0:00:02 > 0:00:06Three months ago, eight young people embarked
0:00:06 > 0:00:09on the most challenging part of their lives so far.
0:00:09 > 0:00:14I've got the uniform, I've got the badge. It's time to be Dr Tom.
0:00:15 > 0:00:18After five years of training in medical school
0:00:18 > 0:00:22they hit the wards for the first time ever as junior doctors.
0:00:22 > 0:00:26I don't know where anything is. Do you know where the forms are?
0:00:26 > 0:00:29On a daily basis they faced trauma...
0:00:29 > 0:00:32- She's got a pulse, she's got a strong pulse.- Any pain up here?
0:00:32 > 0:00:35- ..tears...- Sorry.
0:00:35 > 0:00:36That's all right.
0:00:36 > 0:00:38..and intense pressure...
0:00:38 > 0:00:40Changing the oxygen over.
0:00:41 > 0:00:45..as they took their place on medicine's front line.
0:00:48 > 0:00:52They were young, untested...
0:00:52 > 0:00:54This is my first patient ever.
0:00:54 > 0:00:58..and from their very first day work became a matter of life and death.
0:00:58 > 0:01:01- Don't let me die.- We're not going to let you go anywhere.
0:01:03 > 0:01:05They were party animal, Tom...
0:01:05 > 0:01:09I've got two or three patients who I have absolutely world-class banter with.
0:01:10 > 0:01:11..arty Emily...
0:01:11 > 0:01:13I've been working really hard and I'm really tired.
0:01:18 > 0:01:19..competitive Jen...
0:01:19 > 0:01:22There's nothing I love more than a challenge,
0:01:22 > 0:01:26and the opportunity to beat somebody. I'll sort you out.
0:01:26 > 0:01:28..young dad, Tristan...
0:01:28 > 0:01:32The worst thing about the job is not seeing Lottie and Jenna
0:01:32 > 0:01:34as much as I'd like, so I feel really bad about that.
0:01:34 > 0:01:37..Italian mountain medic, Ed...
0:01:37 > 0:01:40I definitely have to ask less questions about simple things.
0:01:40 > 0:01:44I'm starting to ask more questions about more complicated things.
0:01:44 > 0:01:47..and second years, straight-talking Kiera...
0:01:47 > 0:01:49I've done myself a bit of damage there, didn't I?
0:01:49 > 0:01:51You've done a proper job of it, haven't you?
0:01:51 > 0:01:53..confident charmer, Oli...
0:01:53 > 0:01:57- That didn't feel bad.- Good. I might manage to keep my job after all.
0:01:57 > 0:02:00..and Malawian medic, Carol.
0:02:00 > 0:02:03- What do we call that?- Um...
0:02:03 > 0:02:04- Haemorrhoids.- Haemorrhoids.
0:02:06 > 0:02:08Now we look back at their highs...
0:02:08 > 0:02:12ALL: Happy birthday!
0:02:12 > 0:02:13I passed.
0:02:15 > 0:02:16..and their lows.
0:02:16 > 0:02:19I think I'm just really sad that someone's died.
0:02:19 > 0:02:21I hope that I always feel a little bit for them.
0:02:21 > 0:02:24This lady being unwell has hit me quite hard, I think.
0:02:24 > 0:02:25I'm quite upset about it.
0:02:26 > 0:02:30- The good times...- It's PAYDAY!
0:02:30 > 0:02:31..and the bad...
0:02:31 > 0:02:34We've made the decision that I'm going to be taking him off the rota.
0:02:37 > 0:02:40..as our juniors found out what it took to be doctors.
0:03:02 > 0:03:04- Hello!- Hello!- Hello!
0:03:04 > 0:03:08All eight junior doctors have now come to the end of their first
0:03:08 > 0:03:13three month placements at the Royal Liverpool University Hospital.
0:03:13 > 0:03:16Tonight they'll be enjoying a rare evening out together to celebrate.
0:03:18 > 0:03:20Waaay!
0:03:23 > 0:03:25The meal will give them a chance to reflect
0:03:25 > 0:03:28on some of the most demanding weeks of their lives.
0:03:28 > 0:03:30I'm going to make a toast and it's not
0:03:30 > 0:03:33so much about getting through the first few months of work,
0:03:33 > 0:03:37because loads of you have been there for a while longer,
0:03:37 > 0:03:39it's more about meeting new people and being good friends
0:03:39 > 0:03:43- and kind of sticking with everything, so... to friends.- Aw, cheers.- Cheers.
0:03:49 > 0:03:53It all began three months earlier.
0:03:53 > 0:03:56Back then, nerves were jangling as the junior doctors
0:03:56 > 0:04:00prepared for their first day on the wards.
0:04:00 > 0:04:02I feel like I'm living in a bit of a dream, to be honest.
0:04:04 > 0:04:07Nobody expects us to be, you know, child prodigies
0:04:07 > 0:04:08the day we walk onto the ward.
0:04:13 > 0:04:16- It's crunch time. - SHE LAUGHS
0:04:16 > 0:04:19The enormity of what's about to happen has just suddenly dawned on me.
0:04:19 > 0:04:22Emily! You bloody fool, you'll get us killed!
0:04:28 > 0:04:31I'm going to be the F2 on AMU for the next four months.
0:04:31 > 0:04:32- Oh, right. Welcome. - Hi, you all right?
0:04:32 > 0:04:35I'm Emily, one of the F1s on A-Tech, so I've just started today.
0:04:41 > 0:04:44Welcome, everybody. This will be an exciting four months for you.
0:04:44 > 0:04:49A steep learning curve, but you will learn a phenomenal amount while you're here.
0:04:49 > 0:04:54But no-one had more to get to grips with on day one than NHS new boy Ed,
0:04:54 > 0:04:58who was put in the hospital's busy Emergency Department.
0:04:58 > 0:05:02'The main fear about today is that I haven't seen an x-ray in six months.
0:05:02 > 0:05:06I really need to get up to reading these things again.
0:05:06 > 0:05:10It's so easy to miss out obvious things when you don't practise them.
0:05:15 > 0:05:18The pace of life in a British Emergency Department was
0:05:18 > 0:05:20worlds apart from Ed's last job
0:05:20 > 0:05:24as the only medic in an Italian mountain village.
0:05:27 > 0:05:31Ed's first patient was a man who'd come in with a knee injury.
0:05:32 > 0:05:34So do you want to tell me what happened?
0:05:34 > 0:05:38- I stepped off the van, my knee twisted.- OK.
0:05:38 > 0:05:42Ed had to perform an immediate examination.
0:05:42 > 0:05:45The ligament here is very tough and very thick. Does that hurt?
0:05:45 > 0:05:50- That's sore there. - If I press there?- Yeah.- OK? OK.
0:05:50 > 0:05:53The patient went for an x-ray
0:05:53 > 0:05:56but when the results came back, Ed wasn't sure how to interpret them.
0:05:58 > 0:06:01Can you remember what sits inside the knee joint,
0:06:01 > 0:06:05just to the side here? There are a couple of spongy pads that sit there.
0:06:05 > 0:06:09- That would be cartilage? - OK, what particular cartilage?
0:06:09 > 0:06:13- Articulate cartilage? - No, what particular, particular.
0:06:13 > 0:06:18What do we call that? It's a semi-lunar shape...
0:06:18 > 0:06:19half moon shaped.
0:06:19 > 0:06:22Ah, ha!
0:06:22 > 0:06:25- How do you call them now? - In English, it begins with an M.
0:06:25 > 0:06:26Yeah, um...
0:06:30 > 0:06:33- No.- OK. The menisci. - Menisci, yeah.
0:06:40 > 0:06:44During Ed's second shift in A&E, there was more at stake than
0:06:44 > 0:06:46just the health of the patients.
0:06:46 > 0:06:51After his shaky start, Ed's seniors had started to monitor him closely.
0:06:51 > 0:06:54Within our department, we're providing them
0:06:54 > 0:06:57with 24-hour senior supervision and support, but they are expected
0:06:57 > 0:07:00to see patients from the offset on their own.
0:07:00 > 0:07:03Now having not worked within the UK, Edward is finding that difficult
0:07:03 > 0:07:06because he's unaware of the systems and the treatments in place.
