What They Don't Teach You in Medical School Junior Doctors: Your Life in Their Hands

Trauma...

-She's got a pulse, she's got a strong pulse.

-Any pain up here?

..tears...

HE BREAKS DOWN

..and intense pressure.

Changing the oxygen over.

Just another day on medicine's frontline.

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 are following seven junior doctors

over their first three months on the job...

-Sharp scratch.

-Ewww!

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

..where there is a first time for everything.

I didn't really know what to do.

It's 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 for just two months.

OK, and swallow.

-Can I have a tap on your back?

-Yes.

Could you please make a humming noise.

Second-years Ollie and Kiera have been in the job 12 months.

When I press in here, is that sore?

And now there's Malawian doctor, Carol,

who is hoping to get a full-time position working in A&E.

No cough, no chest pain?

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

They're here to look after you, lad! Give it a rest.

They're learning lots on the job

but are realising there's plenty that medical school

could never have prepared them for...

I think that's cardiology.

Your guess is as good as mine, I'm afraid.

..and that dealing with the critically ill and dying

is going to take its toll.

I'm not used to this kind of thing, happening in my life everyday,

but I'm OK.

Late nights and long days are now a reality for all the junior doctors.

With a million patients

passing through the doors of the hospital every year,

making it as a medic takes skill and stamina.

We were warned before we became juniors

that we'd be signing up for a few long stints.

It's been a long night.

I feel that I want to get home because I'm a bit tired.

SHE YAWNS Sorry!

I want to cry little bit, I'm so tired.

For Emily, in particular, getting used to the long hours

working around the clock has been an uphill struggle.

So, lady on 8X just...

YAWN OBSCURES SPEECH

So, I just came to check on her.

Oh, dear.

BLEEPER ALERT

Just put my toast on.

The exhausted junior doctor has been working for 11 consecutive shifts.

I'll set my alarm.

Later today, she will be catching a train to her mum's

for a much-needed break.

So, she's hoping for a quiet Friday on the ward.

But working in an inner-city hospital,

you don't always get what you wish for.

One of Emily's patients, a prisoner,

has been admitted with a knife wound,

but somehow he's slipped his prison guards.

Very busy, not finished ward round yet, midday.

One of our patients was stabbed, had a chest drain put in,

he's ripped it out and he's on the roof and the police are here.

So, we are waiting for him to get brought down so we can assess him.

With the fugitive on the run,

any chance of Emily making her train on time hangs in the balance.

You don't get prisoners escaping off the ward every day

and I am sure on a normal day

it would be quite a novelty and exciting,

but today I really need to get on.

Word has spread quickly and excitement is near fever-pitch.

We believe the convict is still in the ventilation system.

I would be worried about him if I didn't have 60 other patients,

so at the minute he is just annoying me.

I've been reliably informed it's one of Emily's patients.

Emily's patient?

I don't think I'd ever seen a patient

with that amount of security.

I didn't think she was that bad a doctor!

There's no need to jump out of the hospital.

No patient is an inconvenience,

but I think some are more challenging than others.

With the end of her shift approaching,

Emily has lots to get done

if she is to leave on time and catch her train.

There isn't a class on how to treat an escaped convict

at medical school.

Just like there isn't one on how to read a consultant's handwriting.

How can I do this?

Italian medic Ed has come up against this age-old problem

and has turned to Ollie for help.

Confusion, I think that's cardiology.

I'm not used to this writing.

So, it's a cardiology problem.

-It's either cardiology or gerontology.

-I don't know.

-It could be gerontology, cardiology.

-It could be any ology!

Your guess is as good as mine, I'm afraid.

We've all felt his pain, trying to decipher some ancient runes

that have been scribbled across the page

by some professor or consultant.

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

Can you tell me something more about this?

Ask Hannah.

Yeah, because I just can't do this.

I don't want to put through a random referral and follow-up with who?

Giving up on the undecipherable notes,

Ed has been tasked with the job of getting blood from a patient

with weak veins and a serious phobia of needles.

Is that OK if we can take some bloods from you?

Yeah, I'm feeling around. Pump your hand a bit.

Let's just have a look. I don't want to stab you many times.

There's really not much here. I will have a look on this side as well,

then we will just decide.

Ed calls in some assistance to help calm the patient's nerves.

Someone's already tried here.

-I would say...

-That looks like a vein.

-Yeah.

It's your best bet so far.

There's absolutely nothing there. There's no blood at all.

OK, we will try this one. Seems like there's something there.

Just keep it nice and still.

Ed is having no luck finding a vein.

The patient is getting increasingly agitated.

-Don't move this hand, please. Don't. Stop it.

-Stop moving this hand.

-Don't move it any more.

-Just keep your hand still.

Keep your hand still.

Shall we have another go?

Right, I'm going to try this one again. You must keep still.

Otherwise the needle goes out.

Nice and still, nice and still. Nearly done.

