0:00:02 > 0:00:06This programme contains some strong language.
0:00:06 > 0:00:07Trauma...tears...
0:00:07 > 0:00:09That's all right.
0:00:09 > 0:00:11..and intense pressure.
0:00:11 > 0:00:13Changing the oxygen over.
0:00:15 > 0:00:19Just another day on medicine's front line.
0:00:22 > 0:00:25Three months ago, eight junior doctors began work here,
0:00:25 > 0:00:28at the Royal Liverpool University Hospital.
0:00:28 > 0:00:30Hey, you've no need to look happy, you lot.
0:00:30 > 0:00:32Give it a rest!
0:00:32 > 0:00:35'No matter how long hours I'm working,
0:00:35 > 0:00:38'no matter how fed up I am, you do feel rewarded by the job.'
0:00:38 > 0:00:40And that's a massive plus.
0:00:40 > 0:00:44'There's been points in the day where I think, "Oh, God,
0:00:44 > 0:00:47'"I just need to sit down.' Oh, dear!
0:00:47 > 0:00:48"I can't do this any more."
0:00:48 > 0:00:51'The more that I learn, the more realise'
0:00:51 > 0:00:54I don't know. I think it might have been in the wrong hole.
0:00:54 > 0:00:57And it just makes me excited to go and learn.
0:00:59 > 0:01:02'I was expecting it to be a more positive experience,
0:01:02 > 0:01:04'and at the beginning it wasn't,'
0:01:04 > 0:01:08but in the longer term, I can see it's been really good up to now.
0:01:08 > 0:01:10BEEPING
0:01:12 > 0:01:14'It's an incredibly steep learning curve,
0:01:14 > 0:01:18'which can either be overwhelming if you let it be'
0:01:18 > 0:01:20or can actually be quite a lot of fun.
0:01:20 > 0:01:24'The human experiences that I've got from it
0:01:24 > 0:01:26'and meeting all the patients, it's just been'
0:01:26 > 0:01:29really worthwhile.
0:01:29 > 0:01:32'It's really scary. Your level or responsibility goes from down here'
0:01:32 > 0:01:35to somewhere absolutely sky-high.
0:01:37 > 0:01:39'It's been interesting, very busy.'
0:01:39 > 0:01:41It's been good.
0:01:43 > 0:01:47They're now reaching the end of their first placements.
0:01:47 > 0:01:51And their thoughts are turning to the future.
0:01:51 > 0:01:55The endgame is to end up as a consultant in hospital.
0:01:55 > 0:01:57It's how you try and prove that you're dedicated.
0:01:57 > 0:02:02We're sort of forced to decide what we want to specialise in
0:02:02 > 0:02:04quite early on, so I'm starting to feel the pressure.
0:02:04 > 0:02:07The best candidates get the job
0:02:07 > 0:02:10so, if I really want it, I need to do the work.
0:02:23 > 0:02:26# Mama told me not to waste my life
0:02:26 > 0:02:31# She said spread your wings, my little butterfly... #
0:02:34 > 0:02:38The junior doctors have made it to the end of their first
0:02:38 > 0:02:40three months in the hospital.
0:02:40 > 0:02:42You not having any breakfast?
0:02:42 > 0:02:44I've got an hour until I need to be at work.
0:02:44 > 0:02:48They'll soon be moving on to different wards to start their next
0:02:48 > 0:02:53rotations, so it's time to start getting serious about their futures.
0:02:53 > 0:02:56It's never going to be just a job - it will always be more than a job.
0:02:56 > 0:02:58I definitely feel I've found
0:02:58 > 0:03:01what I want to do for the rest of my life.
0:03:01 > 0:03:03- Are you ready?- Yep.
0:03:07 > 0:03:09- See you, Oli.- See you, mate.
0:03:09 > 0:03:12Climbing higher up the medical career ladder will take drive
0:03:12 > 0:03:14and determination.
0:03:14 > 0:03:17But that shouldn't be a problem for go-getter Jen.
0:03:17 > 0:03:20I definitely consider myself a competitive person.
0:03:20 > 0:03:24There is nothing that I love more than a challenge
0:03:24 > 0:03:26and the opportunity to beat somebody.
0:03:26 > 0:03:30Since starting work, she's dealt with tough medical procedures...
0:03:30 > 0:03:33- HE YELLS - 'I didn't really know what to do.'
0:03:33 > 0:03:35It's having the confidence, isn't it?
0:03:36 > 0:03:39..and the death of her patients...
0:03:41 > 0:03:44Just not used to this kind of thing happening in my life.
0:03:44 > 0:03:50..Jen's dedication has impressed her seniors,
0:03:50 > 0:03:52who, after just two weeks on the job,
0:03:52 > 0:03:55allowed her to observe an operation.
0:03:55 > 0:03:57What do you think? Have you seen one before?
0:03:57 > 0:03:59No, I haven't seen one of those before.
0:03:59 > 0:04:05Now, almost three months on, Jen is thinking about her next step.
0:04:05 > 0:04:07We're sort of forced to decide
0:04:07 > 0:04:10what we want to specialise in quite early on,
0:04:10 > 0:04:12'so I'm starting to feel the pressure.
0:04:12 > 0:04:16'When I started work, I thought I knew I wanted to do anaesthetics.'
0:04:16 > 0:04:19Now, because I have enjoyed surgery so much,
0:04:19 > 0:04:21I'm starting to question that.
0:04:21 > 0:04:25I'm just going to have to explore both of the careers
0:04:25 > 0:04:27'a lot before I apply.'
0:04:27 > 0:04:31More time in the operating theatre could help Jen make up her mind.
0:04:31 > 0:04:34And then what we'll do is make sure everything is cleaned up inside
0:04:36 > 0:04:39Senior House Officer Andrea Sheel has given Jen another chance
0:04:39 > 0:04:41to put on her surgical scrubs.
0:04:41 > 0:04:44And this time, she'll really be getting stuck in.
0:04:44 > 0:04:45Oh, yeah, I've seen one.
0:04:45 > 0:04:48Jen has been asked to incise
0:04:48 > 0:04:53and drain an abscess on a chap's back. There is a large collection of
0:04:53 > 0:04:56pus there we need to release because it's quite painful for him.
0:04:57 > 0:05:01It will be the first time Jen has ever performed an operation
0:05:01 > 0:05:05herself, but Dr Sheel will be on hand to guide her through it.
0:05:05 > 0:05:07Give that a really good working around and then wash it again
0:05:07 > 0:05:10and pop the dressings in.
0:05:16 > 0:05:19Little bit nervous because you're cutting into somebody
0:05:19 > 0:05:21and I've never done that before but it's only very superficial,
0:05:21 > 0:05:23so it's not too bad.
0:05:23 > 0:05:27Who needs a scouse tan when you've got iodine?
0:05:27 > 0:05:31Cool, let's go.
0:05:31 > 0:05:35Start off in the area where you'll make the incision first of all.
0:05:35 > 0:05:40- So right over the...- Like that? - Yeah. Give it a really good...
0:05:40 > 0:05:42Oh, right, round it.
0:05:42 > 0:05:45With the patient prepared for the operation, it's time for Jen
0:05:45 > 0:05:48to make her first ever surgical cut.
0:05:50 > 0:05:52- OK. Knife, please.- Thank you
0:05:52 > 0:05:56So you've got your scalpel.
0:05:56 > 0:05:59- Nice and decisive, don't push it in too far.- Like that?
0:05:59 > 0:06:02Yeah. Just a little stab incision at the top.
0:06:04 > 0:06:06OK, we need to go a little bit further there.
0:06:06 > 0:06:09just a little bit deeper.
0:06:09 > 0:06:12Get your finger inside there...
0:06:13 > 0:06:16..get some of that nice, juicy pus out.
0:06:16 > 0:06:19It's coming out now.
0:06:19 > 0:06:20Are you happy with that?
0:06:20 > 0:06:22I think it's empty now.
0:06:22 > 0:06:28As surgery progresses, Jen is showing little sign of nerves.
0:06:28 > 0:06:31- A bit of force, just to squeeze it in.- Bit of force you want?
0:06:31 > 0:06:35Yeah, make a nice little irrigation. That's great. Thank you very much.
0:06:35 > 0:06:37With the operation complete,
0:06:37 > 0:06:42and dressing applied, it's a proud moment for any aspiring surgeon.
0:06:42 > 0:06:44- Go and write in the notes.- Yes.
0:06:44 > 0:06:48It felt really nice when I was writing in the operation notes,
0:06:48 > 0:06:49"Surgeon: J Whiteley."
0:06:49 > 0:06:52That was weird because I was like, "Do I put your name down?"
0:06:52 > 0:06:55She was like, "No, you put both of our names down."
0:06:55 > 0:06:57So that was a bit of a strange thing, it was nice.
0:06:57 > 0:07:00I think Jenny did really well there,
0:07:00 > 0:07:03she's attacked it with a very confident positive approach.