0:07:06 > 0:07:11With the pressure on, Ed's next case was a man who seemed to be
0:07:11 > 0:07:12disorientated and confused.
0:07:12 > 0:07:15Can you close your eyes, please?
0:07:15 > 0:07:16No, look, like this.
0:07:17 > 0:07:22Eyes closed. No, no. If you can close your eyes...
0:07:22 > 0:07:26..both closed, both closed. That was good. OK, keep them both closed.
0:07:28 > 0:07:30'I've got a confused patient.
0:07:30 > 0:07:33'He's not able to tell me where he lives, what he does, why he's here,
0:07:33 > 0:07:38he doesn't know where he is, but he is able to perform simple tasks.
0:07:38 > 0:07:42Unsure of his next move, Ed went to consultant, Dr Raj, for help.
0:07:42 > 0:07:45Have you gone through each cranial nerve, that's what I'm asking.
0:07:45 > 0:07:48- No, I haven't done it.- Right, so do a full neurological examination,
0:07:48 > 0:07:50so saying that he can speak and his eyes are all right
0:07:50 > 0:07:56- doesn't mean his neurological examination is normal.- OK.- Yeah?- OK.
0:07:56 > 0:07:59I probably would ask you to follow me during the first examination.
0:07:59 > 0:08:01Is that OK or shall I come back?
0:08:01 > 0:08:03You should be able to do a neurological examination.
0:08:03 > 0:08:06- Can you not do a neurological examination?- It's been a while.
0:08:06 > 0:08:10- Let's go do a neurological examination.- That would be nice.
0:08:10 > 0:08:12- You have completed your training in medicine, yeah?- Yeah.
0:08:12 > 0:08:16Then you should be able to do a basic examination.
0:08:16 > 0:08:18He's come in with a neurological problem,
0:08:18 > 0:08:20confusion is a neurological problem,
0:08:20 > 0:08:22so he needs a neurological examination.
0:08:22 > 0:08:24And when you do a neurological examination,
0:08:24 > 0:08:27you can't test some nerves and not test some nerves,
0:08:27 > 0:08:29that's not a neurological examination.
0:08:29 > 0:08:32The night before I started, I was just really, really tired
0:08:32 > 0:08:35because I'd just finished a nightshift on my previous job in Italy
0:08:35 > 0:08:39so I do remember that, and I was expecting it to be hard and it was hard.
0:08:39 > 0:08:43I was expecting it to be a more positive experience,
0:08:43 > 0:08:45and at the beginning it wasn't.
0:08:49 > 0:08:52It became clear to Dr Raj and the hospital
0:08:52 > 0:08:56that there was a big difference between what Ed had been taught in Italy
0:08:56 > 0:08:58and what the department expected of him.
0:08:58 > 0:09:00Speaking to colleagues,
0:09:00 > 0:09:03it's quite obvious that it would be unfair on him
0:09:03 > 0:09:07and also on patients in particular to allow him to carry on
0:09:07 > 0:09:12seeing those patients when we feel he would be out of his depth.
0:09:12 > 0:09:15With the priority being patient welfare
0:09:15 > 0:09:18and making sure Ed got the training and support he needed,
0:09:18 > 0:09:20the department came to a difficult decision.
0:09:20 > 0:09:23We were having to spend a lot of time with Ed,
0:09:23 > 0:09:27and we made a decision that I'm going to be taking him off the rota.
0:09:28 > 0:09:30- Goodbye.- See you.- Goodbye.
0:09:30 > 0:09:34'I could have easily packed up and just went back.'
0:09:34 > 0:09:38My job in Italy was still there waiting for me if I wanted to.
0:09:38 > 0:09:41Even today I had a conversation with the hospital back in Italy
0:09:41 > 0:09:44and they said "The job is still there if you want it."
0:09:44 > 0:09:49And I said, no, I've made this decision, it's good for my training.
0:09:49 > 0:09:51I'll see it through.
0:09:51 > 0:09:53Though a qualified medic in Italy,
0:09:53 > 0:09:57the hospital decided that Ed should be removed from frontline medicine
0:09:57 > 0:10:00and begin his placement as a first year.
0:10:00 > 0:10:05It meant a move to the Acute Unit where he could get intensive training and supervision.
0:10:12 > 0:10:17Now, three months on and Ed is philosophical about his rocky start to life in Liverpool.
0:10:17 > 0:10:22Looking back, I wasn't prepared at the time to do an F2 job in A&E,
0:10:22 > 0:10:26and I think, for my personal benefit and my practice as a doctor,
0:10:26 > 0:10:30working as an F1 in acute medicine has been much better.
0:10:30 > 0:10:31- Any pain at the moment?- No.
0:10:31 > 0:10:33We're getting there.
0:10:33 > 0:10:38So, yeah, I think the A&E issue was tackled not in the best way,
0:10:38 > 0:10:40but the outcome was certainly positive for me.
0:10:42 > 0:10:45You had the steepest learning curve of all of us when you first started.
0:10:45 > 0:10:48How do you feel now compared to then? It must be different.
0:10:48 > 0:10:52I feel a bit more independent, which is the greatest thing.
0:10:52 > 0:10:54I can do my stuff without having to continually
0:10:54 > 0:10:56ask for assistance for anything.
0:10:56 > 0:11:00But, yeah, it is good and I can also see other people putting responsibility on me.
0:11:00 > 0:11:04You've finally managed to start understanding the Scouse accent?
0:11:04 > 0:11:05(SCOUSE ACCENT) Yes, mate.
0:11:05 > 0:11:07LAUGHTER
0:11:11 > 0:11:14Ed may not have enjoyed the best start,
0:11:14 > 0:11:18but he wasn't the only one finding those first few weeks on the job
0:11:18 > 0:11:20to be a real challenge.
0:11:20 > 0:11:21Am I bothering you?
0:11:21 > 0:11:24I'm so embarrassed about how I was when I started at hospital,
0:11:24 > 0:11:27I feel like my voice was three octaves higher
0:11:27 > 0:11:29and I was just like this little shaking leaf.
0:11:29 > 0:11:31- I need to find some ice. - Down the other end.
0:11:32 > 0:11:38- How do I work it?- I have doubted myself at every corner I turned.
0:11:38 > 0:11:41I think it might have been in the wrong hole.
0:11:41 > 0:11:43You start to think about everything that can go wrong,
0:11:43 > 0:11:46rather than can go right.
0:11:46 > 0:11:49I didn't really know what to do when he was sort of panicking.
0:11:52 > 0:11:56I gave the wrong name, so the test has been done on the wrong patient.
0:11:57 > 0:12:01- You're so efficient.- Am I? - I'm being sarcastic!
0:12:03 > 0:12:08With time, the new doctors did begin to find their feet.
0:12:08 > 0:12:11And swallow. Fantastic.
0:12:11 > 0:12:12< Good. Excellent. Well done.
0:12:12 > 0:12:15But there was still one thing that most of them struggled with
0:12:15 > 0:12:19in those early days. Their needlework.
0:12:19 > 0:12:24- Aaaah.- Does that hurt? Having a bad day today, aren't we?
0:12:24 > 0:12:28And nobody grappled with needles more than Tom.
0:12:28 > 0:12:31- No good.- No.- Oh.
0:12:31 > 0:12:35- Taking anything?- No.- OK. Don't worry, don't worry.
0:12:35 > 0:12:37Just crack on.
0:12:37 > 0:12:41Go on, just pull. Pull. Don't be gentle.
0:12:41 > 0:12:42I know, but I don't want... I want... OK.
0:12:42 > 0:12:45I always felt I was good at taking bloods and doing cannulas
0:12:45 > 0:12:48until I started the job and then once you start
0:12:48 > 0:12:50you have kind of the additional pressures
0:12:50 > 0:12:52and all of a sudden you think,
0:12:52 > 0:12:55oh, gosh, I'm way less good at this than I used to be.
0:12:55 > 0:12:58I'm afraid I didn't get it first time either.
0:12:58 > 0:13:02With even the most routine procedures involving needles
0:13:02 > 0:13:05proving tricky, would Tom be able to handle things
0:13:05 > 0:13:06when the pressure was really on?
0:13:09 > 0:13:12While working in the Heart Emergency Centre,
0:13:12 > 0:13:17Tom had been asked to treat a patient who had been brought into A&E with chest pains.
