'What's My Future?' Junior Doctors: Your Life in Their Hands

This programme contains some strong language.

Trauma...tears...

That's all right.

..and intense pressure.

Changing the oxygen over.

Just another day on medicine's front line.

Three months ago, eight junior doctors began work here,

at the Royal Liverpool University Hospital.

Hey, you've no need to look happy, you lot.

Give it a rest!

'No matter how long hours I'm working,

'no matter how fed up I am, you do feel rewarded by the job.'

And that's a massive plus.

'There's been points in the day where I think, "Oh, God,

'"I just need to sit down.' Oh, dear!

"I can't do this any more."

'The more that I learn, the more realise'

I don't know. I think it might have been in the wrong hole.

And it just makes me excited to go and learn.

'I was expecting it to be a more positive experience,

'and at the beginning it wasn't,'

but in the longer term, I can see it's been really good up to now.

BEEPING

'It's an incredibly steep learning curve,

'which can either be overwhelming if you let it be'

or can actually be quite a lot of fun.

'The human experiences that I've got from it

'and meeting all the patients, it's just been'

really worthwhile.

'It's really scary. Your level or responsibility goes from down here'

to somewhere absolutely sky-high.

'It's been interesting, very busy.'

It's been good.

They're now reaching the end of their first placements.

And their thoughts are turning to the future.

The endgame is to end up as a consultant in hospital.

It's how you try and prove that you're dedicated.

We're sort of forced to decide what we want to specialise in

quite early on, so I'm starting to feel the pressure.

The best candidates get the job

so, if I really want it, I need to do the work.

# Mama told me not to waste my life

# She said spread your wings, my little butterfly... #

The junior doctors have made it to the end of their first

three months in the hospital.

You not having any breakfast?

I've got an hour until I need to be at work.

They'll soon be moving on to different wards to start their next

rotations, so it's time to start getting serious about their futures.

It's never going to be just a job - it will always be more than a job.

I definitely feel I've found

what I want to do for the rest of my life.

-Are you ready?

-Yep.

-See you, Oli.

-See you, mate.

Climbing higher up the medical career ladder will take drive

and determination.

But that shouldn't be a problem for go-getter Jen.

I definitely consider myself a competitive person.

There is nothing that I love more than a challenge

and the opportunity to beat somebody.

Since starting work, she's dealt with tough medical procedures...

-HE YELLS

-'I didn't really know what to do.'

It's having the confidence, isn't it?

..and the death of her patients...

Just not used to this kind of thing happening in my life.

..Jen's dedication has impressed her seniors,

who, after just two weeks on the job,

allowed her to observe an operation.

What do you think? Have you seen one before?

No, I haven't seen one of those before.

Now, almost three months on, Jen is thinking about her next step.

We're sort of forced to decide

what we want to specialise in quite early on,

'so I'm starting to feel the pressure.

'When I started work, I thought I knew I wanted to do anaesthetics.'

Now, because I have enjoyed surgery so much,

I'm starting to question that.

I'm just going to have to explore both of the careers

'a lot before I apply.'

More time in the operating theatre could help Jen make up her mind.

And then what we'll do is make sure everything is cleaned up inside

Senior House Officer Andrea Sheel has given Jen another chance

to put on her surgical scrubs.

And this time, she'll really be getting stuck in.

Oh, yeah, I've seen one.

Jen has been asked to incise

and drain an abscess on a chap's back. There is a large collection of

pus there we need to release because it's quite painful for him.

It will be the first time Jen has ever performed an operation

herself, but Dr Sheel will be on hand to guide her through it.

Give that a really good working around and then wash it again

and pop the dressings in.

Little bit nervous because you're cutting into somebody

and I've never done that before but it's only very superficial,

so it's not too bad.

Who needs a scouse tan when you've got iodine?

Cool, let's go.

Start off in the area where you'll make the incision first of all.

-So right over the...

-Like that?

-Yeah. Give it a really good...

Oh, right, round it.

With the patient prepared for the operation, it's time for Jen

to make her first ever surgical cut.

-OK. Knife, please.

-Thank you

So you've got your scalpel.

-Nice and decisive, don't push it in too far.

-Like that?

Yeah. Just a little stab incision at the top.

OK, we need to go a little bit further there.

just a little bit deeper.

Get your finger inside there...

..get some of that nice, juicy pus out.

It's coming out now.

Are you happy with that?

I think it's empty now.

As surgery progresses, Jen is showing little sign of nerves.

-A bit of force, just to squeeze it in.

-Bit of force you want?

Yeah, make a nice little irrigation. That's great. Thank you very much.

With the operation complete,

and dressing applied, it's a proud moment for any aspiring surgeon.

-Go and write in the notes.

-Yes.

It felt really nice when I was writing in the operation notes,

"Surgeon: J Whiteley."

That was weird because I was like, "Do I put your name down?"

She was like, "No, you put both of our names down."

So that was a bit of a strange thing, it was nice.

I think Jenny did really well there,

she's attacked it with a very confident positive approach.