0:07:03 > 0:07:07It is officially an entire operation so it's something that she can
0:07:07 > 0:07:10put on her logbook and in her portfolio and it's just something
0:07:10 > 0:07:13that will make her stand out from the rest of the house officers.
0:07:15 > 0:07:18And when it comes to choosing a specialism, the experience
0:07:18 > 0:07:21has given Jen even more food for thought.
0:07:23 > 0:07:26'I've really, really enjoyed surgery.
0:07:26 > 0:07:30'I have definitely noticed the buzz from surgery.
0:07:30 > 0:07:34'I understand why people enjoy it.'
0:07:34 > 0:07:36I definitely have considered it
0:07:36 > 0:07:39more in the last few weeks than I have before.
0:07:39 > 0:07:42I will just have to probably explore it a bit more.
0:07:42 > 0:07:46- That was really well done. - Thanks very much.- Thanks, guys.
0:07:46 > 0:07:51As a first-year junior doctor, Jen still has a bit of breathing space
0:07:51 > 0:07:54before finalising her career plans.
0:07:54 > 0:07:57But over in the Emergency Department,
0:07:57 > 0:08:00it's crunch time for second-year Kiera.
0:08:00 > 0:08:02Amazing, thank you.
0:08:04 > 0:08:08My long-term plan is to apply to do A&E training in Liverpool,
0:08:08 > 0:08:10because it's brilliant.
0:08:10 > 0:08:15For me, the long hours, the stress and everything else, the shifts of
0:08:15 > 0:08:21A&E is worth the sacrifice because the excitement and the challenge
0:08:21 > 0:08:26of not knowing what's coming in next gives you a real buzz.
0:08:28 > 0:08:32During a hectic few months in Accident & Emergency, Kiera
0:08:32 > 0:08:36has coped well with everything that's been thrown at her.
0:08:36 > 0:08:39It's a good job I don't hit women, you know.
0:08:39 > 0:08:42You wouldn't be able to catch me, mate.
0:08:42 > 0:08:45You all right, sir, you OK there?
0:08:45 > 0:08:50Ram a load of fluids up in case his blood pressure is on the low side.
0:08:50 > 0:08:54Kiera's skilful stitching has won her particular praise.
0:08:54 > 0:08:55Wonderful service.
0:08:55 > 0:08:57Oh, thank you.
0:08:57 > 0:08:59It's nice to hear that.
0:08:59 > 0:09:04But a needle is the last thing her next patient wants to see.
0:09:04 > 0:09:06How have you actually done this?
0:09:06 > 0:09:09I was cleaning, I went along the skirting board, and as I did
0:09:09 > 0:09:12the needle just went... I thought it was a staple at first.
0:09:12 > 0:09:15..went in and out and there was a cloth all around it,
0:09:15 > 0:09:17so we had to cut the cloth off.
0:09:17 > 0:09:19Oh, dear. OK.
0:09:19 > 0:09:23We've done a little X-ray of it and it's not gone into the bone
0:09:23 > 0:09:24so that's a good sign.
0:09:24 > 0:09:27- I thought that.- Yeah, so it'll be a matter of actually pulling it out.
0:09:27 > 0:09:30Are you just going to pull it out in one go?
0:09:30 > 0:09:34- Just one smooth go, yeah. - Just pull it out, then.
0:09:34 > 0:09:36Do you want some gas and air?
0:09:36 > 0:09:40I don't want to feel woozy. I look after my mum, she's got
0:09:40 > 0:09:42dementia - she's palliative and she's at home.
0:09:42 > 0:09:45I've left my daughter with a two-year-old and a six month baby,
0:09:45 > 0:09:47- she's six months pregnant. - So you just need it out.
0:09:47 > 0:09:50- Fine. I'll come and do it for you now.- Thank you.
0:09:50 > 0:09:53Make yourself comfortable, my love, and I'll be back.
0:09:53 > 0:09:55It may be the patient's idea of hell
0:09:55 > 0:09:59but doing a procedure like this is Kiera's idea of heaven.
0:09:59 > 0:10:02Yup, I enjoy doing things like this.
0:10:04 > 0:10:07Did I just hear you say you enjoy doing things like this?
0:10:07 > 0:10:10You did, isn't that terrible!
0:10:10 > 0:10:14When you're ready, let's just have a feel of it.
0:10:14 > 0:10:18Kiera will need the help of another doctor to pull the needle out.
0:10:18 > 0:10:22I'm not going to look, just do what you've got to do.
0:10:22 > 0:10:24I'm going to hold your finger.
0:10:24 > 0:10:26Just hold my fingers down.
0:10:27 > 0:10:29So first of all, we're just going to clamp on,
0:10:29 > 0:10:31and make sure you get a good clamp.
0:10:31 > 0:10:34And remember, it's got a little bend to it,
0:10:34 > 0:10:36- remember the bend on the X-ray? - Yeah.
0:10:36 > 0:10:40And the bend is that way, so you need to just firmly...
0:10:40 > 0:10:42I'll hold me hand down so you don't lift it up.
0:10:42 > 0:10:45Whatever you do, darling, don't move your hand for us.
0:10:45 > 0:10:46- Please hold it steady.- Yup.
0:10:46 > 0:10:48OK. Here we go.
0:10:52 > 0:10:55- Well done.- All done.- Thank you.
0:10:55 > 0:11:00- Do you want that as a souvenir?- No!
0:11:00 > 0:11:02We'll give it a wash out and check the tetanus status,
0:11:02 > 0:11:04antibiotics, some painkillers.
0:11:04 > 0:11:06- We'll let you get back.- Thank you.
0:11:06 > 0:11:08How does that feel now?
0:11:08 > 0:11:09A thousand times better.
0:11:09 > 0:11:13I think it's more nerves to begin with, thinking how bad it'll be.
0:11:13 > 0:11:17It's kind of a weird thing, liking doing things like that.
0:11:17 > 0:11:19It's simple to do
0:11:19 > 0:11:21but the relief it gives the patient is sort of instantaneous.
0:11:21 > 0:11:28A bit of a sick thing to enjoy doing but, yeah, I enjoy things like that.
0:11:39 > 0:11:43Kiera's fellow second year, Oli, has spent an action-packed
0:11:43 > 0:11:45three months on the Acute Medical Unit...
0:11:45 > 0:11:48It's Oli, the AMU SHO, you bleeped me?
0:11:48 > 0:11:53..dealing with everything from anxious patients...
0:11:53 > 0:11:56- Toerag!- Sorry?- You toerag!
0:11:57 > 0:11:59..to tricky procedures.
0:12:01 > 0:12:02Viscous effusion fluid.
0:12:02 > 0:12:05Don't know how else you would describe it,
0:12:05 > 0:12:07it's quite thick, actually.
0:12:07 > 0:12:11Sitting the first phase of his registrar exams early has put
0:12:11 > 0:12:13Oli ahead of the competition.
0:12:15 > 0:12:17Yeah, I passed.
0:12:17 > 0:12:21To pass that exam means I'm one third of my way to becoming
0:12:21 > 0:12:24a member of the Royal College of Physicians,
0:12:24 > 0:12:27and after that you can apply for training in medical specialties.
0:12:27 > 0:12:29I want to do acute medicine eventually.
0:12:29 > 0:12:31This last rotation has sort of consolidated that in my ideas
0:12:31 > 0:12:33so I really want to do that now.
0:12:33 > 0:12:36John, can you turn your head to the left for me?
0:12:36 > 0:12:40You just pick up a patient's notes, you're the first person they see
0:12:40 > 0:12:43in the hospital that day and you get their story and it's almost like
0:12:43 > 0:12:45you are their opportunity for them to explain what's been going on.
0:12:48 > 0:12:50Ann Smith, I've just got her stuff ready to see her.
0:12:53 > 0:12:56Oli's next patient, Ann, has only recently been
0:12:56 > 0:12:59discharged from hospital...but now she's back.
0:12:59 > 0:13:02Just take a seat on here for me. My name's Dr Harris.
0:13:02 > 0:13:04Thank you.
0:13:04 > 0:13:08I've put two stone on in two weeks and I've pain here,
0:13:08 > 0:13:15under my left breast - it's terrible, I'm so breathless.
0:13:15 > 0:13:19But Ann's rapid weight gain is only part of her story.
0:13:19 > 0:13:21I don't know if you know...
0:13:21 > 0:13:23I was diagnosed with cancer three weeks ago.
0:13:23 > 0:13:26Yeah, I've got the notes from your GPs there.
0:13:26 > 0:13:28Biggest shock of my life,
0:13:28 > 0:13:31because I didn't have any symptoms - it was picked up in a blood test.
0:13:31 > 0:13:34Yeah, yeah.
0:13:34 > 0:13:35It's like a bad dream.
0:13:35 > 0:13:38Did they tell you then that it had gone to the liver?
0:13:38 > 0:13:39They can't do nothing for me.