0:13:17 > 0:13:21- So it's Mr Flynn?- Yeah. - Hi, Mr Flynn. My name's Tom.
0:13:23 > 0:13:26Mr Flynn had previously had a heart attack and a heart bypass.
0:13:26 > 0:13:29Since then he'd suffered from angina.
0:13:29 > 0:13:31Do you want to describe it to me?
0:13:31 > 0:13:33Well, it's just a very heavy pain on my chest.
0:13:33 > 0:13:36- Like a crushing kind of pain?- Yeah.
0:13:36 > 0:13:39- Has it been happening at rest, this pain?- It just happened now, yeah.
0:13:39 > 0:13:43- OK. So you take your GTN spray under your tongue?- Yeah.
0:13:43 > 0:13:45And you took two squirts of it, did you?
0:13:45 > 0:13:47And it's still taken 25 minutes to work?
0:13:48 > 0:13:52Tom began to suspect something was seriously wrong.
0:13:52 > 0:13:55- You're feeling clammy and sweaty? - Yeah.- Do you feel like that now?
0:13:55 > 0:14:00- I do, yes.- You do?- I'm really sweating now, though.- Are you?
0:14:00 > 0:14:04- I'll tell you what...- I'm really uncomfortable.- You're uncomfortable?
0:14:04 > 0:14:07Hang on, just give me two minutes.
0:14:07 > 0:14:10He quickly alerted the team to the emergency.
0:14:13 > 0:14:16This is a man who came in with unstable angina,
0:14:16 > 0:14:18and for all intents and purposes he is having a heart attack, so...
0:14:18 > 0:14:21This is his ECG now, so we're going to get inside and get it done.
0:14:21 > 0:14:24Thank you very much.
0:14:24 > 0:14:27He's having some morphine and having an ECG now.
0:14:27 > 0:14:30He's also sweaty and clammy and pretty grey.
0:14:30 > 0:14:32- FEMALE DOCTOR:- Oh, really? - Yeah.
0:14:40 > 0:14:42Has the blood pressure changed?
0:14:42 > 0:14:47Guys, his blood pressure is dropping.
0:14:47 > 0:14:52If the man was having a heart attack, a drop in blood pressure could have been fatal.
0:14:52 > 0:14:57I need to get another cannula in for fluids if his blood pressure is dropping.
0:14:57 > 0:15:00Tom needs to fit a cannula, but the clock was ticking.
0:15:15 > 0:15:19It's come out. Sorry...
0:15:19 > 0:15:21Tom failed with his first attempt.
0:15:21 > 0:15:27And the patient's blood pressure was still dropping, meaning his veins were getting thinner by the second.
0:15:27 > 0:15:30He needed to get the cannula in quickly.
0:15:30 > 0:15:32You just relax your hand and let me move it around a bit.
0:15:38 > 0:15:40Yep, that one's in. Can I get, er...the flush?
0:15:40 > 0:15:45The cannula was in, and the team managed to stabilise the patient.
0:15:47 > 0:15:50I think that what you gain from having this first
0:15:50 > 0:15:53kind of rotation in your first year of being a junior doctor,
0:15:53 > 0:15:56being able to think about a situation and make a decision
0:15:56 > 0:15:59and not have to have doubts in your mind, just to know that
0:15:59 > 0:16:03you're making that decision and something will potentially be life-changing...
0:16:03 > 0:16:06I think I've definitely gained another level of confidence,
0:16:06 > 0:16:08and that'll just keep increasing I hope.
0:16:10 > 0:16:12With a year's experience already under their belts,
0:16:12 > 0:16:16second years Kiera and Oli were less fazed by needles,
0:16:16 > 0:16:19even when their patients were a bag of nerves.
0:16:19 > 0:16:22What's up? You look a bit worried.
0:16:23 > 0:16:26- I just don't like needles. - You don't like needles?
0:16:26 > 0:16:28Have you ever had a blood test taken from the wrist before?
0:16:28 > 0:16:31- Is it all right if I come back and do one of those on you?- No.
0:16:31 > 0:16:33I think I've already had one done, and it's very painful.
0:16:33 > 0:16:38But a year on the wards had equipped them to deal with most situations.
0:16:38 > 0:16:43I'll bring the stuff back ready to do it, and we'll have a look and see what your pulse is like.
0:16:43 > 0:16:44If it hurts, you can punch me.
0:16:46 > 0:16:48Sorry...
0:16:48 > 0:16:50SHE GROANS
0:16:53 > 0:16:56Sorry... Nearly done.
0:16:58 > 0:16:59SHE GROANS
0:16:59 > 0:17:03- All done. Put some pressure on there for me. - SHE GROANS
0:17:03 > 0:17:06- Wasn't too bad, was it?- No...
0:17:06 > 0:17:10- Just like eating a bag of chips. - SHE CHUCKLES
0:17:10 > 0:17:11- You toerag!- Toerag! - HE LAUGHS
0:17:11 > 0:17:16- You didn't punch me, anyway. - No, I'm not that type of person. - OK. Fair enough.
0:17:24 > 0:17:29Fortunately for Oli, not all of his patients thought he was a toerag.
0:17:29 > 0:17:34In fact, only a week into his placement in the Acute Medical Unit,
0:17:34 > 0:17:37and his charming bedside manner had won him an army of fans.
0:17:40 > 0:17:41Keep looking straight at my nose.
0:17:41 > 0:17:44I saw you sneak a peek there! You can't cheat.
0:17:45 > 0:17:49- I'll see you later, OK?- Will you? - I don't know, will I(?)
0:17:49 > 0:17:51With patients you have to understand that,
0:17:51 > 0:17:54first of all they don't want to be in hospital,
0:17:54 > 0:17:57they're probably at their most vulnerable, they're sick, they're unhappy,
0:17:57 > 0:18:01and you just try and be in their shoes and empathise with them.
0:18:01 > 0:18:03- Didn't feel that.- Good.
0:18:03 > 0:18:06I managed to keep my job after all!
0:18:06 > 0:18:09'Trying to make them smile a bit puts them at ease,
0:18:09 > 0:18:11'or makes them feel a bit more confident in you and...
0:18:11 > 0:18:15'Just coming across as professional and at the same time approachable.'
0:18:15 > 0:18:19Very nice chap. Felt at ease with him. Nice bedside manner.
0:18:20 > 0:18:23And it wasn't just the patients that had been won over.
0:18:23 > 0:18:27I think he is quite popular with the nurses, yes.
0:18:32 > 0:18:35I'm probably old enough to be his mum - so it's no good for me...
0:18:39 > 0:18:43So Oli, I hear you were out with the nurses the other night, how did that go?
0:18:43 > 0:18:45Yep, fine. No gossip whatsoever.
0:18:45 > 0:18:48It was all above board,
0:18:48 > 0:18:51I didn't touch a drop of alcohol, and I was in bed by 10 o'clock.
0:18:51 > 0:18:54- With all of them(?) - THEY LAUGH
0:18:56 > 0:18:58Whatever.
0:19:04 > 0:19:06As the placements continued,
0:19:06 > 0:19:10and the juniors began to take on greater responsibility,
0:19:10 > 0:19:13the need to deal with the emotional aspects of the job
0:19:13 > 0:19:15began to feature more heavily for all of the doctors.
0:19:15 > 0:19:18I was told there was a cancer three week ago...
0:19:20 > 0:19:23- I feel awful. - Let's get you a tissue.
0:19:23 > 0:19:28I'm not really looking forward to seeing her after she's passed away. I think it's...
0:19:28 > 0:19:30I just don't know how I'm going to react to it, really.
0:19:34 > 0:19:37On the gastro-intestinal ward, Jen was faced with a job
0:19:37 > 0:19:41that no junior ever wants - breaking bad news.
0:19:42 > 0:19:45- When did you stop those? - Beginning of last week.
0:19:45 > 0:19:50A 72-year-old man on her ward had been diagnosed with cancer,
0:19:50 > 0:19:52and his family needed to be told.
0:19:52 > 0:19:56Jen called her senior house officer, Andrea Sheel, for support.
0:19:56 > 0:20:00She's on her way up, be about ten minutes. She's asked if you guys don't mind hanging on. Is that OK?
0:20:00 > 0:20:04- Just so you know what's going on and you get an update.- OK.
