Junior Doctors: Your Life In Their Hands (2011) s03e02 Episode Script
Emotional Cost
1 Trauma - He's got a pulse, a strong pulse.
- Any pain up here? Tears and intense pressure.
Changing the oxygen over.
Just another day on medicine's front line.
They're young, they're untested This is my first patient ever.
And from their very first day, work is a matter of life and death.
- Don't let me die.
- We're not going to let you go anywhere.
For a junior doctor, fresh out of medical school, it's time to put theory into practice.
No, I haven't.
We're following seven junior doctors over their first three months on the job Sharp scratch.
It's all about the glamour.
It's all about the bums.
Where there's a first time for everything I didn't really know what to do.
It's having the confidence, isn't it? And first impressions count.
I'm afraid I didn't get it first time either.
First years Tom, Emily, Jen, Ed and Tristan have been finding their feet for the last two weeks.
I'm really sorry about that, just that's not gone in.
Second years Keira and Oli have 12 months' experience.
He called me a toerag.
I can handle being called a toerag.
I have been called a lot worse before.
Now they're finding out how tough life on the wards can really be.
I really don't like it when it causes discomfort but you've got to do it.
And that being a doctor is one of the most emotionally demanding jobs in the world.
I hope I can get over crying but I hope I always feel a little bit for them.
They're working here, at the Royal Liverpool University Hospital, but are the junior doctors really ready? For this hospital, in this city, it doesn't get any tougher.
They're here to look after you, lad! Give it a rest! It's Saturday and across Liverpool, thousands of people are gearing up to head into the city.
Junior doctor Jen is getting ready too, for her first ever night shift.
And after a successful start to hospital life, she can't wait to step up to her latest challenge.
I'm massively jealous that Tom has got to do some of the exciting stuff like cardiac arrest calls, treating really unwell patients first.
I wanted to do it because I'm competitive.
But I know my nights are coming this weekend so I'll have to see if I can beat him in the number of lives I can save in one night.
We'll have a tally chart in the kitchen.
Jen's only been a doctor for two weeks but with fewer senior staff around, tonight she's facing the daunting prospect of being the only junior doctor working across five wards.
The nights are the scary part because you're on your own.
And it's all the sick people in the surgical wards in the hospital so that's something I've never done before on my own.
Jen's first patient, a man who's suffering from a seriously inflamed pancreas, puts her right in at the deep end.
Is he in pain? Is that what I've been called for? - He's in agony.
He's sweating.
- OK.
- He's doubled over in pain.
He's had IV paracetamol and he's had oral tramadol.
OK, what's his obs like at the moment? I'll get his chart.
Hi, I'm, Jen I'm one of the doctors.
I'm just going to have a feel of your tummy if that's OK.
Jen wants to give him morphine but it's a procedure that she's only ever watched someone more senior do.
He's in quite a lot of pain, isn't he? How do we feel about IV morphine, if I give it? I can give it.
It's now down to Jen to inject the man so she can get the pain relieving drug into his system quickly.
I think I'll do that because he's in quite a lot of pain, I'll give him some oral morphine, PRN.
I've never given IV morphine before.
On my own, I've never given it on my own, I've given it with somebody.
I've seen it done.
Getting the dose wrong can have fatal consequences, so Jen must be sure she is using the right amount.
Sign here.
We just put this in 10 mills normally, do we? Yes.
10 mills.
All right, thanks very much.
With the patient in so much pain, Jen needs to get the morphine into his system as quickly as possible.
Do you just want to lie down, I'll give you something to stop the pain.
We're just going to put the morphine in now.
You might feel a little bit dizzy.
We're just going to put it through really slowly.
Is that helping the pain at all? - Not yet.
- Not yet, OK.
Is it easing your pain at all? It's starting to, good.
I'm just going to go with a little bit more.
Feeling a little bit better? You're obviously in a lot of pain.
You might feel a little bit sleepy.
Success, and Jen's pleased with how the procedure has gone.
I just looked at him and he was in a lot of pain.
And as you saw, when you give IV it just goes away.
You can literally see the pain leaving him which is nice.
With the patient now comfortable and out of pain, it's time for Jen to move on to her next case, and it's another new experience for the first year junior doctor.
We're going to A&E to meet Andrea, my SHO, to put in an NG tube, which is a tube which goes in the nose and in to the stomach.
Fitting a nasal tube takes technique and skill so she'll be assessed throughout by senior doctor Andrea Sheel, who has some words of advice.
Hello, you all right? - Have you got a preference on which side? - This one.
And you know just to swallow when it's going down in case it justso give it a swallow, OK? For me to give it a swallow? Yeah, when it goes into the back, just give it a little swallow.
When you feel it tickling.
That's it, and swallow.
HE COUGHS PAINFULLY The patient's coughing, which means the tube has gone down the wrong hole.
Just pull it out a little bit, sorry about that.
Just catch your breath for a sec.
You're all right, it's coming out.
Deep breaths in and out.
With the patient panicking, Jen's senior steps in to release it.
That's it, just have a breath for a minute.
And when Jen has another go, this time she gets it right.
If you want to stop, tap on the bed and we'll give you a break.
All doctors should have this done to them at least once.
You will feel a lot better.
With the tube correctly in place, the contents of the patient's stomach are finally released, providing him with instant relief.
It's making you feel better, is it? Jen may have finally mastered her first nasal tube procedure, but she's in no mood to celebrate.
I think it's just because I didn't know what to do when he was panicking, that's all.
It's just having the confidence, isn't it? Every time you don't succeed in something, especially when your bosses are around or your seniors are around, you do take it a bit personally.
I can remember what it's like.
The thing is we've all done it, we've all been there.
It's one of those procedures that you just have to have a lot of practice in.
Jenny did really well there.
It's just that it was a bit tricky.
MUSIC: "Taste It" by Jake Bugg Back at the house, and Jen's nightshift is finally over, but she's still thinking about how she handled the difficult nasal tube procedure.
I'm not really sure whether it was the patient being anxious or my inexperience that meant that I found it quite difficult to get down.
I really don't like it when it causes discomfort but you've got to do it.
Poor guy.
He was in a lot of pain.
It was nice to see the relief afterwards.
As a junior doctor, grappling with needles is a big part of the job.
- Sharp scratch.
- Sharp scratch.
- Sharp scratch.
And on the acute medical ward, first year Tom has had his fair share of tricky veins.
- Did they get it first time last time? - No.
- Didn't they?! I'm afraid I didn't get it first time either.
In some patients it's difficult to get intravenous access at all.
That's basically what just happened to me! - Is it good? - No.
I'm sorry.
You're going to feel a sharp scratch on your hand.
I couldn't literally feel any kind of vein I could put it in.
Tom's next patient is a man who has come in complaining of dizziness.
Tingling in my legs, tingling in my arms.