It is officially an entire operation so it's something that she can

put on her logbook and in her portfolio and it's just something

that will make her stand out from the rest of the house officers.

And when it comes to choosing a specialism, the experience

has given Jen even more food for thought.

'I've really, really enjoyed surgery.

'I have definitely noticed the buzz from surgery.

'I understand why people enjoy it.'

I definitely have considered it

more in the last few weeks than I have before.

I will just have to probably explore it a bit more.

-That was really well done.

-Thanks very much.

-Thanks, guys.

As a first-year junior doctor, Jen still has a bit of breathing space

before finalising her career plans.

But over in the Emergency Department,

it's crunch time for second-year Kiera.

Amazing, thank you.

My long-term plan is to apply to do A&E training in Liverpool,

because it's brilliant.

For me, the long hours, the stress and everything else, the shifts of

A&E is worth the sacrifice because the excitement and the challenge

of not knowing what's coming in next gives you a real buzz.

During a hectic few months in Accident & Emergency, Kiera

has coped well with everything that's been thrown at her.

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

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

You all right, sir, you OK there?

Ram a load of fluids up in case his blood pressure is on the low side.

Kiera's skilful stitching has won her particular praise.

Wonderful service.

Oh, thank you.

It's nice to hear that.

But a needle is the last thing her next patient wants to see.

How have you actually done this?

I was cleaning, I went along the skirting board, and as I did

the needle just went... I thought it was a staple at first.

..went in and out and there was a cloth all around it,

so we had to cut the cloth off.

Oh, dear. OK.

We've done a little X-ray of it and it's not gone into the bone

so that's a good sign.

-I thought that.

-Yeah, so it'll be a matter of actually pulling it out.

Are you just going to pull it out in one go?

-Just one smooth go, yeah.

-Just pull it out, then.

Do you want some gas and air?

I don't want to feel woozy. I look after my mum, she's got

dementia - she's palliative and she's at home.

I've left my daughter with a two-year-old and a six month baby,

-she's six months pregnant.

-So you just need it out.

-Fine. I'll come and do it for you now.

-Thank you.

Make yourself comfortable, my love, and I'll be back.

It may be the patient's idea of hell

but doing a procedure like this is Kiera's idea of heaven.

Yup, I enjoy doing things like this.

Did I just hear you say you enjoy doing things like this?

You did, isn't that terrible!

When you're ready, let's just have a feel of it.

Kiera will need the help of another doctor to pull the needle out.

I'm not going to look, just do what you've got to do.

I'm going to hold your finger.

Just hold my fingers down.

So first of all, we're just going to clamp on,

and make sure you get a good clamp.

And remember, it's got a little bend to it,

-remember the bend on the X-ray?

-Yeah.

And the bend is that way, so you need to just firmly...

I'll hold me hand down so you don't lift it up.

Whatever you do, darling, don't move your hand for us.

-Please hold it steady.

-Yup.

OK. Here we go.

-Well done.

-All done.

-Thank you.

-Do you want that as a souvenir?

-No!

We'll give it a wash out and check the tetanus status,

antibiotics, some painkillers.

-We'll let you get back.

-Thank you.

How does that feel now?

A thousand times better.

I think it's more nerves to begin with, thinking how bad it'll be.

It's kind of a weird thing, liking doing things like that.

It's simple to do

but the relief it gives the patient is sort of instantaneous.

A bit of a sick thing to enjoy doing but, yeah, I enjoy things like that.

Kiera's fellow second year, Oli, has spent an action-packed

three months on the Acute Medical Unit...

It's Oli, the AMU SHO, you bleeped me?

..dealing with everything from anxious patients...

-Toerag!

-Sorry?

-You toerag!

..to tricky procedures.

Viscous effusion fluid.

Don't know how else you would describe it,

it's quite thick, actually.

Sitting the first phase of his registrar exams early has put

Oli ahead of the competition.

Yeah, I passed.

To pass that exam means I'm one third of my way to becoming

a member of the Royal College of Physicians,

and after that you can apply for training in medical specialties.

I want to do acute medicine eventually.

This last rotation has sort of consolidated that in my ideas

so I really want to do that now.

John, can you turn your head to the left for me?

You just pick up a patient's notes, you're the first person they see

in the hospital that day and you get their story and it's almost like

you are their opportunity for them to explain what's been going on.

Ann Smith, I've just got her stuff ready to see her.

Oli's next patient, Ann, has only recently been

discharged from hospital...but now she's back.

Just take a seat on here for me. My name's Dr Harris.

Thank you.

I've put two stone on in two weeks and I've pain here,

under my left breast - it's terrible, I'm so breathless.

But Ann's rapid weight gain is only part of her story.

I don't know if you know...

I was diagnosed with cancer three weeks ago.

Yeah, I've got the notes from your GPs there.

Biggest shock of my life,

because I didn't have any symptoms - it was picked up in a blood test.

Yeah, yeah.

It's like a bad dream.