0:13:39 > 0:13:44They can't, my son, he's flown in from Australia to look after me.
0:13:44 > 0:13:46And I was in here last week...
0:13:46 > 0:13:49SHE SOBS
0:13:49 > 0:13:52- I feel awful. - I'll just get you a tissue.
0:13:52 > 0:13:53Sorry.
0:13:53 > 0:13:56No, it's all right.
0:13:59 > 0:14:04Being able to help a seriously ill patient like Ann is exactly
0:14:04 > 0:14:07why Oli wants a career in acute medicine.
0:14:07 > 0:14:11Do you feel you have to go and pass water a lot of the time?
0:14:11 > 0:14:14You can step in, do an intervention and improve that person's
0:14:14 > 0:14:18quality of life or send them home, even, feeling a bit better,
0:14:18 > 0:14:21so that's why I really like the Acute Medical Unit, yeah, it's good.
0:14:25 > 0:14:27Is it sore?
0:14:27 > 0:14:29It's agony.
0:14:29 > 0:14:32Point to me where the most painful part is.
0:14:32 > 0:14:33It's all under there.
0:14:33 > 0:14:35How does it feel if I press?
0:14:35 > 0:14:36That's sore.
0:14:36 > 0:14:40- That there. Sorry, sorry. - It's OK, you got to do it.
0:14:41 > 0:14:44A build up of fluid has caused Ann's stomach to swell.
0:14:46 > 0:14:48It's too painful, isn't it?
0:14:50 > 0:14:52Do you want me to get a nurse in to give us a hand?
0:14:52 > 0:14:56No, I'm independent, I'll do it.
0:14:56 > 0:15:00Don't want you to hurt yourself though, you're doing very well.
0:15:00 > 0:15:02Right, let's have a listen to your heart on the front.
0:15:04 > 0:15:07Take some nice, deep breaths for me.
0:15:10 > 0:15:13I'm just going to press here.
0:15:13 > 0:15:14Sorry.
0:15:14 > 0:15:20Hmm, so the shortness of breath could actually be due to all
0:15:20 > 0:15:22this fluid in your tummy,
0:15:22 > 0:15:25cos if it's pressing up into your diaphragm making it difficult
0:15:25 > 0:15:28for you to breathe that could also be causing the pain as well.
0:15:28 > 0:15:30Because you have this underlying...
0:15:30 > 0:15:32Ann's cancer isn't treatable,
0:15:32 > 0:15:36so Oli needs to think about what can be done to manage her symptoms.
0:15:36 > 0:15:38I think the main thing is seeing
0:15:38 > 0:15:40if we could drain some fluid off your tummy.
0:15:40 > 0:15:43- Please. I can't go on like this. - Yeah.
0:15:43 > 0:15:47I mean, when my son goes back I don't know what I'm going to do.
0:15:47 > 0:15:49Do you live with anyone at home?
0:15:49 > 0:15:54No. I've been a widow 23 years. I'm very independent.
0:15:54 > 0:15:57I've had difficulty doing the hoovering with
0:15:57 > 0:16:01- the breathlessness but I've done it. - Yeah, OK.- If it's had to take me
0:16:01 > 0:16:04three goes to do one room, I've done it.
0:16:06 > 0:16:10After X-raying the patient to check there's no clots in her blood or
0:16:10 > 0:16:15on her lungs, Oli can now arrange to drain the fluid off Ann's stomach.
0:16:15 > 0:16:18As she's aware, there's no cure for her cancer at the moment.
0:16:18 > 0:16:21She's not a candidate for surgery, it's just trying to manage
0:16:21 > 0:16:23the symptoms and make her live
0:16:23 > 0:16:25as much of a fulfilling life as possible.
0:16:25 > 0:16:29By draining that fluid off, you know, her mobility will improve,
0:16:29 > 0:16:34her breathing will get better and she might get her independence back,
0:16:34 > 0:16:36which is really important to her.
0:16:43 > 0:16:46After a busy day at the hospital, some of the junior doctors
0:16:46 > 0:16:48are relaxing with a takeaway.
0:16:48 > 0:16:51And career plans are dominating the conversation.
0:16:51 > 0:16:54I do love acute medicine, it's my favourite thing.
0:16:54 > 0:16:57It's just so good, there's so much variety,
0:16:57 > 0:17:01and it's not investigation-heavy so you can go around,
0:17:01 > 0:17:03do an examination, history, make a diagnosis
0:17:03 > 0:17:07and then just go with it and use your clinical skills, I love that.
0:17:07 > 0:17:10I'm definitely interested in working in cardiology.
0:17:10 > 0:17:12It's been a really good thing but there's nothing that
0:17:12 > 0:17:15changes my wanting to work with children and so whether or not
0:17:15 > 0:17:18I want to follow a paediatric cardiology route, I don't know.
0:17:18 > 0:17:21Emily, what would you like to do when you're older?
0:17:21 > 0:17:23I want to do a bit of everything.
0:17:23 > 0:17:26If I do clinical medicine, it won't be what I'm doing, it will be
0:17:26 > 0:17:31where I'm doing it, like, somewhere interesting, but I want to do
0:17:31 > 0:17:34a bit of health policy as well, public health, infectious diseases.
0:17:34 > 0:17:36Are you enjoying any part of the clinical job?
0:17:36 > 0:17:39I really like my team and I really like the patients.
0:17:39 > 0:17:42I suppose the thing is, if you do health promotion, you're
0:17:42 > 0:17:45having an impact on so many people and although you're not instantly
0:17:45 > 0:17:49going to see the benefits, you know that if you stop that many people
0:17:49 > 0:17:51smoking or drinking or whatever,
0:17:51 > 0:17:53then you're going to prevent that many...
0:17:53 > 0:17:56The thing is, I'm that selfless, I don't need to see people...
0:17:56 > 0:17:59We just like being on the shop floor and seeing what we do, that's all.
0:17:59 > 0:18:02I don't think that's true, Emily, I think it's more about
0:18:02 > 0:18:05the nine-to-five job and being able to go home and not do the weekends
0:18:05 > 0:18:07and then you won't get in a grump.
0:18:07 > 0:18:09There's no nightshifts on public health is there?
0:18:11 > 0:18:13# Anything can happen
0:18:13 > 0:18:16# Anything can happen
0:18:16 > 0:18:18# Anything can happen... #
0:18:21 > 0:18:24Nightshifts might not feature in Emily's future plans,
0:18:24 > 0:18:27but as the only junior doctor yet to work one,
0:18:27 > 0:18:28they are very much on Ed's mind.
0:18:30 > 0:18:33This weekend, I'm going to be working on nights.
0:18:33 > 0:18:36It's the first time I'm doing this.
0:18:36 > 0:18:38Of course, I'll be hoping for the quietest night
0:18:38 > 0:18:41the hospital has ever seen,
0:18:41 > 0:18:45but if business comes my way, I'll just try to do the best I can.
0:18:47 > 0:18:51Mountaineer Ed has faced an uphill struggle since swapping the remote
0:18:51 > 0:18:55Italian village where he was previously working for Liverpool.
0:18:55 > 0:18:59He soon discovered that his training in Italy couldn't prepare him
0:18:59 > 0:19:02for the hectic and demanding Emergency Department.
0:19:02 > 0:19:05You should be able to do a neurological examination.
0:19:05 > 0:19:07Can you not do a neurological examination?
0:19:07 > 0:19:09It's been a while.
0:19:09 > 0:19:10'Speaking to colleagues,'
0:19:10 > 0:19:13It's quite obvious that it would be unfair on him,
0:19:13 > 0:19:15and also on patients, in particular,
0:19:15 > 0:19:17to allow him to carry on.
0:19:17 > 0:19:22We've made the decision that I'm going to be taking him off the rota.
0:19:22 > 0:19:23I'm not completely glad, the fact that
0:19:23 > 0:19:26I was moved back from Foundation Two in A&E
0:19:26 > 0:19:28to Foundation One training.
0:19:28 > 0:19:32But I'm really glad how things turned out in the end.
0:19:32 > 0:19:35This has given me loads of opportunity to learn tasks.
0:19:36 > 0:19:41Under the watchful eye of his new bosses on the Acute Medical Unit,
0:19:41 > 0:19:43Ed has grown in self-belief.
0:19:43 > 0:19:47- So you're going to have a little stab.- Yes.
0:19:47 > 0:19:50- OK, sir?- Yes, you can come again, you can.
0:19:50 > 0:19:52Now I'm feeling more confident,
0:19:52 > 0:19:55especially after having received comments from my supervisors,
0:19:55 > 0:19:59saying that the work I was doing was going in the right direction.
0:19:59 > 0:20:04But for now, Ed is still taking his future one step at a time.
0:20:04 > 0:20:08At the moment, I'm not particularly interested in having...
0:20:08 > 0:20:10a super-brilliant career.
0:20:10 > 0:20:14I'm just interested in doing my job well
0:20:14 > 0:20:18and having enough time to build something long-term
0:20:18 > 0:20:22with Martina, maybe a family, get a house, settle down somewhere.
