Four Months On Junior Doctors: Your Life in Their Hands

Three months ago, eight young people embarked

on the most challenging part of their lives so far.

I've got the uniform, I've got the badge. It's time to be Dr Tom.

After five years of training in medical school

they hit the wards for the first time ever as junior doctors.

I don't know where anything is. Do you know where the forms are?

On a daily basis they faced trauma...

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

-Any pain up here?

-..tears...

-Sorry.

That's all right.

..and intense pressure...

Changing the oxygen over.

..as they took their place on medicine's front line.

They were young, untested...

This is my first patient ever.

..and from their very first day work became a matter of life and death.

-Don't let me die.

-We're not going to let you go anywhere.

They were party animal, Tom...

I've got two or three patients who I have absolutely world-class banter with.

..arty Emily...

I've been working really hard and I'm really tired.

..competitive Jen...

There's nothing I love more than a challenge,

and the opportunity to beat somebody. I'll sort you out.

..young dad, Tristan...

The worst thing about the job is not seeing Lottie and Jenna

as much as I'd like, so I feel really bad about that.

..Italian mountain medic, Ed...

I definitely have to ask less questions about simple things.

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

..and second years, straight-talking Kiera...

I've done myself a bit of damage there, didn't I?

You've done a proper job of it, haven't you?

..confident charmer, Oli...

-That didn't feel bad.

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

..and Malawian medic, Carol.

-What do we call that?

-Um...

-Haemorrhoids.

-Haemorrhoids.

Now we look back at their highs...

ALL: Happy birthday!

I passed.

..and their lows.

I think I'm just really sad that someone's died.

I hope that I always feel a little bit for them.

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

I'm quite upset about it.

-The good times...

-It's PAYDAY!

..and the bad...

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

..as our juniors found out what it took to be doctors.

-Hello!

-Hello!

-Hello!

All eight junior doctors have now come to the end of their first

three month placements at the Royal Liverpool University Hospital.

Tonight they'll be enjoying a rare evening out together to celebrate.

Waaay!

The meal will give them a chance to reflect

on some of the most demanding weeks of their lives.

I'm going to make a toast and it's not

so much about getting through the first few months of work,

because loads of you have been there for a while longer,

it's more about meeting new people and being good friends

-and kind of sticking with everything, so... to friends.

-Aw, cheers.

-Cheers.

It all began three months earlier.

Back then, nerves were jangling as the junior doctors

prepared for their first day on the wards.

I feel like I'm living in a bit of a dream, to be honest.

Nobody expects us to be, you know, child prodigies

the day we walk onto the ward.

-It's crunch time.

-SHE LAUGHS

The enormity of what's about to happen has just suddenly dawned on me.

Emily! You bloody fool, you'll get us killed!

I'm going to be the F2 on AMU for the next four months.

-Oh, right. Welcome.

-Hi, you all right?

I'm Emily, one of the F1s on A-Tech, so I've just started today.

Welcome, everybody. This will be an exciting four months for you.

A steep learning curve, but you will learn a phenomenal amount while you're here.

But no-one had more to get to grips with on day one than NHS new boy Ed,

who was put in the hospital's busy Emergency Department.

'The main fear about today is that I haven't seen an x-ray in six months.

I really need to get up to reading these things again.

It's so easy to miss out obvious things when you don't practise them.

The pace of life in a British Emergency Department was

worlds apart from Ed's last job

as the only medic in an Italian mountain village.

Ed's first patient was a man who'd come in with a knee injury.

So do you want to tell me what happened?

-I stepped off the van, my knee twisted.

-OK.

Ed had to perform an immediate examination.

The ligament here is very tough and very thick. Does that hurt?

-That's sore there.

-If I press there?

-Yeah.

-OK? OK.

The patient went for an x-ray

but when the results came back, Ed wasn't sure how to interpret them.

Can you remember what sits inside the knee joint,

just to the side here? There are a couple of spongy pads that sit there.

-That would be cartilage?

-OK, what particular cartilage?

-Articulate cartilage?

-No, what particular, particular.

What do we call that? It's a semi-lunar shape...

half moon shaped.

Ah, ha!

-How do you call them now?

-In English, it begins with an M.

Yeah, um...

-No.

-OK. The menisci.

-Menisci, yeah.

During Ed's second shift in A&E, there was more at stake than

just the health of the patients.

After his shaky start, Ed's seniors had started to monitor him closely.

Within our department, we're providing them

with 24-hour senior supervision and support, but they are expected

to see patients from the offset on their own.