0:20:04 > 0:20:08I do feel quite bad sitting in, like, metres away from them,
0:20:08 > 0:20:14knowing the diagnosis and prognosis and not giving them any information,
0:20:14 > 0:20:16so it's quite difficult.
0:20:16 > 0:20:19But they're aware that my senior's coming
0:20:19 > 0:20:23and that she'll explain it to them, so I think they're quite happy with that.
0:20:23 > 0:20:24PHONE RINGS
0:20:27 > 0:20:35Luckily for Jen, it wasn't a situation she needed to face alone.
0:21:01 > 0:21:05It had proven a hard first experience for Jen.
0:21:05 > 0:21:08That was a tough conversation. It's the worst part of the job, isn't it?
0:21:08 > 0:21:11- Maybe, sometimes I think I'm a bit too blunt.- No, I thought you were...
0:21:11 > 0:21:13Otherwise you end up beating around the bush.
0:21:13 > 0:21:19I thought you were so nice to them, honestly. It's heartbreaking.
0:21:21 > 0:21:26The worst sort of thing about it is the relatives.
0:21:26 > 0:21:31It's when everybody's stood around the bed, and all they want is good news
0:21:31 > 0:21:35and you've not got any to give them, that's when it's quite hard.
0:21:37 > 0:21:40You can't brush it under the carpet, can you?
0:21:40 > 0:21:45You've just got to focus and carry on. That's all you can do.
0:21:48 > 0:21:51It's going to be a lot for Jen to take in.
0:21:51 > 0:21:54But I specifically wanted her to be involved in that situation,
0:21:54 > 0:21:56because I think the sooner you get used to it,
0:21:56 > 0:22:00dealing with situations like that, the better.
0:22:00 > 0:22:02Obviously it's upsetting for everybody involved
0:22:02 > 0:22:06and I think she's dealt with it really well so far.
0:22:08 > 0:22:14Three months on, and Jen has had time to reflect on the emotional cost of the job.
0:22:14 > 0:22:18At this point I am comfortable with sharing the emotional
0:22:18 > 0:22:21journeys of a patient, but at first I found it quite difficult.
0:22:21 > 0:22:24You're not scared of needles, are you?
0:22:24 > 0:22:26- Good job I'm not. - It is, really, isn't it?
0:22:26 > 0:22:29But when you're actually working, you realise that they're people,
0:22:29 > 0:22:32and people have attachments to other people and their families, and
0:22:32 > 0:22:34you start to just feel it a little bit more.
0:22:34 > 0:22:37And I think that I'm coping with it OK,
0:22:37 > 0:22:39but I found it a bit rough at first.
0:22:42 > 0:22:46Another vital part of the job that all the junior doctors quickly
0:22:46 > 0:22:49needed to adapt to, was being part of the hospital crash team.
0:22:53 > 0:22:55Carrying the cardiac arrest bleep
0:22:55 > 0:22:58was a massive step up in responsibility for everyone.
0:22:58 > 0:23:02This is one thing you can categorically say, "I've not done this before."
0:23:02 > 0:23:05Even if you've been to an arrest with somebody you've shadowed,
0:23:05 > 0:23:09it's still very different to feel that the responsibility is far more on your shoulders.
0:23:09 > 0:23:11And when it goes off, I suppose it is quite scary.
0:23:11 > 0:23:13BLEEPING
0:23:14 > 0:23:16'Cardiac arrest...'
0:23:17 > 0:23:18Let's go, guys.
0:23:22 > 0:23:26Being part of the crash team meant that they could be summoned
0:23:26 > 0:23:28to an emergency anywhere in the hospital.
0:23:28 > 0:23:32Being on the crash bleep is a mixture of apprehension and excitement.
0:23:32 > 0:23:34Said to go to A&E rescus urgently.
0:23:34 > 0:23:38You hope you can rely on your training to remember everything you're supposed to do.
0:23:38 > 0:23:40'When the call comes through, you forget how tired you are.
0:23:40 > 0:23:43'Adrenaline pumps and you just run there.
0:23:43 > 0:23:48'You're just focusing so much on what's going on that you don't notice how tired you are.'
0:23:51 > 0:23:56Focus was exactly what Oli needed when one of his night shifts ended with a crash bleep -
0:23:56 > 0:23:59an emergency that he was to share with Emily,
0:23:59 > 0:24:04who had just arrived at the hospital to begin work for the day.
0:24:04 > 0:24:08BLEEPING
0:24:08 > 0:24:11The emergency was on Emily's ward.
0:24:15 > 0:24:18One of her patients was in cardiac arrest -
0:24:18 > 0:24:21and Emily was the first doctor on the scene.
0:24:21 > 0:24:25Does anyone know about this patient?
0:24:25 > 0:24:28Could I get one of you two to get me an Ambu bag and a mask, please?
0:24:28 > 0:24:31Changing the oxygen over...
0:24:37 > 0:24:39Is there a pulse?
0:24:45 > 0:24:47Is there... I'll get gas.
0:24:47 > 0:24:52Despite the team's efforts, the man was showing no signs of improvement.
0:24:56 > 0:25:01Oli took some blood, while Emily continued chest compressions on her patient.
0:25:10 > 0:25:12Nothing seemed to be working.
0:25:12 > 0:25:15And as there was no sign of a heartbeat,
0:25:15 > 0:25:19the doctor in charge had a difficult decision to make.
0:25:28 > 0:25:33As the team tried one last time to restart the man's heart,
0:25:33 > 0:25:35Emily did another round of compressions.
0:25:47 > 0:25:51The team paused, to check whether the monitor showed the patient's
0:25:51 > 0:25:53heart had started working on its own again.
0:25:59 > 0:26:01But there was still no change.
0:26:01 > 0:26:02STEADY BEEPING
0:26:36 > 0:26:39Just walked into the ward, and suddenly the alarm went off
0:26:39 > 0:26:42and we all went running into the patient and...
0:26:42 > 0:26:45I got there and I realised it was one of my patients.
0:26:45 > 0:26:48It was really horrible, and just completely threw me.
0:26:49 > 0:26:54It's just something that you don't really expect to deal with...
0:26:54 > 0:27:01Having a relationship with somebody and then seeing them die in front of you.
0:27:01 > 0:27:03It was really hard to deal with, definitely.
0:27:05 > 0:27:08The worst side of the job is definitely losing a patient.
0:27:08 > 0:27:11It was only the other day that somebody said to me,
0:27:11 > 0:27:15you shouldn't judge yourself on the outcomes, because that might always happen to them,
0:27:15 > 0:27:18judge yourself on what you do to help the person.
0:27:18 > 0:27:22But I think there's always a part of you that feels like you've
0:27:22 > 0:27:24failed if someone dies when you weren't expecting them to.
0:27:35 > 0:27:38Liverpool. One of Britain's biggest party cities.
0:27:43 > 0:27:45And when your job is as demanding as that of a junior doctor,
0:27:45 > 0:27:49it helps to let off steam from time to time.
0:27:49 > 0:27:51Can you please try it on?
0:27:51 > 0:27:52Away from the wards,
0:27:52 > 0:27:55the new medics could let their hair down with the best of them.
0:27:55 > 0:27:57It's...payday!
0:28:02 > 0:28:04Mmm, that's nice.
0:28:04 > 0:28:06Ooh, that's quite strong.
0:28:06 > 0:28:08It's not that strong.
0:28:08 > 0:28:11I think it's really important to have a life outside medicine.
0:28:11 > 0:28:15It's really easy to get sucked into the role of "I'm a doctor" 24/7.
0:28:15 > 0:28:16You hold this up while I blow.
0:28:18 > 0:28:21You still enjoy a good night out. I think you need to.
0:28:21 > 0:28:22I think it's good for you.
0:28:25 > 0:28:30But with the highest number of alcohol-related cases in England,
0:28:30 > 0:28:34working life at the Royal Liverpool University Hospital
0:28:34 > 0:28:36proved a sobering experience.
0:28:37 > 0:28:39MONITOR BEEPS
0:28:39 > 0:28:41Whose patient is it?
0:28:42 > 0:28:45- How long have you been drinking for? - About five years.
0:28:45 > 0:28:48- How much do you drink?- A litre to a litre-and-a-half of vodka.
0:28:48 > 0:28:51A litre-and-a-half a day.