-She moved around and it went out the other side.

-Just relax.

Nope, I'm sorry. There's no way I can get a cannular in there.

If somebody else wants to try, but I definitely can't. I've looked.

A frustrated Ed beats a hasty retreat.

Meanwhile, back on colorectal...

-I haven't finished the ward round yet.

-You're kidding me!

Emily's day is also showing no signs of improvement.

She is still hoping to get out on time

so she can make it to her parents for supper,

but with her prisoner patient still hiding

and a mountain of work to complete, it's not looking likely.

I've got a lady who's got an exacerbation of CUPD.

I've totally forgotten what CUPD stands for!

There's bloods to take...

-I'm not convinced there's anything there.

-No.

-Do you mind if I go in the back of your hand?

-No.

-Is that all right?

..and patients to please...

Don't move. I'm being quite rude, aren't I?

-..but none of it is going to plan.

-You're trickier than you look!

We're having a bad day today, aren't we?

Argh!

Does that hurt? Going to need a stiff drink after this.

As the afternoon draws on,

news of the escaped prisoner has reached the local news stations.

'A prisoner who was due to undergo surgery

'at the Royal Liverpool Hospital

'has been recaptured after escaping from his guards.

'He was caught around two hours later.'

So, I've had to assess him.

I think he's just done his lung in again. We need another X-ray on him.

It's two o'clock and I've not finished my ward round

and I need to be out on time and it's not going to happen.

Over in cardiology, Tom's day is proving just as challenging.

This is a patient of ours who, unfortunately,

during the early hours of this morning,

had a cardiac arrest and passed away.

So, he's still on the ward now, he's about to go to the mortuary

and we will certify him as dead.

Verifying a patient's death is a job all junior doctors have to do.

I spent quite a lot of time with this chap's family.

This is my first certification,

so my senior, Laura, came and gave me a hand,

just make sure I did it all right.

Date of death is this morning. So...

'It's a bit of a strange situation

'and it was sad to know that patient had died,'

because I got to know him and his family quite well over the past few days.

And Tom is not the only junior doctor dealing with this.

Emily has also been called

to confirm the death of a patient on her ward.

Hello, Valerie. I'm just going to rub on your chest.

'I talk to the patients'

when I'm verifying their death just for myself, in a way.

Just to make it a little bit less eerie in the room,

because it's so quiet, which gives me the shivers.

I'm just going to shine a light in your eye, OK?

I think it makes you feel better if there's a bit of noise

and also just... It's nice for the patient.

You don't know what's going on, in a way.

You're only walking into the room. It's nice for them and their family.

There's a fee you get from the funeral home

for doing all the legal paperwork

and checking for a pacemaker and anything like that,

so the patient can be cremated.

I think it's one of the weirder parts of being a doctor,

being paid for when somebody dies.

So, I haven't quite worked out how to deal with it yet.

What I'll probably do is put it towards things I need for my job.

That's probably the nicest thing to do - books and equipment.

It's been a long day for Emily, but it's finally over.

I've just done 11 days in a row and I've not stopped today.

I'm feeling very tired and need to rush off to get my train.

So, I'm going home to see my family - really looking forward to it.

Need someone to look after me for a few days after this week.

With Emily safely on the train

and heading to Leicester for some home cooking, back at the house

the other junior doctors are eating whatever's in the fridge.

It's my dinner. As usual. Piri-piri chicken tonight.

Piri-picky chicken!

SHE LAUGHS

Ollie, Tom and Jen are sitting down to dinner junior doctor style.

How was your day?

Really hectic but fine. I got in this morning and...

one of our patients had died,

not somebody who was ill yesterday either.

Somebody who's had ongoing angina. He went into cardiac arrest

and died at 7:30 this morning. Verified certified. Yeah.

It's hit everyone quite hard, because we all really liked him.

He was lovely.

-And also didn't expect it.

-Yeah, it's a bit of both.

My consultant didn't know until this afternoon.

He came on the ward and we told him and he goes, "Oh."

-Did you hear about the chap on top of the Royal?

-Ollie told me!

-I heard it was Emily's patient!

-Of course it was.

Running away from her!

Who else's patient would it have been running away?

The doctor is just going to come and see you now...!

That would make me go through the ventilation shaft as well!

-Hello!

-Hello! Come here.

I have been counting down the days to come home

after 11 or 12 days on the ward.

I just wanted to come home and sleep in a nice bed and eat nice food

and just sit around and do nothing.

Emily's mum has gathered the family together for a celebratory dinner.

Whoa!

EMILY GIGGLES

-A toast for Emily.

-One of many, I think.

-Oh, quick.

-Welcome home, Emily.

-Welcome home!

-What's the toast to?

-Welcome home!

Conversation turns to the other junior doctors in the house,

-in particular, fellow singleton, Ollie.

-Tell me about him.

He's one of the doctors, a year above me. He works in AMU.

What's his hobbies?