Just feeling disorientated, couldn't see properly.
- Did you have any visual problems? - Yeah.
- What happened? Basically, it's black spots but things are just rotating.
- In your eyes? - In my vision.
Pins and needles in the legs and the arms.
To find out what's wrong, Tom will need to do a blood test.
It's an opportunity to succeed where he's previously failed.
Are we locked in forever? But, first, Tom has another obstacle to overcome.
I unlocked it and then I locked it! OK, sharp scratch.
He starts with the wrist.
First time I've actually had it taken from my wrist.
Where do they normally take it from? Up here? I'll go from there then.
In the right place for when a thing goes wrong.
There's not many things can go wrong with this at least.
They're not putting me in charge of doing hip replacements just yet.
Sharp scratch.
He then tries the arm.
- Taken anything? - Sorry.
- No.
- OK, don't worry! Don't worry, just crack on.
I'm going to go down here and use a different needle as well.
Tom needs to have another go, but he's running out of veins in all the usual places.
Finally, third time lucky.
- This one's working.
- Yay.
- Yay.
Done.
Cheers, dude.
The patient is one step closer to a diagnosis, but as a doctor, Tom should be able to hit the target much quicker.
And he knows it.
Yeah, I'll be particularly pleased to see the back of those, I think.
After the three attempts! It's about as many times as I've ever had to get blood out of somebody and it wasn't particularly challenging.
At the end of a long day, Tom gets a chance to put his feet up with housemate Emily.
Can I tell you about my day? It wasn't too busy - Friday busy which is busier than normal but not bad for a Friday.
Tonight, Tom's planning to relax by having some friends round, but Emily can't be there.
I can't believe you've organised a party when I'm on a night shift.
It was bank holiday weekend, Emily, it wasn't aimed at you.
We'll have another one when you're not on night shift, don't worry.
Well, I'd better go get ready for my night shift.
You get ready for your party.
I'm sorry you're working when we're having a party.
Me too.
Mmm.
Not only is Emily missing the party, but the moment she's been dreading since she became a junior doctor has arrived - the start of a gruelling 12-hour night shift.
I am feeling mildly grumpy that I'm in hospital overnight.
From what I've heard from other people, it's either going to be, like, really dramatic and manic and exciting and interesting, or it's going to be a couple of jobs, and then twiddling my thumbs.
And I haven't decided which one I prefer.
At the moment I'm kind of leaning towards the quiet, twiddling thumbs.
On the wards, Emily wants a quiet life.
Outside the hospital, she's anything but a thumb-twiddler.
I'm one of these people that I need hobbies to go to outside of work, otherwise I'll just sit down and sleep.
I'm also creative.
I love the arts.
I'm not a competitive person at all.
I'm not bothered about being top of the pile.
I would describe myself as optimistic and positive and emotional.
I do cry quite easily.
I need to learn to toughen up, otherwise I'm just not going to cope with the job.
I still have this thought in the back of my mind of, "What if I'm not good enough? "What if I don't even get through the year?" That's something that really terrifies me.
CHEERING I'm really worried about night shifts.
I'm not a night person.
Everybody knows when you're tired, you're going to make more mistakes, and that's something that's really worrying me, because I'm just not in a position to make mistakes.
PHONE RINGS Hello, 8A? Oh, sorry, 5A.
She's not tired yet, but Emily's already finding simple tasks more challenging than usual.
Hello, 5A? On nights, junior doctors need to take calls from anywhere in the hospital.
Hello, 8A? Trouble is, Emily's not on her usual ward - and she keeps forgetting where she is.
Oh, sorry, I mean 5 oh, OK.
I got the name of the ward wrong.
You're so efficient! Am I? I was being sarcastic.
THEY LAUGH When she finally remembers what ward she's on, Emily goes to see her first patient.
How you feeling in yourself at the moment? - Still sore.
- Still really sore in your tummy? - Yeah.
- OK.
And you've not opened your bowels in a week, I hear? The woman has a pressing problem - she's extremely constipated.
Is it worse when I press in or when I let go? When you press in.
What did the X-ray show? The X-ray showed absolutely loads of poo.
It must feel horrendous.
Her stomach's out here.
She must just feel so uncomfortable.
Bless her.
That's all poo.
I think she's got something called adhesion, so, like, due to previous surgery or inflammation of the bowel, it all just sticks together and it's all horrible.
Emily decides to do a rectal examination.
It's her first one since she qualified as a doctor, and doing it on a nightshift, where there's fewer seniors around to supervise, is an added pressure.
With the problem you've got, it's really important that I examine your back passage as well.
- OK.
- So it might be a little bit uncomfortable, but it'll be really quick, - and it'll let us know what's going on really well.
- OK.
- Is that OK with you? - Yeah, OK.
You just have to put a finger in and just make sure there's no blood or any poo in the rectum.
Emily knows if she can relax the patient, it'll be easier for both of them.
All right.
I'm going in now.
Just squeeze for me.
OK.
Is that sore at all? Brilliant.
Well done.
Thankfully the rectal went smoothly, and Emily's hoping that the rest of her night is uneventful.
It's all about the glamour.
It's all about the bums, isn't it, surgery? Have you tried the soca Let's lift the beat all over Dance all night With me till the morning light Back at the house, Tom's party is getting into full swing.
Dance with me, dance with me All night But at the hospital, Emily's making the most of a quiet night on the wards instead.
All night, all night All night Dance with me, dance with me Junior doctors working on-call night shifts are allowed 20-minute breaks every four hours.
Luckily for Emily, they can use this time to nap.
And that's something she intends to take full advantage of.
Today I don't feel like doing anything I just want to lay in my bed Have you had a nap? Have you had a rest? No, not yet.
I've been working really hard, and I'm really tired.
LAUGHS I'm going to kick my feet up, then stare at the fan Turn the TV on, throw my hand in my pants Nobody's going to tell me I can't It's 8am, and Emily's night shift has finally come to an end.
I hate working nights and it's been really tiring, and I feel like I'm not here and I'm a bit zombied, so it's just not nice trying to think when your brain's like cotton wool.
It's just not pleasant.
As Emily finally gets to go home .
.
Ed's arriving for his first day on his new ward of acute medicine.
The Italian medic has had a difficult start to life in a British hospital.
He started off as a second year in the emergency department, but he struggled with some basic medical procedures.
It's been a while.
So he agreed to leave, and redo his first year in another, less demanding department.
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.
There was also another dramatic turn of events when he received the news that his father was seriously ill and he needed to leave the country immediately to visit him.
They said, "Please take one week off and go and see your family.
" I did and, well, my girlfriend and I got a plane Saturday morning and unfortunately we arrived in Paris and my father had just passed away.
Now he's back and more determined than ever to get his career on track.
- Do I just follow you? - Yes.
- OK.
His day starts with a ward round.