Did they tell you then that it had gone to the liver?

They can't do nothing for me.

They can't, my son, he's flown in from Australia to look after me.

And I was in here last week...

SHE SOBS

-I feel awful.

-I'll just get you a tissue.

Sorry.

No, it's all right.

Being able to help a seriously ill patient like Ann is exactly

why Oli wants a career in acute medicine.

Do you feel you have to go and pass water a lot of the time?

You can step in, do an intervention and improve that person's

quality of life or send them home, even, feeling a bit better,

so that's why I really like the Acute Medical Unit, yeah, it's good.

Is it sore?

It's agony.

Point to me where the most painful part is.

It's all under there.

How does it feel if I press?

That's sore.

-That there. Sorry, sorry.

-It's OK, you got to do it.

A build up of fluid has caused Ann's stomach to swell.

It's too painful, isn't it?

Do you want me to get a nurse in to give us a hand?

No, I'm independent, I'll do it.

Don't want you to hurt yourself though, you're doing very well.

Right, let's have a listen to your heart on the front.

Take some nice, deep breaths for me.

I'm just going to press here.

Sorry.

Hmm, so the shortness of breath could actually be due to all

this fluid in your tummy,

cos if it's pressing up into your diaphragm making it difficult

for you to breathe that could also be causing the pain as well.

Because you have this underlying...

Ann's cancer isn't treatable,

so Oli needs to think about what can be done to manage her symptoms.

I think the main thing is seeing

if we could drain some fluid off your tummy.

-Please. I can't go on like this.

-Yeah.

I mean, when my son goes back I don't know what I'm going to do.

Do you live with anyone at home?

No. I've been a widow 23 years. I'm very independent.

I've had difficulty doing the hoovering with

-the breathlessness but I've done it.

-Yeah, OK.

-If it's had to take me

three goes to do one room, I've done it.

After X-raying the patient to check there's no clots in her blood or

on her lungs, Oli can now arrange to drain the fluid off Ann's stomach.

As she's aware, there's no cure for her cancer at the moment.

She's not a candidate for surgery, it's just trying to manage

the symptoms and make her live

as much of a fulfilling life as possible.

By draining that fluid off, you know, her mobility will improve,

her breathing will get better and she might get her independence back,

which is really important to her.

After a busy day at the hospital, some of the junior doctors

are relaxing with a takeaway.

And career plans are dominating the conversation.

I do love acute medicine, it's my favourite thing.

It's just so good, there's so much variety,

and it's not investigation-heavy so you can go around,

do an examination, history, make a diagnosis

and then just go with it and use your clinical skills, I love that.

I'm definitely interested in working in cardiology.

It's been a really good thing but there's nothing that

changes my wanting to work with children and so whether or not

I want to follow a paediatric cardiology route, I don't know.

Emily, what would you like to do when you're older?

I want to do a bit of everything.

If I do clinical medicine, it won't be what I'm doing, it will be

where I'm doing it, like, somewhere interesting, but I want to do

a bit of health policy as well, public health, infectious diseases.

Are you enjoying any part of the clinical job?

I really like my team and I really like the patients.

I suppose the thing is, if you do health promotion, you're

having an impact on so many people and although you're not instantly

going to see the benefits, you know that if you stop that many people

smoking or drinking or whatever,

then you're going to prevent that many...

The thing is, I'm that selfless, I don't need to see people...

We just like being on the shop floor and seeing what we do, that's all.

I don't think that's true, Emily, I think it's more about

the nine-to-five job and being able to go home and not do the weekends

and then you won't get in a grump.

There's no nightshifts on public health is there?

# Anything can happen

# Anything can happen

# Anything can happen... #

Nightshifts might not feature in Emily's future plans,

but as the only junior doctor yet to work one,

they are very much on Ed's mind.

This weekend, I'm going to be working on nights.

It's the first time I'm doing this.

Of course, I'll be hoping for the quietest night

the hospital has ever seen,

but if business comes my way, I'll just try to do the best I can.

Mountaineer Ed has faced an uphill struggle since swapping the remote

Italian village where he was previously working for Liverpool.

He soon discovered that his training in Italy couldn't prepare him

for the hectic and demanding Emergency Department.

You should be able to do a neurological examination.

Can you not do a neurological examination?

It's been a while.

'Speaking to colleagues,'

It's quite obvious that it would be unfair on him,

and also on patients, in particular,

to allow him to carry on.

We've made the decision that I'm going to be taking him off the rota.

I'm not completely glad, the fact that

I was moved back from Foundation Two in A&E

to Foundation One training.

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

This has given me loads of opportunity to learn tasks.

Under the watchful eye of his new bosses on the Acute Medical Unit,

Ed has grown in self-belief.

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

-Yes.

-OK, sir?

-Yes, you can come again, you can.

Now I'm feeling more confident,

especially after having received comments from my supervisors,

saying that the work I was doing was going in the right direction.

But for now, Ed is still taking his future one step at a time.

At the moment, I'm not particularly interested in having...

a super-brilliant career.