-Um...boxing.

-Boxing?! Boxing! How old is he?

I don't know.

-What does he look like?

-Carry on, Nina...

-You've been without a boyfriend for a little while.

-I'm all right!

Leave her alone. She's quite happy.

-I'll back off.

-You're trying to make me feel awkward.

After giving up on her love life,

the next item on the agenda is Emily's future.

That is a good question, Emily.

Where do you see yourself in five years' time?

Um... I don't know really. Hopefully somewhere abroad.

I'd like to go abroad. Where do you see yourself?

-Where do I see myself in five years' time?

-Don't ask me!

THEY LAUGH

That's horrible!

-Grandma, you've got a rather generous portion of champagne.

-I'm a grandma!

Back in Liverpool,

second-year Kiera is at work in the hospital's emergency department.

She is under the supervision of Dr Demnitz.

I'll come and have a look when you've finished.

Kiera's first patient has asked not to be identified.

He's fallen and has a large wound on his head.

Oh, dear. Feeling a bit sicky?

Dr Demnitz, the consultant,

has asked me if I would pop your head back together for you, if that's OK?

26-year-old Kiera eventually hopes to specialise in A&E.

Dealing with a serious head injury like this

is a chance for her to prove she has what it takes.

You've made a good job of that, haven't you?

Close your eyes if you want.

When I first do this, it will be uncomfortable. How's that?

-How are you doing? Yeah.

-Yeah.

-Be very brave.

-Can you feel that?

-No.

-There?

-No.

-There?

-No.

Kiera is under pressure,

as she must present her stitching skills to Dr Demnitz.

I'm just going to get something a little bit bigger.

But the task requires a little extra creativity.

Yeah, this is an incontinence pad

but it's also a good way of protecting your clothes, OK?

-What did you fall on?

-On the road.

-Onto the road.

-OK.

-Have you done this before?

-Have I done it before?

No, it's my first time. No, it's not my first time.

I've done it innumerable times before.

As a junior doctor,

a key part of Kiera's job is to put patients at ease.

At least you'll have a good scar to show all your mates.

That's what you boys all seem to be worried about.

IN LIVERPOOL ACCENT: "How's my scar going to look, Doc?"

Right, I'm just going to go and get Dr Demnitz,

-he wanted to have a look at it once I was done.

-OK.

Just check that I haven't sewn your hand to your head, or something!

All done and dusted, eh?

Looks a heap better. Looks really nice, OK?

Do you feel up to, er, going?

Kiera's done a very nice, neat job, there.

The wound's come together beautifully,

and, er, I'm very pleased with the outcome.

Take it easy, bye-bye.

-You might need a new shirt!

-Oh, I like this!

It's a new day at the hospital

and new girl Carol is back in the emergency department.

She's on a trial period,

hoping to fill the vacancy left by Italian medic Ed,

after he was moved from A&E

and dropped down to do his first year in another department.

I'm Carol, I'm doing a clinical attachment.

I haven't seen a central line being put in before.

The Malawian medic needs to impress her seniors

if she's to be taken on as a second-year junior doctor.

I've noticed blood glucoses haven't been well controlled.

Carol may only be allowed to observe at the moment,

but she's already finding Liverpool a big contrast

to the African hospital where she trained.

I am ambitious and very focused,

and I think I would go that extra mile to be successful.

# Into the streets... #

So we're at Queen Elizabeth Central Hospital

and this is where I trained as a doctor.

I've worked in a setting where resources are limited

and you have to learn to cope.

I've learnt to work under pressure,

so I think I have what it takes to be a good doctor.

# Who's going to save the world tonight? #

I am the first doctor in the family.

I think for that reason, my family is proud,

because I think they have wanted a doctor for a while!

How many? They're good for you.

'It was a very thrilling experience,'

when we heard that she wanted to be a doctor.

'Everyone was so excited.'

The first doctor in both families!

-Some more?

-Thank you.

'I think she has a passion for her job. And I think once you have

'a passion for whatever you do,'

you always succeed.

CAROL LAUGHS

I do feel happy that I did medicine

and I wouldn't change my career for anything else.

I'm looking forward to the challenges that Liverpool has to offer.

I think just trying to find my feet might be a bit overwhelming,

but I'm ready for the challenge and I'm looking forward to it.

# We're going to save the world tonight. #

Back in Liverpool,

and she's dealing with a case very rarely seen in Malawi.

A suspected overdose.

The patient in question

says he's taken a cocktail of over-the-counter drugs.

How many tablets did you take?

Was it a box?

Like a strip? OK, what did you take it down with?

Cough syrup, OK.

Carol will need to arrange for blood tests,

to determine whether the overdose has put the man in danger.

Basically, we're going to keep him in just

to make sure he's medically stable, check that whatever he has taken...

He hasn't been able to identify it properly.

Just do some blood levels, to try to identify the toxin,

just in case that has some potential lethal risks.

