ward round
0:10:14 > 0:10:17and I need to be out on time and it's not going to happen.
0:10:30 > 0:10:35Over in cardiology, Tom's day is proving just as challenging.
0:10:36 > 0:10:39This is a patient of ours who, unfortunately,
0:10:39 > 0:10:41during the early hours of this morning,
0:10:41 > 0:10:44had a cardiac arrest and passed away.
0:10:44 > 0:10:48So, he's still on the ward now, he's about to go to the mortuary
0:10:48 > 0:10:51and we will certify him as dead.
0:10:55 > 0:10:59Verifying a patient's death is a job all junior doctors have to do.
0:11:01 > 0:11:05I spent quite a lot of time with this chap's family.
0:11:05 > 0:11:06This is my first certification,
0:11:06 > 0:11:08so my senior, Laura, came and gave me a hand,
0:11:08 > 0:11:10just make sure I did it all right.
0:11:10 > 0:11:13Date of death is this morning. So...
0:11:13 > 0:11:15'It's a bit of a strange situation
0:11:15 > 0:11:18'and it was sad to know that patient had died,'
0:11:18 > 0:11:22because I got to know him and his family quite well over the past few days.
0:11:26 > 0:11:30And Tom is not the only junior doctor dealing with this.
0:11:30 > 0:11:32Emily has also been called
0:11:32 > 0:11:36to confirm the death of a patient on her ward.
0:11:38 > 0:11:40Hello, Valerie. I'm just going to rub on your chest.
0:11:40 > 0:11:42'I talk to the patients'
0:11:42 > 0:11:45when I'm verifying their death just for myself, in a way.
0:11:45 > 0:11:49Just to make it a little bit less eerie in the room,
0:11:49 > 0:11:54because it's so quiet, which gives me the shivers.
0:11:54 > 0:11:56I'm just going to shine a light in your eye, OK?
0:11:58 > 0:12:02I think it makes you feel better if there's a bit of noise
0:12:02 > 0:12:05and also just... It's nice for the patient.
0:12:05 > 0:12:07You don't know what's going on, in a way.
0:12:07 > 0:12:11You're only walking into the room. It's nice for them and their family.
0:12:19 > 0:12:22There's a fee you get from the funeral home
0:12:22 > 0:12:24for doing all the legal paperwork
0:12:24 > 0:12:26and checking for a pacemaker and anything like that,
0:12:26 > 0:12:29so the patient can be cremated.
0:12:29 > 0:12:33I think it's one of the weirder parts of being a doctor,
0:12:33 > 0:12:35being paid for when somebody dies.
0:12:35 > 0:12:38So, I haven't quite worked out how to deal with it yet.
0:12:41 > 0:12:45What I'll probably do is put it towards things I need for my job.
0:12:45 > 0:12:49That's probably the nicest thing to do - books and equipment.
0:12:58 > 0:13:01It's been a long day for Emily, but it's finally over.
0:13:02 > 0:13:05I've just done 11 days in a row and I've not stopped today.
0:13:05 > 0:13:11I'm feeling very tired and need to rush off to get my train.
0:13:11 > 0:13:14So, I'm going home to see my family - really looking forward to it.
0:13:14 > 0:13:17Need someone to look after me for a few days after this week.
0:13:17 > 0:13:19With Emily safely on the train
0:13:19 > 0:13:23and heading to Leicester for some home cooking, back at the house
0:13:23 > 0:13:27the other junior doctors are eating whatever's in the fridge.
0:13:28 > 0:13:33It's my dinner. As usual. Piri-piri chicken tonight.
0:13:33 > 0:13:36Piri-picky chicken!
0:13:36 > 0:13:38SHE LAUGHS
0:13:38 > 0:13:43Ollie, Tom and Jen are sitting down to dinner junior doctor style.
0:13:45 > 0:13:47How was your day?
0:13:47 > 0:13:52Really hectic but fine. I got in this morning and...
0:13:52 > 0:13:54one of our patients had died,
0:13:54 > 0:13:56not somebody who was ill yesterday either.
0:13:56 > 0:13:59Somebody who's had ongoing angina. He went into cardiac arrest
0:13:59 > 0:14:05and died at 7:30 this morning. Verified certified. Yeah.
0:14:05 > 0:14:07It's hit everyone quite hard, because we all really liked him.
0:14:07 > 0:14:08He was lovely.
0:14:08 > 0:14:12- And also didn't expect it. - Yeah, it's a bit of both.
0:14:12 > 0:14:15My consultant didn't know until this afternoon.
0:14:15 > 0:14:18He came on the ward and we told him and he goes, "Oh."
0:14:20 > 0:14:24- Did you hear about the chap on top of the Royal?- Ollie told me!
0:14:24 > 0:14:28- I heard it was Emily's patient! - Of course it was.
0:14:28 > 0:14:30Running away from her!
0:14:30 > 0:14:33Who else's patient would it have been running away?
0:14:33 > 0:14:35The doctor is just going to come and see you now...!
0:14:37 > 0:14:41That would make me go through the ventilation shaft as well!
0:14:56 > 0:14:58- Hello!- Hello! Come here.
0:14:58 > 0:15:00I have been counting down the days to come home
0:15:00 > 0:15:04after 11 or 12 days on the ward.
0:15:04 > 0:15:09I just wanted to come home and sleep in a nice bed and eat nice food
0:15:09 > 0:15:11and just sit around and do nothing.
0:15:11 > 0:15:15Emily's mum has gathered the family together for a celebratory dinner.
0:15:15 > 0:15:17Whoa!
0:15:17 > 0:15:20EMILY GIGGLES
0:15:24 > 0:15:29- A toast for Emily. - One of many, I think.- Oh, quick.
0:15:29 > 0:15:34- Welcome home, Emily.- Welcome home! - What's the toast to?- Welcome home!
0:15:37 > 0:15:41Conversation turns to the other junior doctors in the house,
0:15:41 > 0:15:45- in particular, fellow singleton, Ollie.- Tell me about him.
0:15:45 > 0:15:50He's one of the doctors, a year above me. He works in AMU.
0:15:50 > 0:15:51What's his hobbies?
0:15:51 > 0:15:57- Um...boxing.- Boxing?! Boxing! How old is he?
0:15:57 > 0:15:59I don't know.
0:15:59 > 0:16:03- What does he look like? - Carry on, Nina...
0:16:03 > 0:16:07- You've been without a boyfriend for a little while.- I'm all right!
0:16:07 > 0:16:09Leave her alone. She's quite happy.
0:16:11 > 0:16:14- I'll back off.- You're trying to make me feel awkward.
0:16:15 > 0:16:17After giving up on her love life,
0:16:17 > 0:16:21the next item on the agenda is Emily's future.
0:16:21 > 0:16:22That is a good question, Emily.
0:16:22 > 0:16:25Where do you see yourself in five years' time?
0:16:25 > 0:16:30Um... I don't know really. Hopefully somewhere abroad.
0:16:30 > 0:16:33I'd like to go abroad. Where do you see yourself?
0:16:33 > 0:16:37- Where do I see myself in five years' time?- Don't ask me!
0:16:37 > 0:16:40THEY LAUGH
0:16:40 > 0:16:41That's horrible!
0:16:43 > 0:16:48- Grandma, you've got a rather generous portion of champagne.- I'm a grandma!