Now having not worked within the UK, Edward is finding that difficult

because he's unaware of the systems and the treatments in place.

With the pressure on, Ed's next case was a man who seemed to be

disorientated and confused.

Can you close your eyes, please?

No, look, like this.

Eyes closed. No, no. If you can close your eyes...

..both closed, both closed. That was good. OK, keep them both closed.

'I've got a confused patient.

'He's not able to tell me where he lives, what he does, why he's here,

he doesn't know where he is, but he is able to perform simple tasks.

Unsure of his next move, Ed went to consultant, Dr Raj, for help.

Have you gone through each cranial nerve, that's what I'm asking.

-No, I haven't done it.

-Right, so do a full neurological examination,

so saying that he can speak and his eyes are all right

-doesn't mean his neurological examination is normal.

-OK.

-Yeah?

-OK.

I probably would ask you to follow me during the first examination.

Is that OK or shall I come back?

You should be able to do a neurological examination.

-Can you not do a neurological examination?

-It's been a while.

-Let's go do a neurological examination.

-That would be nice.

-You have completed your training in medicine, yeah?

-Yeah.

Then you should be able to do a basic examination.

He's come in with a neurological problem,

confusion is a neurological problem,

so he needs a neurological examination.

And when you do a neurological examination,

you can't test some nerves and not test some nerves,

that's not a neurological examination.

The night before I started, I was just really, really tired

because I'd just finished a nightshift on my previous job in Italy

so I do remember that, and I was expecting it to be hard and it was hard.

I was expecting it to be a more positive experience,

and at the beginning it wasn't.

It became clear to Dr Raj and the hospital

that there was a big difference between what Ed had been taught in Italy

and what the department expected of him.

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

seeing those patients when we feel he would be out of his depth.

With the priority being patient welfare

and making sure Ed got the training and support he needed,

the department came to a difficult decision.

We were having to spend a lot of time with Ed,

and we made a decision that I'm going to be taking him off the rota.

-Goodbye.

-See you.

-Goodbye.

'I could have easily packed up and just went back.'

My job in Italy was still there waiting for me if I wanted to.

Even today I had a conversation with the hospital back in Italy

and they said "The job is still there if you want it."

And I said, no, I've made this decision, it's good for my training.

I'll see it through.

Though a qualified medic in Italy,

the hospital decided that Ed should be removed from frontline medicine

and begin his placement as a first year.

It meant a move to the Acute Unit where he could get intensive training and supervision.

Now, three months on and Ed is philosophical about his rocky start to life in Liverpool.

Looking back, I wasn't prepared at the time to do an F2 job in A&E,

and I think, for my personal benefit and my practice as a doctor,

working as an F1 in acute medicine has been much better.

-Any pain at the moment?

-No.

We're getting there.

So, yeah, I think the A&E issue was tackled not in the best way,

but the outcome was certainly positive for me.

You had the steepest learning curve of all of us when you first started.

How do you feel now compared to then? It must be different.

I feel a bit more independent, which is the greatest thing.

I can do my stuff without having to continually

ask for assistance for anything.

But, yeah, it is good and I can also see other people putting responsibility on me.

You've finally managed to start understanding the Scouse accent?

(SCOUSE ACCENT) Yes, mate.

LAUGHTER

Ed may not have enjoyed the best start,

but he wasn't the only one finding those first few weeks on the job

to be a real challenge.

Am I bothering you?

I'm so embarrassed about how I was when I started at hospital,

I feel like my voice was three octaves higher

and I was just like this little shaking leaf.

-I need to find some ice.

-Down the other end.

-How do I work it?

-I have doubted myself at every corner I turned.

I think it might have been in the wrong hole.

You start to think about everything that can go wrong,

rather than can go right.

I didn't really know what to do when he was sort of panicking.

I gave the wrong name, so the test has been done on the wrong patient.

-You're so efficient.

-Am I?

-I'm being sarcastic!

With time, the new doctors did begin to find their feet.

And swallow. Fantastic.

< Good. Excellent. Well done.

But there was still one thing that most of them struggled with

in those early days. Their needlework.

-Aaaah.

-Does that hurt? Having a bad day today, aren't we?

And nobody grappled with needles more than Tom.

-No good.

-No.

-Oh.

-Taking anything?

-No.

-OK. Don't worry, don't worry.

Just crack on.

Go on, just pull. Pull. Don't be gentle.

I know, but I don't want... I want... OK.