And Consultant Dr Osman uses a patient's results to test Ed's knowledge.
She's a lady who came in feeling unwell.
She's 86.
- This might be old changes.
- Yeah.
- They might be new changes.
So what will you do? Ed studied medicine for seven years in Italy, but, under pressure, he's finding it difficult to come up with the answers.
Yeah, I don't know the measurements.
- Normally it's less than 14.
- OK.
You have to know that.
- So you go and read about that, that will be very useful.
- Yeah.
- But you'll see this patient now.
- OK.
Dr Osman needs to know that his new starter has enough experience to cut it in a big hospital, so he asks Ed some questions about his training in Italy.
Unfortunately not.
No, I've never worked in a hospital.
I've seen outpatients and GP patients, but I've never worked in a hospital, so I'm getting to see all the patients now that I haven't seen in my previous job.
I haven't been treating patients with I've been working in a little mountain village in Italy and seeing patients during nights and weekends when the GP was not available.
That's all.
I haven't worked in a hospital yet.
Ed's beginning to realise that even though he's qualified, his studying days are far from over.
I was just caught, er, taken aback by one question which I should have answered straight away and to which I actually know the answer but for some reason, I just didn't tell him.
Anyway, I just need to convert the stuff I know into practice.
Nothing else, and that annoys me a bit, because it's all stuff I have studied and knew well, but never used in practice.
when you don't do things, you forget about them.
After a testing time on the night shift, Jen's back on days and it's the busiest week of the month as her ward fills up with new surgical admissions.
We've gone from about ten to about .
.
30, maybe, over the weekend, so quite a lot.
ECGs She's particularly concerned about one of the new arrivals.
- Are you looking after Mr Flusk? - I am.
- Has he had an ECG yet? - No, not yet.
OK, shall we do this ECG, and then I'll go and do his gases? - I'll see if he's finished with it now.
- Thank you.
83 year old Thomas Flusk has just had emergency surgery to remove his appendix.
The surgery was a success, but he's now having difficulty breathing.
And Jen is determined to get to the bottom of why.
He probably has a chest infection because he's post-op, and that's the most likely cause, but, you know, there's other things.
If he's very, very hypoxic, which means he's got very low blood oxygen levels, that can be a sign of a clot on his lungs.
The first thing Jen does is order an ECG to check his heart, but she also needs to test his blood.
How are you feeling? Yeah.
I'll sort you out.
But for a junior doctor, getting to the root of a complex problem isn't always straightforward.
The further you go with medicine, the more you realise you don't know anything.
So, yeah, it might look like I remember a lot, but there's an awful lot I don't remember as well.
The most important thing for a junior doctor is to recognise when something is wrong, but not necessarily what it is, because that's the years later that you'll find out.
Would I be able to sit you up just to listen to the back of your chest? - Yeah.
- Thank you.
Deep breath in.
When Jen finally gets to check Mr Flusk's blood tests, they confirm that something is wrong, but don't reveal precisely what.
He's on 40% oxygen, and his pO2's 8.
7.
So she sends him off to radiology.
If, as Jen suspects, he does have an infection, then it will show up on his chest X-ray.
Because the X-rays go straight on my computer, I get to see them almost immediately, so he's still down, he's not back yet, but I've seen his X-ray.
I can see that he's actually got fluid on his lungs, probably means that it's not a chest infection.
It's more likely to be this problem with his heart, which is quite common in someone his age.
Now that Jen has finally established what's causing his shortness of breath, she can plan his treatment.
I'm just putting some medication through and then I'm going to come and repeat his bloods just to see what's going on.
Hopefully it'll all be improving and going the right way.
You can't say you're not getting looked after, can you? It's another case ticked off for Jen, and she can now update her senior house officer with her findings.
Has he had an ECG? Yeah, his ECG.
I know if I tell Jen to do something, it'll be done, it'll be done quickly and it'll be done to a high standard, and I won't have to go back and double check that it's been done properly.
It's really nice to see the progress.
Whereas with the first take, it would be, "This has happened? "What do I do?" Now it's, "This has happened.
"I've seen the patient, I've done this, I've done this.
"Is that OK?" And I go, "Yeah, that's great.
You don't need me.
" The way Jen's handled this case has demonstrated just how far the first year junior doctor has come in a short space of time.
I'm a lot more confident in dealing with things like that than I was when I first started.
It's satisfying that we've found a problem, treated him for it and he looks a bit better.
He's still got a bit of a way to go .
.
and we'll see him on the ward round tomorrow and see how he is.
After a busy day on the wards, the junior doctors finally get a chance to relax together, ahead of a night out for Emily.
Emily, who you going on a date with tonight? I'm not going on a date with anyone, Olly.
Oh, God, you are.
Don't lie.
She so is.
- I'm not.
- Face tells it all.
- She's done her eyelashes.
I haven't.
They're real.
They're perfect.
You've separated them all.
I have.
Date.
Stinks of date.
Is he cooking you a nice vegetarian meal? Oh this is so embarrassing Or is he going to cook you up a meat feast? LAUGHTER Have you got any pre-date nerves? No, because I'm not going on a date.
And, one more question.
If it all goes tits up, how are you going to get home? I've got a car.
Oh, are you not drinking? No, it's a school night.
Don't drink on a school night.
- Sensible.
- Well, you do.
You old tanker.
What you trying to do? I don't know.
I'm never going to get a job or a boyfriend.
LAUGHTER It's a new day at the hospital.
And in the Heart Emergency Centre, Tom has been asked to treat a patient who came into A&E with chest pains.
- So it's Mr Flynn? - Yes.
Hi, Mr Flynn.
My name is Tom.
Mr Flynn has previously had a heart attack and a heart bypass, and since then, he's suffered from angina.
Do you just want to just describe it to me? Well, it's just a very heavy pain in my chest and, er Like a crushing kind of pain? - Yeah.
- Has it been happening at rest, this chest pain? Just happened now, yeah.
OK.
So you take your GTN spray under your tongue? - Yeah.
- And you took two squirts of it, do you? - Yeah.
- And it's still taken 25 minutes to work? - Yeah.
- OK.
Tom begins to suspect something is seriously wrong.
- You feeling clammy and sweaty? - Yeah.
- Do you feel like that now? - I do, yes.
- You do.
- I'm really sweating now, though.
- Are you? - Yes.
- Tell you what, I'll just - Really uncomfortable.
You're uncomfortable? Hang on, just give me two minutes.
Tom quickly alerts 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 getting some morphine and having his ECG now.
He's also sweaty and clammy and really grey.
- FEMALE DOCTOR: - Oh, really? - Yeah.
Has the blood pressure changed? Guys, his blood pressure is dropping.
If the man is having a heart attack, a drop in blood pressure could be 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 is ticking.
And this time, there is no margin for error.
Sorry.
Tom fails with his first attempt.