0:16:56 > 0:16:57Back in Liverpool,
0:16:57 > 0:17:02second-year Kiera is at work in the hospital's emergency department.
0:17:02 > 0:17:05She is under the supervision of Dr Demnitz.
0:17:05 > 0:17:08I'll come and have a look when you've finished.
0:17:08 > 0:17:12Kiera's first patient has asked not to be identified.
0:17:12 > 0:17:15He's fallen and has a large wound on his head.
0:17:15 > 0:17:18Oh, dear. Feeling a bit sicky?
0:17:19 > 0:17:21Dr Demnitz, the consultant,
0:17:21 > 0:17:25has asked me if I would pop your head back together for you, if that's OK?
0:17:27 > 0:17:3126-year-old Kiera eventually hopes to specialise in A&E.
0:17:31 > 0:17:34Dealing with a serious head injury like this
0:17:34 > 0:17:37is a chance for her to prove she has what it takes.
0:17:37 > 0:17:40You've made a good job of that, haven't you?
0:17:42 > 0:17:44Close your eyes if you want.
0:17:44 > 0:17:49When I first do this, it will be uncomfortable. How's that?
0:17:49 > 0:17:53- How are you doing? Yeah. - Yeah.- Be very brave.
0:17:54 > 0:17:57- Can you feel that?- No.
0:17:59 > 0:18:03- There?- No.- There?- No.
0:18:04 > 0:18:05Kiera is under pressure,
0:18:05 > 0:18:09as she must present her stitching skills to Dr Demnitz.
0:18:09 > 0:18:12I'm just going to get something a little bit bigger.
0:18:13 > 0:18:17But the task requires a little extra creativity.
0:18:17 > 0:18:19Yeah, this is an incontinence pad
0:18:19 > 0:18:23but it's also a good way of protecting your clothes, OK?
0:18:31 > 0:18:35- What did you fall on? - On the road.- Onto the road.
0:18:39 > 0:18:43- OK.- Have you done this before? - Have I done it before?
0:18:43 > 0:18:46No, it's my first time. No, it's not my first time.
0:18:46 > 0:18:49I've done it innumerable times before.
0:18:50 > 0:18:52As a junior doctor,
0:18:52 > 0:18:56a key part of Kiera's job is to put patients at ease.
0:18:57 > 0:19:00At least you'll have a good scar to show all your mates.
0:19:00 > 0:19:03That's what you boys all seem to be worried about.
0:19:03 > 0:19:06IN LIVERPOOL ACCENT: "How's my scar going to look, Doc?"
0:19:06 > 0:19:08Right, I'm just going to go and get Dr Demnitz,
0:19:08 > 0:19:12- he wanted to have a look at it once I was done.- OK.
0:19:12 > 0:19:15Just check that I haven't sewn your hand to your head, or something!
0:19:16 > 0:19:19All done and dusted, eh?
0:19:19 > 0:19:22Looks a heap better. Looks really nice, OK?
0:19:22 > 0:19:24Do you feel up to, er, going?
0:19:24 > 0:19:27Kiera's done a very nice, neat job, there.
0:19:27 > 0:19:30The wound's come together beautifully,
0:19:30 > 0:19:33and, er, I'm very pleased with the outcome.
0:19:33 > 0:19:35Take it easy, bye-bye.
0:19:35 > 0:19:39- You might need a new shirt! - Oh, I like this!
0:19:46 > 0:19:48It's a new day at the hospital
0:19:48 > 0:19:52and new girl Carol is back in the emergency department.
0:19:55 > 0:19:56She's on a trial period,
0:19:56 > 0:20:00hoping to fill the vacancy left by Italian medic Ed,
0:20:00 > 0:20:02after he was moved from A&E
0:20:02 > 0:20:06and dropped down to do his first year in another department.
0:20:08 > 0:20:10I'm Carol, I'm doing a clinical attachment.
0:20:10 > 0:20:13I haven't seen a central line being put in before.
0:20:13 > 0:20:16The Malawian medic needs to impress her seniors
0:20:16 > 0:20:20if she's to be taken on as a second-year junior doctor.
0:20:20 > 0:20:24I've noticed blood glucoses haven't been well controlled.
0:20:24 > 0:20:27Carol may only be allowed to observe at the moment,
0:20:27 > 0:20:30but she's already finding Liverpool a big contrast
0:20:30 > 0:20:32to the African hospital where she trained.
0:20:36 > 0:20:38I am ambitious and very focused,
0:20:38 > 0:20:42and I think I would go that extra mile to be successful.
0:20:42 > 0:20:45# Into the streets... #
0:20:45 > 0:20:47So we're at Queen Elizabeth Central Hospital
0:20:47 > 0:20:50and this is where I trained as a doctor.
0:20:53 > 0:20:56I've worked in a setting where resources are limited
0:20:56 > 0:20:57and you have to learn to cope.
0:20:57 > 0:21:01I've learnt to work under pressure,
0:21:01 > 0:21:03so I think I have what it takes to be a good doctor.
0:21:03 > 0:21:09# Who's going to save the world tonight? #
0:21:09 > 0:21:12I am the first doctor in the family.
0:21:12 > 0:21:15I think for that reason, my family is proud,
0:21:15 > 0:21:17because I think they have wanted a doctor for a while!
0:21:19 > 0:21:22How many? They're good for you.
0:21:22 > 0:21:23'It was a very thrilling experience,'
0:21:23 > 0:21:25when we heard that she wanted to be a doctor.
0:21:25 > 0:21:27'Everyone was so excited.'
0:21:27 > 0:21:30The first doctor in both families!
0:21:30 > 0:21:32- Some more?- Thank you.
0:21:32 > 0:21:35'I think she has a passion for her job. And I think once you have
0:21:35 > 0:21:37'a passion for whatever you do,'
0:21:37 > 0:21:38you always succeed.
0:21:38 > 0:21:40CAROL LAUGHS
0:21:40 > 0:21:42I do feel happy that I did medicine
0:21:42 > 0:21:45and I wouldn't change my career for anything else.
0:21:45 > 0:21:49I'm looking forward to the challenges that Liverpool has to offer.
0:21:49 > 0:21:51I think just trying to find my feet might be a bit overwhelming,
0:21:51 > 0:21:54but I'm ready for the challenge and I'm looking forward to it.
0:21:54 > 0:22:01# We're going to save the world tonight. #
0:22:02 > 0:22:03Back in Liverpool,
0:22:03 > 0:22:07and she's dealing with a case very rarely seen in Malawi.
0:22:07 > 0:22:08A suspected overdose.
0:22:08 > 0:22:10The patient in question
0:22:10 > 0:22:14says he's taken a cocktail of over-the-counter drugs.
0:22:14 > 0:22:16How many tablets did you take?
0:22:18 > 0:22:19Was it a box?
0:22:21 > 0:22:25Like a strip? OK, what did you take it down with?
0:22:30 > 0:22:32Cough syrup, OK.
0:22:34 > 0:22:36Carol will need to arrange for blood tests,
0:22:36 > 0:22:40to determine whether the overdose has put the man in danger.
0:22:41 > 0:22:43Basically, we're going to keep him in just
0:22:43 > 0:22:47to make sure he's medically stable, check that whatever he has taken...
0:22:47 > 0:22:49He hasn't been able to identify it properly.