0:20:27 > 0:20:30With fewer senior doctors around for support,
0:20:30 > 0:20:33tonight Ed must prove that he can cope.
0:20:33 > 0:20:36It's an eerily empty corridor here.
0:20:38 > 0:20:41To add to the pressure, he'll be carrying a cardiac arrest,
0:20:41 > 0:20:44or "crash" bleep. If it goes off, his ability to act quickly
0:20:44 > 0:20:47and decisively could be crucial.
0:20:47 > 0:20:49BLEEPING
0:20:49 > 0:20:53These bleeps need to be tested at the beginning of every shift.
0:20:53 > 0:20:56'Testing, testing, testing. Please respond.'
0:20:58 > 0:21:01Yeah, OK. Working.
0:21:01 > 0:21:05But Ed, a crash bleep first-timer, isn't sure how to let
0:21:05 > 0:21:08the switchboard know that his is working.
0:21:08 > 0:21:10Yeah, hello?
0:21:10 > 0:21:12BLEEPING
0:21:18 > 0:21:21'Testing, testing, testing. Please respond.'
0:21:23 > 0:21:27I've got one crash bleep and the other one is something else.
0:21:27 > 0:21:29The thing is that I don't know how the bleeps work.
0:21:29 > 0:21:31Nobody's ever told me.
0:21:32 > 0:21:36I just received a call for the crash bleep, who do I have to call?
0:21:40 > 0:21:43Oh, OK. That's good, thanks a lot. Bye.
0:21:45 > 0:21:48Just call switch and give them the numbers of the bleeps.
0:21:50 > 0:21:53Hi, I just wanted to confirm that my arrest bleep is working.
0:21:53 > 0:21:55Thank you, bye.
0:22:00 > 0:22:04With his bleeper sorted, Ed can now get on with some jobs.
0:22:04 > 0:22:07He's been asked by a nurse to fit a cannula.
0:22:07 > 0:22:09OK, yup, I'll have a look.
0:22:09 > 0:22:11Thank you, you're a star.
0:22:11 > 0:22:15Hi, I just need to put a little tube in one of your veins
0:22:15 > 0:22:17so we can give you some medication.
0:22:17 > 0:22:19Sorry to wake you up for this.
0:22:19 > 0:22:22Fitting the cannula should be straightforward.
0:22:22 > 0:22:26But the patient in the next bed has other ideas.
0:22:28 > 0:22:30Don't get the curtain, please.
0:22:33 > 0:22:36Yeah, later. I need to work, I need to do something.
0:22:36 > 0:22:38Just this old man, possibly a bit confused.
0:22:38 > 0:22:41He was trying to grab my trolley and steal my cannulas.
0:22:41 > 0:22:44He was just wrestling my trolley away from me.
0:22:46 > 0:22:48Sir, leave it.
0:22:48 > 0:22:52Don't... Don't touch it, sir.
0:22:52 > 0:22:56Just leave it. Just leave it. Leave it.
0:22:59 > 0:23:03Hands through the curtain grabbing my legs and my cannulas.
0:23:03 > 0:23:06Anyway, I put the cannula in and retreated.
0:23:08 > 0:23:10Done!
0:23:16 > 0:23:17BLEEPING
0:23:17 > 0:23:22Ed has been crash-bleeped. And, this time, it's not a test.
0:23:22 > 0:23:27'Cardiac arrest for 3X, side room 12.'
0:23:27 > 0:23:31Crash calls like this one demand an urgent response.
0:23:34 > 0:23:37- See you in a bit.- Yeah, bye.
0:23:49 > 0:23:52Some of the crash team are already on the scene by the time Ed arrives.
0:23:52 > 0:23:55There were a couple of advanced nurse practitioners there,
0:23:55 > 0:23:58but it turned out to be a seizure,
0:23:58 > 0:24:01so a pre-emptive call rather than an actual call.
0:24:01 > 0:24:04The patient's condition has been stabilised
0:24:04 > 0:24:07and she is out of immediate danger.
0:24:07 > 0:24:10But the emergency has given Ed a short-term shot of adrenaline.
0:24:12 > 0:24:15Certainly, the bleep when it went off, did wake me up
0:24:15 > 0:24:19but the effect of that lasted about ten minutes' time.
0:24:19 > 0:24:22I realised the situation was under control
0:24:22 > 0:24:26and was really sleepy again, walking back up the stairs.
0:24:26 > 0:24:29I just need half an hour lay-down to go back to reasonable
0:24:29 > 0:24:31levels of function.
0:24:31 > 0:24:34'Route 3X and 3Y.'
0:24:38 > 0:24:40Why doesn't it just let me in?
0:24:46 > 0:24:47It's 8.00am.
0:24:47 > 0:24:51Ten hours into his shift, and Ed is really feeling the pace.
0:24:52 > 0:24:54Oh, come on, computer!
0:24:54 > 0:24:59Learning to cope with fatigue is a must for any doctor on call.
0:25:01 > 0:25:05Ed had planned a quick nap but didn't have a chance to take it.
0:25:07 > 0:25:11When we went down to the mess to get half an hour's sleep,
0:25:11 > 0:25:15I put an alarm to wake me up, which went off now.
0:25:15 > 0:25:19And in that half an hour's sleep I've seen epileptic fits,
0:25:19 > 0:25:23prescribed antibiotics and I'm back to the epileptic fits.
0:25:23 > 0:25:29And this computer...is having an epileptic fit!
0:25:31 > 0:25:33It's finally the end of his shift
0:25:33 > 0:25:38and time for a weary Ed to head home.
0:25:38 > 0:25:41Working nights is a right of passage for every first-year junior doctor
0:25:41 > 0:25:46and the experience Ed's gained is another milestone in his career.
0:25:46 > 0:25:49I lost my night virginity.
0:25:49 > 0:25:52It was exciting from a certain point of view.
0:25:52 > 0:25:55Really good chance to learn a lot of stuff.
0:25:55 > 0:25:59I'm very willing to get on the bike and go home.
0:25:59 > 0:26:03After just a few hours' sleep, Ed will have to come back
0:26:03 > 0:26:05and do it all over again.
0:26:14 > 0:26:19Young dad Tristan has enjoyed a steady start to his medical career.
0:26:19 > 0:26:21If you just look straight ahead,
0:26:21 > 0:26:23I'm going to shine a light into your eyes.
0:26:23 > 0:26:27His calmness and dedication have made him popular with both
0:26:27 > 0:26:31colleagues and his elderly patients on the gerontology ward.
0:26:31 > 0:26:35I think the patients are really warming to Tristan at the moment.
0:26:35 > 0:26:37He does introduce himself as "Tristan", which is good
0:26:37 > 0:26:39cos it gives them a good connection with him,
0:26:39 > 0:26:42they like that he does go through everything with them.
0:26:42 > 0:26:44But with wife, Jenna,
0:26:44 > 0:26:47and two-year-old daughter, Lottie, to think about, striking
0:26:47 > 0:26:52the right balance between work and home hasn't always been easy.
0:26:52 > 0:26:56I think this has been of the hardest points even in our relationship,
0:26:56 > 0:26:59especially when he has been getting home at about 11 o'clock at night.
0:26:59 > 0:27:02So she'll see him for an hour in the morning and that's it and when
0:27:02 > 0:27:05it comes to bedtime, she's looking at me, like, "Where's Daddy?"
0:27:05 > 0:27:07And with career choices looming, that balancing act
0:27:07 > 0:27:10is at the forefront of his mind.
0:27:10 > 0:27:13Acute medicine would be good, I think it's exciting, you get to
0:27:13 > 0:27:17see a lot of different patients and their presentations but,
0:27:17 > 0:27:18say I wanted to do A&E,
0:27:18 > 0:27:21that's a lot of nights, a lot of weekends and I'm going to
0:27:21 > 0:27:24have to have a chat with Jenna about the future and things like that.
0:27:24 > 0:27:28On the gerontology ward, it's clocking off time for Tristan.
0:27:28 > 0:27:32He's about to head home to his family
0:27:32 > 0:27:36when one of his favourite patients takes a sudden turn for the worse.
0:27:36 > 0:27:40Hello, you all right? What's going on?
0:27:40 > 0:27:42You OK?
0:27:42 > 0:27:46Tristan brings the nurses up to speed.
0:27:46 > 0:27:48She became unresponsive.
0:27:48 > 0:27:51She opened her eyes, vacant stare, then she saw me
0:27:51 > 0:27:55and literally looked like she'd seen a ghost, put both her arms up
0:27:55 > 0:27:57and then went back like this.
0:27:57 > 0:28:00Have you ever seen anything like that before?
0:28:00 > 0:28:03The patient's condition is life-threatening.