And the patient's blood pressure is still dropping, meaning his veins are getting thinner by the second.
He needs to fit the cannula now.
You just relax your hand and let me move it around a bit.
Yep, that one's in.
Can I get, erthe flush? The cannula's in, much to everyone's relief.
And the team manage to stabilise the patient.
Had we left him, there's every chance he could have had a full-blown heart attack.
No-one could say whether or not we prevented it.
No-one could say that.
But what is important was that we reacted quickly and, you know, we've just got to monitor him now to see what happened during that time.
Over the next 12 hours we should get a better picture of what's just happened.
So we'll see.
Now that Emily's off nights, she's back on her own ward doing what she loves most - building relationships with her patients.
- You feeling better today? - Oh, a lot better.
Are you? Good, good.
Must be tea time! SHE LAUGHS For the vampires! You're doing brilliantly.
Well done.
And since she started as a junior doctor, Emily's favourite patient has been 83 year-old Doris.
You're in the wars a bit, aren't you, Doris? You're bloodless.
I've taken it all.
I really like Doris, because she's so lovely.
That's her, really.
She's just so nice to everybody.
She always seems really happy, no matter what's going on.
She's never got a bad word about anyone.
So she's just lovely.
But Doris isn't responding to treatment, and her condition has become critical.
Why does her temperature go up and down like that? Doris' family and doctors now need to plan the best possible care for her in the last days of her life.
I think the end outcome is that she's going to die.
OK.
So it's more of a pragmatic decision in terms of, what is the end of her life going to be like? End of life care.
Are we going to make the end of her life comfortable? So for Doris, there's a difference between stopping all her medications and just carrying on, but not doing anything else.
The point is that we're not escalating her care.
All the treatment we're giving her isn't making her better.
It's a natural part of life, is death, and it's something that is sort of you have to work out when it's a priority to make sure that somebody's comfortable, rather than trying to treat them.
A few days later, Emily has to deal with the news that Doris has died.
And she has chance to reflect on the decisions made about her final days.
Doris and her family were really prepared for her to die.
They all thought it was the best thing for her to pass away peacefully rather than struggling on with active treatment.
So I'm really happy with how it happened.
I feel that she had a really dignified death, and she passed away peacefully and comfortably.
Emily must do one last thing for Doris - register her death.
It's a difficult job for any junior doctor at the beginning of their career.
I'm not 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.
But I'm glad that it's me who's got to come and say goodbye to her, because I feel like we've got to know her really well and it's quite important to me that we kind of finish off the whole process and close the book on it.
Emily isn't the only doctor struggling to deal with death.
First year Tristan works on a ward where all the patients are elderly.
The dilemma of when to stop escalating the care of those who are at the end of their lives is an issue of some debate, and one he'll regularly face.
I think there's already been a couple of patients where the senior doctors have, um I guess diagnosed dying, and I found it really hard to adjust to that.
Sort of saying, "This is what we've been able to do, "It hasn't worked, and "this is just the natural progression of things.
" Tristan's come for some advice from his senior, Dr Scott, about when to make the call to accept that a patient is dying.
We sort of made the decision to only provide supportive treatment, so that they can have a more comfortable and dignified time and the family can have that precious time with them before they died.
I don't know, I felt it was really difficult.
That's exactly the way you should be feeling at the minute.
You have this kind of conflict between what you have been trained to do, which is to make people better and get them home, versus actually then encountering the reality.
What you're learning now is not so much the science of being a doctor, but the art of being a doctor.
'The fact that he's actually thinking about that' and coming to talk to me about that at this early stage, I think, is a very good sign.
There will come a point in anybody who's severely ill where if you've got to the stage where treatment's not working, you've got to make a judgement.
Your patient relies on you to do that.
Your patient's family relies on you to do that.
But if you're worth your salt as a doctor, you will then go away and you will probably agonise over that.
The junior doctors are learning to deal with the emotional challenges of the job.
And after five years of hard study, one of the rewards is just round the corner.
Payday.
I can't really process the idea of having money at the moment.
It seems so alien.
The starting salary for a first year junior doctor is £22,500.
And their first slice of it can't come quick enough.
Because they're all skint, and resorting to desperate measures.
This one went off on the 10th of August.
- Can I have it still? - What? Lentil mousakka.
It might be all right? Yeah, you kill the bacteria, don't you, when you heat it up? Yeah.
It's not got meat in or anything that can go wormy, has it? I'm so excited about getting paid now.
I didn't genuinely think payday would be such a big deal to me until I became the poorest person I know.
And now, that's why we're having stir fry, because this entire meal probably cost me about 5 quid.
As the first years enjoy a budget stir fry, the only thing second year, Oli, will be eating tonight is hospital catering.
He's about to start a run of night shifts, so he'll be putting his social life on hold.
I went and saw some of my friends before nights, and we were just sitting around, playing a bit of FIFA, and I was thinking, "Ugh! "That would be a lovely way to spend this weekend.
" A few beers with some friends.
But instead, I will be with the fine residents of the Royal Liverpool and Broadgreen University Hospital.
Being the on-call medic on nights is a tough test for any new junior doctor, but for laidback Oli, a night shift is all in a day's work.
So I was brought up in Reading.
Went to school there.
I'm the first in my immediate family to go to university.
He was quite young, eight or nine, when we were at the dinner table one night and he said, "I'd really love to be a doctor when I'm older.
" And we all kind of laughed and said, "Oh, that would be a really good idea!" He worked hard.
I think he played hard too.
How would I describe myself? I'm probably a secretly competitive person.
Although, I don't know, my friends might say it's not so secret.
Smart, sleepy.
I'd go for lazy! I'm quite a laidback person.
I don't let things get on top of me.
I try not to get stressed out too much.
The chances of getting your full ten hours of sleep is highly unlikely, so I tend to make up for it with, yeah, napping in the evening or during the day, if I can get away with it.
When you start off, it's all a bit new and you're not quite sure how to handle it and you worry a bit.
- Is that the first one you've done? - Yeah, that was the first one, yeah.
'But as time goes on, you begin to take it more in your stride 'and, you know, you still take it seriously,' but it becomes a bit more routine and easier to deal with.
ALARM SOUNDS You're often thrown in at the deep end and you're just expected to be able to deal with these really difficult situations at times, yeah.
ALARM SOUNDS Where is it? Straight away, Oli's called into action.
It's an emergency.
This floor's fine.
But it turns out to be a false alarm.
The routine tasks Oli faces on a nightshift all need to be done during demanding 12-hour stints.
Something of a struggle for a man who likes his sleep.
You do, occasionally, when you're walking round on wards, you see an empty bed, and you're like, "Mmm, I could sleep the shit out of you!" But then, you're not allowed.
So you just carry on working! But night shifts are unpredictable.
And unfortunately for Oli, it's never long before there's another challenge to deal with.