0:28:51 > 0:28:55You think of it as normal, being sociable, going out, having a drink. People might have a few too many.
0:28:55 > 0:28:58But you see the real extreme end of it in hospital.
0:29:02 > 0:29:06Working in the hospital's emergency department,
0:29:06 > 0:29:09second-year Kiera was on the frontline when it came
0:29:09 > 0:29:12to dealing with the fall-out from the city's bars and clubs.
0:29:12 > 0:29:15Working in A&E probably has changed the way I feel about going out
0:29:15 > 0:29:19and getting absolutely smashed, as maybe I'd like to do as a student.
0:29:19 > 0:29:21It kind of upsets me a little bit,
0:29:21 > 0:29:24because I have seen the really negative effects
0:29:24 > 0:29:25that that can actually have.
0:29:27 > 0:29:31But one of Kiera's patients was no boozed-up twentysomething,
0:29:31 > 0:29:34even though an evening spent sampling the city's nightlife
0:29:34 > 0:29:38- had still ended in a trip to casualty.- I had a couple of drinks.
0:29:38 > 0:29:42- Yeah?- Went into a bar and I had... sitting on a stool.
0:29:42 > 0:29:46I had a cocktail, but it must have gone down the wrong hole,
0:29:46 > 0:29:48and I took a fit of coughing.
0:29:48 > 0:29:50And I felt light-headed as I coughed.
0:29:50 > 0:29:55- The next thing I know, I'm on the floor.- Dearie me. You poor thing.
0:29:55 > 0:29:57So you fell and hit your face?
0:29:57 > 0:29:59The next thing I remember is, I wake up,
0:29:59 > 0:30:04and there are people around me and somebody's wiping the blood from me.
0:30:04 > 0:30:05- Oh, dear.- And I couldn't move,
0:30:05 > 0:30:07but then I could move and it was all right.
0:30:07 > 0:30:10- I think you've broken your nose there.- Oh, God.
0:30:11 > 0:30:14You've got a bit of a cut there as well. Been in the wars, eh?
0:30:14 > 0:30:17Did myself a bit of damage, didn't I?
0:30:17 > 0:30:19You've done a proper job of it, haven't you?
0:30:19 > 0:30:22I'm going to just pop a bit of local on that head
0:30:22 > 0:30:24and put a couple of stitches in that
0:30:24 > 0:30:26to get you looking beautiful again, OK?
0:30:26 > 0:30:27HE LAUGHS
0:30:27 > 0:30:29Cheers, thanks!
0:30:32 > 0:30:34OK, this is when the sharp, stingy bit's coming up now.
0:30:34 > 0:30:36You might not like this bit.
0:30:36 > 0:30:40- Oh, God, OK.- Right. I'm just going to go for it.
0:30:42 > 0:30:43OK, sharp scratch coming up.
0:30:51 > 0:30:54- That wasn't too bad.- You'll start to notice it numbing soon.
0:30:57 > 0:30:59You'll be pleased to know that everyone winds me up
0:30:59 > 0:31:02for being a bit of a perfectionist with this,
0:31:02 > 0:31:05which is probably what you'd want, I imagine.
0:31:05 > 0:31:06I couldn't care less.
0:31:06 > 0:31:10- Fine, then, I'll go now! - No, you're doing a good job.
0:31:10 > 0:31:14- You have a lovely face, a sweet face.- Ah.
0:31:15 > 0:31:17Beauty's in the eye of the beholder, as they say.
0:31:17 > 0:31:22Let's have a little look inside. We've given it a good wash out.
0:31:22 > 0:31:26- Can you feel any of this? - No, you're all right.- Great.
0:31:31 > 0:31:35You're going to have quite a nice black eye from this.
0:31:35 > 0:31:37One to show off down the pub, eh?
0:31:38 > 0:31:44- Perfectionist Kiera had stitching down to a fine art.- New nose.
0:31:44 > 0:31:49- Wonderful service.- Oh, thank you. It's nice to hear that.
0:31:49 > 0:31:51It's not always echoed by most people.
0:31:53 > 0:31:56So, it was yet another happy customer for Kiera,
0:31:56 > 0:31:57who throughout her placement
0:31:57 > 0:31:59had seemed to revel in her role
0:31:59 > 0:32:02as Liverpool's handiest doctor with a needle and thread.
0:32:04 > 0:32:08A lovely surgeon in Stoke sat me down one day and said,
0:32:08 > 0:32:10"This is how you suture," in my third year.
0:32:10 > 0:32:13And then I spent some time in Borneo last year,
0:32:13 > 0:32:15doing plastic surgery out there,
0:32:15 > 0:32:19and that was invaluable experience for me, which I'm really glad of.
0:32:19 > 0:32:22I saw someone who I'd sutured the other day in the shop,
0:32:22 > 0:32:24and I didn't want him to see me,
0:32:24 > 0:32:26but I was trying to get close to see how good his face looked!
0:32:31 > 0:32:34Elsewhere in the department, A&E had a new recruit,
0:32:34 > 0:32:37second year medic, Carol.
0:32:37 > 0:32:39He's alert and comfortable, but definitely jaundiced.
0:32:39 > 0:32:43Carol started her career in A&E on a trial basis,
0:32:43 > 0:32:46hoping to fill the vacancy left by Ed
0:32:46 > 0:32:49after he was moved from the department
0:32:49 > 0:32:51to the Acute Medical Unit.
0:32:53 > 0:32:55Can you just hold them out? Let's have a look.
0:32:55 > 0:32:58But she soon discovered that life in Liverpool
0:32:58 > 0:33:01was a world away from her training in Malawi.
0:33:02 > 0:33:05I've worked in a setting where resources are limited
0:33:05 > 0:33:07and you have to learn to cope.
0:33:07 > 0:33:10I'm looking forward to the challenges Liverpool has to offer.
0:33:10 > 0:33:13I'm ready for the challenge and looking forward to it.
0:33:13 > 0:33:16As Carol settled into the department,
0:33:16 > 0:33:19she found dealing with the fall-out from alcohol and drug abuse
0:33:19 > 0:33:21to be a real eye-opener.
0:33:21 > 0:33:22How much do you drink?
0:33:23 > 0:33:28At the moment, I'm probably on about a litre, half a litre a day.
0:33:28 > 0:33:32- Of what?- Well, cider, beer.
0:33:32 > 0:33:34At least 5-7%.
0:33:34 > 0:33:35OK.
0:33:35 > 0:33:38- It takes the edge off the tablets. - OK.
0:33:38 > 0:33:40I've noticed that a lot of patients
0:33:40 > 0:33:43come in with conditions which are self-inflicted,
0:33:43 > 0:33:47like alcohol intoxication, abuse from recreational drugs.
0:33:47 > 0:33:50In terms of what drugs you took, do you remember?
0:33:50 > 0:33:53Were they tablets, were they liquid? Do you remember anything?
0:33:53 > 0:33:54Suicide attempts...
0:33:54 > 0:33:56How many tablets did you take?
0:33:58 > 0:34:01Those are things which in Malawi, as a student, you read about
0:34:01 > 0:34:05and learn how to deal with, but you don't actually see patients.
0:34:05 > 0:34:09You see them, but not to the same degree as you do here.
0:34:09 > 0:34:10For me, that's very shocking.
0:34:10 > 0:34:12Which arm are you most comfortable with?
0:34:12 > 0:34:16But by the end of her placement, Carol had found her feet,
0:34:16 > 0:34:18and despite the initial culture shock,
0:34:18 > 0:34:21she became an integral part of the emergency team.
0:34:23 > 0:34:27- How are you settling into Liverpool? - Oh, I'm enjoying it.- You like it?
0:34:27 > 0:34:31Yeah, it's good fun. Lots of mad people, but it's nice!
0:34:31 > 0:34:35- Is it different to back home?- It's very different.- Different patients?
0:34:35 > 0:34:37No, patients are the same everywhere,
0:34:37 > 0:34:39but the pathology's different.
0:34:39 > 0:34:42The structure of A&E's very different from Malawi.
0:34:42 > 0:34:45Do you feel like you've slipped into it now?
0:34:45 > 0:34:47I'm getting there, yeah, finding my feet.