I always felt I was good at taking bloods and doing cannulas

until I started the job and then once you start

you have kind of the additional pressures

and all of a sudden you think,

oh, gosh, I'm way less good at this than I used to be.

I'm afraid I didn't get it first time either.

With even the most routine procedures involving needles

proving tricky, would Tom be able to handle things

when the pressure was really on?

While working in the Heart Emergency Centre,

Tom had been asked to treat a patient who had been brought into A&E with chest pains.

-So it's Mr Flynn?

-Yeah.

-Hi, Mr Flynn. My name's Tom.

Mr Flynn had previously had a heart attack and a heart bypass.

Since then he'd suffered from angina.

Do you want to describe it to me?

Well, it's just a very heavy pain on my chest.

-Like a crushing kind of pain?

-Yeah.

-Has it been happening at rest, this pain?

-It just happened now, yeah.

-OK. So you take your GTN spray under your tongue?

-Yeah.

And you took two squirts of it, did you?

And it's still taken 25 minutes to work?

Tom began to suspect something was seriously wrong.

-You're feeling clammy and sweaty?

-Yeah.

-Do you feel like that now?

-I do, yes.

-You do?

-I'm really sweating now, though.

-Are you?

-I'll tell you what...

-I'm really uncomfortable.

-You're uncomfortable?

Hang on, just give me two minutes.

He quickly alerted the team to the emergency.

This is a man who came in with unstable angina,

and for all intents and purposes he is having a heart attack, so...

This is his ECG now, so we're going to get inside and get it done.

Thank you very much.

He's having some morphine and having an ECG now.

He's also sweaty and clammy and pretty grey.

-FEMALE DOCTOR:

-Oh, really?

-Yeah.

Has the blood pressure changed?

Guys, his blood pressure is dropping.

If the man was having a heart attack, a drop in blood pressure could have been fatal.

I need to get another cannula in for fluids if his blood pressure is dropping.

Tom needs to fit a cannula, but the clock was ticking.

It's come out. Sorry...

Tom failed with his first attempt.

And the patient's blood pressure was still dropping, meaning his veins were getting thinner by the second.

He needed to get the cannula in quickly.

You just relax your hand and let me move it around a bit.

Yep, that one's in. Can I get, er...the flush?

The cannula was in, and the team managed to stabilise the patient.

I think that what you gain from having this first

kind of rotation in your first year of being a junior doctor,

being able to think about a situation and make a decision

and not have to have doubts in your mind, just to know that

you're making that decision and something will potentially be life-changing...

I think I've definitely gained another level of confidence,

and that'll just keep increasing I hope.

With a year's experience already under their belts,

second years Kiera and Oli were less fazed by needles,

even when their patients were a bag of nerves.

What's up? You look a bit worried.

-I just don't like needles.

-You don't like needles?

Have you ever had a blood test taken from the wrist before?

-Is it all right if I come back and do one of those on you?

-No.

I think I've already had one done, and it's very painful.

But a year on the wards had equipped them to deal with most situations.

I'll bring the stuff back ready to do it, and we'll have a look and see what your pulse is like.

If it hurts, you can punch me.

Sorry...

SHE GROANS

Sorry... Nearly done.

SHE GROANS

-All done. Put some pressure on there for me.

-SHE GROANS

-Wasn't too bad, was it?

-No...

-Just like eating a bag of chips.

-SHE CHUCKLES

-You toerag!

-Toerag!

-HE LAUGHS

-You didn't punch me, anyway.

-No, I'm not that type of person.

-OK. Fair enough.

Fortunately for Oli, not all of his patients thought he was a toerag.

In fact, only a week into his placement in the Acute Medical Unit,

and his charming bedside manner had won him an army of fans.

Keep looking straight at my nose.

I saw you sneak a peek there! You can't cheat.

-I'll see you later, OK?

-Will you?

-I don't know, will I(?)

With patients you have to understand that,

first of all they don't want to be in hospital,

they're probably at their most vulnerable, they're sick, they're unhappy,

and you just try and be in their shoes and empathise with them.

-Didn't feel that.

-Good.

I managed to keep my job after all!

'Trying to make them smile a bit puts them at ease,

'or makes them feel a bit more confident in you and...

'Just coming across as professional and at the same time approachable.'

Very nice chap. Felt at ease with him. Nice bedside manner.

And it wasn't just the patients that had been won over.

I think he is quite popular with the nurses, yes.

I'm probably old enough to be his mum - so it's no good for me...