-He's basically come in because he's attempted suicide...

-OK.

-..at home.

He's taken some medication

which I think he described as a paracetamol, a strip of paracetamol.

He doesn't remember how many tablets.

He's had this medication with him for a couple of weeks.

He was suffering from a flu recently

and he just bought some medication over the counter.

He says he took them around four hours ago

and, on top of that, he has also taken half a bottle of cough syrup.

Cubicle...I think it's six.

Carol's senior decides to ask the patient some further questions.

This time, would you say that you wanted to kill yourself,

or was it more you wanted help?

If we didn't treat you in hospital, if we said, OK,

you can go home, would you go home and try to do it again?

I think this is the second case I've seen so far

of a self-harmer here. It is new,

knowing how to manage patients who come in with self-harm.

Carol continues to monitor the patient,

but there's more he wants to open up about.

He reveals he's an Egyptian asylum seeker.

The patient's confession means Carol needs to think on her feet.

A case of self-harm is suddenly becoming much more complicated.

He's clearly not himself. He needs some help.

He's gone and tried to express that need for help

in a different sort of way, which has made him want to harm himself.

Would you like to talk to somebody?

We have what we call the Crisis Management Team here.

No, no, no, no. No.

It's nothing to do with the Home Office at all.

This is a hospital. We're here only to help people.

It's just a hospital.

Regardless of where people have come from, or what problems they have,

we're just here to look after your health.

All the extra attention is making the patient nervous.

As Carol types up her notes,

another member of staff finds him trying to leave.

Let's do your bloods. Peace of mind.

We'll take some bloods, it'll take a few hours before he gets the results.

Sit tight with us here and let's just get you properly checked.

This case has been another lesson for Carol

in the sort of skills a junior doctor needs

to work in an inner-city British hospital.

The other junior doctors may have more experience of the NHS,

but the learning doesn't stop for them either.

For the past five years, they've been glued to their textbooks,

but since they started working on the wards full time,

it's the patients they're now becoming attached to.

I just wanted to come and say goodbye, because I understand

that your daughters are going to come and pick you up later.

Yes, they are, yes.

'It is going to be sad to see her go, because...'

that's the sort of patient

you want to sit down and have a cup of tea with.

The emotional side of the job has hit me

probably more than I expected it to in the last few months, actually.

First-year Jen has been treating an elderly lady

for the past few days and has already formed a bond.

She's my favourite patient.

There's nowhere to find a vein on you.

I might just have to put it in this one here.

She needs a cannula, but elderly patients can often suffer

from weak veins that break down once a needle has been inserted.

I just can't find anywhere on her.

Jen hatches a plan, but needs help from Emily,

who's back on the wards.

I wondered if we could double-team it?

-Yeah.

-So you could hold her...

-Like, squeeze, and pull the skin back for me, while I put it in.

-Yeah.

Because I think that's a bit, like...

She's got good veins, but...

-Exactly, yeah.

-Are you ready?

-All right, then.

-Have you got the gel?

-Yep.

If it works, we're going to call it the Phipps Method.

-What, this?

-Yeah.

-Why? This is my method, I devised it!

If anything, it's going to be Whiteley-Phipps.

-OK, it's the Whiteley-Phipps.

-Hello!

Right, squeeze her arm here for me.

Yeah? Can you feel that?

Oh, that's good. Ooh, yes.

Fingers crossed!

Sharp scratch... Come on.

We're in!

The two doctors think they've done it.

Can you put your hand there?

Stop bleeding...

Good job.

But despite their optimism,

the vein has broken down.

-Is it feeling OK?

-I think that's blue.

Does it not feel very nice?

What do you want to do?

We can have another go,

put the cannula in, then she can have the pain relief through the cannula.

Or we can wait till she can drink and then have oral.

Giving her painkillers in tablet form

is one alternative Jen can offer the patient.

And if that's not doing the job for you,

we'll send somebody up that can do this much better than we can.

Is that fair enough?

You are officially my most awkward customer!

THEY LAUGH

Looks like Jen and Emily

will have to work on their Whiteley-Phipps Method another time.

-Damn it, Emily, I thought we had it there.

-I know.

First-year Ed has had a tougher time than most

adjusting to life in Liverpool.

His transition from an Italian GP practice

to an inner-city hospital has not always been smooth

and he's still getting used to NHS rules and regulations.

I discussed it sensibly with the family yesterday

and they were pretty sure that...

They can understand that the situation is very, very serious...

Ed has been treating a terminally ill patient for the last few days.

His condition has rapidly deteriorated and is now critical.

So the background is, he has got acute myeloid leukaemia,

and that's why he's receiving transfusions regularly here.

He's also got a background history of adenoca of the prostate,

so there are two different malignancies not linked.

Ed will need to give the patient regular doses of morphine,

the first time he's given it since working in the hospital.

So it eases breathing, it eases pain.

Get him nice and calm,

get him as comfortable as we can.