0:34:59 > 0:35:01After a couple of months on the wards,
0:35:01 > 0:35:05the physical and emotional demands of being a fully-fledged doctor
0:35:05 > 0:35:07were beginning to catch up with everyone.
0:35:09 > 0:35:10It's been a long night.
0:35:10 > 0:35:13I feel that I want to get home, because I'm a bit tired.
0:35:13 > 0:35:15Sorry.
0:35:16 > 0:35:18Oh, I want to cry a little bit, I'm so tired.
0:35:23 > 0:35:26Long hours made maintaining a work-life balance hard,
0:35:26 > 0:35:28and at the house some of them shared,
0:35:28 > 0:35:31the effects were beginning to show.
0:35:31 > 0:35:33Feel like I'm just living in the hospital at the minute.
0:35:33 > 0:35:37Stuff like doing the washing up and changing my bed sheets
0:35:37 > 0:35:41and stupid things like that get completely thrown out of the window.
0:35:41 > 0:35:45- I need to sort my life out. - Oh, my God, it really is so messy.
0:35:45 > 0:35:50- Half of Tom's dirty washing is in the gym.- Tom's room's pretty messy.
0:35:50 > 0:35:52Dirty socks.
0:35:52 > 0:35:54- My room's pretty messy. - Dirty shirts.
0:35:54 > 0:36:00I think if it was down to us two, the house would be disgusting.
0:36:00 > 0:36:04This went off on 10th August. Can I have it, still?
0:36:04 > 0:36:08- What?- Vegetable and lentil moussaka. Will that be all right?
0:36:08 > 0:36:12- Yeah.- It's not got meat or anything in it
0:36:12 > 0:36:14that can go wormy, has it?
0:36:14 > 0:36:18Juggling the competing demands of work and home
0:36:18 > 0:36:21was a particular issue for young dad, Tristan.
0:36:22 > 0:36:26He was working hard to support his wife and daughter
0:36:26 > 0:36:28by taking on extra shifts.
0:36:28 > 0:36:31It's safe to say that we're in a lot of debt
0:36:31 > 0:36:33in terms of the fact that we've got
0:36:33 > 0:36:38not one student loan, but two, each. So I am looking forward to payday.
0:36:38 > 0:36:41It'll be nice to start chipping away at the debt.
0:36:41 > 0:36:43- Hi.- What would you like to talk about?
0:36:43 > 0:36:47Well, I just wanted to get an update of what's been going on.
0:36:47 > 0:36:50One benefit of Tristan spending so much time in work
0:36:50 > 0:36:51was that he soon developed
0:36:51 > 0:36:56a reputation for being one of the ward's most diligent doctors.
0:36:56 > 0:36:58Justin's very conscientious.
0:36:58 > 0:37:01He's always determined to make sure his patients are fine,
0:37:01 > 0:37:03and all his jobs are done before he goes home.
0:37:03 > 0:37:05He doesn't like to hand anything over.
0:37:05 > 0:37:07I think he worries that jobs won't get done
0:37:07 > 0:37:09or things will get missed, so he is very good like that.
0:37:09 > 0:37:11It is a lovely trait,
0:37:11 > 0:37:14but he does also need to remember to go home sometimes!
0:37:14 > 0:37:17I'll see you later and give you another update.
0:37:17 > 0:37:20But Tristan's approach to work didn't make striking a balance
0:37:20 > 0:37:24between life inside and outside the hospital any easier.
0:37:26 > 0:37:27That might be a bit tricky.
0:37:27 > 0:37:30'It's been hard, especially when he's been getting home
0:37:30 > 0:37:31'at about 11 at night',
0:37:31 > 0:37:34so she'll see him for an hour in the morning, and that's it.
0:37:34 > 0:37:37When it comes to dinner time and bedtime,
0:37:37 > 0:37:40she's looking at me like, "Where's Daddy? What's going on?"
0:37:40 > 0:37:44"Daddy's going to take you to nursery and give you a big squeeze.
0:37:44 > 0:37:47"Daddy's at work, helping people", things like that.
0:37:47 > 0:37:53He's doing it for us, but obviously at the end of the day,
0:37:53 > 0:37:55I'm really tired. It's getting pretty difficult.
0:37:55 > 0:37:59This has been one of the hardest points even in our relationship.
0:38:07 > 0:38:11On the gerontology ward, it was clocking-off time for Tristan.
0:38:11 > 0:38:13He was about to head home to see his family,
0:38:13 > 0:38:17when one of his favourite patients took a sudden turn for the worse.
0:38:17 > 0:38:19Hello, you all right?
0:38:20 > 0:38:23What's going on? You OK?
0:38:23 > 0:38:24ALARM SOUNDS
0:38:24 > 0:38:28Tristan brought the nurses up to speed.
0:38:28 > 0:38:32She became unresponsive. She opened her eyes...vacant stare.
0:38:32 > 0:38:35Then she saw me and literally looked like she'd seen a ghost,
0:38:35 > 0:38:38put both her arms up and then went back like this.
0:38:38 > 0:38:40You ever seen anything like that before?
0:38:40 > 0:38:45Can you open your eyes for me? Can you open your eyes?
0:38:45 > 0:38:48Can you squeeze my fingers tightly for me?
0:38:53 > 0:38:59It was 8pm, three hours after Tristan's scheduled finish time.
0:38:59 > 0:39:02He could have handed the patient over to the on-call team.
0:39:06 > 0:39:08She's a trouper. Do you want me to go and run this down?
0:39:08 > 0:39:10Would you mind? That would be amazing.
0:39:16 > 0:39:19Although Tristan's wife and daughter were expecting him home,
0:39:19 > 0:39:22the patient's condition was life-threatening,
0:39:22 > 0:39:25and he couldn't bring himself to hand over their care.
0:39:32 > 0:39:35It is quite hard, because I know this patient very well,
0:39:35 > 0:39:39and she's been in the hospital for longer than I've been a doctor.
0:39:39 > 0:39:42So, first day on the wards, she was there.
0:39:42 > 0:39:44We're doing these blood tests to make sure
0:39:44 > 0:39:47there's nothing extra that we're missing.
0:39:47 > 0:39:49Otherwise, we know what's going on
0:39:49 > 0:39:51and we know that it's quite serious for her.
0:39:51 > 0:39:52Right.
0:39:59 > 0:40:04- Nothing dramatic.- Thank you. Open your eyes, darling.
0:40:04 > 0:40:07I know you're tired. Open your eyes.
0:40:07 > 0:40:10- Is there anything else you want me to do?- No, thank you.
0:40:10 > 0:40:11I'll just print this out.
0:40:13 > 0:40:17I think a shot of antibiotics is probably the way we're going to go.
0:40:20 > 0:40:22See you later. Bye.
0:40:22 > 0:40:27Having done all he could, Tristan finally left the hospital,
0:40:27 > 0:40:30four hours after the official end of his shift.
0:40:35 > 0:40:37I wouldn't want to be the sort of person
0:40:37 > 0:40:38that could just walk away from that.
0:40:39 > 0:40:43This lady being unwell has hit me quite hard, I think.
0:40:43 > 0:40:44I'm quite upset about it.
0:40:46 > 0:40:50But it wasn't just a bad day at the office that was bothering Tristan.
0:40:53 > 0:40:55I just feel really bad for Lottie,
0:40:55 > 0:40:58because I know it impacts upon her when I'm not around as much.
0:41:00 > 0:41:02It's a selfish thing as well.
0:41:02 > 0:41:04I don't want to miss out on that time with Lottie,
0:41:04 > 0:41:07so I just have to figure some way to make it all work.
0:41:10 > 0:41:13Balancing the competing demands of work and home
0:41:13 > 0:41:16remains an issue for family man Tristan.
0:41:19 > 0:41:21Seeing what it's like with me working for three months
0:41:21 > 0:41:24and sometimes coming home late,
0:41:24 > 0:41:27what do you think of if I was to do emergency medicine
0:41:27 > 0:41:32or A&E or, you know, acute medicine as a career?
0:41:32 > 0:41:34It's knowingly going into something
0:41:34 > 0:41:36that will make our life a bit more difficult,
0:41:36 > 0:41:38and you've got to weigh up
0:41:38 > 0:41:41whether that's going to be worth it for you.
0:41:41 > 0:41:44You're a great dad to Lottie and she loves having you around,
0:41:44 > 0:41:46but that balance will become more difficult.