So Oli, I hear you were out with the nurses the other night, how did that go?

Yep, fine. No gossip whatsoever.

It was all above board,

I didn't touch a drop of alcohol, and I was in bed by 10 o'clock.

-With all of them(?)

-THEY LAUGH

Whatever.

As the placements continued,

and the juniors began to take on greater responsibility,

the need to deal with the emotional aspects of the job

began to feature more heavily for all of the doctors.

I was told there was a cancer three week ago...

-I feel awful.

-Let's get you a tissue.

I'm not really looking forward to seeing her after she's passed away. I think it's...

I just don't know how I'm going to react to it, really.

On the gastro-intestinal ward, Jen was faced with a job

that no junior ever wants - breaking bad news.

-When did you stop those?

-Beginning of last week.

A 72-year-old man on her ward had been diagnosed with cancer,

and his family needed to be told.

Jen called her senior house officer, Andrea Sheel, for support.

She's on her way up, be about ten minutes. She's asked if you guys don't mind hanging on. Is that OK?

-Just so you know what's going on and you get an update.

-OK.

I do feel quite bad sitting in, like, metres away from them,

knowing the diagnosis and prognosis and not giving them any information,

so it's quite difficult.

But they're aware that my senior's coming

and that she'll explain it to them, so I think they're quite happy with that.

PHONE RINGS

Luckily for Jen, it wasn't a situation she needed to face alone.

It had proven a hard first experience for Jen.

That was a tough conversation. It's the worst part of the job, isn't it?

-Maybe, sometimes I think I'm a bit too blunt.

-No, I thought you were...

Otherwise you end up beating around the bush.

I thought you were so nice to them, honestly. It's heartbreaking.

The worst sort of thing about it is the relatives.

It's when everybody's stood around the bed, and all they want is good news

and you've not got any to give them, that's when it's quite hard.

You can't brush it under the carpet, can you?

You've just got to focus and carry on. That's all you can do.

It's going to be a lot for Jen to take in.

But I specifically wanted her to be involved in that situation,

because I think the sooner you get used to it,

dealing with situations like that, the better.

Obviously it's upsetting for everybody involved

and I think she's dealt with it really well so far.

Three months on, and Jen has had time to reflect on the emotional cost of the job.

At this point I am comfortable with sharing the emotional

journeys of a patient, but at first I found it quite difficult.

You're not scared of needles, are you?

-Good job I'm not.

-It is, really, isn't it?

But when you're actually working, you realise that they're people,

and people have attachments to other people and their families, and

you start to just feel it a little bit more.

And I think that I'm coping with it OK,

but I found it a bit rough at first.

Another vital part of the job that all the junior doctors quickly

needed to adapt to, was being part of the hospital crash team.

Carrying the cardiac arrest bleep

was a massive step up in responsibility for everyone.

This is one thing you can categorically say, "I've not done this before."

Even if you've been to an arrest with somebody you've shadowed,

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

And when it goes off, I suppose it is quite scary.

BLEEPING

'Cardiac arrest...'

Let's go, guys.

Being part of the crash team meant that they could be summoned

to an emergency anywhere in the hospital.

Being on the crash bleep is a mixture of apprehension and excitement.

Said to go to A&E rescus urgently.

You hope you can rely on your training to remember everything you're supposed to do.

'When the call comes through, you forget how tired you are.

'Adrenaline pumps and you just run there.

'You're just focusing so much on what's going on that you don't notice how tired you are.'

Focus was exactly what Oli needed when one of his night shifts ended with a crash bleep -

an emergency that he was to share with Emily,

who had just arrived at the hospital to begin work for the day.

BLEEPING

The emergency was on Emily's ward.

One of her patients was in cardiac arrest -

and Emily was the first doctor on the scene.

Does anyone know about this patient?

Could I get one of you two to get me an Ambu bag and a mask, please?

Changing the oxygen over...

Is there a pulse?

Is there... I'll get gas.

Despite the team's efforts, the man was showing no signs of improvement.

Oli took some blood, while Emily continued chest compressions on her patient.

Nothing seemed to be working.

And as there was no sign of a heartbeat,

the doctor in charge had a difficult decision to make.

As the team tried one last time to restart the man's heart,

Emily did another round of compressions.

The team paused, to check whether the monitor showed the patient's

heart had started working on its own again.

But there was still no change.

STEADY BEEPING

Just walked into the ward, and suddenly the alarm went off

and we all went running into the patient and...

I got there and I realised it was one of my patients.

It was really horrible, and just completely threw me.