-We want 2.5.

-Yeah.

-So we'll mix that in five.

-Yeah, then get rid of half of it.

-Yeah.

When a patient is given morphine,

any leftover medication needs to be disposed of.

It's a hospital rule that Ed's struggling to get his head around.

Well, I mean, if it was for me, I wouldn't waste it,

but unfortunately, we've got some rules to follow.

It's just silly for me to waste all this medication, simply because...

Because of concerns. It's just silly.

I'm helping him, I'm giving him the medication,

so it's not that I'm going to go and sell it on the black market.

Ed spends the next few hours at the dying patient's bedside,

providing him with essential pain relief.

-It's OK, we'll flush it with the rest of this.

-Yeah.

But some colleagues are still concerned

that he's not following the protocols

around the use of morphine.

Yeah, I don't want to go around with it.

As soon as we give it, I'll chuck it away.

-Well, it needs signing off as well.

-Yeah, of course.

-OK?

-Yep.

-You're not going to forget?

-No, don't worry. No, no, no, I will!

-Don't worry.

-How much have you given?

I clocked him in yesterday evening, took care of him yesterday evening,

then I came on again this morning, and I'm taking care of him right now.

He's groaning permanently.

Having never dealt with a case like this before,

Ed is being tested at every level.

All right. Thank you very much for your help.

OK, thank you, bye.

I'm going to write these things down,

because that's something I've got to remember how to do in future

on my own, without having to ring anybody else...

Ed's trying to stay focused on caring for the patient,

but the hospital rules still have to be followed.

-If he needs it, he needs it. Give it to him.

-That's what I thought.

The thing you mustn't do is to walk around with it without labels,

-in your pocket, you mustn't do that.

-OK.

-Someone could just pick it up.

If you think he is uncomfortable, call me,

because I can do something to make him a bit more comfortable, OK?

Even though Ed has struggled with the rules around morphine,

his care for the patient hasn't gone unnoticed

by other staff on the ward.

The nurse just told me that they were happy with the way

I'd been dealing with them,

so that was, you know,

that's a very positive thing, for me to know that...

at least from the social point of view, the approach was correct.

Tom is working the night shift.

It's 4am and he's been called to see a patient on the respiratory ward.

So this is a gentleman who was found collapsed on board his cruise ship.

I was called to see him because his temperature's been spiking

and his kind of general demeanour's gone downhill.

His breathing rate has gone right up into the sky, he's on oxygen,

he's still not saturating very well.

The man is German and doesn't speak any English.

Excuse me, can you sit forwards?

'Having these communication issues makes managing patients

'particularly challenging.'

Often, you can get hold of interpreters,

but given the fact it's the middle of the night,

it does make it slightly difficult.

My German is shoddy!

It's not a scenario in any medical textbook,

and a bit of creative thinking is called for.

Oh...

"Doktor" is the German for doctor anyway. So, "Ich bin ein Doktor."

-Do it all on here, it speaks and everything.

-Wow. That's amazing.

Doctor.

-PHONE:

-Arzt.

Ooh, gosh! SHE LAUGHS

"Doktor". The same word, there.

-Or "Doktor".

-Oh, gosh.

I need to ask him if I can just have a listen to his chest.

As long as it doesn't think chest is a chest of drawers!

-PHONE:

-"Kann ich an die Brust zu horen?"

Change the word "chest" to "lungs".

Just to make sure it doesn't come up with, like, wardrobe or something.

Ich bin ein Doktor.

-PHONE:

-Kann ich an die Brust zu horen?

It's another situation, this is, of applying theory to reality...

Being a doctor always involves learning,

right from the first day till the day you retire.

Carol has been on trial in the emergency department

for the past month.

And today, she's received the news that she's been waiting for,

the green light to work as a second-year junior doctor.

And she can't wait to tell her parents back in Malawi.

Hello, Daddy.

I was calling to tell you I'm going for my first shift this evening.

'That's good news.'

I'm excited, a bit nervous,

but I'm looking forward to it.

The thing to do is to ask the nurses.

Today will be the first time

Carol can treat patients in the hospital

since arriving from Malawi.

But despite being an experienced doctor, Carol is feeling nervous.

So you have to do it properly, properly.

She turns to husband Mas for support.

Be calm and pass everything through the seniors.

Carol, you know this stuff,

you've done it in Malawi. It's the same, nothing different.

You'll be fine, Carol, you'll be fine.

As a consultant at the same hospital,

he knows how she's feeling.

The first couple of shifts will be a bit, you know, there'll be that,

you know, frog-in-the-throat feeling, but she'll be fine.

But I'll be dreading the moment of picking her up!

That will be the, you know... "How was it?"

And then if there's a smile, it's easy. But if there's a, "Oh..."

But, you know, that's how it is.

Just packing my bag, making sure I have everything I need. Notepad.

I want it to go well.

I want to walk out of A&E feeling confident, at the end of my shift.