Yet again, it's a crash bleep.
And this one is for real.
'When the call comes through, you forget how tired you are.
'Adrenalin 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.
' 5A.
We'll go through 5X.
Arriving at the scene of the emergency, Oli finds nurses working on an elderly woman who has stopped breathing.
Is there an output? She's got a pulse.
She's got a strong pulse.
Good output.
What's going in? Is that just normal fluids, or is there any antibiotics? - No, dextrose.
- Dextrose? Yeah, could we get a glucose? Oli takes charge of the team and they soon manage to stabilise the patient.
She's breathing now.
Just get the stats monitor on.
Have we got a drug card around here at all? With the patient beginning to recover, the situation no longer seems as bad as first feared.
It's not a cardiac arrest, but it is somebody who's maybe had a fit.
Sounds like they're known to have seizures, so Don't need any more of them tonight.
That'll do for me! One crash call per night is enough, I think.
Oli's made it to the end of his shift.
But just when he thought it was safe to go home .
.
there's another crash bleep.
And it's on Emily's ward.
What's going on? She's been on shift for less than an hour, but one of her patients is in cardiac arrest.
Does anyone know about this patient? As the on-call medic, second year, Oli, is needed to assist at the scene.
Could I get one of you two to get me an Ambu bag and a mask, please? Is there a pulse? Is thereI'll get gas.
Despite the teams' efforts, the man is showing no signs of improvement.
As Oli takes some blood, Emily continues chest compressions on her patient.
Nothing seems to be working.
And as the monitor shows no signs of a heartbeat, the doctor in charge has a difficult decision to make.
As the team tries one last time to restart the man's heart, Emily does another round of compressions.
The team pause, to check whether the monitor shows the patient's heart has started working on its own again.
But there's still no change.
It's been a tragic end to an otherwise routine night shift for Oli.
It was unexpected, a bit of a shock, bit of a downer to the night shift, to be honest.
For Emily, it's the second of her patients to die this week.
It's always much harder when it's your own patients.
She has a day job to get on with as well, so I don't think she'll let it affect her too much.
I think maybe wait until you get home, then let the emotional sidehave a think about that, otherwise, you can't get on with your day, can you? Emily was the first doctor on the scene when her patient went into cardiac arrest, and she's reliving the events with Tristan and Jen.
I hate being the first person there.
I hate it so much.
And I did not know what I was doing.
How long were you on your own for? I wasn't really on my own, I had the nurses with me, but I feel like I needed somebody very senior and calm just to direct everything, cos we were all rushing about, trying to get oxygen and start compressions and start timing.
I didn't know how to organise it, I wasn't organising it well.
You did the best you could do at the time, which is all anyone can expect of you.
Sounds like you did a really good job.
But Tristan's words are cold comfort to Emily.
When the senior doctor said, "Does everybody agree "that this is futile?" Then everybody took a step back and he was just laying there and got really pale and his eyes were open and he wasn't breathing, and I had to check on his chest that he was breathing' Do you think it will ever get easier? I hope it doesn't, in a way.
I don't want to get blase about crashes.
I hope that I get over crying, that I stop crying.
But I hope that I always feel a little bit for them.
After a shaky start yesterday, Ed's back for another shift on the Acute Medical Ward.
He trained in Italy, so his lack of practical experience of working in a British hospital means the learning curve has been that bit steeper.
He's in B2.
He's ready in B2? You go round the corner.
OK.
His first job is treating a patient with a severe headache.
- Do you feel anything at the back of your eyes? - A bit, yeah.
The man suffers from migraines, but Ed must rule out anything more serious by doing a neurological examination.
Can you give me some qualities of this pain? Is it throbbing? Is it continuous? Does it come and go during the day? Do you have peaks? It just throbs up there.
- It's been throbbing ever since yesterday? - Since yesterday, yeah.
I saw you marked your pain from zero to ten around ten.
- That must be very painful.
- Yeah, it was very painful.
How is it now? It's subsiding a little bit but it's still there.
Still throbbing, OK.
For Ed, there's a lot riding on this.
His last neurological examination was one of the reasons he left the emergency department.
So he can't afford to get it wrong.
If you could please follow the pen.
Look at my hands.
OK.
- Say, "Ah".
- Ah.
Can you feel? The examination requires Ed's full concentration.
And there's a lot to tick off his mental checklist.
Can you stick out your tongue? Lift up your shoulders against my force.
Grab my hands as firmly as you can.
Right.
Erm That, I think, isperfectly fine.
Look at me again.
Your right eye does seem redder than your left eye, so that also makes me think more towards some kinds of migraine.
I've had a migraine before and it's nothing like it.
I've never had flashing lights in my vision.
The patient is unsure of the diagnosis, so Ed gets a senior doctor to do a second assessment, which confirms he's got it right.
- SENIOR DOCTOR: - Your blood tests have all come back normal.
Good, good.
It sounds like a migraine.
We went over the history of the patient and the clinical examination and it was confirmed what I'd found, so it looks like I didn't miss out anything relevant, so that's good.
Now he's got the backing of his seniors, Ed goes to discharge the patient.
But he's got fed up of waiting, and has gone home.
There's nothing much I can do about that.
He's gone, he decided to go, he goes.
After a bumpy start to life as a junior doctor in Liverpool, Italian Ed's finally tasted success.
Just in time for a catch up with his mentor, Dr Pickles.
You are going in the right direction and that's encouraging.
Certainly when you've presented cases to me, I've been pleased with your initial diagnosis, your management plan, your examination.
- Obviously - There's loads of space for improvement.
- Absolutely.
At least I know I'm not working in a bad way.
I think this is a culture shock to him.
My understanding is that he was pretty much the only doctor in a rural area and didn't get too much hands-on experience.
I think coming to a hospital as big as the Royal, where you've got such a vast turnover of patients, where you're expected to see a lot of patients quickly, to do a lot of things in a short period of time.
It's going to be so hard for him, but he'll get there.
It's been a challenging week, and Ed's relieved that Dr Pickles has ended it on a positive note.
All in all, I'm feeling a bit worn out because it has been a long and busy day.
Certainly I've gained a little bit of confidence at least from my meeting.
I'm not worried about confidence, I'm just worried about working in the right direction and doing things as I should be doing them at my level, and that seems to be OK.
Plenty of space for improvement.
Ed's not the only junior doctor feeling upbeat.
They've all made it through their first stressful month on the wards.
And the moment they've all been waiting for has finally arrived.
- It's payday! - It's payday! - It's payday! ALL: It's payday! And after all their years of training, there can be only one way to mark such a milestone - cocktails.
Happy payday, guys.
Happy payday! Almost the first bit of gratification.
You've just got paid.
"Oh, good.
"It's a job, I'm settled, I've had my first pay cheque.
"I feel a little bit established.
" It's nice! It's really nice.