It's just something that you don't really expect to deal with...

Having a relationship with somebody and then seeing them die in front of you.

It was really hard to deal with, definitely.

The worst side of the job is definitely losing a patient.

It was only the other day that somebody said to me,

you shouldn't judge yourself on the outcomes, because that might always happen to them,

judge yourself on what you do to help the person.

But I think there's always a part of you that feels like you've

failed if someone dies when you weren't expecting them to.

Liverpool. One of Britain's biggest party cities.

And when your job is as demanding as that of a junior doctor,

it helps to let off steam from time to time.

Can you please try it on?

Away from the wards,

the new medics could let their hair down with the best of them.

It's...payday!

Mmm, that's nice.

Ooh, that's quite strong.

It's not that strong.

I think it's really important to have a life outside medicine.

It's really easy to get sucked into the role of "I'm a doctor" 24/7.

You hold this up while I blow.

You still enjoy a good night out. I think you need to.

I think it's good for you.

But with the highest number of alcohol-related cases in England,

working life at the Royal Liverpool University Hospital

proved a sobering experience.

MONITOR BEEPS

Whose patient is it?

-How long have you been drinking for?

-About five years.

-How much do you drink?

-A litre to a litre-and-a-half of vodka.

A litre-and-a-half a day.

You think of it as normal, being sociable, going out, having a drink. People might have a few too many.

But you see the real extreme end of it in hospital.

Working in the hospital's emergency department,

second-year Kiera was on the frontline when it came

to dealing with the fall-out from the city's bars and clubs.

Working in A&E probably has changed the way I feel about going out

and getting absolutely smashed, as maybe I'd like to do as a student.

It kind of upsets me a little bit,

because I have seen the really negative effects

that that can actually have.

But one of Kiera's patients was no boozed-up twentysomething,

even though an evening spent sampling the city's nightlife

-had still ended in a trip to casualty.

-I had a couple of drinks.

-Yeah?

-Went into a bar and I had... sitting on a stool.

I had a cocktail, but it must have gone down the wrong hole,

and I took a fit of coughing.

And I felt light-headed as I coughed.

-The next thing I know, I'm on the floor.

-Dearie me. You poor thing.

So you fell and hit your face?

The next thing I remember is, I wake up,

and there are people around me and somebody's wiping the blood from me.

-Oh, dear.

-And I couldn't move,

but then I could move and it was all right.

-I think you've broken your nose there.

-Oh, God.

You've got a bit of a cut there as well. Been in the wars, eh?

Did myself a bit of damage, didn't I?

You've done a proper job of it, haven't you?

I'm going to just pop a bit of local on that head

and put a couple of stitches in that

to get you looking beautiful again, OK?

HE LAUGHS

Cheers, thanks!

OK, this is when the sharp, stingy bit's coming up now.

You might not like this bit.

-Oh, God, OK.

-Right. I'm just going to go for it.

OK, sharp scratch coming up.

-That wasn't too bad.

-You'll start to notice it numbing soon.

You'll be pleased to know that everyone winds me up

for being a bit of a perfectionist with this,

which is probably what you'd want, I imagine.

I couldn't care less.

-Fine, then, I'll go now!

-No, you're doing a good job.

-You have a lovely face, a sweet face.

-Ah.

Beauty's in the eye of the beholder, as they say.

Let's have a little look inside. We've given it a good wash out.

-Can you feel any of this?

-No, you're all right.

-Great.

You're going to have quite a nice black eye from this.

One to show off down the pub, eh?

-Perfectionist Kiera had stitching down to a fine art.

-New nose.

-Wonderful service.

-Oh, thank you. It's nice to hear that.

It's not always echoed by most people.

So, it was yet another happy customer for Kiera,

who throughout her placement

had seemed to revel in her role

as Liverpool's handiest doctor with a needle and thread.

A lovely surgeon in Stoke sat me down one day and said,

"This is how you suture," in my third year.

And then I spent some time in Borneo last year,

doing plastic surgery out there,

and that was invaluable experience for me, which I'm really glad of.

I saw someone who I'd sutured the other day in the shop,

and I didn't want him to see me,

but I was trying to get close to see how good his face looked!

Elsewhere in the department, A&E had a new recruit,

second year medic, Carol.

He's alert and comfortable, but definitely jaundiced.

Carol started her career in A&E on a trial basis,

hoping to fill the vacancy left by Ed

after he was moved from the department

to the Acute Medical Unit.

Can you just hold them out? Let's have a look.