0:41:46 > 0:41:50But if you love doing that so much, then that's what's important,
0:41:50 > 0:41:51because at the end of the day,
0:41:51 > 0:41:54that's where you spend the majority of your time.
0:41:54 > 0:41:56I think it'll just be a matter of experience.
0:41:56 > 0:41:59I'll be able to get through everything quicker every day.
0:41:59 > 0:42:02Yes. I am really proud of you for getting yourself to where you are.
0:42:02 > 0:42:04I think you've worked really hard at it.
0:42:04 > 0:42:07I think you always had it a bit more complicated than most,
0:42:07 > 0:42:11but you stuck with it, and not even that, you've done really well.
0:42:16 > 0:42:21- OK? We'll survive?- Yes. - Agreed?- Yes.- Good.
0:42:26 > 0:42:29There's definitely a juggling act to be had
0:42:29 > 0:42:31between being a doctor and a dad.
0:42:31 > 0:42:33I don't know whether I'm good at it or not,
0:42:33 > 0:42:36but it's just sometimes they just don't mesh at all.
0:42:36 > 0:42:40It's just there's not enough hours in the day, which makes it difficult.
0:42:40 > 0:42:43I'm not the only person who works long hours, who also has a family
0:42:43 > 0:42:46at home, so I just have to make the best of each situation,
0:42:46 > 0:42:49and so when I'm with my family, make sure that that time counts.
0:42:50 > 0:42:52I think you should be proud of yourself.
0:42:52 > 0:42:54- I think you've done really well. - I agree.
0:42:54 > 0:43:00See, I can barely cope. I can't even... I crawl home...
0:43:00 > 0:43:03You have another life outside of work.
0:43:03 > 0:43:09And Tristan's life outside of work is about to get even busier.
0:43:09 > 0:43:11Also, I didn't know whether I was going to mention it,
0:43:11 > 0:43:15but also Jenna is pregnant.
0:43:15 > 0:43:20- Boom!- Congratulations! A toast. Yeah!
0:43:20 > 0:43:25- Here's to Tristan's super sperm. - THEY LAUGH
0:43:25 > 0:43:27Less hours, more babies.
0:43:40 > 0:43:44A career in medicine requires hard work and dedication.
0:43:45 > 0:43:48But even five years of study can't prepare you for everything,
0:43:48 > 0:43:52as our junior doctors soon discovered.
0:43:53 > 0:43:57For starters, they found patients had suddenly become very real.
0:43:57 > 0:44:01So, you like giving banter out but you don't like taking it, do you?
0:44:01 > 0:44:05- What do you mean?- Ahh! See, I do fortunes.
0:44:05 > 0:44:10- I've never met anyone who reads fortunes before. - I'm right though, aren't I?
0:44:10 > 0:44:11And nobody had ever taught them
0:44:11 > 0:44:15how to deal with one of their patients being wanted by the police.
0:44:15 > 0:44:18You don't get prisoners escaping off the ward every day
0:44:18 > 0:44:21and I am sure on a normal day, it would be quite a novelty and
0:44:21 > 0:44:24exciting, but today, I really need to just get on.
0:44:26 > 0:44:30For Italian Ed, now a first year in the Acute Medical Unit,
0:44:30 > 0:44:33one added complication was getting to grips with
0:44:33 > 0:44:36life in the large and bureaucratic National Health Service.
0:44:38 > 0:44:40How can I do this?
0:44:40 > 0:44:44I think that's cardiology.
0:44:44 > 0:44:47I'm not used to this writing.
0:44:47 > 0:44:52It is either cardiology or gerontology, isn't it? I don't know.
0:44:52 > 0:44:54It could be any ology.
0:44:54 > 0:44:55BLEEPER BEEPS
0:44:58 > 0:45:01'Testing. Testing. Testing. Please respond.'
0:45:02 > 0:45:05Yes, OK. Working.
0:45:05 > 0:45:07I don't know how the bleeps work. Nobody has ever told me.
0:45:07 > 0:45:10I think his confidence was initially knocked,
0:45:10 > 0:45:12obviously, because he had started in A&E
0:45:12 > 0:45:16and he had to be moved to the Acute Medicine Unit.
0:45:16 > 0:45:19But I think as time has gone along, he has been supervised closely,
0:45:19 > 0:45:21we have given him more and more responsibility
0:45:21 > 0:45:24and I think he has relished it.
0:45:24 > 0:45:27Ed had a further chance to prove himself on the acute ward
0:45:27 > 0:45:30when an elderly man was having trouble breathing.
0:45:30 > 0:45:35- Hello.- It was Ed's task to drain the excess fluid off the patient's lungs
0:45:35 > 0:45:39using a needle and syringe. The only problem -
0:45:39 > 0:45:42this would be the first time the junior doctor had ever
0:45:42 > 0:45:44performed such a procedure.
0:45:44 > 0:45:49This patient has got a particularly large collection of fluid in the pleural space.
0:45:49 > 0:45:53- All this black stuff... - Is fluid. Yeah.
0:45:53 > 0:45:56And the top is towards the skin. Yeah.
0:45:56 > 0:46:00Acute medicine for me has been a really good ground on which to
0:46:00 > 0:46:03start dealing with very, very different cases.
0:46:05 > 0:46:09There was some pressure on Ed during the procedure.
0:46:09 > 0:46:13The untested doctor needed to be precise to avoid puncturing
0:46:13 > 0:46:14the patient's lung.
0:46:14 > 0:46:19Just go straight in, slightly inclined.
0:46:19 > 0:46:22Is everything OK? Yeah, straight in. Very good.
0:46:22 > 0:46:28Keep sucking as you are going in. OK. Yes. Yes. Yes.
0:46:28 > 0:46:31- Is it OK, sir?- Yeah.
0:46:31 > 0:46:33HE GROANS
0:46:35 > 0:46:40So, obviously if there was a bigger needle,
0:46:40 > 0:46:42it would have been better.
0:46:42 > 0:46:44With this one, keep the pressure there.
0:46:47 > 0:46:50And I want you to take the syringe off.
0:46:50 > 0:46:55As you take the syringe off, I want you to put your thumb on the needle.
0:46:55 > 0:47:01- OK.- There we go. Nicely. Slowly. That is fine.
0:47:03 > 0:47:06Could you please make a humming noise, sir, please. That is lovely.
0:47:06 > 0:47:11The lung drain proved a success for both patient and junior doctor.
0:47:11 > 0:47:14OK, sir, we can position you back.
0:47:14 > 0:47:17- Was that all right?- That was fine, thank you.- OK. That is good.
0:47:17 > 0:47:20Sometimes I miss the job I used to have before coming to Liverpool,
0:47:20 > 0:47:22that's for sure, but I think in the long run,
0:47:22 > 0:47:24this will be the good decision.
0:47:24 > 0:47:29The training I get here is outstanding in comparison to
0:47:29 > 0:47:32the self-training I was giving myself in the previous job.
0:47:32 > 0:47:35But here I am in a system that is designed to
0:47:35 > 0:47:37bring your knowledge to the highest standards,
0:47:37 > 0:47:39so I am glad I am here, yes.
0:47:41 > 0:47:43With the end of their ward placements looming,
0:47:43 > 0:47:46all of the junior doctors were starting to think about
0:47:46 > 0:47:47their next steps.
0:47:49 > 0:47:52The end game, I suppose, is to end up as a consultant in a hospital.
0:47:52 > 0:47:55It's how you try and prove that you're dedicated.
0:47:55 > 0:47:59We are sort of forced to decide what we want to specialise in
0:47:59 > 0:48:02quite early on. I'm starting to feel the pressure.
0:48:02 > 0:48:04The best candidates get the jobs, so if I really want it,
0:48:04 > 0:48:06I need to do the work.
0:48:06 > 0:48:11Climbing the medical career ladder would take drive and ambition.
0:48:11 > 0:48:14But that shouldn't be a problem for go-getter Jen.
0:48:16 > 0:48:19She was allowed to observe a surgical procedure early on
0:48:19 > 0:48:23in her placement and it prompted a potential change in direction.
0:48:24 > 0:48:28When I started work, I thought I knew what I wanted to do, anaesthetics,
0:48:28 > 0:48:33now because I have enjoyed surgery so much, I'm starting to question that.