That will make me feel encouraged and make me want to go back again!

I think when I start talking to the patients, I'll be OK.

See you!

-Hello.

-Hello.

After being inducted, Carol starts her shift.

Mr William Dale?

Mr William Dale?

But it looks like she'll have to wait a little longer

to treat her first patient.

Mr William Dale?

'Most patients wait in the waiting room and then they get called in.'

I called the patient three times and I didn't get any response.

I'll just talk to the nurse,

maybe I'll document him as "did not answer", give it a while,

then try to find him again, and see the next patient.

On the other side of A&E, Kiera has just started her shift.

Is he...?

Her first patient is pensioner Brian Taylor.

Fine, I'll have a look at him. Ta.

I've just been asked to see a gentleman

who's been feeling a bit dizzy recently.

His GP's had at look at him and he's a bit concerned

so we need to get onto it quite quickly and make sure he's OK.

Just tell me about this dizzy feeling when it comes on, then.

I just have problems sitting.

I get a rush to my head

and I feel... I feel warm

and then I feel a little bit sick and it just goes dark for a second.

And I have to grab hold of something before I hit the deck.

Have you passed out at all with it?

Um...yeah.

Kiera is so concerned about his symptoms

that she transfers him to the resuscitation bay,

which is equipped to treat patients

whose conditions can suddenly change.

-Can we get this chap on some monitoring, please?

-Yep.

And...

Yeah, he's a query leaking AAA.

Right, so a sharp scratch coming up now, OK?

Try and keep your arm nice and relaxed for me.

That's great, well done.

Sharp scratch.

But as soon as Kiera fits the cannula,

his health seems to take a turn for the worse.

Are you all right, sir?

-Are you OK there?

-Are you all right?

-What's wrong there, sir?

My head's just gone...

Shall we lie a bit flatter?

Yeah, I'll just pop you back, all right?

Try and stay awake with us. Well done.

Ram a load of fluids up him

in case his blood pressure is on the low side.

Mr Taylor, how are you doing?

What's his pulse? Is that his pulse there? OK.

-And his blood pressure's 120?

-125/86.

-OK, fine. How's that?

-Still feel dizzy?

-I'm coming round.

You're coming round, there we go.

Was it me plugging that thing in your arm?

With the patient stabilised, Kiera can continue her investigations.

OK, I just want to do a little test with you now.

Try putting your head right back as far as it'll go.

Right back.

Dizziness? OK, just relax.

Sit back for me, sir, well done, that's it.

-Did that make you feel dizzy?

-Yeah.

Is that the feeling you've been getting?

The examination explains

the likely cause of the patient's fainting and dizzy spells.

The reason for that, we think what's going on,

is sometimes when you get a little bit older,

you get a bit of arthritis around the neck

and sometimes in certain positions, if you put your head back

or if you put your head forward,

the vertebra kind of do that,

they squeeze a little bit

on the blood vessels that go up into the brain

and when that happens, it starves the brain of oxygen

for just a little bit and that's what makes you feel really dizzy.

While it's bad news for Mr Taylor, Kiera's quick diagnosis

is the first step on the road to his recovery.

He's got an element of vertebrobasilar insufficiency.

Being trusted to carry out accurate examinations of patients

is key to succeeding in the busy emergency department.

I think it's very important

to make the right impression for your seniors.

There's certainly a balance to get.

You don't want to be consistently pestering with them.

You also don't want to be too overconfident

-because it's dangerous for patients.

-Smashing.

-OK, so plan as...above?

-Lovely.

-Any questions?

-No.

But for now, there's little time to reflect on her success...

-Thank you very much.

-OK, and I'll see you in a little bit anyway.

Any problems, let me know.

..as there are plenty more patients just like Brian waiting to be seen.

Meanwhile, Carol is hoping for an equally successful diagnosis

for her first patient.

I have a gentleman who's been complaining of ongoing chills,

rigors, fever on and off, since December last year.

-How long were you in Dubai for?

-Two and a half years, almost.

-OK, and what work were you doing when you were there?

-Drainage.

And when you were out there,

were you on any prophylactic treatment for malaria

or anything like that?

What she hears immediately alerts Carol

to a potential malaria infection.

Something she's experienced in diagnosing

and treating from her time in Malawi.

Things like malaria, TB, meningitis are so common in Malawi, so...

With his story, you have a high suspicion

because of the area he's been to as well.

Are you all right with needles?

-Yeah.

-OK.

Which arm are you most comfortable with?

-Sharp scratch coming through. Are you OK?

-Yeah.

Carol's a dab hand at getting blood

and despite her first-night nerves, her skills don't fail her.

-Are you doing OK?

-Yeah, I'm OK.

OK.

Squeeze there for me. Mh-hm.

With the blood sent off,

she runs her diagnosis past the staff registrar.

I'm thinking he probably has something infectious

because of the nature of the rigors and the chills

and the fevers on and off.