0:28:03 > 0:28:06She had a septicaemia, an infection in her blood, starting
0:28:06 > 0:28:11a week and a half ago, and she has got septic arthritis as well,
0:28:11 > 0:28:14she just became unresponsive,
0:28:14 > 0:28:17so things aren't looking very good for her.
0:28:21 > 0:28:23It's a medical emergency
0:28:23 > 0:28:26and Tristan needs senior support to manage the situation.
0:28:28 > 0:28:32This has been sort of a relatively sudden downturn, cos she was
0:28:32 > 0:28:36really well until Friday, even though she had the septicaemia.
0:28:37 > 0:28:40- SISTER:- Can you open your eyes for me? Open your eyes?
0:28:42 > 0:28:44Can you squeeze my fingers tightly for me?
0:28:49 > 0:28:55It's 8.00pm, three hours after Tristan's scheduled finish time.
0:28:55 > 0:28:58He could hand the patient over to the on-call team.
0:29:01 > 0:29:03She is a trooper.
0:29:03 > 0:29:06But with his patient's life hanging in the balance,
0:29:06 > 0:29:11Tristan can't bring himself to go home just yet.
0:29:11 > 0:29:13Tristan is very conscientious he is always determined to make sure
0:29:13 > 0:29:16his patients are fine and all his jobs are done before
0:29:16 > 0:29:19he goes home, doesn't like to hand anything over.
0:29:19 > 0:29:22I feel a bit weird just going mid-thing.
0:29:22 > 0:29:24I'll get the blood gas.
0:29:26 > 0:29:27I think he worries that jobs
0:29:27 > 0:29:30won't get done or things will get missed,
0:29:30 > 0:29:32so he is very good like that.
0:29:32 > 0:29:34It is a lovely trait,
0:29:34 > 0:29:36but he does also need to remember to go home sometimes!
0:29:36 > 0:29:39Right, that's the blood gas.
0:29:40 > 0:29:43Do you want me to just go and run this down?
0:29:43 > 0:29:45Would you mind? That would be amazing!
0:29:49 > 0:29:52Tristan's wife, Jenna, and daughter, Lottie, are expecting him.
0:29:54 > 0:29:57He's let them know that he's running late.
0:29:57 > 0:29:59But leaving now, with his patient still gravely ill,
0:29:59 > 0:30:01simply isn't an option.
0:30:06 > 0:30:09It is quite hard, because I know this patient very well
0:30:09 > 0:30:12and she's been in hospital longer than I've been a doctor,
0:30:12 > 0:30:15so first day on the wards, she was there.
0:30:15 > 0:30:18We're doing these blood tests to make sure that there's
0:30:18 > 0:30:22nothing extra that we're missing, otherwise
0:30:22 > 0:30:25we know what's going on and we know that it is quite serious for her.
0:30:32 > 0:30:34Nothing dramatic.
0:30:34 > 0:30:40Thank you. Open your eyes, darling. I know you're tired, open your eyes.
0:30:40 > 0:30:44For now, Tristan has done all he can.
0:30:44 > 0:30:48Can you text me if anything happens to her?
0:30:50 > 0:30:53But leaving behind such a sick patient still isn't easy.
0:30:53 > 0:30:56Is there anything else that you want me to do?
0:31:06 > 0:31:08See you later.
0:31:08 > 0:31:12Tristan is finally leaving the hospital, four hours after
0:31:12 > 0:31:16the official end of his shift.
0:31:18 > 0:31:20Bye.
0:31:22 > 0:31:24I wouldn't want to be the sort of person
0:31:24 > 0:31:25that could just walk away from that.
0:31:25 > 0:31:29This lady being unwell has hit me quite hard, I think.
0:31:29 > 0:31:30I'm quite upset about it.
0:31:32 > 0:31:36But it's not just a bad day at the office that's bothering Tristan.
0:31:39 > 0:31:41I just feel really bad for Lottie
0:31:41 > 0:31:46because I know that it impacts upon her when I'm not around as much.
0:31:46 > 0:31:47It's a selfish thing, as well,
0:31:47 > 0:31:50I don't want to miss out on that time with Lottie,
0:31:50 > 0:31:53so I just have to figure out some way to make it all work.
0:31:56 > 0:31:59Without the support of his family, Tristan's ambitions
0:31:59 > 0:32:03of a career in emergency medicine are unlikely to become a reality.
0:32:03 > 0:32:07But yet another late finish on the wards has prompted
0:32:07 > 0:32:10a heart-to-heart with wife Jenna.
0:32:10 > 0:32:13Having seen what it's like, me working for three months
0:32:13 > 0:32:15and sometimes coming home late, what do you think
0:32:15 > 0:32:23if I was to do emergency medicine or A&E or acute medicine as a career?
0:32:23 > 0:32:26It's knowingly going into something that will make our life
0:32:26 > 0:32:29a bit more difficult and you've got to weigh up
0:32:29 > 0:32:32whether that's going to be worth it for you.
0:32:32 > 0:32:35You're a great dad to Lottie and she loves having you around,
0:32:35 > 0:32:37and that balance is going to become more difficult.
0:32:37 > 0:32:42But if you love doing that so much, then that's what's important because
0:32:42 > 0:32:45at the end of the day, that's where you spend the majority of your time.
0:32:45 > 0:32:48But I think it'll just be a matter of experience. I'll be able
0:32:48 > 0:32:50to get through everything quicker every day.
0:32:50 > 0:32:54Yes. I am really proud of you for getting yourself to where you are.
0:32:54 > 0:32:56I think you worked really hard at it.
0:32:56 > 0:32:59I think you always had it a little bit more complicated than most
0:32:59 > 0:33:02but you've stuck with it and not only that, you've done really well.
0:33:08 > 0:33:12- OK? We'll survive.- Yes. - Agreed?- Yes.- Good.
0:33:12 > 0:33:14SHE LAUGHS
0:33:25 > 0:33:28In the Accident & Emergency Department, Kiera is working
0:33:28 > 0:33:30the late shift.
0:33:30 > 0:33:31Deary me. Well done.
0:33:33 > 0:33:37After three months in A&E, she's no stranger to long hours
0:33:37 > 0:33:38and unusual cases.
0:33:38 > 0:33:40But on medicine's front line,
0:33:40 > 0:33:43a fresh challenge lurks behind every curtain.
0:33:48 > 0:33:51Hello. What's been going on?
0:33:51 > 0:33:54A man has come in with persistent vomiting and diarrhoea.
0:33:54 > 0:33:59It's been going on for like a few weeks now, but it stops
0:33:59 > 0:34:01and then comes back again.
0:34:01 > 0:34:05And when I vomit, it just comes out of my back passage and all.
0:34:05 > 0:34:07Had you eaten anything funny at the time?
0:34:07 > 0:34:09I'm always eating spicy foods.
0:34:09 > 0:34:11And have you lost any weight?
0:34:11 > 0:34:12I've lost loads of weight,
0:34:12 > 0:34:16I've lost about two stone in a week. Look at me hands!
0:34:16 > 0:34:18Oh, dear, OK.
0:34:18 > 0:34:20I shouldn't be telling you this.
0:34:20 > 0:34:22I was going to put a hosepipe up me bum...
0:34:22 > 0:34:26- What?! OK.- ..and wash myself out, it's one of those things
0:34:26 > 0:34:27- I was thinking to do, know what I mean?- OK.
0:34:27 > 0:34:30- You haven't done that, though? - No, no.
0:34:30 > 0:34:33Fine! OK. Good, I'm glad to hear it.
0:34:33 > 0:34:36It's clearly a pretty desperate situation for the patient.
0:34:36 > 0:34:40And Kiera will need all of her diagnostic skills to get to
0:34:40 > 0:34:42the bottom of it.
0:34:42 > 0:34:44With your tattoos, have you ever had them done abroad?
0:34:44 > 0:34:45I've done all them meself.
0:34:45 > 0:34:48Have you been away anywhere recently?
0:34:48 > 0:34:50The furthest I've ever been is Glastonbury.
0:34:50 > 0:34:53OK. And have you been around anyone who's been poorly?
0:34:53 > 0:34:55Yeah, the caretaker downstairs and his wife.
0:34:55 > 0:34:58There's eight people where I live and only one toilet.
0:34:58 > 0:35:01I could be catching something off the seat, couldn't I?
0:35:01 > 0:35:04How much would you say you drink?
0:35:04 > 0:35:07I drink a lot, love. I have, like, eight pints a night.
0:35:07 > 0:35:10Have you ever injected yourself with drugs?
0:35:10 > 0:35:12Never, love.
0:35:12 > 0:35:16Have you been coughing up anything nasty recently?
0:35:16 > 0:35:17Just phlegm.
0:35:17 > 0:35:20Kiera is still not sure what's wrong with the man.
0:35:20 > 0:35:23- Aw!- Sorry!
0:35:23 > 0:35:25But in medicine, helpful clues
0:35:25 > 0:35:28can sometimes come from the most-unexpected places.
0:35:28 > 0:35:31HE COUGHS
0:35:31 > 0:35:33Oh, dear, there you are.