I'm just interested in doing my job well

and having enough time to build something long-term

with Martina, maybe a family, get a house, settle down somewhere.

With fewer senior doctors around for support,

tonight Ed must prove that he can cope.

It's an eerily empty corridor here.

To add to the pressure, he'll be carrying a cardiac arrest,

or "crash" bleep. If it goes off, his ability to act quickly

and decisively could be crucial.

BLEEPING

These bleeps need to be tested at the beginning of every shift.

'Testing, testing, testing. Please respond.'

Yeah, OK. Working.

But Ed, a crash bleep first-timer, isn't sure how to let

the switchboard know that his is working.

Yeah, hello?

BLEEPING

'Testing, testing, testing. Please respond.'

I've got one crash bleep and the other one is something else.

The thing is that I don't know how the bleeps work.

Nobody's ever told me.

I just received a call for the crash bleep, who do I have to call?

Oh, OK. That's good, thanks a lot. Bye.

Just call switch and give them the numbers of the bleeps.

Hi, I just wanted to confirm that my arrest bleep is working.

Thank you, bye.

With his bleeper sorted, Ed can now get on with some jobs.

He's been asked by a nurse to fit a cannula.

OK, yup, I'll have a look.

Thank you, you're a star.

Hi, I just need to put a little tube in one of your veins

so we can give you some medication.

Sorry to wake you up for this.

Fitting the cannula should be straightforward.

But the patient in the next bed has other ideas.

Don't get the curtain, please.

Yeah, later. I need to work, I need to do something.

Just this old man, possibly a bit confused.

He was trying to grab my trolley and steal my cannulas.

He was just wrestling my trolley away from me.

Sir, leave it.

Don't... Don't touch it, sir.

Just leave it. Just leave it. Leave it.

Hands through the curtain grabbing my legs and my cannulas.

Anyway, I put the cannula in and retreated.

Done!

BLEEPING

Ed has been crash-bleeped. And, this time, it's not a test.

'Cardiac arrest for 3X, side room 12.'

Crash calls like this one demand an urgent response.

-See you in a bit.

-Yeah, bye.

Some of the crash team are already on the scene by the time Ed arrives.

There were a couple of advanced nurse practitioners there,

but it turned out to be a seizure,

so a pre-emptive call rather than an actual call.

The patient's condition has been stabilised

and she is out of immediate danger.

But the emergency has given Ed a short-term shot of adrenaline.

Certainly, the bleep when it went off, did wake me up

but the effect of that lasted about ten minutes' time.

I realised the situation was under control

and was really sleepy again, walking back up the stairs.

I just need half an hour lay-down to go back to reasonable

levels of function.

'Route 3X and 3Y.'

Why doesn't it just let me in?

It's 8.00am.

Ten hours into his shift, and Ed is really feeling the pace.

Oh, come on, computer!

Learning to cope with fatigue is a must for any doctor on call.

Ed had planned a quick nap but didn't have a chance to take it.

When we went down to the mess to get half an hour's sleep,

I put an alarm to wake me up, which went off now.

And in that half an hour's sleep I've seen epileptic fits,

prescribed antibiotics and I'm back to the epileptic fits.

And this computer...is having an epileptic fit!

It's finally the end of his shift

and time for a weary Ed to head home.

Working nights is a right of passage for every first-year junior doctor

and the experience Ed's gained is another milestone in his career.

I lost my night virginity.

It was exciting from a certain point of view.

Really good chance to learn a lot of stuff.

I'm very willing to get on the bike and go home.

After just a few hours' sleep, Ed will have to come back

and do it all over again.

Young dad Tristan has enjoyed a steady start to his medical career.

If you just look straight ahead,

I'm going to shine a light into your eyes.

His calmness and dedication have made him popular with both

colleagues and his elderly patients on the gerontology ward.

I think the patients are really warming to Tristan at the moment.

He does introduce himself as "Tristan", which is good

cos it gives them a good connection with him,

they like that he does go through everything with them.

But with wife, Jenna,

and two-year-old daughter, Lottie, to think about, striking

the right balance between work and home hasn't always been easy.

I think this has been of the hardest points even in our relationship,

especially when he has been getting home at about 11 o'clock at night.

So she'll see him for an hour in the morning and that's it and when

it comes to bedtime, she's looking at me, like, "Where's Daddy?"

And with career choices looming, that balancing act

is at the forefront of his mind.

Acute medicine would be good, I think it's exciting, you get to

see a lot of different patients and their presentations but,

say I wanted to do A&E,

that's a lot of nights, a lot of weekends and I'm going to

have to have a chat with Jenna about the future and things like that.

On the gerontology ward, it's clocking off time for Tristan.

He's about to head home to his family

when one of his favourite patients takes a sudden turn for the worse.

Hello, you all right? What's going on?

You OK?

Tristan brings the nurses up to speed.

She became unresponsive.

She opened her eyes, vacant stare, then she saw me

and literally looked like she'd seen a ghost, put both her arms up

and then went back like this.