I've taken some bloods.

I think I know what his diagnosis is,

but I'm still interested

in learning what the specialists have to say about him

and see if there's something new I can pick up.

So, can I give the medics a ring

and ask them to see the patient, or do I refer him

to the medics, or...?

OK, great. OK, thank you. Yep.

An hour later, the patient's results still aren't back

and Carol realises she's made a rookie mistake.

I called in earlier on

to ask for an add-on investigation on a patient for malaria blood smear.

But I think it was my mistake completely. I gave the wrong name.

So the test has been done on the wrong patient.

I'm really sorry, it was my fault completely.

With time running out,

Carol must make sure the right blood gets retested

before the specialist lab closes at 8pm.

Thank you so much, thank you very much. It's George Cuthbert.

I had two sets of patients' details in front of me

so I recorded the wrong number.

I should have probably separated my notes

and not had everything together cos that may have confused me.

It's just about being efficient with your paperwork.

All Mr Cuthbert can do is wait.

It's been nearly two hours since he arrived

but eventually the results come through.

I've got his results back.

Oh, wow, OK.

His malaria screen is positive.

-So I'm going to refer him to ID because he's got malaria.

-He has?

-His test is positive.

-How come it's got "Not detected"?

However, on further inspection, the result contradicts itself.

I just need to check, what does this mean?

What's the difference between this and this report?

This one says "Not detected"... "Positive". I don't know.

Carol will need to get urgent advice from the Infectious Diseases Unit.

And then malaria parasites detected, it says "Not detected."

So there's two parts of the report.

Yeah, but then the screen says "Positive."

Carol's shift should have ended two hours ago

but she's determined to finish what she started.

She must now break the news he's staying in for the night

and his results are at this stage inconclusive.

The malaria blood tests, there is a little bit of low parasite levels.

But it's not quite consistent, so we need to repeat the test.

So just the screening test, which is what they do,

shows that it's positive for malaria.

For that reason, they'd like to keep you in

just so that tomorrow they can repeat the blood test and see.

If it still shows the same thing, they may consider treating you but if it's negative, they'll send you home.

-Are you happy to be in overnight?

-I'm happy with that.

-And you're feeling OK?

-Yep. I'm OK.

OK, well, I wish you well. OK, then. Yep.

It's been interesting. It's been very busy.

It's been longer than I expected it to be. But it's been good.

I'm ready to go home.

It's been a long first shift for Carol,

but husband Mas has kept his promise

and is waiting for her as she finally gets out of work.

-Hi. Oh, what's this?

-Something to eat.

-Oh, thank you. This is nice.

-Go on, then, did you enjoy it?

-I did enjoy it. Yeah.

-What did you enjoy?

-I just enjoyed talking to the patients, you know?

You know, suddenly I felt like...

I really did feel today that, gosh, I've missed being in a hospital.

I've missed clinical work. I've missed doing all this.

-I've missed seeing patients.

-Yup.

-That's good.

And how long did the nervousness last for?

-When we... When we got to the hospital. I just...

-I told you.

As soon as you walk in, your mind will go.

-It's all past me, it was all behind me.

-Great.

-Yeah.

-I have to say, I'm feeling happy after my shift.

-I told you.

-It would be quite straightforward.

-Yeah.

It's a new day on Upper GI

and Jen be spending most of it in lectures.

But she's concerned about an elderly patient

that she and Emily tried to cannulate the day before,

so goes to check in on her first.

This morning, your heart rate was a little bit fast,

so we're just trying to find out why. It's probably nothing.

I'm going to listen to your chest, if that's OK? You look tired.

Aw...

I'll be as gentle as I can. Is it sore here?

Or there? What about here?

Jen does all she can for her patient...

Probably be fine but we just need to double check.

..before handing over her care to a colleague...

She came in with a UTI, so I think we need to get her midstream urine sent off.

That'll be fine to do.

..as her lectures are about to start.

Meanwhile, in the Acute Medical Unit...

-Tom is just starting his on-call shift.

-Not on this ward.

-Yeah, on this ward since last night.

-It's been since then?

-Should be.

-I don't think it was.

Part of the role of being on call,

I have to hold the cardiac arrest pager and when I hold this,

basically, if it goes off,

I have to get to a cardiac arrest as quickly as I can.

It's a huge responsibility

and one that medical school could never have prepared him for.

This is one thing you can categorically say,

"I've not done this before," even if you've been to an arrest with somebody you've shadowed,

it's still very different to feel the responsibility is far more on your shoulders.

When it goes off, I suppose, it is quite scary.

PAGER BEEPS

30 minutes in and he's received a crash bleep.

Let's go, guys.

He needs to get to the Upper GI ward as soon as possible.

A patient has gone into cardiac arrest.

Can I just go to Five first cos I've got a cardiac arrest?

HE SIGHS

Despite his best efforts,

the crash team are already in place and at work.