We've been working for a month now, so it's nice to see some money in the bank and stop scrimping and saving for the time being.
I need a handbag, some clothes, some new shoes, a bike, and I'm going to take my nan up some dinner.
- SHE LAUGHS - Cos she's helped me through uni.
The best thing about payday is being independent.
I want to buy my mum flowers because she's supported me for ages and now we can sever the cord and cut the standing order.
I can actually look after myself now.
Next week, on Junior Doctors can they handle the pressure of being doctors in one of Britain's booziest cities? You think of it as normal, going out with friends, but you see the real extreme end of it in hospital.
It's a race against the clock for Tristan as he takes on his very first ward round.
15 minutes behind already.
You can't switch off and let your seniors give you a list of things to do.
You have to make some decisions.
And Tom comes under fire in his very first presentation to senior consultants.
It's obviously irregular.
It's the irreg-, irreg-, irregularity of it.
There was no doubt I was going to get grilled when I was doing it.
There's no doubt I wouldn't get everything right.
- Any pain up here? Tears and intense pressure.
Changing the oxygen over.
Just another day on medicine's front line.
They're young, they're untested This is my first patient ever.
And from their very first day, work is a matter of life and death.
- Don't let me die.
- We're not going to let you go anywhere.
For a junior doctor, fresh out of medical school, it's time to put theory into practice.
No, I haven't.
We're following seven junior doctors over their first three months on the job Sharp scratch.
It's all about the glamour.
It's all about the bums.
Where there's a first time for everything I didn't really know what to do.
It's having the confidence, isn't it? And first impressions count.
I'm afraid I didn't get it first time either.
First years Tom, Emily, Jen, Ed and Tristan have been finding their feet for the last two weeks.
I'm really sorry about that, just that's not gone in.
Second years Keira and Oli have 12 months' experience.
He called me a toerag.
I can handle being called a toerag.
I have been called a lot worse before.
Now they're finding out how tough life on the wards can really be.
I really don't like it when it causes discomfort but you've got to do it.
And that being a doctor is one of the most emotionally demanding jobs in the world.
I hope I can get over crying but I hope I always feel a little bit for them.
They're working here, at the Royal Liverpool University Hospital, but are the junior doctors really ready? For this hospital, in this city, it doesn't get any tougher.
They're here to look after you, lad! Give it a rest! It's Saturday and across Liverpool, thousands of people are gearing up to head into the city.
Junior doctor Jen is getting ready too, for her first ever night shift.
And after a successful start to hospital life, she can't wait to step up to her latest challenge.
I'm massively jealous that Tom has got to do some of the exciting stuff like cardiac arrest calls, treating really unwell patients first.
I wanted to do it because I'm competitive.
But I know my nights are coming this weekend so I'll have to see if I can beat him in the number of lives I can save in one night.
We'll have a tally chart in the kitchen.
Jen's only been a doctor for two weeks but with fewer senior staff around, tonight she's facing the daunting prospect of being the only junior doctor working across five wards.
The nights are the scary part because you're on your own.
And it's all the sick people in the surgical wards in the hospital so that's something I've never done before on my own.
Jen's first patient, a man who's suffering from a seriously inflamed pancreas, puts her right in at the deep end.
Is he in pain? Is that what I've been called for? - He's in agony.
He's sweating.
- OK.
- He's doubled over in pain.
He's had IV paracetamol and he's had oral tramadol.
OK, what's his obs like at the moment? I'll get his chart.
Hi, I'm, Jen I'm one of the doctors.
I'm just going to have a feel of your tummy if that's OK.
Jen wants to give him morphine but it's a procedure that she's only ever watched someone more senior do.
He's in quite a lot of pain, isn't he? How do we feel about IV morphine, if I give it? I can give it.
It's now down to Jen to inject the man so she can get the pain relieving drug into his system quickly.
I think I'll do that because he's in quite a lot of pain, I'll give him some oral morphine, PRN.
I've never given IV morphine before.
On my own, I've never given it on my own, I've given it with somebody.
I've seen it done.
Getting the dose wrong can have fatal consequences, so Jen must be sure she is using the right amount.
Sign here.
We just put this in 10 mills normally, do we? Yes.
10 mills.
All right, thanks very much.
With the patient in so much pain, Jen needs to get the morphine into his system as quickly as possible.
Do you just want to lie down, I'll give you something to stop the pain.
We're just going to put the morphine in now.
You might feel a little bit dizzy.
We're just going to put it through really slowly.
Is that helping the pain at all? - Not yet.
- Not yet, OK.
Is it easing your pain at all? It's starting to, good.
I'm just going to go with a little bit more.
Feeling a little bit better? You're obviously in a lot of pain.
You might feel a little bit sleepy.
Success, and Jen's pleased with how the procedure has gone.
I just looked at him and he was in a lot of pain.
And as you saw, when you give IV it just goes away.
You can literally see the pain leaving him which is nice.
With the patient now comfortable and out of pain, it's time for Jen to move on to her next case, and it's another new experience for the first year junior doctor.
We're going to A&E to meet Andrea, my SHO, to put in an NG tube, which is a tube which goes in the nose and in to the stomach.
Fitting a nasal tube takes technique and skill so she'll be assessed throughout by senior doctor Andrea Sheel, who has some words of advice.
Hello, you all right? - Have you got a preference on which side? - This one.
And you know just to swallow when it's going down in case it justso give it a swallow, OK? For me to give it a swallow? Yeah, when it goes into the back, just give it a little swallow.
When you feel it tickling.
That's it, and swallow.
HE COUGHS PAINFULLY The patient's coughing, which means the tube has gone down the wrong hole.
Just pull it out a little bit, sorry about that.
Just catch your breath for a sec.
You're all right, it's coming out.
Deep breaths in and out.
With the patient panicking, Jen's senior steps in to release it.
That's it, just have a breath for a minute.
And when Jen has another go, this time she gets it right.
If you want to stop, tap on the bed and we'll give you a break.
All doctors should have this done to them at least once.
You will feel a lot better.
With the tube correctly in place, the contents of the patient's stomach are finally released, providing him with instant relief.
It's making you feel better, is it? Jen may have finally mastered her first nasal tube procedure, but she's in no mood to celebrate.
I think it's just because I didn't know what to do when he was panicking, that's all.
It's just having the confidence, isn't it? Every time you don't succeed in something, especially when your bosses are around or your seniors are around, you do take it a bit personally.
I can remember what it's like.
The thing is we've all done it, we've all been there.
It's one of those procedures that you just have to have a lot of practice in.
Jenny did really well there.
It's just that it was a bit tricky.
MUSIC: "Taste It" by Jake Bugg Back at the house, and Jen's nightshift is finally over, but she's still thinking about how she handled the difficult nasal tube procedure.
I'm not really sure whether it was the patient being anxious or my inexperience that meant that I found it quite difficult to get down.