Have you ever seen anything like that before?

The patient's condition is life-threatening.

She had a septicaemia, an infection in her blood, starting

a week and a half ago, and she has got septic arthritis as well,

she just became unresponsive,

so things aren't looking very good for her.

It's a medical emergency

and Tristan needs senior support to manage the situation.

This has been sort of a relatively sudden downturn, cos she was

really well until Friday, even though she had the septicaemia.

-SISTER:

-Can you open your eyes for me? Open your eyes?

Can you squeeze my fingers tightly for me?

It's 8.00pm, three hours after Tristan's scheduled finish time.

He could hand the patient over to the on-call team.

She is a trooper.

But with his patient's life hanging in the balance,

Tristan can't bring himself to go home just yet.

Tristan is very conscientious he is always determined to make sure

his patients are fine and all his jobs are done before

he goes home, doesn't like to hand anything over.

I feel a bit weird just going mid-thing.

I'll get the blood gas.

I think he worries that jobs

won't get done or things will get missed,

so he is very good like that.

It is a lovely trait,

but he does also need to remember to go home sometimes!

Right, that's the blood gas.

Do you want me to just go and run this down?

Would you mind? That would be amazing!

Tristan's wife, Jenna, and daughter, Lottie, are expecting him.

He's let them know that he's running late.

But leaving now, with his patient still gravely ill,

simply isn't an option.

It is quite hard, because I know this patient very well

and she's been in hospital longer than I've been a doctor,

so first day on the wards, she was there.

We're doing these blood tests to make sure that there's

nothing extra that we're missing, otherwise

we know what's going on and we know that it is quite serious for her.

Nothing dramatic.

Thank you. Open your eyes, darling. I know you're tired, open your eyes.

For now, Tristan has done all he can.

Can you text me if anything happens to her?

But leaving behind such a sick patient still isn't easy.

Is there anything else that you want me to do?

See you later.

Tristan is finally leaving the hospital, four hours after

the official end of his shift.

Bye.

I wouldn't want to be the sort of person

that could just walk away from that.

This lady being unwell has hit me quite hard, I think.

I'm quite upset about it.

But it's not just a bad day at the office that's bothering Tristan.

I just feel really bad for Lottie

because I know that it impacts upon her when I'm not around as much.

It's a selfish thing, as well,

I don't want to miss out on that time with Lottie,

so I just have to figure out some way to make it all work.

Without the support of his family, Tristan's ambitions

of a career in emergency medicine are unlikely to become a reality.

But yet another late finish on the wards has prompted

a heart-to-heart with wife Jenna.

Having seen what it's like, me working for three months

and sometimes coming home late, what do you think

if I was to do emergency medicine or A&E or acute medicine as a career?

It's knowingly going into something that will make our life

a bit more difficult and you've got to weigh up

whether that's going to be worth it for you.

You're a great dad to Lottie and she loves having you around,

and that balance is going to become more difficult.

But if you love doing that so much, then that's what's important because

at the end of the day, that's where you spend the majority of your time.

But I think it'll just be a matter of experience. I'll be able

to get through everything quicker every day.

Yes. I am really proud of you for getting yourself to where you are.

I think you worked really hard at it.

I think you always had it a little bit more complicated than most

but you've stuck with it and not only that, you've done really well.

-OK? We'll survive.

-Yes.

-Agreed?

-Yes.

-Good.

SHE LAUGHS

In the Accident & Emergency Department, Kiera is working

the late shift.

Deary me. Well done.

After three months in A&E, she's no stranger to long hours

and unusual cases.

But on medicine's front line,

a fresh challenge lurks behind every curtain.

Hello. What's been going on?

A man has come in with persistent vomiting and diarrhoea.

It's been going on for like a few weeks now, but it stops

and then comes back again.

And when I vomit, it just comes out of my back passage and all.

Had you eaten anything funny at the time?

I'm always eating spicy foods.

And have you lost any weight?

I've lost loads of weight,

I've lost about two stone in a week. Look at me hands!

Oh, dear, OK.

I shouldn't be telling you this.

I was going to put a hosepipe up me bum...

-What?! OK.

-..and wash myself out, it's one of those things

-I was thinking to do, know what I mean?

-OK.

-You haven't done that, though?

-No, no.

Fine! OK. Good, I'm glad to hear it.

It's clearly a pretty desperate situation for the patient.

And Kiera will need all of her diagnostic skills to get to

the bottom of it.

With your tattoos, have you ever had them done abroad?

I've done all them meself.

Have you been away anywhere recently?

The furthest I've ever been is Glastonbury.

OK. And have you been around anyone who's been poorly?

Yeah, the caretaker downstairs and his wife.

There's eight people where I live and only one toilet.

I could be catching something off the seat, couldn't I?

How much would you say you drink?

I drink a lot, love. I have, like, eight pints a night.

Have you ever injected yourself with drugs?

Never, love.

Have you been coughing up anything nasty recently?

Just phlegm.