But she soon discovered that life in Liverpool

was a world away from her training in Malawi.

I've worked in a setting where resources are limited

and you have to learn to cope.

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

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

As Carol settled into the department,

she found dealing with the fall-out from alcohol and drug abuse

to be a real eye-opener.

How much do you drink?

At the moment, I'm probably on about a litre, half a litre a day.

-Of what?

-Well, cider, beer.

At least 5-7%.

OK.

-It takes the edge off the tablets.

-OK.

I've noticed that a lot of patients

come in with conditions which are self-inflicted,

like alcohol intoxication, abuse from recreational drugs.

In terms of what drugs you took, do you remember?

Were they tablets, were they liquid? Do you remember anything?

Suicide attempts...

How many tablets did you take?

Those are things which in Malawi, as a student, you read about

and learn how to deal with, but you don't actually see patients.

You see them, but not to the same degree as you do here.

For me, that's very shocking.

Which arm are you most comfortable with?

But by the end of her placement, Carol had found her feet,

and despite the initial culture shock,

she became an integral part of the emergency team.

-How are you settling into Liverpool?

-Oh, I'm enjoying it.

-You like it?

Yeah, it's good fun. Lots of mad people, but it's nice!

-Is it different to back home?

-It's very different.

-Different patients?

No, patients are the same everywhere,

but the pathology's different.

The structure of A&E's very different from Malawi.

Do you feel like you've slipped into it now?

I'm getting there, yeah, finding my feet.

After a couple of months on the wards,

the physical and emotional demands of being a fully-fledged doctor

were beginning to catch up with everyone.

It's been a long night.

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

Sorry.

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

Long hours made maintaining a work-life balance hard,

and at the house some of them shared,

the effects were beginning to show.

Feel like I'm just living in the hospital at the minute.

Stuff like doing the washing up and changing my bed sheets

and stupid things like that get completely thrown out of the window.

-I need to sort my life out.

-Oh, my God, it really is so messy.

-Half of Tom's dirty washing is in the gym.

-Tom's room's pretty messy.

Dirty socks.

-My room's pretty messy.

-Dirty shirts.

I think if it was down to us two, the house would be disgusting.

This went off on 10th August. Can I have it, still?

-What?

-Vegetable and lentil moussaka. Will that be all right?

-Yeah.

-It's not got meat or anything in it

that can go wormy, has it?

Juggling the competing demands of work and home

was a particular issue for young dad, Tristan.

He was working hard to support his wife and daughter

by taking on extra shifts.

It's safe to say that we're in a lot of debt

in terms of the fact that we've got

not one student loan, but two, each. So I am looking forward to payday.

It'll be nice to start chipping away at the debt.

-Hi.

-What would you like to talk about?

Well, I just wanted to get an update of what's been going on.

One benefit of Tristan spending so much time in work

was that he soon developed

a reputation for being one of the ward's most diligent doctors.

Justin's very conscientious.

He's always determined to make sure his patients are fine,

and all his jobs are done before he goes home.

He doesn't like to hand anything over.

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!

I'll see you later and give you another update.

But Tristan's approach to work didn't make striking a balance

between life inside and outside the hospital any easier.

That might be a bit tricky.

'It's been hard, especially when he's been getting home

'at about 11 at night',

so she'll see him for an hour in the morning, and that's it.

When it comes to dinner time and bedtime,

she's looking at me like, "Where's Daddy? What's going on?"

"Daddy's going to take you to nursery and give you a big squeeze.

"Daddy's at work, helping people", things like that.

He's doing it for us, but obviously at the end of the day,

I'm really tired. It's getting pretty difficult.

This has been one of the hardest points even in our relationship.

On the gerontology ward, it was clocking-off time for Tristan.

He was about to head home to see his family,

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

Hello, you all right?

What's going on? You OK?

ALARM SOUNDS

Tristan brought 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.

You ever seen anything like that before?

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

Can you squeeze my fingers tightly for me?

It was 8pm, three hours after Tristan's scheduled finish time.

He could have handed the patient over to the on-call team.

She's a trouper. Do you want me to go and run this down?

Would you mind? That would be amazing.

Although Tristan's wife and daughter were expecting him home,

the patient's condition was life-threatening,

and he couldn't bring himself to hand over their care.

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

and she's been in the hospital for 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

there's nothing extra that we're missing.

Otherwise, we know what's going on

and we know that it's quite serious for her.

Right.

-Nothing dramatic.

-Thank you. Open your eyes, darling.