0:22:49 > 0:22:52Just do some blood levels, to try to identify the toxin,
0:22:52 > 0:22:55just in case that has some potential lethal risks.
0:22:55 > 0:22:58- He's basically come in because he's attempted suicide...- OK.- ..at home.
0:22:58 > 0:23:00He's taken some medication
0:23:00 > 0:23:03which I think he described as a paracetamol, a strip of paracetamol.
0:23:03 > 0:23:04He doesn't remember how many tablets.
0:23:04 > 0:23:07He's had this medication with him for a couple of weeks.
0:23:07 > 0:23:08He was suffering from a flu recently
0:23:08 > 0:23:11and he just bought some medication over the counter.
0:23:11 > 0:23:15He says he took them around four hours ago
0:23:15 > 0:23:19and, on top of that, he has also taken half a bottle of cough syrup.
0:23:19 > 0:23:21Cubicle...I think it's six.
0:23:24 > 0:23:29Carol's senior decides to ask the patient some further questions.
0:23:29 > 0:23:32This time, would you say that you wanted to kill yourself,
0:23:32 > 0:23:34or was it more you wanted help?
0:23:39 > 0:23:42If we didn't treat you in hospital, if we said, OK,
0:23:42 > 0:23:46you can go home, would you go home and try to do it again?
0:23:55 > 0:23:58I think this is the second case I've seen so far
0:23:58 > 0:24:01of a self-harmer here. It is new,
0:24:01 > 0:24:05knowing how to manage patients who come in with self-harm.
0:24:05 > 0:24:09Carol continues to monitor the patient,
0:24:09 > 0:24:11but there's more he wants to open up about.
0:24:11 > 0:24:15He reveals he's an Egyptian asylum seeker.
0:24:33 > 0:24:38The patient's confession means Carol needs to think on her feet.
0:24:38 > 0:24:41A case of self-harm is suddenly becoming much more complicated.
0:24:43 > 0:24:48He's clearly not himself. He needs some help.
0:24:48 > 0:24:50He's gone and tried to express that need for help
0:24:50 > 0:24:57in a different sort of way, which has made him want to harm himself.
0:24:59 > 0:25:01Would you like to talk to somebody?
0:25:01 > 0:25:04We have what we call the Crisis Management Team here.
0:25:08 > 0:25:09No, no, no, no. No.
0:25:09 > 0:25:11It's nothing to do with the Home Office at all.
0:25:11 > 0:25:14This is a hospital. We're here only to help people.
0:25:14 > 0:25:15It's just a hospital.
0:25:15 > 0:25:19Regardless of where people have come from, or what problems they have,
0:25:19 > 0:25:21we're just here to look after your health.
0:25:21 > 0:25:25All the extra attention is making the patient nervous.
0:25:25 > 0:25:27As Carol types up her notes,
0:25:27 > 0:25:30another member of staff finds him trying to leave.
0:25:30 > 0:25:34Let's do your bloods. Peace of mind.
0:25:34 > 0:25:37We'll take some bloods, it'll take a few hours before he gets the results.
0:25:37 > 0:25:40Sit tight with us here and let's just get you properly checked.
0:25:46 > 0:25:48This case has been another lesson for Carol
0:25:48 > 0:25:50in the sort of skills a junior doctor needs
0:25:50 > 0:25:53to work in an inner-city British hospital.
0:25:59 > 0:26:03The other junior doctors may have more experience of the NHS,
0:26:03 > 0:26:06but the learning doesn't stop for them either.
0:26:06 > 0:26:10For the past five years, they've been glued to their textbooks,
0:26:10 > 0:26:13but since they started working on the wards full time,
0:26:13 > 0:26:16it's the patients they're now becoming attached to.
0:26:16 > 0:26:20I just wanted to come and say goodbye, because I understand
0:26:20 > 0:26:23that your daughters are going to come and pick you up later.
0:26:23 > 0:26:24Yes, they are, yes.
0:26:24 > 0:26:26'It is going to be sad to see her go, because...'
0:26:26 > 0:26:28that's the sort of patient
0:26:28 > 0:26:30you want to sit down and have a cup of tea with.
0:26:30 > 0:26:33The emotional side of the job has hit me
0:26:33 > 0:26:37probably more than I expected it to in the last few months, actually.
0:26:37 > 0:26:40First-year Jen has been treating an elderly lady
0:26:40 > 0:26:44for the past few days and has already formed a bond.
0:26:44 > 0:26:45She's my favourite patient.
0:26:49 > 0:26:51There's nowhere to find a vein on you.
0:26:51 > 0:26:54I might just have to put it in this one here.
0:26:54 > 0:26:58She needs a cannula, but elderly patients can often suffer
0:26:58 > 0:27:02from weak veins that break down once a needle has been inserted.
0:27:02 > 0:27:04I just can't find anywhere on her.
0:27:04 > 0:27:08Jen hatches a plan, but needs help from Emily,
0:27:08 > 0:27:09who's back on the wards.
0:27:09 > 0:27:11I wondered if we could double-team it?
0:27:11 > 0:27:14- Yeah.- So you could hold her...
0:27:14 > 0:27:18- Like, squeeze, and pull the skin back for me, while I put it in.- Yeah.
0:27:18 > 0:27:20Because I think that's a bit, like...
0:27:20 > 0:27:22She's got good veins, but...
0:27:22 > 0:27:26- Exactly, yeah.- Are you ready? - All right, then.
0:27:26 > 0:27:29- Have you got the gel?- Yep.
0:27:29 > 0:27:33If it works, we're going to call it the Phipps Method.
0:27:33 > 0:27:36- What, this?- Yeah.- Why? This is my method, I devised it!
0:27:36 > 0:27:38If anything, it's going to be Whiteley-Phipps.
0:27:38 > 0:27:40- OK, it's the Whiteley-Phipps.- Hello!
0:27:40 > 0:27:44Right, squeeze her arm here for me.
0:27:52 > 0:27:54Yeah? Can you feel that?
0:27:55 > 0:27:57Oh, that's good. Ooh, yes.
0:27:57 > 0:27:59Fingers crossed!
0:28:01 > 0:28:05Sharp scratch... Come on.
0:28:05 > 0:28:06We're in!
0:28:06 > 0:28:09The two doctors think they've done it.
0:28:09 > 0:28:11Can you put your hand there?
0:28:12 > 0:28:14Stop bleeding...
0:28:14 > 0:28:15Good job.
0:28:17 > 0:28:20But despite their optimism,
0:28:20 > 0:28:23the vein has broken down.
0:28:23 > 0:28:26- Is it feeling OK? - I think that's blue.
0:28:26 > 0:28:28Does it not feel very nice?
0:28:33 > 0:28:34What do you want to do?
0:28:34 > 0:28:36We can have another go,
0:28:36 > 0:28:41put the cannula in, then she can have the pain relief through the cannula.
0:28:41 > 0:28:45Or we can wait till she can drink and then have oral.
0:28:45 > 0:28:48Giving her painkillers in tablet form
0:28:48 > 0:28:51is one alternative Jen can offer the patient.
0:28:51 > 0:28:53And if that's not doing the job for you,
0:28:53 > 0:28:58we'll send somebody up that can do this much better than we can.
0:28:58 > 0:28:59Is that fair enough?