Kiera is still not sure what's wrong with the man.

-Aw!

-Sorry!

But in medicine, helpful clues

can sometimes come from the most-unexpected places.

HE COUGHS

Oh, dear, there you are.

There. Look, see.

How long's that been like that for?

Weeks.

Again going along with this poorliness?

OK, I'll be back in with you shortly, OK?

-All right, love, thanks.

-All right. See you in a bit.

When someone comes in with an awful lot of problems and diagnoses,

it can mean one of two things. Either, A - they think there's

a lot of things wrong with them but actually there's not an awful lot

wrong with them at all, or, B -

they're really poorly and you need to panic.

Kiera might not be panicking

but she does suspect that the man is seriously unwell.

And she's got a theory about exactly what could be wrong with him.

-I'm worried about maybe Legionella.

-Yes, very good.

I know that maybe there is a bit of an outbreak going on.

-It's probably worth discussing him with ID.

-Fine, yeah.

Luckily for Kiera an infectious diseases specialist is on hand.

What's making you think of Legionnaires'?

Erm, he's got a three-week history of diarrhoea,

vomiting and also sputum, productive cough, chest sounds.

Any X-ray done yet?

No, I've literally just come back from seeing him now.

I'll go and see him. Chest X-ray, blood, we've got a bed!

-Very good.

-Thank you.

Legionella, or Legionnaires' Disease, is a rare

but potentially fatal form of pneumonia.

Kiera's seniors might be impressed with

her investigative skills so far,

but that doesn't necessarily mean she's got the diagnosis right.

Kiera, we need to assess him for TB,

cos he's alcoholic and he lives in a hostel,

well, shared accommodation, and he's had it more than three weeks.

Fever, sputum and weight loss.

His chest is quite nasty-sounding, actually.

-That's why I'm thinking of TB.

-Yeah, sure.

He's got an infection up here.

Oops! How are you getting on?

Have you ever heard of TB before, tuberculosis?

No, I don't know.

It's just a little bacteria that gets in

and causes lots of different problems and stuff.

Right, I'll go and get those tests sent off

and we'll be back round in a bit.

Although TB is looking to be the likely cause,

the patient's diagnosis can't be confirmed until the tests come back.

So for now, he'll be moved on to a ward.

I really enjoy the fast pace of A&E.

You always have to be thinking on your feet,

short and snappy and you hopefully go home at the end of each day having

learnt a whole new concept. It sort of suits my personality, really.

I am very keen to carry on doing A&E as my speciality, yeah.

As Kiera clocks off,

second-year Carol is starting a busy evening shift.

Which arm are you most comfortable with?

Any one will do.

Let's have a go at this side.

Carol has already had plenty to contend with

since swapping Malawi for Merseyside.

How many tablets did you take?

The whole...the whole lot.

It is new, knowing how to manage patients who come in with self-harm.

She started on a trial period,

hoping to fill the vacancy left by Ed after he was moved

from the department to do his first year elsewhere in the hospital.

How much do you drink?

A litre, half a litre a day

One litre to half a litre in a day?

In a day, it takes the edge off the tablets.

Then, as a fully qualified second-year junior doctor,

she started getting hands-on.

Carol, you know this stuff you've done it for years in Malawi,

it's the same, nothing different, you'll be fine!

I wanted to work in A&E, so now that I'm actually

here in A&E, I feel very good about that, and I'm happy.

But her future as a full-time member of the team hangs on her ability

to handle the bread-and-butter work of a busy British hospital.

It's 1.00am,

and Carol's next patient has had a bad reaction to a takeaway.

Hello, my name's Carol, I'm one of the junior doctors.

Can you tell me what happened?

We got food from a Chinese

and I think they may have cooked something in the same pan

that had nuts in it and then maybe cooked my food in it.

Are you allergic to something that you know?

I'm allergic to nuts, yeah.

My tongue got all swelled up.

How soon after you ate?

Straight away, and I was struggling a bit with my breathing.

For most of the staff on A&E,

dealing with an allergic reaction like this one is routine.

But not for Carol.

In Malawi, I didn't see patients with nut allergies.

I don't think it's as common.

There may be reactions and allergies to different things but not nuts.

She went to sleep for an hour, and when she woke up,

I asked her if she was feeling OK

and she said she was feeling a bit better,

but when she was speaking, she was wheezing,

and she was coughing quite badly.

I've never been that worried about somebody in my life.

A trip to Accident & Emergency isn't the Saturday night out

that the patient and her mates had planned.

We were meant to be going somewhere called Crazy House.

I don't know what it is but she says it's good and I'd rather be dancing.

But, you know, I'm not.

I'm never going to that Chinese again on principle -

they nearly killed my friend.

We are going to do some basic blood tests on her

and just treat her symptomatically.

Unfortunately for Carol, nuts aren't the only thing to provoke

a strong reaction in her patient.

I'm scared of needles. I had to be held down

when I had an injection last time, like literally held down to the bed.

So I'm a bit pathetic.