I really don't like it when it causes discomfort but you've got to do it.
Poor guy.
He was in a lot of pain.
It was nice to see the relief afterwards.
As a junior doctor, grappling with needles is a big part of the job.
- Sharp scratch.
- Sharp scratch.
- Sharp scratch.
And on the acute medical ward, first year Tom has had his fair share of tricky veins.
- Did they get it first time last time? - No.
- Didn't they?! I'm afraid I didn't get it first time either.
In some patients it's difficult to get intravenous access at all.
That's basically what just happened to me! - Is it good? - No.
I'm sorry.
You're going to feel a sharp scratch on your hand.
I couldn't literally feel any kind of vein I could put it in.
Tom's next patient is a man who has come in complaining of dizziness.
Tingling in my legs, tingling in my arms.
Just feeling disorientated, couldn't see properly.
- Did you have any visual problems? - Yeah.
- What happened? Basically, it's black spots but things are just rotating.
- In your eyes? - In my vision.
Pins and needles in the legs and the arms.
To find out what's wrong, Tom will need to do a blood test.
It's an opportunity to succeed where he's previously failed.
Are we locked in forever? But, first, Tom has another obstacle to overcome.
I unlocked it and then I locked it! OK, sharp scratch.
He starts with the wrist.
First time I've actually had it taken from my wrist.
Where do they normally take it from? Up here? I'll go from there then.
In the right place for when a thing goes wrong.
There's not many things can go wrong with this at least.
They're not putting me in charge of doing hip replacements just yet.
Sharp scratch.
He then tries the arm.
- Taken anything? - Sorry.
- No.
- OK, don't worry! Don't worry, just crack on.
I'm going to go down here and use a different needle as well.
Tom needs to have another go, but he's running out of veins in all the usual places.
Finally, third time lucky.
- This one's working.
- Yay.
- Yay.
Done.
Cheers, dude.
The patient is one step closer to a diagnosis, but as a doctor, Tom should be able to hit the target much quicker.
And he knows it.
Yeah, I'll be particularly pleased to see the back of those, I think.
After the three attempts! It's about as many times as I've ever had to get blood out of somebody and it wasn't particularly challenging.
At the end of a long day, Tom gets a chance to put his feet up with housemate Emily.
Can I tell you about my day? It wasn't too busy - Friday busy which is busier than normal but not bad for a Friday.
Tonight, Tom's planning to relax by having some friends round, but Emily can't be there.
I can't believe you've organised a party when I'm on a night shift.
It was bank holiday weekend, Emily, it wasn't aimed at you.
We'll have another one when you're not on night shift, don't worry.
Well, I'd better go get ready for my night shift.
You get ready for your party.
I'm sorry you're working when we're having a party.
Me too.
Mmm.
Not only is Emily missing the party, but the moment she's been dreading since she became a junior doctor has arrived - the start of a gruelling 12-hour night shift.
I am feeling mildly grumpy that I'm in hospital overnight.
From what I've heard from other people, it's either going to be, like, really dramatic and manic and exciting and interesting, or it's going to be a couple of jobs, and then twiddling my thumbs.
And I haven't decided which one I prefer.
At the moment I'm kind of leaning towards the quiet, twiddling thumbs.
On the wards, Emily wants a quiet life.
Outside the hospital, she's anything but a thumb-twiddler.
I'm one of these people that I need hobbies to go to outside of work, otherwise I'll just sit down and sleep.
I'm also creative.
I love the arts.
I'm not a competitive person at all.
I'm not bothered about being top of the pile.
I would describe myself as optimistic and positive and emotional.
I do cry quite easily.
I need to learn to toughen up, otherwise I'm just not going to cope with the job.
I still have this thought in the back of my mind of, "What if I'm not good enough? "What if I don't even get through the year?" That's something that really terrifies me.
CHEERING I'm really worried about night shifts.
I'm not a night person.
Everybody knows when you're tired, you're going to make more mistakes, and that's something that's really worrying me, because I'm just not in a position to make mistakes.
PHONE RINGS Hello, 8A? Oh, sorry, 5A.
She's not tired yet, but Emily's already finding simple tasks more challenging than usual.
Hello, 5A? On nights, junior doctors need to take calls from anywhere in the hospital.
Hello, 8A? Trouble is, Emily's not on her usual ward - and she keeps forgetting where she is.
Oh, sorry, I mean 5 oh, OK.
I got the name of the ward wrong.
You're so efficient! Am I? I was being sarcastic.
THEY LAUGH When she finally remembers what ward she's on, Emily goes to see her first patient.
How you feeling in yourself at the moment? - Still sore.
- Still really sore in your tummy? - Yeah.
- OK.
And you've not opened your bowels in a week, I hear? The woman has a pressing problem - she's extremely constipated.
Is it worse when I press in or when I let go? When you press in.
What did the X-ray show? The X-ray showed absolutely loads of poo.
It must feel horrendous.
Her stomach's out here.
She must just feel so uncomfortable.
Bless her.
That's all poo.
I think she's got something called adhesion, so, like, due to previous surgery or inflammation of the bowel, it all just sticks together and it's all horrible.
Emily decides to do a rectal examination.
It's her first one since she qualified as a doctor, and doing it on a nightshift, where there's fewer seniors around to supervise, is an added pressure.
With the problem you've got, it's really important that I examine your back passage as well.
- OK.
- So it might be a little bit uncomfortable, but it'll be really quick, - and it'll let us know what's going on really well.
- OK.
- Is that OK with you? - Yeah, OK.
You just have to put a finger in and just make sure there's no blood or any poo in the rectum.
Emily knows if she can relax the patient, it'll be easier for both of them.
All right.
I'm going in now.
Just squeeze for me.
OK.
Is that sore at all? Brilliant.
Well done.
Thankfully the rectal went smoothly, and Emily's hoping that the rest of her night is uneventful.
It's all about the glamour.
It's all about the bums, isn't it, surgery? Have you tried the soca Let's lift the beat all over Dance all night With me till the morning light Back at the house, Tom's party is getting into full swing.
Dance with me, dance with me All night But at the hospital, Emily's making the most of a quiet night on the wards instead.
All night, all night All night Dance with me, dance with me Junior doctors working on-call night shifts are allowed 20-minute breaks every four hours.
Luckily for Emily, they can use this time to nap.
And that's something she intends to take full advantage of.
Today I don't feel like doing anything I just want to lay in my bed Have you had a nap? Have you had a rest? No, not yet.
I've been working really hard, and I'm really tired.
LAUGHS I'm going to kick my feet up, then stare at the fan Turn the TV on, throw my hand in my pants Nobody's going to tell me I can't It's 8am, and Emily's night shift has finally come to an end.
I hate working nights and it's been really tiring, and I feel like I'm not here and I'm a bit zombied, so it's just not nice trying to think when your brain's like cotton wool.