0:48:33 > 0:48:39I'm just going to have to explore both of the careers a lot before I apply.
0:48:39 > 0:48:42More time in the operating theatre could help Jen make up her mind.
0:48:46 > 0:48:50Senior House Officer Andrea Sheel had given Jen another chance
0:48:50 > 0:48:52to put on her surgical scrubs,
0:48:52 > 0:48:54and this time she'd really be getting stuck in.
0:48:55 > 0:49:01Jen has been asked to incise and drain an abscess on a chap's back.
0:49:01 > 0:49:03It's got a large collection of pus there,
0:49:03 > 0:49:06which we need to release because it's quite painful for him.
0:49:06 > 0:49:11It would be the first time Jen had ever performed an operation herself,
0:49:11 > 0:49:14but Miss Sheel was on hand to guide her through it.
0:49:14 > 0:49:17Give that a really good working around and then wash it again,
0:49:17 > 0:49:20and then pop the dressings in.
0:49:26 > 0:49:29A little bit nervous because you're cutting into somebody and I've
0:49:29 > 0:49:33never done that before, but it's very superficial, so it's not too bad.
0:49:37 > 0:49:41Cool. Let's go.
0:49:41 > 0:49:43Start off in the area you're going to make the incision
0:49:43 > 0:49:45first of all. Right over the...
0:49:45 > 0:49:50- Like that?- Yeah. Give it a really good...
0:49:50 > 0:49:52- Oh, right. Round it.- Yeah.
0:49:52 > 0:49:55With the patient prepared for the operation, it was time for Jen
0:49:55 > 0:49:58to make her first ever surgical cut.
0:50:00 > 0:50:02OK. Knife, please. Thank you.
0:50:05 > 0:50:08So take your scalpel and nice and decisive, don't push it in too far.
0:50:08 > 0:50:13- Like that?- Yeah, just a little incision at the top. Yep. OK.
0:50:14 > 0:50:17OK, so we need to go a little bit further there. Can you see...
0:50:17 > 0:50:20Just a little bit deeper there.
0:50:20 > 0:50:22Get your finger inside just to give it a good...
0:50:24 > 0:50:27Get some of that nice juicy pus out. There you go, it's coming out now.
0:50:29 > 0:50:32- Are you happy with that? - I think it's empty now.- OK.
0:50:33 > 0:50:37As surgery progressed, Jen was showing little sign of nerves.
0:50:37 > 0:50:40- A bit of force and squeeze it in. - A bit of force you want?- Yeah.
0:50:40 > 0:50:44Just make a nice little...irrigation. That's great.
0:50:44 > 0:50:45Thank you very much.
0:50:45 > 0:50:47With the operation complete
0:50:47 > 0:50:52and dressing applied, it was a proud moment for any aspiring surgeon.
0:50:52 > 0:50:54- Go and write in the notes?- Yeah.
0:50:54 > 0:50:57It felt really nice when I was writing in the operation notes,
0:50:57 > 0:51:01"Surgeon: J Whiteley." It was a bit weird, cos I was like,
0:51:01 > 0:51:02"Do I put your name down?"
0:51:02 > 0:51:05She was like, "No, you put both of our names down,"
0:51:05 > 0:51:08so that was a bit of a strange thing, but it was nice.
0:51:08 > 0:51:09I think Jenny did really well there.
0:51:09 > 0:51:13She attacked it with a very confident and positive approach.
0:51:13 > 0:51:14It is officially an entire operation,
0:51:14 > 0:51:17so it is something that she can put in her log book
0:51:17 > 0:51:20and in her portfolio, and it's just something that will make her
0:51:20 > 0:51:23stand out from the rest of the house officers.
0:51:25 > 0:51:29And when it came to choosing a specialism, the experience had
0:51:29 > 0:51:31given Jen even more food for thought.
0:51:34 > 0:51:37I've really, really, really enjoyed surgery.
0:51:37 > 0:51:41I have definitely noticed the buzz from surgery that
0:51:41 > 0:51:44I understand why people enjoy it.
0:51:44 > 0:51:47I definitely have considered it more in the last few weeks than
0:51:47 > 0:51:49I ever have before.
0:51:49 > 0:51:52I will probably just have to explore it a bit more.
0:51:52 > 0:51:55- That was really well done. - Thank you very much. See you, guys.
0:51:57 > 0:52:01Three months on, and Jen is reminiscing about her first
0:52:01 > 0:52:03surgical procedure.
0:52:03 > 0:52:06I've really enjoyed working on surgery, which was quite a surprise -
0:52:06 > 0:52:08I didn't expect to like it as much as I did.
0:52:08 > 0:52:12The biggest highlight being when I could write down, "Procedure.
0:52:12 > 0:52:17- "Surgeon: J Whiteley." - Was it an abscess?
0:52:17 > 0:52:21I cut and then I put my finger in and pulled the rest out.
0:52:21 > 0:52:27- That's what I was told to do. - It's like when I clear the drain.
0:52:27 > 0:52:28THEY LAUGH
0:52:33 > 0:52:35Three months have passed
0:52:35 > 0:52:38since these new doctors started their lives on the wards.
0:52:41 > 0:52:42Erm, no, I haven't.
0:52:44 > 0:52:47They've all faced their own challenges.
0:52:47 > 0:52:50I hate being the first person there. I hate it so much.
0:52:51 > 0:52:54But each of them has proved their worth.
0:52:54 > 0:52:57There's going to be a short scratch. Try and stay as still.
0:52:57 > 0:53:00It's had its bad points and its good points, but I wouldn't swap it.
0:53:00 > 0:53:03I don't think there's another job that would give me
0:53:03 > 0:53:04the same satisfaction.
0:53:04 > 0:53:07- Are you all right to sort out the MI?- Yeah.- Cheers.
0:53:07 > 0:53:09I've enjoyed it, I've worked hard, learned loads,
0:53:09 > 0:53:13I've been on a team that I was proud to be a part of and it made me
0:53:13 > 0:53:16100% sure that I want to carry on being a doctor.
0:53:16 > 0:53:18- Trust you. - HE LAUGHS
0:53:18 > 0:53:20When I started, I thought I'd be a nervous wreck
0:53:20 > 0:53:24and I'd be like crying on the floor, or hiding all the time.
0:53:24 > 0:53:27I would be worried about him if I didn't have 60 other patients,
0:53:27 > 0:53:29so at the minute, he's just annoying me.
0:53:29 > 0:53:31I've toughened up in the last few months.
0:53:31 > 0:53:35It kind of makes me think that maybe I'm stronger than I thought I was.
0:53:35 > 0:53:38He's lovely, isn't he? Are you married?
0:53:38 > 0:53:41It's not every day you get a marriage proposal while doing a cannula.
0:53:41 > 0:53:43I think I must be getting quite good at them.
0:53:44 > 0:53:48It's ended up turning out to be my dream job and I'm really happy.
0:53:48 > 0:53:52There are very few days I've worked so far when I've not loved it.
0:53:52 > 0:53:56Now, with their placements at an end, it's time for our eight
0:53:56 > 0:53:58new medics to move on,
0:53:58 > 0:54:02as they continue their careers as fully-fledged doctors.
0:54:06 > 0:54:08Must be teatime.
0:54:08 > 0:54:11- SHE LAUGHS - For the vampires.
0:54:19 > 0:54:22Oh, that's quite strong.
0:54:22 > 0:54:23It's not that strong.
0:54:32 > 0:54:35I think that's code for, it could be worse.
0:54:44 > 0:54:47If I get this wrong, I kill the patient.
0:54:56 > 0:54:59- Does he know what he was eating? - Chicken curry.
0:54:59 > 0:55:01He said it was a bit of rice. He stinks of curry!
0:55:01 > 0:55:03He stinks of curry powder!
0:55:12 > 0:55:17- I'm nice and still. - You are...a good customer.
0:55:22 > 0:55:27Hot flush? Open the doors, make way for the menopause.
0:55:31 > 0:55:34You'll be pleased to know that everyone winds me up
0:55:34 > 0:55:37for being a bit of a perfectionist with this.
0:55:45 > 0:55:48They're amazing when you come back after a night out.
0:56:07 > 0:56:08HE LAUGHS
0:56:30 > 0:56:33Subtitles by Red Bee Media Ltd