Will I feel the needle?

A little bit, it will be a small scratch.

But don't think about it. You'll be OK.

Pump your fist for me.

Just relax.

Injections are the worst, cos you can't see them

when they're coming, especially if they're in your buttocks.

If it's in your arm, at least you can see it, you know it's happening

and you know it's over.

That's it, that's it. Well done.

I think she'll be able to go home by the end of the evening.

Just after we get some results from the blood tests

and as soon as she feels OK to go home, I think she'll be able to.

It's cases like this that reinforce Carol's hopes of

a future career in the NHS.

I'm very keen on A&E and I'm keen on building on my previous

experiences in Malawi, so looking forward to learning a lot here

and learning what A&E is like and hopefully get a job in A&E.

# Got to get up and try, try, try... #

As Carol works through the night, back at the house, Jen, Tom

and Emily are putting thoughts of the future aside,

with some late-night karaoke classics.

# Hey, Macarena! #

# I'd do anything for love... #

MUMBLED LYRICS

# You know, you gotta do those things that couples do when in love

# You know, walks on the beach and stuff, you know... #

INDISTINCT LYRICS

# ..I've got all my life to live I've got all my love to give

# So I'll survive, I will survive!

# Hey-hey!

# Wooh-ooh-ooh-ooh-ooh doo-doo doo-doo... #

At the hospital, first-year Ed is back working the nightshift.

He's survived an action-packed first night.

But in a busy inner-city hospital, the challenges just keep coming.

First on your left?

The most striking difference between Liverpool

and the previous job is the sheer volume of patients.

Probably the hospital sees as many people on a daily basis

as there were in the whole mountain village.

All the really acute patients would go from the ambulance

to hospital, so completely different patients

and completely different walks of life as well.

Ed's been called to one of the wards to verify a death.

When did he die?

Quarter-past.

-1.15.

-1.15.

So, he had a red card and everything?

Red card was in date.

The deceased patient's bed is in the middle of a busy bay.

Ed needs to handle the situation swiftly and discreetly.

The gentleman died about an hour ago.

You are called to the bedside of the patient

and you should listen to the heart, check for a pulse.

Of course you feel the skin, he will be cold, will look very pale.

And then, a very important thing is to check reflexes,

to light in the eyes.

No respiratory effort, pupils fixed,

not responsive.

That's about it.

That WAS cold. Other than that, just standard procedure.

It's not the first time that Ed has had to verify a death.

I've done it in my previous job,

but I just had to certify an old person's death

in my little village in the mountains, so I just filled

in a white sheet of paper, put my stamp on it, wrote down my findings.

While a dead body might hold few surprises, the accompanying

paperwork is a different matter.

Just sign here that you've verified it. That's all. That's it.

-No, I do the rest.

-Consultant? No.

-No, no.

-Do I have to sign it, actually?

Yeah, you have to sign it. You've done it there. That's it.

-I see.

-I can't verify a death.

-All right.

-Only you can.

There you go.

-OK. Thank you.

-OK. Thank you.

Job done. But there's no time to relax.

Ed has received a call about a difficult patient.

Is he so aggressive, can't we just check his BMs? No?

All right. I'll go and have a look at him in a while. Yep. OK.

The patient has very low blood pressure

and has fallen over twice, hitting his head.

He is confused and refusing to cooperate with the nurses.

He doesn't want to be touched,

he doesn't want any blood pressure, he doesn't want any medication.

Otherwise, he's refusing everything.

-But does he get violent and aggressive?

-Yeah.

Yeah, OK.

Where is he?

Room eight, bed two.

Where did you bang your head?

You banged your head on the floor, OK.

Can I have a look? Yeah? Thank you.

Let me have a look, yeah?

Where did you hit it? Behind here?

It's just important to check your blood pressure because...

The patient is threatening to discharge himself from hospital.

But he is in no state to go home.

We would need to keep you in for another little bit...

The patient's behaviour is erratic

and Ed wants to establish just how much he understands.

Do you know where we are now?

Yeah, but apart from being in the moon....

OK, are you convinced

we are on the moon?

Or are you just telling me this

because you are angry with me?

He's very confused, isn't he?

Well...

He's not like that.

He's not like that?

It's just started since he had a fall.

I'm just worried about what the falls might have caused

and what might have caused the fall.

It's not easy to define whether he is compos mentis or

if he is completely out of it.

Do we have to follow what we think is the best option...forcibly?

Ed wants the patient to go for a scan of his head

to check for internal damage.

But he's going to have to use all of his powers of persuasion.

I want to send you to have a CT head,

that means a scan of your head.

Do you know what we will look for?

OK, fine. You gave me the answer I wanted.

That's all right.

Now try and relax and have some sleep

and we'll talk to you again tomorrow morning.

He's told us all to bugger off and threatened to snap us

in half with his hands, the lot of us.

So, I mean, he's quite clear in his mind

that he doesn't want us around him.

Ed has handled this difficult case in textbook fashion.

Ensuring his own safety as well as that of the other staff.