0:35:35 > 0:35:37There. Look, see.
0:35:39 > 0:35:41How long's that been like that for?
0:35:41 > 0:35:43Weeks.
0:35:43 > 0:35:45Again going along with this poorliness?
0:35:45 > 0:35:49OK, I'll be back in with you shortly, OK?
0:35:49 > 0:35:51- All right, love, thanks. - All right. See you in a bit.
0:35:51 > 0:35:55When someone comes in with an awful lot of problems and diagnoses,
0:35:55 > 0:35:58it can mean one of two things. Either, A - they think there's
0:35:58 > 0:36:01a lot of things wrong with them but actually there's not an awful lot
0:36:01 > 0:36:03wrong with them at all, or, B -
0:36:03 > 0:36:05they're really poorly and you need to panic.
0:36:05 > 0:36:08Kiera might not be panicking
0:36:08 > 0:36:12but she does suspect that the man is seriously unwell.
0:36:12 > 0:36:16And she's got a theory about exactly what could be wrong with him.
0:36:16 > 0:36:18- I'm worried about maybe Legionella. - Yes, very good.
0:36:18 > 0:36:21I know that maybe there is a bit of an outbreak going on.
0:36:21 > 0:36:25- It's probably worth discussing him with ID.- Fine, yeah.
0:36:25 > 0:36:29Luckily for Kiera an infectious diseases specialist is on hand.
0:36:29 > 0:36:31What's making you think of Legionnaires'?
0:36:31 > 0:36:34Erm, he's got a three-week history of diarrhoea,
0:36:34 > 0:36:40vomiting and also sputum, productive cough, chest sounds.
0:36:40 > 0:36:42Any X-ray done yet?
0:36:42 > 0:36:45No, I've literally just come back from seeing him now.
0:36:45 > 0:36:48I'll go and see him. Chest X-ray, blood, we've got a bed!
0:36:48 > 0:36:50- Very good.- Thank you.
0:36:52 > 0:36:55Legionella, or Legionnaires' Disease, is a rare
0:36:55 > 0:36:58but potentially fatal form of pneumonia.
0:36:59 > 0:37:02Kiera's seniors might be impressed with
0:37:02 > 0:37:05her investigative skills so far,
0:37:05 > 0:37:08but that doesn't necessarily mean she's got the diagnosis right.
0:37:08 > 0:37:11Kiera, we need to assess him for TB,
0:37:11 > 0:37:15cos he's alcoholic and he lives in a hostel,
0:37:15 > 0:37:18well, shared accommodation, and he's had it more than three weeks.
0:37:18 > 0:37:23Fever, sputum and weight loss.
0:37:23 > 0:37:25His chest is quite nasty-sounding, actually.
0:37:25 > 0:37:27- That's why I'm thinking of TB. - Yeah, sure.
0:37:27 > 0:37:29He's got an infection up here.
0:37:33 > 0:37:36Oops! How are you getting on?
0:37:38 > 0:37:41Have you ever heard of TB before, tuberculosis?
0:37:41 > 0:37:43No, I don't know.
0:37:43 > 0:37:45It's just a little bacteria that gets in
0:37:45 > 0:37:48and causes lots of different problems and stuff.
0:37:51 > 0:37:54Right, I'll go and get those tests sent off
0:37:54 > 0:37:56and we'll be back round in a bit.
0:37:58 > 0:38:00Although TB is looking to be the likely cause,
0:38:00 > 0:38:04the patient's diagnosis can't be confirmed until the tests come back.
0:38:04 > 0:38:07So for now, he'll be moved on to a ward.
0:38:07 > 0:38:11I really enjoy the fast pace of A&E.
0:38:11 > 0:38:13You always have to be thinking on your feet,
0:38:13 > 0:38:16short and snappy and you hopefully go home at the end of each day having
0:38:16 > 0:38:20learnt a whole new concept. It sort of suits my personality, really.
0:38:20 > 0:38:25I am very keen to carry on doing A&E as my speciality, yeah.
0:38:38 > 0:38:39As Kiera clocks off,
0:38:39 > 0:38:43second-year Carol is starting a busy evening shift.
0:38:45 > 0:38:47Which arm are you most comfortable with?
0:38:47 > 0:38:48Any one will do.
0:38:48 > 0:38:50Let's have a go at this side.
0:38:53 > 0:38:56Carol has already had plenty to contend with
0:38:56 > 0:38:58since swapping Malawi for Merseyside.
0:39:00 > 0:39:02How many tablets did you take?
0:39:02 > 0:39:04The whole...the whole lot.
0:39:04 > 0:39:10It is new, knowing how to manage patients who come in with self-harm.
0:39:10 > 0:39:12She started on a trial period,
0:39:12 > 0:39:16hoping to fill the vacancy left by Ed after he was moved
0:39:16 > 0:39:19from the department to do his first year elsewhere in the hospital.
0:39:19 > 0:39:22How much do you drink?
0:39:22 > 0:39:24A litre, half a litre a day
0:39:24 > 0:39:26One litre to half a litre in a day?
0:39:26 > 0:39:28In a day, it takes the edge off the tablets.
0:39:28 > 0:39:32Then, as a fully qualified second-year junior doctor,
0:39:32 > 0:39:34she started getting hands-on.
0:39:34 > 0:39:37Carol, you know this stuff you've done it for years in Malawi,
0:39:37 > 0:39:40it's the same, nothing different, you'll be fine!
0:39:40 > 0:39:42I wanted to work in A&E, so now that I'm actually
0:39:42 > 0:39:47here in A&E, I feel very good about that, and I'm happy.
0:39:49 > 0:39:53But her future as a full-time member of the team hangs on her ability
0:39:53 > 0:39:57to handle the bread-and-butter work of a busy British hospital.
0:40:01 > 0:40:02It's 1.00am,
0:40:02 > 0:40:06and Carol's next patient has had a bad reaction to a takeaway.
0:40:06 > 0:40:09Hello, my name's Carol, I'm one of the junior doctors.
0:40:09 > 0:40:11Can you tell me what happened?
0:40:11 > 0:40:14We got food from a Chinese
0:40:14 > 0:40:17and I think they may have cooked something in the same pan
0:40:17 > 0:40:21that had nuts in it and then maybe cooked my food in it.
0:40:21 > 0:40:23Are you allergic to something that you know?
0:40:23 > 0:40:25I'm allergic to nuts, yeah.
0:40:25 > 0:40:27My tongue got all swelled up.
0:40:27 > 0:40:29How soon after you ate?
0:40:29 > 0:40:33Straight away, and I was struggling a bit with my breathing.
0:40:33 > 0:40:35For most of the staff on A&E,
0:40:35 > 0:40:40dealing with an allergic reaction like this one is routine.
0:40:40 > 0:40:41But not for Carol.
0:40:41 > 0:40:44In Malawi, I didn't see patients with nut allergies.
0:40:44 > 0:40:46I don't think it's as common.
0:40:46 > 0:40:50There may be reactions and allergies to different things but not nuts.
0:40:50 > 0:40:53She went to sleep for an hour, and when she woke up,
0:40:53 > 0:40:55I asked her if she was feeling OK
0:40:55 > 0:40:57and she said she was feeling a bit better,
0:40:57 > 0:41:00but when she was speaking, she was wheezing,
0:41:00 > 0:41:04and she was coughing quite badly.
0:41:04 > 0:41:06I've never been that worried about somebody in my life.
0:41:09 > 0:41:13A trip to Accident & Emergency isn't the Saturday night out
0:41:13 > 0:41:15that the patient and her mates had planned.
0:41:15 > 0:41:19We were meant to be going somewhere called Crazy House.
0:41:19 > 0:41:23I don't know what it is but she says it's good and I'd rather be dancing.
0:41:23 > 0:41:26But, you know, I'm not.
0:41:26 > 0:41:29I'm never going to that Chinese again on principle -
0:41:29 > 0:41:30they nearly killed my friend.
0:41:30 > 0:41:34We are going to do some basic blood tests on her
0:41:34 > 0:41:36and just treat her symptomatically.
0:41:36 > 0:41:39Unfortunately for Carol, nuts aren't the only thing to provoke
0:41:39 > 0:41:42a strong reaction in her patient.
0:41:42 > 0:41:46I'm scared of needles. I had to be held down
0:41:46 > 0:41:50when I had an injection last time, like literally held down to the bed.
0:41:50 > 0:41:51So I'm a bit pathetic.
0:41:52 > 0:41:54Will I feel the needle?
0:41:54 > 0:41:57A little bit, it will be a small scratch.
0:41:57 > 0:41:59But don't think about it. You'll be OK.
0:41:59 > 0:42:03Pump your fist for me.
0:42:03 > 0:42:04Just relax.
0:42:06 > 0:42:08Injections are the worst, cos you can't see them
0:42:08 > 0:42:11when they're coming, especially if they're in your buttocks.