0:28:59 > 0:29:02You are officially my most awkward customer!
0:29:02 > 0:29:04THEY LAUGH
0:29:04 > 0:29:05Looks like Jen and Emily
0:29:05 > 0:29:09will have to work on their Whiteley-Phipps Method another time.
0:29:10 > 0:29:13- Damn it, Emily, I thought we had it there.- I know.
0:29:28 > 0:29:31First-year Ed has had a tougher time than most
0:29:31 > 0:29:33adjusting to life in Liverpool.
0:29:33 > 0:29:36His transition from an Italian GP practice
0:29:36 > 0:29:39to an inner-city hospital has not always been smooth
0:29:39 > 0:29:43and he's still getting used to NHS rules and regulations.
0:29:44 > 0:29:47I discussed it sensibly with the family yesterday
0:29:47 > 0:29:49and they were pretty sure that...
0:29:49 > 0:29:53They can understand that the situation is very, very serious...
0:29:55 > 0:29:59Ed has been treating a terminally ill patient for the last few days.
0:29:59 > 0:30:03His condition has rapidly deteriorated and is now critical.
0:30:04 > 0:30:07So the background is, he has got acute myeloid leukaemia,
0:30:07 > 0:30:11and that's why he's receiving transfusions regularly here.
0:30:11 > 0:30:15He's also got a background history of adenoca of the prostate,
0:30:15 > 0:30:18so there are two different malignancies not linked.
0:30:18 > 0:30:22Ed will need to give the patient regular doses of morphine,
0:30:22 > 0:30:26the first time he's given it since working in the hospital.
0:30:26 > 0:30:31So it eases breathing, it eases pain.
0:30:31 > 0:30:34Get him nice and calm,
0:30:34 > 0:30:36get him as comfortable as we can.
0:30:36 > 0:30:41- We want 2.5.- Yeah. - So we'll mix that in five.
0:30:41 > 0:30:44- Yeah, then get rid of half of it.- Yeah.
0:30:45 > 0:30:47When a patient is given morphine,
0:30:47 > 0:30:51any leftover medication needs to be disposed of.
0:30:51 > 0:30:55It's a hospital rule that Ed's struggling to get his head around.
0:30:55 > 0:30:57Well, I mean, if it was for me, I wouldn't waste it,
0:30:57 > 0:31:00but unfortunately, we've got some rules to follow.
0:31:04 > 0:31:08It's just silly for me to waste all this medication, simply because...
0:31:11 > 0:31:15Because of concerns. It's just silly.
0:31:16 > 0:31:19I'm helping him, I'm giving him the medication,
0:31:19 > 0:31:22so it's not that I'm going to go and sell it on the black market.
0:31:24 > 0:31:28Ed spends the next few hours at the dying patient's bedside,
0:31:28 > 0:31:30providing him with essential pain relief.
0:31:30 > 0:31:33- It's OK, we'll flush it with the rest of this.- Yeah.
0:31:33 > 0:31:35But some colleagues are still concerned
0:31:35 > 0:31:37that he's not following the protocols
0:31:37 > 0:31:39around the use of morphine.
0:31:39 > 0:31:41Yeah, I don't want to go around with it.
0:31:41 > 0:31:43As soon as we give it, I'll chuck it away.
0:31:43 > 0:31:47- Well, it needs signing off as well. - Yeah, of course.- OK?- Yep.
0:31:47 > 0:31:50- You're not going to forget? - No, don't worry. No, no, no, I will!
0:31:50 > 0:31:52- Don't worry. - How much have you given?
0:31:52 > 0:31:55I clocked him in yesterday evening, took care of him yesterday evening,
0:31:55 > 0:31:59then I came on again this morning, and I'm taking care of him right now.
0:31:59 > 0:32:01He's groaning permanently.
0:32:01 > 0:32:04Having never dealt with a case like this before,
0:32:04 > 0:32:07Ed is being tested at every level.
0:32:07 > 0:32:09All right. Thank you very much for your help.
0:32:09 > 0:32:11OK, thank you, bye.
0:32:11 > 0:32:13I'm going to write these things down,
0:32:13 > 0:32:17because that's something I've got to remember how to do in future
0:32:17 > 0:32:19on my own, without having to ring anybody else...
0:32:19 > 0:32:23Ed's trying to stay focused on caring for the patient,
0:32:23 > 0:32:26but the hospital rules still have to be followed.
0:32:26 > 0:32:28- If he needs it, he needs it. Give it to him.- That's what I thought.
0:32:28 > 0:32:31The thing you mustn't do is to walk around with it without labels,
0:32:31 > 0:32:35- in your pocket, you mustn't do that. - OK.- Someone could just pick it up.
0:32:38 > 0:32:41If you think he is uncomfortable, call me,
0:32:41 > 0:32:46because I can do something to make him a bit more comfortable, OK?
0:32:46 > 0:32:49Even though Ed has struggled with the rules around morphine,
0:32:49 > 0:32:51his care for the patient hasn't gone unnoticed
0:32:51 > 0:32:53by other staff on the ward.
0:32:53 > 0:32:57The nurse just told me that they were happy with the way
0:32:57 > 0:32:59I'd been dealing with them,
0:32:59 > 0:33:00so that was, you know,
0:33:00 > 0:33:04that's a very positive thing, for me to know that...
0:33:04 > 0:33:08at least from the social point of view, the approach was correct.
0:33:21 > 0:33:25Tom is working the night shift.
0:33:25 > 0:33:29It's 4am and he's been called to see a patient on the respiratory ward.
0:33:30 > 0:33:36So this is a gentleman who was found collapsed on board his cruise ship.
0:33:36 > 0:33:39I was called to see him because his temperature's been spiking
0:33:39 > 0:33:43and his kind of general demeanour's gone downhill.
0:33:43 > 0:33:46His breathing rate has gone right up into the sky, he's on oxygen,
0:33:46 > 0:33:47he's still not saturating very well.
0:33:51 > 0:33:54The man is German and doesn't speak any English.
0:33:54 > 0:33:56Excuse me, can you sit forwards?
0:33:56 > 0:33:59'Having these communication issues makes managing patients
0:33:59 > 0:34:01'particularly challenging.'
0:34:01 > 0:34:03Often, you can get hold of interpreters,
0:34:03 > 0:34:05but given the fact it's the middle of the night,
0:34:05 > 0:34:07it does make it slightly difficult.
0:34:07 > 0:34:09My German is shoddy!
0:34:11 > 0:34:15It's not a scenario in any medical textbook,
0:34:15 > 0:34:17and a bit of creative thinking is called for.
0:34:17 > 0:34:19Oh...
0:34:19 > 0:34:22"Doktor" is the German for doctor anyway. So, "Ich bin ein Doktor."
0:34:22 > 0:34:26- Do it all on here, it speaks and everything.- Wow. That's amazing.
0:34:27 > 0:34:29Doctor.
0:34:29 > 0:34:30- PHONE:- Arzt.
0:34:30 > 0:34:32Ooh, gosh! SHE LAUGHS
0:34:32 > 0:34:34"Doktor". The same word, there.
0:34:34 > 0:34:37- Or "Doktor".- Oh, gosh.
0:34:37 > 0:34:40I need to ask him if I can just have a listen to his chest.
0:34:40 > 0:34:43As long as it doesn't think chest is a chest of drawers!