I know you're tired. Open your eyes.

-Is there anything else you want me to do?

-No, thank you.

I'll just print this out.

I think a shot of antibiotics is probably the way we're going to go.

See you later. Bye.

Having done all he could, Tristan finally left the hospital,

four hours after the official end of his shift.

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 wasn't just a bad day at the office that was bothering Tristan.

I just feel really bad for Lottie,

because I know 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 some way to make it all work.

Balancing the competing demands of work and home

remains an issue for family man Tristan.

Seeing what it's like with me working for three months

and sometimes coming home late,

what do you think of if I was to do emergency medicine

or A&E or, you know, 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,

but that balance will 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.

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've worked really hard at it.

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

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

-OK? We'll survive?

-Yes.

-Agreed?

-Yes.

-Good.

There's definitely a juggling act to be had

between being a doctor and a dad.

I don't know whether I'm good at it or not,

but it's just sometimes they just don't mesh at all.

It's just there's not enough hours in the day, which makes it difficult.

I'm not the only person who works long hours, who also has a family

at home, so I just have to make the best of each situation,

and so when I'm with my family, make sure that that time counts.

I think you should be proud of yourself.

-I think you've done really well.

-I agree.

See, I can barely cope. I can't even... I crawl home...

You have another life outside of work.

And Tristan's life outside of work is about to get even busier.

Also, I didn't know whether I was going to mention it,

but also Jenna is pregnant.

-Boom!

-Congratulations! A toast. Yeah!

-Here's to Tristan's super sperm.

-THEY LAUGH

Less hours, more babies.

A career in medicine requires hard work and dedication.

But even five years of study can't prepare you for everything,

as our junior doctors soon discovered.

For starters, they found patients had suddenly become very real.

So, you like giving banter out but you don't like taking it, do you?

-What do you mean?

-Ahh! See, I do fortunes.

-I've never met anyone who reads fortunes before.

-I'm right though, aren't I?

And nobody had ever taught them

how to deal with one of their patients being wanted by the police.

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

and I am sure on a normal day, it would be quite a novelty and

exciting, but today, I really need to just get on.

For Italian Ed, now a first year in the Acute Medical Unit,

one added complication was getting to grips with

life in the large and bureaucratic National Health Service.

How can I do this?

I think that's cardiology.

I'm not used to this writing.

It is either cardiology or gerontology, isn't it? I don't know.

It could be any ology.

BLEEPER BEEPS

'Testing. Testing. Testing. Please respond.'

Yes, OK. Working.

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

I think his confidence was initially knocked,

obviously, because he had started in A&E

and he had to be moved to the Acute Medicine Unit.

But I think as time has gone along, he has been supervised closely,

we have given him more and more responsibility

and I think he has relished it.

Ed had a further chance to prove himself on the acute ward

when an elderly man was having trouble breathing.

-Hello.

-It was Ed's task to drain the excess fluid off the patient's lungs

using a needle and syringe. The only problem -

this would be the first time the junior doctor had ever

performed such a procedure.

This patient has got a particularly large collection of fluid in the pleural space.

-All this black stuff...

-Is fluid. Yeah.

And the top is towards the skin. Yeah.

Acute medicine for me has been a really good ground on which to

start dealing with very, very different cases.

There was some pressure on Ed during the procedure.

The untested doctor needed to be precise to avoid puncturing

the patient's lung.

Just go straight in, slightly inclined.

Is everything OK? Yeah, straight in. Very good.

Keep sucking as you are going in. OK. Yes. Yes. Yes.

-Is it OK, sir?

-Yeah.

HE GROANS

So, obviously if there was a bigger needle,

it would have been better.

With this one, keep the pressure there.

And I want you to take the syringe off.

As you take the syringe off, I want you to put your thumb on the needle.

-OK.

-There we go. Nicely. Slowly. That is fine.

Could you please make a humming noise, sir, please. That is lovely.

The lung drain proved a success for both patient and junior doctor.

OK, sir, we can position you back.

-Was that all right?

-That was fine, thank you.

-OK. That is good.

Sometimes I miss the job I used to have before coming to Liverpool,

that's for sure, but I think in the long run,

this will be the good decision.

The training I get here is outstanding in comparison to

the self-training I was giving myself in the previous job.

But here I am in a system that is designed to

bring your knowledge to the highest standards,

so I am glad I am here, yes.

With the end of their ward placements looming,

all of the junior doctors were starting to think about

their next steps.