0:42:11 > 0:42:15If it's in your arm, at least you can see it, you know it's happening
0:42:15 > 0:42:18and you know it's over.
0:42:18 > 0:42:21That's it, that's it. Well done.
0:42:21 > 0:42:24I think she'll be able to go home by the end of the evening.
0:42:24 > 0:42:26Just after we get some results from the blood tests
0:42:26 > 0:42:30and as soon as she feels OK to go home, I think she'll be able to.
0:42:31 > 0:42:35It's cases like this that reinforce Carol's hopes of
0:42:35 > 0:42:37a future career in the NHS.
0:42:37 > 0:42:43I'm very keen on A&E and I'm keen on building on my previous
0:42:43 > 0:42:47experiences in Malawi, so looking forward to learning a lot here
0:42:47 > 0:42:52and learning what A&E is like and hopefully get a job in A&E.
0:42:52 > 0:42:55# Got to get up and try, try, try... #
0:42:55 > 0:43:00As Carol works through the night, back at the house, Jen, Tom
0:43:00 > 0:43:03and Emily are putting thoughts of the future aside,
0:43:03 > 0:43:06with some late-night karaoke classics.
0:43:11 > 0:43:14# Hey, Macarena! #
0:43:14 > 0:43:17# I'd do anything for love... #
0:43:17 > 0:43:19MUMBLED LYRICS
0:43:19 > 0:43:24# You know, you gotta do those things that couples do when in love
0:43:24 > 0:43:26# You know, walks on the beach and stuff, you know... #
0:43:26 > 0:43:30INDISTINCT LYRICS
0:43:30 > 0:43:35# ..I've got all my life to live I've got all my love to give
0:43:35 > 0:43:38# So I'll survive, I will survive!
0:43:38 > 0:43:40# Hey-hey!
0:43:40 > 0:43:43# Wooh-ooh-ooh-ooh-ooh doo-doo doo-doo... #
0:43:52 > 0:43:56At the hospital, first-year Ed is back working the nightshift.
0:43:56 > 0:43:59He's survived an action-packed first night.
0:43:59 > 0:44:03But in a busy inner-city hospital, the challenges just keep coming.
0:44:03 > 0:44:05First on your left?
0:44:05 > 0:44:07The most striking difference between Liverpool
0:44:07 > 0:44:11and the previous job is the sheer volume of patients.
0:44:11 > 0:44:16Probably the hospital sees as many people on a daily basis
0:44:16 > 0:44:19as there were in the whole mountain village.
0:44:19 > 0:44:23All the really acute patients would go from the ambulance
0:44:23 > 0:44:25to hospital, so completely different patients
0:44:25 > 0:44:27and completely different walks of life as well.
0:44:27 > 0:44:30Ed's been called to one of the wards to verify a death.
0:44:30 > 0:44:32When did he die?
0:44:32 > 0:44:34Quarter-past.
0:44:34 > 0:44:36- 1.15.- 1.15.
0:44:36 > 0:44:38So, he had a red card and everything?
0:44:38 > 0:44:40Red card was in date.
0:44:40 > 0:44:43The deceased patient's bed is in the middle of a busy bay.
0:44:43 > 0:44:48Ed needs to handle the situation swiftly and discreetly.
0:44:48 > 0:44:51The gentleman died about an hour ago.
0:44:51 > 0:44:56You are called to the bedside of the patient
0:44:56 > 0:45:00and you should listen to the heart, check for a pulse.
0:45:00 > 0:45:06Of course you feel the skin, he will be cold, will look very pale.
0:45:06 > 0:45:09And then, a very important thing is to check reflexes,
0:45:09 > 0:45:12to light in the eyes.
0:45:12 > 0:45:16No respiratory effort, pupils fixed,
0:45:16 > 0:45:17not responsive.
0:45:19 > 0:45:20That's about it.
0:45:23 > 0:45:29That WAS cold. Other than that, just standard procedure.
0:45:29 > 0:45:34It's not the first time that Ed has had to verify a death.
0:45:34 > 0:45:37I've done it in my previous job,
0:45:37 > 0:45:41but I just had to certify an old person's death
0:45:41 > 0:45:44in my little village in the mountains, so I just filled
0:45:44 > 0:45:50in a white sheet of paper, put my stamp on it, wrote down my findings.
0:45:50 > 0:45:54While a dead body might hold few surprises, the accompanying
0:45:54 > 0:45:57paperwork is a different matter.
0:45:57 > 0:46:01Just sign here that you've verified it. That's all. That's it.
0:46:03 > 0:46:05- No, I do the rest.- Consultant? No.
0:46:05 > 0:46:07- No, no.- Do I have to sign it, actually?
0:46:07 > 0:46:10Yeah, you have to sign it. You've done it there. That's it.
0:46:10 > 0:46:13- I see.- I can't verify a death.
0:46:13 > 0:46:15- All right.- Only you can.
0:46:18 > 0:46:20There you go.
0:46:20 > 0:46:22- OK. Thank you.- OK. Thank you.
0:46:22 > 0:46:26Job done. But there's no time to relax.
0:46:26 > 0:46:30Ed has received a call about a difficult patient.
0:46:30 > 0:46:34Is he so aggressive, can't we just check his BMs? No?
0:46:35 > 0:46:39All right. I'll go and have a look at him in a while. Yep. OK.
0:46:39 > 0:46:42The patient has very low blood pressure
0:46:42 > 0:46:45and has fallen over twice, hitting his head.
0:46:45 > 0:46:49He is confused and refusing to cooperate with the nurses.
0:46:49 > 0:46:51He doesn't want to be touched,
0:46:51 > 0:46:54he doesn't want any blood pressure, he doesn't want any medication.
0:46:54 > 0:46:57Otherwise, he's refusing everything.
0:46:57 > 0:47:01- But does he get violent and aggressive?- Yeah.
0:47:01 > 0:47:02Yeah, OK.
0:47:02 > 0:47:04Where is he?
0:47:04 > 0:47:07Room eight, bed two.
0:47:07 > 0:47:08Where did you bang your head?
0:47:10 > 0:47:12You banged your head on the floor, OK.
0:47:12 > 0:47:15Can I have a look? Yeah? Thank you.
0:47:15 > 0:47:17Let me have a look, yeah?
0:47:17 > 0:47:19Where did you hit it? Behind here?
0:47:19 > 0:47:23It's just important to check your blood pressure because...
0:47:29 > 0:47:32The patient is threatening to discharge himself from hospital.
0:47:32 > 0:47:35But he is in no state to go home.
0:47:35 > 0:47:40We would need to keep you in for another little bit...
0:47:44 > 0:47:46The patient's behaviour is erratic
0:47:46 > 0:47:50and Ed wants to establish just how much he understands.
0:47:50 > 0:47:52Do you know where we are now?
0:47:54 > 0:47:57Yeah, but apart from being in the moon....
0:47:59 > 0:48:00OK, are you convinced
0:48:00 > 0:48:02we are on the moon?
0:48:02 > 0:48:03Or are you just telling me this
0:48:03 > 0:48:05because you are angry with me?
0:48:08 > 0:48:09He's very confused, isn't he?
0:48:09 > 0:48:11Well...
0:48:11 > 0:48:13He's not like that.
0:48:13 > 0:48:15He's not like that?
0:48:15 > 0:48:18It's just started since he had a fall.
0:48:18 > 0:48:22I'm just worried about what the falls might have caused
0:48:22 > 0:48:26and what might have caused the fall.
0:48:26 > 0:48:31It's not easy to define whether he is compos mentis or
0:48:31 > 0:48:33if he is completely out of it.
0:48:33 > 0:48:39Do we have to follow what we think is the best option...forcibly?
0:48:39 > 0:48:42Ed wants the patient to go for a scan of his head
0:48:42 > 0:48:45to check for internal damage.
0:48:45 > 0:48:49But he's going to have to use all of his powers of persuasion.
0:48:49 > 0:48:51I want to send you to have a CT head,
0:48:51 > 0:48:54that means a scan of your head.
0:48:54 > 0:48:56Do you know what we will look for?
0:49:05 > 0:49:08OK, fine. You gave me the answer I wanted.
0:49:08 > 0:49:10That's all right.
0:49:10 > 0:49:12Now try and relax and have some sleep
0:49:12 > 0:49:14and we'll talk to you again tomorrow morning.
0:49:14 > 0:49:18He's told us all to bugger off and threatened to snap us
0:49:18 > 0:49:21in half with his hands, the lot of us.
0:49:21 > 0:49:25So, I mean, he's quite clear in his mind
0:49:25 > 0:49:28that he doesn't want us around him.
0:49:28 > 0:49:31Ed has handled this difficult case in textbook fashion.
0:49:31 > 0:49:36Ensuring his own safety as well as that of the other staff.
0:49:36 > 0:49:40But he still needs to work out the next phase of the man's treatment.
0:49:40 > 0:49:42What will be your plan of care for him?