0:34:43 > 0:34:45- PHONE:- "Kann ich an die Brust zu horen?"
0:34:45 > 0:34:47Change the word "chest" to "lungs".
0:34:47 > 0:34:50Just to make sure it doesn't come up with, like, wardrobe or something.
0:34:50 > 0:34:52Ich bin ein Doktor.
0:34:52 > 0:34:55- PHONE:- Kann ich an die Brust zu horen?
0:34:55 > 0:34:59It's another situation, this is, of applying theory to reality...
0:34:59 > 0:35:02Being a doctor always involves learning,
0:35:02 > 0:35:06right from the first day till the day you retire.
0:35:13 > 0:35:16Carol has been on trial in the emergency department
0:35:16 > 0:35:18for the past month.
0:35:18 > 0:35:21And today, she's received the news that she's been waiting for,
0:35:21 > 0:35:26the green light to work as a second-year junior doctor.
0:35:26 > 0:35:29And she can't wait to tell her parents back in Malawi.
0:35:29 > 0:35:30Hello, Daddy.
0:35:30 > 0:35:33I was calling to tell you I'm going for my first shift this evening.
0:35:33 > 0:35:34'That's good news.'
0:35:34 > 0:35:37I'm excited, a bit nervous,
0:35:37 > 0:35:40but I'm looking forward to it.
0:35:40 > 0:35:43The thing to do is to ask the nurses.
0:35:43 > 0:35:45Today will be the first time
0:35:45 > 0:35:48Carol can treat patients in the hospital
0:35:48 > 0:35:49since arriving from Malawi.
0:35:49 > 0:35:54But despite being an experienced doctor, Carol is feeling nervous.
0:35:54 > 0:35:56So you have to do it properly, properly.
0:35:56 > 0:35:59She turns to husband Mas for support.
0:35:59 > 0:36:02Be calm and pass everything through the seniors.
0:36:02 > 0:36:04Carol, you know this stuff,
0:36:04 > 0:36:07you've done it in Malawi. It's the same, nothing different.
0:36:07 > 0:36:09You'll be fine, Carol, you'll be fine.
0:36:09 > 0:36:11As a consultant at the same hospital,
0:36:11 > 0:36:13he knows how she's feeling.
0:36:13 > 0:36:17The first couple of shifts will be a bit, you know, there'll be that,
0:36:17 > 0:36:20you know, frog-in-the-throat feeling, but she'll be fine.
0:36:20 > 0:36:22But I'll be dreading the moment of picking her up!
0:36:22 > 0:36:25That will be the, you know... "How was it?"
0:36:25 > 0:36:28And then if there's a smile, it's easy. But if there's a, "Oh..."
0:36:28 > 0:36:30But, you know, that's how it is.
0:36:32 > 0:36:37Just packing my bag, making sure I have everything I need. Notepad.
0:36:37 > 0:36:39I want it to go well.
0:36:39 > 0:36:43I want to walk out of A&E feeling confident, at the end of my shift.
0:36:43 > 0:36:48That will make me feel encouraged and make me want to go back again!
0:36:48 > 0:36:51I think when I start talking to the patients, I'll be OK.
0:36:55 > 0:36:57See you!
0:37:02 > 0:37:04- Hello.- Hello.
0:37:04 > 0:37:08After being inducted, Carol starts her shift.
0:37:11 > 0:37:14Mr William Dale?
0:37:14 > 0:37:16Mr William Dale?
0:37:16 > 0:37:18But it looks like she'll have to wait a little longer
0:37:18 > 0:37:21to treat her first patient.
0:37:21 > 0:37:23Mr William Dale?
0:37:23 > 0:37:26'Most patients wait in the waiting room and then they get called in.'
0:37:26 > 0:37:30I called the patient three times and I didn't get any response.
0:37:30 > 0:37:32I'll just talk to the nurse,
0:37:32 > 0:37:36maybe I'll document him as "did not answer", give it a while,
0:37:36 > 0:37:38then try to find him again, and see the next patient.
0:37:50 > 0:37:53On the other side of A&E, Kiera has just started her shift.
0:37:53 > 0:37:56Is he...?
0:37:56 > 0:38:00Her first patient is pensioner Brian Taylor.
0:38:00 > 0:38:02Fine, I'll have a look at him. Ta.
0:38:02 > 0:38:04I've just been asked to see a gentleman
0:38:04 > 0:38:06who's been feeling a bit dizzy recently.
0:38:06 > 0:38:08His GP's had at look at him and he's a bit concerned
0:38:08 > 0:38:12so we need to get onto it quite quickly and make sure he's OK.
0:38:12 > 0:38:15Just tell me about this dizzy feeling when it comes on, then.
0:38:15 > 0:38:18I just have problems sitting.
0:38:18 > 0:38:21I get a rush to my head
0:38:21 > 0:38:23and I feel... I feel warm
0:38:23 > 0:38:30and then I feel a little bit sick and it just goes dark for a second.
0:38:30 > 0:38:33And I have to grab hold of something before I hit the deck.
0:38:33 > 0:38:35Have you passed out at all with it?
0:38:35 > 0:38:37Um...yeah.
0:38:38 > 0:38:41Kiera is so concerned about his symptoms
0:38:41 > 0:38:44that she transfers him to the resuscitation bay,
0:38:44 > 0:38:46which is equipped to treat patients
0:38:46 > 0:38:48whose conditions can suddenly change.
0:38:48 > 0:38:51- Can we get this chap on some monitoring, please?- Yep.
0:38:51 > 0:38:52And...
0:38:52 > 0:38:54Yeah, he's a query leaking AAA.
0:38:56 > 0:38:59Right, so a sharp scratch coming up now, OK?
0:38:59 > 0:39:02Try and keep your arm nice and relaxed for me.
0:39:02 > 0:39:04That's great, well done.
0:39:04 > 0:39:05Sharp scratch.
0:39:05 > 0:39:07But as soon as Kiera fits the cannula,
0:39:07 > 0:39:10his health seems to take a turn for the worse.
0:39:10 > 0:39:12Are you all right, sir?
0:39:13 > 0:39:17- Are you OK there?- Are you all right? - What's wrong there, sir?
0:39:17 > 0:39:18My head's just gone...
0:39:18 > 0:39:21Shall we lie a bit flatter?
0:39:21 > 0:39:23Yeah, I'll just pop you back, all right?
0:39:23 > 0:39:26Try and stay awake with us. Well done.
0:39:26 > 0:39:28Ram a load of fluids up him
0:39:28 > 0:39:30in case his blood pressure is on the low side.
0:39:30 > 0:39:32Mr Taylor, how are you doing?
0:39:37 > 0:39:39What's his pulse? Is that his pulse there? OK.
0:39:39 > 0:39:45- And his blood pressure's 120? - 125/86.- OK, fine. How's that?
0:39:45 > 0:39:48- Still feel dizzy?- I'm coming round.
0:39:48 > 0:39:50You're coming round, there we go.
0:39:50 > 0:39:52Was it me plugging that thing in your arm?
0:39:52 > 0:39:56With the patient stabilised, Kiera can continue her investigations.
0:39:56 > 0:40:00OK, I just want to do a little test with you now.
0:40:00 > 0:40:02Try putting your head right back as far as it'll go.
0:40:04 > 0:40:06Right back.