The end game, I suppose, is to end up as a consultant in a hospital.

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

We are sort of forced to decide what we want to specialise in

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

The best candidates get the jobs, so if I really want it,

I need to do the work.

Climbing the medical career ladder would take drive and ambition.

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

She was allowed to observe a surgical procedure early on

in her placement and it prompted a potential change in direction.

When I started work, I thought I knew what 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.

Senior House Officer Andrea Sheel had given Jen another chance

to put on her surgical scrubs,

and this time she'd really be getting stuck in.

Jen has been asked to incise and drain an abscess on a chap's back.

It's got a large collection of pus there,

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

It would be the first time Jen had ever performed an operation herself,

but Miss Sheel was on hand to guide her through it.

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

and then pop the dressings in.

A little bit nervous because you're cutting into somebody and I've

never done that before, but it's very superficial, so it's not too bad.

Cool. Let's go.

Start off in the area you're going to make the incision

first of all. Right over the...

-Like that?

-Yeah. Give it a really good...

-Oh, right. Round it.

-Yeah.

With the patient prepared for the operation, it was time for Jen

to make her first ever surgical cut.

OK. Knife, please. Thank you.

So take your scalpel and nice and decisive, don't push it in too far.

-Like that?

-Yeah, just a little incision at the top. Yep. OK.

OK, so we need to go a little bit further there. Can you see...

Just a little bit deeper there.

Get your finger inside just to give it a good...

Get some of that nice juicy pus out. There you go, it's coming out now.

-Are you happy with that?

-I think it's empty now.

-OK.

As surgery progressed, Jen was showing little sign of nerves.

-A bit of force and squeeze it in.

-A bit of force you want?

-Yeah.

Just make a nice little...irrigation. That's great.

Thank you very much.

With the operation complete

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

-Go and write in the notes?

-Yeah.

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

"Surgeon: J Whiteley." It was a bit weird, cos 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, but it was nice.

I think Jenny did really well there.

She attacked it with a very confident and positive approach.

It is officially an entire operation,

so it is something that she can put in her log book

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 came to choosing a specialism, the experience had

given Jen even more food for thought.

I've really, really, really enjoyed surgery.

I have definitely noticed the buzz from surgery that

I understand why people enjoy it.

I definitely have considered it more in the last few weeks than

I ever have before.

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

-That was really well done.

-Thank you very much. See you, guys.

Three months on, and Jen is reminiscing about her first

surgical procedure.

I've really enjoyed working on surgery, which was quite a surprise -

I didn't expect to like it as much as I did.

The biggest highlight being when I could write down, "Procedure.

-"Surgeon: J Whiteley."

-Was it an abscess?

I cut and then I put my finger in and pulled the rest out.

-That's what I was told to do.

-It's like when I clear the drain.

THEY LAUGH

Three months have passed

since these new doctors started their lives on the wards.

Erm, no, I haven't.

They've all faced their own challenges.

I hate being the first person there. I hate it so much.

But each of them has proved their worth.

There's going to be a short scratch. Try and stay as still.

It's had its bad points and its good points, but I wouldn't swap it.

I don't think there's another job that would give me

the same satisfaction.

-Are you all right to sort out the MI?

-Yeah.

-Cheers.

I've enjoyed it, I've worked hard, learned loads,

I've been on a team that I was proud to be a part of and it made me

100% sure that I want to carry on being a doctor.

-Trust you.

-HE LAUGHS

When I started, I thought I'd be a nervous wreck

and I'd be like crying on the floor, or hiding all the time.

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

so at the minute, he's just annoying me.

I've toughened up in the last few months.

It kind of makes me think that maybe I'm stronger than I thought I was.

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

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

I think I must be getting quite good at them.

It's ended up turning out to be my dream job and I'm really happy.

There are very few days I've worked so far when I've not loved it.

Now, with their placements at an end, it's time for our eight

new medics to move on,

as they continue their careers as fully-fledged doctors.

Must be teatime.

-SHE LAUGHS

-For the vampires.

Oh, that's quite strong.

It's not that strong.

I think that's code for, it could be worse.

If I get this wrong, I kill the patient.

-Does he know what he was eating?

-Chicken curry.

He said it was a bit of rice. He stinks of curry!

He stinks of curry powder!

-I'm nice and still.

-You are...a good customer.

Hot flush? Open the doors, make way for the menopause.

You'll be pleased to know that everyone winds me up

for being a bit of a perfectionist with this.

They're amazing when you come back after a night out.

HE LAUGHS

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