But he still needs to work out the next phase of the man's treatment.

What will be your plan of care for him?

So my plan is that I am going to stop

a couple of his medications now,

the ones that are affecting his blood pressure,

or at least one of them.

Probably the calcium channel blocker.

See if he responds to higher blood pressure,

if it comes back a bit in his reasoning.

See if he calms down.

More tests are needed, including bloods.

But they require the patient's cooperation.

Ed hopes a new day will bring a change in mood.

I am going to suggest to try and do that in the morning.

Another person, new face. He will remember me and he just told me

to get out of his sight, so I don't think it's appropriate.

It's a confident performance - further evidence that after

his shaky start as a junior doctor, Ed is now firmly on the right track.

I wouldn't say everything is becoming second nature,

but I definitely have to ask less questions about simple things

and I'm starting to ask more questions about complicated things.

It's getting better, I'm more independent,

so I'm happy about the way things are going.

I think the months spent as a foundation trainee

in Liverpool will be really valuable time.

I regard this place as a really good start-off point

but I can't see myself staying here in the long term at the moment.

I definitely would like to try other places as well.

# Shine bright like a diamond... #

With the end of their current ward placements only days away...

..some of the junior doctors are hitting the town.

It's a much-needed chance to relax after a busy

few months in the hospital.

The thing that I'm really, really happy with, I just love my ward.

I'm going to really miss it when I move on, I think.

I've really enjoyed it all as well,

except you do get a bit tired of all that paperwork.

There's a lot of paperwork

Sometimes I feel like all I am is a discharge summary machine.

For first-years Tom, Jen and Tristan,

the first months on the job have been a steep learning curve.

I was saying to a couple of nurses yesterday,

I don't know if I was tired and emotional but I was saying

how much I felt like I'd learnt since I've been there.

You can't actually imagine how much you didn't know when you start,

and you kind of think back and you remember the mistakes you made,

and you're like, "Why? How?"

It would take me half an hour

to decide what fluids to prescribe somebody. I just like write it out.

But losing his second-year status meant NHS new boy Ed

has had the toughest start of all.

It just started out really badly and went better over time and I'm

really happy with the time I've been spending in acute medicine.

I have some excellent colleagues

and learnt a lot of things. It's been really good.

You've probably had the biggest journey of all of us.

It was good. I just needed some time to adapt

but other things just sidetracked me for some time.

Already confident and relaxed on the wards, second-years Kiera

and Oli have continued to make steady progress.

I've enjoyed the past three months in general.

I've just like really liked it, AMU's nice, I've learnt a lot,

it's been a really nice team.

It's been my favourite thing that I've done

since starting over a year ago.

Passed your exam.

Passed my exam, yeah. I was pretty happy with that.

A&E has been fantastic.

It's been absolutely exhausting, sometimes quite stressful

but it's brilliant, you learn so much.

And make really good friends with a lot of the staff.

Cheers, here's to three months with no tears.

Cheers!

Well...almost no tears.

The junior doctors will soon be moving on to new departments

and taking on fresh challenges.

For most, the move spells the end of

the first chapter in their medical careers.

The job's lived up to expectations in every way.

It's been just as frightening, just as exciting,

just as interesting as I ever thought it would be and more.

He's lovely, isn't he? Are you married?

It's not every day you get a marriage proposal while doing a cannula,

I must be getting quite good at them.

You're learning so quickly you're forced to do things that you

probably didn't even think that you could do

but you just have to get on and do it, and try it.

Can you sort it out? Cheers.

It's a period of an incredibly steep learning curve which can either

be overwhelming if you let it be or can be quite a lot of fun.

I didn't feel that.

Good. I might manage to keep my job after all.

Over the past three months, they've experienced highs...

Whooo!

..and lows.

I think I'm just really sad somebody has died,

I hope I always feel a little bit for them.

They've had times they'll always remember...

-Happy birthday!

-Quarter of a century!

..and ones that they'd rather forget.

-What do we call that?

-It's a semi-lunar shape.

God... Oh... No, I don't know.

They've learned to stand on their own two feet...

You're a star!

There has been points in the day where I just think, "Oh, God,

"I can't do this any more," but there's always something like when

somebody is really grateful for what you've done and you think you're

actually doing something really nice for people, which is lovely.

-Easy.

-Easy-peasy.

They've taken some tough decisions.

Can't you just discharge me until tomorrow?

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

It's really scary having people come to you

and you are the one that is telling them what to do.

I'll just pop you in here.

It IS a lot of responsibility but it's quite a privilege

really and one not to be taken lightly.

And it's still only the start of their working lives.

The more I learn, the more I realise there's a whole host

of things that I don't understand and I don't know

and it just makes me excited to go and learn them.

I'll sort you out.

Being a doctor isn't glamorous, you have to do some unpleasant things.

Going in now.

You have to be in very difficult emotional circumstances.

-Don't let me die.

-We're not going to let you go anywhere

But I couldn't imagine myself doing anything else.

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