0:40:08 > 0:40:11Dizziness? OK, just relax.
0:40:11 > 0:40:13Sit back for me, sir, well done, that's it.
0:40:13 > 0:40:16- Did that make you feel dizzy?- Yeah.
0:40:16 > 0:40:18Is that the feeling you've been getting?
0:40:18 > 0:40:20The examination explains
0:40:20 > 0:40:24the likely cause of the patient's fainting and dizzy spells.
0:40:24 > 0:40:26The reason for that, we think what's going on,
0:40:26 > 0:40:28is sometimes when you get a little bit older,
0:40:28 > 0:40:31you get a bit of arthritis around the neck
0:40:31 > 0:40:34and sometimes in certain positions, if you put your head back
0:40:34 > 0:40:36or if you put your head forward,
0:40:36 > 0:40:37the vertebra kind of do that,
0:40:37 > 0:40:39they squeeze a little bit
0:40:39 > 0:40:42on the blood vessels that go up into the brain
0:40:42 > 0:40:45and when that happens, it starves the brain of oxygen
0:40:45 > 0:40:48for just a little bit and that's what makes you feel really dizzy.
0:40:48 > 0:40:52While it's bad news for Mr Taylor, Kiera's quick diagnosis
0:40:52 > 0:40:55is the first step on the road to his recovery.
0:40:55 > 0:41:00He's got an element of vertebrobasilar insufficiency.
0:41:00 > 0:41:04Being trusted to carry out accurate examinations of patients
0:41:04 > 0:41:07is key to succeeding in the busy emergency department.
0:41:07 > 0:41:08I think it's very important
0:41:08 > 0:41:11to make the right impression for your seniors.
0:41:11 > 0:41:13There's certainly a balance to get.
0:41:13 > 0:41:16You don't want to be consistently pestering with them.
0:41:16 > 0:41:18You also don't want to be too overconfident
0:41:18 > 0:41:21- because it's dangerous for patients. - Smashing.
0:41:21 > 0:41:26- OK, so plan as...above? - Lovely.- Any questions?- No.
0:41:26 > 0:41:29But for now, there's little time to reflect on her success...
0:41:29 > 0:41:32- Thank you very much.- OK, and I'll see you in a little bit anyway.
0:41:32 > 0:41:34Any problems, let me know.
0:41:34 > 0:41:38..as there are plenty more patients just like Brian waiting to be seen.
0:41:45 > 0:41:49Meanwhile, Carol is hoping for an equally successful diagnosis
0:41:49 > 0:41:50for her first patient.
0:41:52 > 0:41:57I have a gentleman who's been complaining of ongoing chills,
0:41:57 > 0:42:00rigors, fever on and off, since December last year.
0:42:02 > 0:42:05- How long were you in Dubai for? - Two and a half years, almost.
0:42:05 > 0:42:10- OK, and what work were you doing when you were there?- Drainage.
0:42:10 > 0:42:11And when you were out there,
0:42:11 > 0:42:14were you on any prophylactic treatment for malaria
0:42:14 > 0:42:16or anything like that?
0:42:16 > 0:42:18What she hears immediately alerts Carol
0:42:18 > 0:42:21to a potential malaria infection.
0:42:21 > 0:42:23Something she's experienced in diagnosing
0:42:23 > 0:42:25and treating from her time in Malawi.
0:42:25 > 0:42:31Things like malaria, TB, meningitis are so common in Malawi, so...
0:42:31 > 0:42:33With his story, you have a high suspicion
0:42:33 > 0:42:35because of the area he's been to as well.
0:42:35 > 0:42:37Are you all right with needles?
0:42:37 > 0:42:38- Yeah.- OK.
0:42:40 > 0:42:42Which arm are you most comfortable with?
0:42:43 > 0:42:46- Sharp scratch coming through. Are you OK?- Yeah.
0:42:46 > 0:42:48Carol's a dab hand at getting blood
0:42:48 > 0:42:52and despite her first-night nerves, her skills don't fail her.
0:42:52 > 0:42:54- Are you doing OK?- Yeah, I'm OK.
0:42:54 > 0:42:56OK.
0:42:56 > 0:42:58Squeeze there for me. Mh-hm.
0:43:01 > 0:43:02With the blood sent off,
0:43:02 > 0:43:06she runs her diagnosis past the staff registrar.
0:43:06 > 0:43:08I'm thinking he probably has something infectious
0:43:08 > 0:43:11because of the nature of the rigors and the chills
0:43:11 > 0:43:12and the fevers on and off.
0:43:12 > 0:43:13I've taken some bloods.
0:43:13 > 0:43:15I think I know what his diagnosis is,
0:43:15 > 0:43:17but I'm still interested
0:43:17 > 0:43:20in learning what the specialists have to say about him
0:43:20 > 0:43:23and see if there's something new I can pick up.
0:43:23 > 0:43:25So, can I give the medics a ring
0:43:25 > 0:43:27and ask them to see the patient, or do I refer him
0:43:27 > 0:43:29to the medics, or...?
0:43:33 > 0:43:36OK, great. OK, thank you. Yep.
0:43:37 > 0:43:40An hour later, the patient's results still aren't back
0:43:40 > 0:43:43and Carol realises she's made a rookie mistake.
0:43:43 > 0:43:45I called in earlier on
0:43:45 > 0:43:50to ask for an add-on investigation on a patient for malaria blood smear.
0:43:52 > 0:43:56But I think it was my mistake completely. I gave the wrong name.
0:43:56 > 0:43:59So the test has been done on the wrong patient.
0:43:59 > 0:44:02I'm really sorry, it was my fault completely.
0:44:02 > 0:44:03With time running out,
0:44:03 > 0:44:06Carol must make sure the right blood gets retested
0:44:06 > 0:44:09before the specialist lab closes at 8pm.
0:44:11 > 0:44:15Thank you so much, thank you very much. It's George Cuthbert.
0:44:16 > 0:44:19I had two sets of patients' details in front of me
0:44:19 > 0:44:21so I recorded the wrong number.
0:44:21 > 0:44:23I should have probably separated my notes
0:44:23 > 0:44:26and not had everything together cos that may have confused me.
0:44:26 > 0:44:28It's just about being efficient with your paperwork.
0:44:30 > 0:44:32All Mr Cuthbert can do is wait.
0:44:33 > 0:44:36It's been nearly two hours since he arrived
0:44:36 > 0:44:38but eventually the results come through.
0:44:40 > 0:44:41I've got his results back.
0:44:41 > 0:44:44Oh, wow, OK.
0:44:44 > 0:44:46His malaria screen is positive.
0:44:47 > 0:44:52- So I'm going to refer him to ID because he's got malaria.- He has?
0:44:52 > 0:44:55- His test is positive. - How come it's got "Not detected"?
0:44:55 > 0:44:59However, on further inspection, the result contradicts itself.
0:44:59 > 0:45:01I just need to check, what does this mean?
0:45:01 > 0:45:03What's the difference between this and this report?
0:45:03 > 0:45:07This one says "Not detected"... "Positive". I don't know.
0:45:07 > 0:45:11Carol will need to get urgent advice from the Infectious Diseases Unit.
0:45:11 > 0:45:15And then malaria parasites detected, it says "Not detected."
0:45:16 > 0:45:18So there's two parts of the report.