-Can somebody do the timing?

-I'll time.

'When I arrived, the resuscitation was already under way.'

Can anyone assess the output?

There's no output.

30 seconds left.

'Shortly after, the patient's daughters came to the bedside

'and I think they were probably'

expecting this to happen at some point soon,

judging by what they said.

Tom is unaware that the lady they are attempting to save

is Jen's favourite patient.

It was at the request of the patient's family

that the resuscitation process be stopped.

'The team agreed and it was.'

So, yeah.

'Situations like this are very sad.

'Coming away from that afterwards,

'the moments after arrest when the scene just slowly drifts apart,'

it's kind of quite moving, really.

'But I think you just have to start thinking about it

'and get your head back into thinking about the day ahead

'and looking after your other patients.'

Having finished her lecture,

Jen has just found out that her patient has died.

I think the thing is about this lady,

my first thought after being upset about it was just that...

is there anything that I missed in the last few days

that maybe the house officer previously would have done...

that meant we'd have had a better idea,

but I'm not really sure that's the case.

I just think you just question yourself, don't you?

So, it's just relatively new and...

not used to...

Not used to this kind of thing happening in my life every day.

But, you know, I'm OK.

It's been an emotionally gruelling day for Jen, and she's worn out.

I went to Tesco on the way home

and bought myself some comfort crumpets and a pizza

to make me feel better.

Some crumpets.

Second-year Ollie is on hand to lend support.

So, I had a shitty day.

My favourite patient died.

Little old lady that I loved.

We weren't really expecting her to.

I spent the whole morning stabbing needles into her.

Then she had a cardiac arrest and then... Yeah, she died.

Spent the whole afternoon moping around in the hospital.

-But I saw her family, it made me feel a bit better.

-Poor thing.

But, yeah, I mean, it happens, so ...

-Do you want some cake to cheer you up?

-Have you got cake?

-I've got cake.

-Well, yeah, what kind of cake?

-I don't know.

-It was someone's birthday today. I got given some cake.

-Amazing.

I don't feel like it, cos I've had about five pieces already.

Have you?

Oh, yes! Birthday cake.

One of the nurses on our ward was leaving as well

so they had, like, a leaving thing with loads of food and cake.

So you've eaten loads of cake?

I've eaten a lot of cake. Lots of baked goods.

HE SIGHS

-Well, hopefully, the cake will cheer you up.

-The cake is cheering me up.

I bought other crap food to cheer me up as well.

Yeah, it does always help.

It's been a roller-coaster week for all the junior doctors,

so there's only one place to get over it.

The boozer.

And they're talking about the fee that undertakers pay them

to sign off bodies for cremation.

I'm going to put it in my bank but I'm not going to spend it,

cos I don't know what would be a good way to spend it.

I haven't decided yet.

My rule was, on the way to banking it in town,

I had to have already spent it by the time I got there

from going somewhere else.

And therefore, like, I just used it as disposable money.

I'm going to literally keep it to one side

so even when I do need to do a training day

or get something for myself, I'll get out of that.

-I thought that.

-If there's any courses or anything like that.

If my nan died, what would she want me to spend it on,

that kind of attitude, rather than just...

Rather than just a new pair of shoes.

But, you know, if you happen to go via a pub

on the way to cashing it...

Talking about their responsibilities,

the junior doctors reflect

on how far they've come since medical school.

So, are you finding that you kind of know all the answers

to those questions that you were asking all the time at first?

Oh, God. Definitely. Even though I DID know what to do, I'm like, "Right,

"what goes first? I've checked my Us and Es.

"I've looked at their blood pressure.

"And I've made sure they haven't got heart failure. Have I done everything?"

When you start, you're terrified to give someone paracetamol. And now you're just like...

You're like, "Is it a gram?

"It's definitely a gram, isn't it?

"Sure they haven't got liver failure?"

"No, no, they've just got a headache."

I guess all these things are things that worry you to begin with

and once you, like...

Once you've done it a few times, they just pale into insignificance.

It kind of has to, cos if you spend that long worrying

about what you were doing all day, you wouldn't get anything done.

-You'd be a mess.

-You'd be a bag of nerves, wouldn't you?

THEY LAUGH

Next week on Junior Doctors.

As their first three months come to a close,

Tristan needs to make some big decisions about his future.

What do you think of, like, acute medicine as a career?

It's knowingly going into something

that will make our life more difficult.

And you've got to weigh up whether that's going to be worth it for you.

Jen makes her debut in the operating theatre.

And gets a taste of what the future may hold.

It felt really nice when I was writing in the operation notes, "Surgeon - J Whiteley."

That was a bit weird but nice.

PHONE RINGS

'Testing, testing, testing.'

And Ed's first night shift doesn't get off to the best of starts.

I don't know how the bleeps work. Nobody's ever told me.

WHITE NOISE

Yeah? Hello?

But can he get his act together when the call comes for real?

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