0:49:42 > 0:49:45So my plan is that I am going to stop
0:49:45 > 0:49:46a couple of his medications now,
0:49:46 > 0:49:48the ones that are affecting his blood pressure,
0:49:48 > 0:49:50or at least one of them.
0:49:50 > 0:49:51Probably the calcium channel blocker.
0:49:51 > 0:49:54See if he responds to higher blood pressure,
0:49:54 > 0:49:58if it comes back a bit in his reasoning.
0:49:59 > 0:50:02See if he calms down.
0:50:02 > 0:50:05More tests are needed, including bloods.
0:50:05 > 0:50:08But they require the patient's cooperation.
0:50:08 > 0:50:11Ed hopes a new day will bring a change in mood.
0:50:11 > 0:50:15I am going to suggest to try and do that in the morning.
0:50:15 > 0:50:20Another person, new face. He will remember me and he just told me
0:50:20 > 0:50:25to get out of his sight, so I don't think it's appropriate.
0:50:28 > 0:50:31It's a confident performance - further evidence that after
0:50:31 > 0:50:36his shaky start as a junior doctor, Ed is now firmly on the right track.
0:50:36 > 0:50:39I wouldn't say everything is becoming second nature,
0:50:39 > 0:50:43but I definitely have to ask less questions about simple things
0:50:43 > 0:50:46and I'm starting to ask more questions about complicated things.
0:50:46 > 0:50:48It's getting better, I'm more independent,
0:50:48 > 0:50:50so I'm happy about the way things are going.
0:50:52 > 0:50:55I think the months spent as a foundation trainee
0:50:55 > 0:50:58in Liverpool will be really valuable time.
0:50:58 > 0:51:00I regard this place as a really good start-off point
0:51:00 > 0:51:03but I can't see myself staying here in the long term at the moment.
0:51:03 > 0:51:07I definitely would like to try other places as well.
0:51:14 > 0:51:16# Shine bright like a diamond... #
0:51:20 > 0:51:24With the end of their current ward placements only days away...
0:51:25 > 0:51:29..some of the junior doctors are hitting the town.
0:51:29 > 0:51:32It's a much-needed chance to relax after a busy
0:51:32 > 0:51:34few months in the hospital.
0:51:34 > 0:51:39The thing that I'm really, really happy with, I just love my ward.
0:51:39 > 0:51:42I'm going to really miss it when I move on, I think.
0:51:42 > 0:51:43I've really enjoyed it all as well,
0:51:43 > 0:51:46except you do get a bit tired of all that paperwork.
0:51:46 > 0:51:47There's a lot of paperwork
0:51:47 > 0:51:51Sometimes I feel like all I am is a discharge summary machine.
0:51:51 > 0:51:56For first-years Tom, Jen and Tristan,
0:51:56 > 0:52:00the first months on the job have been a steep learning curve.
0:52:00 > 0:52:02I was saying to a couple of nurses yesterday,
0:52:02 > 0:52:04I don't know if I was tired and emotional but I was saying
0:52:04 > 0:52:10how much I felt like I'd learnt since I've been there.
0:52:10 > 0:52:13You can't actually imagine how much you didn't know when you start,
0:52:13 > 0:52:16and you kind of think back and you remember the mistakes you made,
0:52:16 > 0:52:17and you're like, "Why? How?"
0:52:17 > 0:52:19It would take me half an hour
0:52:19 > 0:52:23to decide what fluids to prescribe somebody. I just like write it out.
0:52:23 > 0:52:28But losing his second-year status meant NHS new boy Ed
0:52:28 > 0:52:30has had the toughest start of all.
0:52:30 > 0:52:35It just started out really badly and went better over time and I'm
0:52:35 > 0:52:38really happy with the time I've been spending in acute medicine.
0:52:38 > 0:52:40I have some excellent colleagues
0:52:40 > 0:52:43and learnt a lot of things. It's been really good.
0:52:43 > 0:52:46You've probably had the biggest journey of all of us.
0:52:46 > 0:52:48It was good. I just needed some time to adapt
0:52:48 > 0:52:51but other things just sidetracked me for some time.
0:52:51 > 0:52:57Already confident and relaxed on the wards, second-years Kiera
0:52:57 > 0:53:00and Oli have continued to make steady progress.
0:53:00 > 0:53:02I've enjoyed the past three months in general.
0:53:02 > 0:53:05I've just like really liked it, AMU's nice, I've learnt a lot,
0:53:05 > 0:53:07it's been a really nice team.
0:53:07 > 0:53:09It's been my favourite thing that I've done
0:53:09 > 0:53:11since starting over a year ago.
0:53:11 > 0:53:13Passed your exam.
0:53:13 > 0:53:15Passed my exam, yeah. I was pretty happy with that.
0:53:15 > 0:53:17A&E has been fantastic.
0:53:17 > 0:53:21It's been absolutely exhausting, sometimes quite stressful
0:53:21 > 0:53:25but it's brilliant, you learn so much.
0:53:25 > 0:53:28And make really good friends with a lot of the staff.
0:53:28 > 0:53:31Cheers, here's to three months with no tears.
0:53:31 > 0:53:33Cheers!
0:53:34 > 0:53:36Well...almost no tears.
0:53:38 > 0:53:42The junior doctors will soon be moving on to new departments
0:53:42 > 0:53:44and taking on fresh challenges.
0:53:44 > 0:53:47For most, the move spells the end of
0:53:47 > 0:53:50the first chapter in their medical careers.
0:53:50 > 0:53:54The job's lived up to expectations in every way.
0:53:54 > 0:53:57It's been just as frightening, just as exciting,
0:53:57 > 0:54:00just as interesting as I ever thought it would be and more.
0:54:00 > 0:54:04He's lovely, isn't he? Are you married?
0:54:04 > 0:54:07It's not every day you get a marriage proposal while doing a cannula,
0:54:07 > 0:54:09I must be getting quite good at them.
0:54:09 > 0:54:12You're learning so quickly you're forced to do things that you
0:54:12 > 0:54:14probably didn't even think that you could do
0:54:14 > 0:54:16but you just have to get on and do it, and try it.
0:54:16 > 0:54:18Can you sort it out? Cheers.
0:54:18 > 0:54:23It's a period of an incredibly steep learning curve which can either
0:54:23 > 0:54:25be overwhelming if you let it be or can be quite a lot of fun.
0:54:25 > 0:54:27I didn't feel that.
0:54:27 > 0:54:29Good. I might manage to keep my job after all.
0:54:29 > 0:54:33Over the past three months, they've experienced highs...
0:54:33 > 0:54:35Whooo!
0:54:35 > 0:54:37..and lows.
0:54:37 > 0:54:39I think I'm just really sad somebody has died,
0:54:39 > 0:54:41I hope I always feel a little bit for them.
0:54:43 > 0:54:45They've had times they'll always remember...
0:54:45 > 0:54:49- Happy birthday! - Quarter of a century!
0:54:49 > 0:54:52..and ones that they'd rather forget.
0:54:52 > 0:54:55- What do we call that? - It's a semi-lunar shape.
0:54:57 > 0:55:00God... Oh... No, I don't know.
0:55:00 > 0:55:03They've learned to stand on their own two feet...
0:55:03 > 0:55:05You're a star!
0:55:05 > 0:55:07There has been points in the day where I just think, "Oh, God,
0:55:07 > 0:55:10"I can't do this any more," but there's always something like when
0:55:10 > 0:55:13somebody is really grateful for what you've done and you think you're
0:55:13 > 0:55:17actually doing something really nice for people, which is lovely.
0:55:17 > 0:55:20- Easy.- Easy-peasy.
0:55:20 > 0:55:23They've taken some tough decisions.
0:55:23 > 0:55:26Can't you just discharge me until tomorrow?
0:55:26 > 0:55:28I'd be very unhappy about you going, really.
0:55:28 > 0:55:31It's really scary having people come to you
0:55:31 > 0:55:33and you are the one that is telling them what to do.
0:55:33 > 0:55:36I'll just pop you in here.
0:55:36 > 0:55:40It IS a lot of responsibility but it's quite a privilege
0:55:40 > 0:55:43really and one not to be taken lightly.
0:55:43 > 0:55:46And it's still only the start of their working lives.
0:55:46 > 0:55:50The more I learn, the more I realise there's a whole host
0:55:50 > 0:55:53of things that I don't understand and I don't know
0:55:53 > 0:55:56and it just makes me excited to go and learn them.
0:55:56 > 0:55:58I'll sort you out.
0:55:58 > 0:56:02Being a doctor isn't glamorous, you have to do some unpleasant things.
0:56:02 > 0:56:04Going in now.
0:56:04 > 0:56:07You have to be in very difficult emotional circumstances.
0:56:07 > 0:56:10- Don't let me die.- We're not going to let you go anywhere
0:56:10 > 0:56:13But I couldn't imagine myself doing anything else.
0:56:51 > 0:56:54Subtitles by Red Bee Media Ltd