0:45:19 > 0:45:22Yeah, but then the screen says "Positive."
0:45:23 > 0:45:26Carol's shift should have ended two hours ago
0:45:26 > 0:45:29but she's determined to finish what she started.
0:45:31 > 0:45:33She must now break the news he's staying in for the night
0:45:33 > 0:45:37and his results are at this stage inconclusive.
0:45:38 > 0:45:43The malaria blood tests, there is a little bit of low parasite levels.
0:45:43 > 0:45:46But it's not quite consistent, so we need to repeat the test.
0:45:46 > 0:45:49So just the screening test, which is what they do,
0:45:49 > 0:45:52shows that it's positive for malaria.
0:45:52 > 0:45:54For that reason, they'd like to keep you in
0:45:54 > 0:45:57just so that tomorrow they can repeat the blood test and see.
0:45:57 > 0:46:01If it still shows the same thing, they may consider treating you but if it's negative, they'll send you home.
0:46:01 > 0:46:04- Are you happy to be in overnight? - I'm happy with that.
0:46:04 > 0:46:07- And you're feeling OK?- Yep. I'm OK.
0:46:07 > 0:46:10OK, well, I wish you well. OK, then. Yep.
0:46:13 > 0:46:15It's been interesting. It's been very busy.
0:46:15 > 0:46:19It's been longer than I expected it to be. But it's been good.
0:46:19 > 0:46:21I'm ready to go home.
0:46:21 > 0:46:23It's been a long first shift for Carol,
0:46:23 > 0:46:26but husband Mas has kept his promise
0:46:26 > 0:46:29and is waiting for her as she finally gets out of work.
0:46:48 > 0:46:54- Hi. Oh, what's this?- Something to eat.- Oh, thank you. This is nice.
0:46:54 > 0:46:58- Go on, then, did you enjoy it? - I did enjoy it. Yeah.
0:46:58 > 0:47:03- What did you enjoy?- I just enjoyed talking to the patients, you know?
0:47:03 > 0:47:05You know, suddenly I felt like...
0:47:05 > 0:47:09I really did feel today that, gosh, I've missed being in a hospital.
0:47:09 > 0:47:12I've missed clinical work. I've missed doing all this.
0:47:12 > 0:47:16- I've missed seeing patients. - Yup.- That's good.
0:47:16 > 0:47:18And how long did the nervousness last for?
0:47:18 > 0:47:23- When we... When we got to the hospital. I just...- I told you.
0:47:23 > 0:47:25As soon as you walk in, your mind will go.
0:47:25 > 0:47:30- It's all past me, it was all behind me.- Great.- Yeah.
0:47:30 > 0:47:34- I have to say, I'm feeling happy after my shift.- I told you.
0:47:34 > 0:47:36- It would be quite straightforward. - Yeah.
0:47:47 > 0:47:49It's a new day on Upper GI
0:47:49 > 0:47:52and Jen be spending most of it in lectures.
0:47:52 > 0:47:55But she's concerned about an elderly patient
0:47:55 > 0:47:58that she and Emily tried to cannulate the day before,
0:47:58 > 0:47:59so goes to check in on her first.
0:48:01 > 0:48:04This morning, your heart rate was a little bit fast,
0:48:04 > 0:48:07so we're just trying to find out why. It's probably nothing.
0:48:09 > 0:48:12I'm going to listen to your chest, if that's OK? You look tired.
0:48:12 > 0:48:14Aw...
0:48:14 > 0:48:18I'll be as gentle as I can. Is it sore here?
0:48:18 > 0:48:20Or there? What about here?
0:48:22 > 0:48:24Jen does all she can for her patient...
0:48:24 > 0:48:27Probably be fine but we just need to double check.
0:48:27 > 0:48:31..before handing over her care to a colleague...
0:48:31 > 0:48:34She came in with a UTI, so I think we need to get her midstream urine sent off.
0:48:34 > 0:48:36That'll be fine to do.
0:48:36 > 0:48:38..as her lectures are about to start.
0:48:43 > 0:48:46Meanwhile, in the Acute Medical Unit...
0:48:47 > 0:48:51- Tom is just starting his on-call shift.- Not on this ward.
0:48:51 > 0:48:54- Yeah, on this ward since last night. - It's been since then?
0:48:54 > 0:48:55- Should be.- I don't think it was.
0:48:55 > 0:48:57Part of the role of being on call,
0:48:57 > 0:49:02I have to hold the cardiac arrest pager and when I hold this,
0:49:02 > 0:49:03basically, if it goes off,
0:49:03 > 0:49:06I have to get to a cardiac arrest as quickly as I can.
0:49:06 > 0:49:08It's a huge responsibility
0:49:08 > 0:49:11and one that medical school could never have prepared him for.
0:49:11 > 0:49:13This is one thing you can categorically say,
0:49:13 > 0:49:17"I've not done this before," even if you've been to an arrest with somebody you've shadowed,
0:49:17 > 0:49:21it's still very different to feel the responsibility is far more on your shoulders.
0:49:21 > 0:49:24When it goes off, I suppose, it is quite scary.
0:49:24 > 0:49:26PAGER BEEPS
0:49:26 > 0:49:2830 minutes in and he's received a crash bleep.
0:49:28 > 0:49:30Let's go, guys.
0:49:32 > 0:49:35He needs to get to the Upper GI ward as soon as possible.
0:49:35 > 0:49:37A patient has gone into cardiac arrest.
0:49:38 > 0:49:41Can I just go to Five first cos I've got a cardiac arrest?
0:49:41 > 0:49:42HE SIGHS
0:49:55 > 0:49:57Despite his best efforts,
0:49:57 > 0:50:00the crash team are already in place and at work.
0:50:00 > 0:50:02- Can somebody do the timing? - I'll time.
0:50:02 > 0:50:06'When I arrived, the resuscitation was already under way.'
0:50:06 > 0:50:08Can anyone assess the output?
0:50:08 > 0:50:10There's no output.
0:50:10 > 0:50:1130 seconds left.
0:50:11 > 0:50:15'Shortly after, the patient's daughters came to the bedside
0:50:15 > 0:50:17'and I think they were probably'
0:50:17 > 0:50:19expecting this to happen at some point soon,
0:50:19 > 0:50:21judging by what they said.
0:50:21 > 0:50:25Tom is unaware that the lady they are attempting to save
0:50:25 > 0:50:27is Jen's favourite patient.
0:50:27 > 0:50:29It was at the request of the patient's family
0:50:29 > 0:50:31that the resuscitation process be stopped.
0:50:33 > 0:50:35'The team agreed and it was.'
0:50:37 > 0:50:39So, yeah.
0:50:42 > 0:50:45'Situations like this are very sad.
0:50:45 > 0:50:47'Coming away from that afterwards,
0:50:47 > 0:50:50'the moments after arrest when the scene just slowly drifts apart,'
0:50:50 > 0:50:52it's kind of quite moving, really.
0:50:52 > 0:50:55'But I think you just have to start thinking about it
0:50:55 > 0:50:57'and get your head back into thinking about the day ahead
0:50:57 > 0:50:59'and looking after your other patients.'
0:51:03 > 0:51:04Having finished her lecture,
0:51:04 > 0:51:07Jen has just found out that her patient has died.
0:51:10 > 0:51:13I think the thing is about this lady,
0:51:13 > 0:51:18my first thought after being upset about it was just that...
0:51:20 > 0:51:23is there anything that I missed in the last few days
0:51:23 > 0:51:27that maybe the house officer previously would have done...
0:51:29 > 0:51:31that meant we'd have had a better idea,
0:51:31 > 0:51:33but I'm not really sure that's the case.
0:51:33 > 0:51:36I just think you just question yourself, don't you?
0:51:36 > 0:51:39So, it's just relatively new and...
0:51:40 > 0:51:43not used to...
0:51:43 > 0:51:46Not used to this kind of thing happening in my life every day.
0:51:46 > 0:51:47But, you know, I'm OK.
0:52:09 > 0:52:14It's been an emotionally gruelling day for Jen, and she's worn out.
0:52:14 > 0:52:15I went to Tesco on the way home
0:52:15 > 0:52:18and bought myself some comfort crumpets and a pizza
0:52:18 > 0:52:19to make me feel better.
0:52:21 > 0:52:22Some crumpets.
0:52:24 > 0:52:27Second-year Ollie is on hand to lend support.
0:52:28 > 0:52:30So, I had a shitty day.
0:52:30 > 0:52:32My favourite patient died.
0:52:33 > 0:52:35Little old lady that I loved.
0:52:36 > 0:52:39We weren't really expecting her to.
0:52:39 > 0:52:42I spent the whole morning stabbing needles into her.
0:52:42 > 0:52:46Then she had a cardiac arrest and then... Yeah, she died.
0:52:49 > 0:52:52Spent the whole afternoon moping around in the hospital.
0:52:54 > 0:52:58- But I saw her family, it made me feel a bit better.- Poor thing.
0:52:58 > 0:53:01But, yeah, I mean, it happens, so ...
0:53:01 > 0:53:03- Do you want some cake to cheer you up?- Have you got cake?
0:53:03 > 0:53:06- I've got cake.- Well, yeah, what kind of cake?- I don't know.
0:53:06 > 0:53:10- It was someone's birthday today. I got given some cake.- Amazing.
0:53:10 > 0:53:12I don't feel like it, cos I've had about five pieces already.
0:53:12 > 0:53:13Have you?
0:53:15 > 0:53:17Oh, yes! Birthday cake.
0:53:18 > 0:53:21One of the nurses on our ward was leaving as well
0:53:21 > 0:53:24so they had, like, a leaving thing with loads of food and cake.
0:53:24 > 0:53:25So you've eaten loads of cake?
0:53:25 > 0:53:28I've eaten a lot of cake. Lots of baked goods.
0:53:28 > 0:53:29HE SIGHS
0:53:29 > 0:53:34- Well, hopefully, the cake will cheer you up.- The cake is cheering me up.
0:53:34 > 0:53:36I bought other crap food to cheer me up as well.
0:53:36 > 0:53:38Yeah, it does always help.
0:53:41 > 0:53:45It's been a roller-coaster week for all the junior doctors,
0:53:45 > 0:53:48so there's only one place to get over it.
0:53:50 > 0:53:52The boozer.
0:53:52 > 0:53:55And they're talking about the fee that undertakers pay them
0:53:55 > 0:53:57to sign off bodies for cremation.
0:53:58 > 0:54:01I'm going to put it in my bank but I'm not going to spend it,
0:54:01 > 0:54:03cos I don't know what would be a good way to spend it.
0:54:03 > 0:54:04I haven't decided yet.
0:54:04 > 0:54:07My rule was, on the way to banking it in town,
0:54:07 > 0:54:10I had to have already spent it by the time I got there
0:54:10 > 0:54:11from going somewhere else.
0:54:11 > 0:54:14And therefore, like, I just used it as disposable money.
0:54:14 > 0:54:17I'm going to literally keep it to one side
0:54:17 > 0:54:19so even when I do need to do a training day
0:54:19 > 0:54:21or get something for myself, I'll get out of that.
0:54:21 > 0:54:24- I thought that.- If there's any courses or anything like that.
0:54:24 > 0:54:26If my nan died, what would she want me to spend it on,
0:54:26 > 0:54:28that kind of attitude, rather than just...
0:54:28 > 0:54:31Rather than just a new pair of shoes.
0:54:31 > 0:54:33But, you know, if you happen to go via a pub
0:54:33 > 0:54:35on the way to cashing it...
0:54:36 > 0:54:39Talking about their responsibilities,
0:54:39 > 0:54:40the junior doctors reflect
0:54:40 > 0:54:43on how far they've come since medical school.
0:54:43 > 0:54:45So, are you finding that you kind of know all the answers
0:54:45 > 0:54:48to those questions that you were asking all the time at first?
0:54:48 > 0:54:52Oh, God. Definitely. Even though I DID know what to do, I'm like, "Right,
0:54:52 > 0:54:55"what goes first? I've checked my Us and Es.
0:54:55 > 0:54:57"I've looked at their blood pressure.
0:54:57 > 0:55:00"And I've made sure they haven't got heart failure. Have I done everything?"
0:55:01 > 0:55:05When you start, you're terrified to give someone paracetamol. And now you're just like...
0:55:05 > 0:55:07You're like, "Is it a gram?
0:55:07 > 0:55:09"It's definitely a gram, isn't it?
0:55:09 > 0:55:11"Sure they haven't got liver failure?"
0:55:11 > 0:55:13"No, no, they've just got a headache."
0:55:13 > 0:55:17I guess all these things are things that worry you to begin with
0:55:17 > 0:55:18and once you, like...
0:55:18 > 0:55:21Once you've done it a few times, they just pale into insignificance.
0:55:21 > 0:55:24It kind of has to, cos if you spend that long worrying
0:55:24 > 0:55:29about what you were doing all day, you wouldn't get anything done.
0:55:29 > 0:55:32- You'd be a mess.- You'd be a bag of nerves, wouldn't you?
0:55:32 > 0:55:34THEY LAUGH
0:55:36 > 0:55:39Next week on Junior Doctors.
0:55:39 > 0:55:42As their first three months come to a close,
0:55:42 > 0:55:46Tristan needs to make some big decisions about his future.
0:55:46 > 0:55:49What do you think of, like, acute medicine as a career?
0:55:49 > 0:55:51It's knowingly going into something
0:55:51 > 0:55:54that will make our life more difficult.
0:55:54 > 0:55:57And you've got to weigh up whether that's going to be worth it for you.
0:55:58 > 0:56:01Jen makes her debut in the operating theatre.
0:56:03 > 0:56:05And gets a taste of what the future may hold.
0:56:07 > 0:56:11It felt really nice when I was writing in the operation notes, "Surgeon - J Whiteley."
0:56:11 > 0:56:13That was a bit weird but nice.
0:56:15 > 0:56:17PHONE RINGS
0:56:17 > 0:56:19'Testing, testing, testing.'
0:56:19 > 0:56:23And Ed's first night shift doesn't get off to the best of starts.
0:56:23 > 0:56:26I don't know how the bleeps work. Nobody's ever told me.
0:56:26 > 0:56:27WHITE NOISE
0:56:27 > 0:56:29Yeah? Hello?
0:56:29 > 0:56:33But can he get his act together when the call comes for real?
0:56:59 > 0:57:03Subtitles by Red Bee Media Ltd