It's just not pleasant.
As Emily finally gets to go home .
.
Ed's arriving for his first day on his new ward of acute medicine.
The Italian medic has had a difficult start to life in a British hospital.
He started off as a second year in the emergency department, but he struggled with some basic medical procedures.
It's been a while.
So he agreed to leave, and redo his first year in another, less demanding department.
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.
There was also another dramatic turn of events when he received the news that his father was seriously ill and he needed to leave the country immediately to visit him.
They said, "Please take one week off and go and see your family.
" I did and, well, my girlfriend and I got a plane Saturday morning and unfortunately we arrived in Paris and my father had just passed away.
Now he's back and more determined than ever to get his career on track.
- Do I just follow you? - Yes.
- OK.
His day starts with a ward round.
And Consultant Dr Osman uses a patient's results to test Ed's knowledge.
She's a lady who came in feeling unwell.
She's 86.
- This might be old changes.
- Yeah.
- They might be new changes.
So what will you do? Ed studied medicine for seven years in Italy, but, under pressure, he's finding it difficult to come up with the answers.
Yeah, I don't know the measurements.
- Normally it's less than 14.
- OK.
You have to know that.
- So you go and read about that, that will be very useful.
- Yeah.
- But you'll see this patient now.
- OK.
Dr Osman needs to know that his new starter has enough experience to cut it in a big hospital, so he asks Ed some questions about his training in Italy.
Unfortunately not.
No, I've never worked in a hospital.
I've seen outpatients and GP patients, but I've never worked in a hospital, so I'm getting to see all the patients now that I haven't seen in my previous job.
I haven't been treating patients with I've been working in a little mountain village in Italy and seeing patients during nights and weekends when the GP was not available.
That's all.
I haven't worked in a hospital yet.
Ed's beginning to realise that even though he's qualified, his studying days are far from over.
I was just caught, er, taken aback by one question which I should have answered straight away and to which I actually know the answer but for some reason, I just didn't tell him.
Anyway, I just need to convert the stuff I know into practice.
Nothing else, and that annoys me a bit, because it's all stuff I have studied and knew well, but never used in practice.
when you don't do things, you forget about them.
After a testing time on the night shift, Jen's back on days and it's the busiest week of the month as her ward fills up with new surgical admissions.
We've gone from about ten to about .
.
30, maybe, over the weekend, so quite a lot.
ECGs She's particularly concerned about one of the new arrivals.
- Are you looking after Mr Flusk? - I am.
- Has he had an ECG yet? - No, not yet.
OK, shall we do this ECG, and then I'll go and do his gases? - I'll see if he's finished with it now.
- Thank you.
83 year old Thomas Flusk has just had emergency surgery to remove his appendix.
The surgery was a success, but he's now having difficulty breathing.
And Jen is determined to get to the bottom of why.
He probably has a chest infection because he's post-op, and that's the most likely cause, but, you know, there's other things.
If he's very, very hypoxic, which means he's got very low blood oxygen levels, that can be a sign of a clot on his lungs.
The first thing Jen does is order an ECG to check his heart, but she also needs to test his blood.
How are you feeling? Yeah.
I'll sort you out.
But for a junior doctor, getting to the root of a complex problem isn't always straightforward.
The further you go with medicine, the more you realise you don't know anything.
So, yeah, it might look like I remember a lot, but there's an awful lot I don't remember as well.
The most important thing for a junior doctor is to recognise when something is wrong, but not necessarily what it is, because that's the years later that you'll find out.
Would I be able to sit you up just to listen to the back of your chest? - Yeah.
- Thank you.
Deep breath in.
When Jen finally gets to check Mr Flusk's blood tests, they confirm that something is wrong, but don't reveal precisely what.
He's on 40% oxygen, and his pO2's 8.
7.
So she sends him off to radiology.
If, as Jen suspects, he does have an infection, then it will show up on his chest X-ray.
Because the X-rays go straight on my computer, I get to see them almost immediately, so he's still down, he's not back yet, but I've seen his X-ray.
I can see that he's actually got fluid on his lungs, probably means that it's not a chest infection.
It's more likely to be this problem with his heart, which is quite common in someone his age.
Now that Jen has finally established what's causing his shortness of breath, she can plan his treatment.
I'm just putting some medication through and then I'm going to come and repeat his bloods just to see what's going on.
Hopefully it'll all be improving and going the right way.
You can't say you're not getting looked after, can you? It's another case ticked off for Jen, and she can now update her senior house officer with her findings.
Has he had an ECG? Yeah, his ECG.
I know if I tell Jen to do something, it'll be done, it'll be done quickly and it'll be done to a high standard, and I won't have to go back and double check that it's been done properly.
It's really nice to see the progress.
Whereas with the first take, it would be, "This has happened? "What do I do?" Now it's, "This has happened.
"I've seen the patient, I've done this, I've done this.
"Is that OK?" And I go, "Yeah, that's great.
You don't need me.
" The way Jen's handled this case has demonstrated just how far the first year junior doctor has come in a short space of time.
I'm a lot more confident in dealing with things like that than I was when I first started.
It's satisfying that we've found a problem, treated him for it and he looks a bit better.
He's still got a bit of a way to go .
.
and we'll see him on the ward round tomorrow and see how he is.
After a busy day on the wards, the junior doctors finally get a chance to relax together, ahead of a night out for Emily.
Emily, who you going on a date with tonight? I'm not going on a date with anyone, Olly.
Oh, God, you are.
Don't lie.
She so is.
- I'm not.
- Face tells it all.
- She's done her eyelashes.
I haven't.
They're real.
They're perfect.
You've separated them all.
I have.
Date.
Stinks of date.
Is he cooking you a nice vegetarian meal? Oh this is so embarrassing Or is he going to cook you up a meat feast? LAUGHTER Have you got any pre-date nerves? No, because I'm not going on a date.
And, one more question.
If it all goes tits up, how are you going to get home? I've got a car.
Oh, are you not drinking? No, it's a school night.
Don't drink on a school night.
- Sensible.
- Well, you do.
You old tanker.
What you trying to do? I don't know.
I'm never going to get a job or a boyfriend.
LAUGHTER It's a new day at the hospital.
And in the Heart Emergency Centre, Tom has been asked to treat a patient who came into A&E with chest pains.
- So it's Mr Flynn? - Yes.
Hi, Mr Flynn.
My name is Tom.
Mr Flynn has previously had a heart attack and a heart bypass, and since then, he's suffered from angina.
Do you just want to just describe it to me? Well, it's just a very heavy pain in my chest and, er Like a crushing kind of pain? - Yeah.
- Has it been happening at rest, this chest pain? Just happened now, yeah.
OK.
So you take your GTN spray under your tongue? - Yeah.
- And you took two squirts of it, do you? - Yeah.
- And it's still taken 25 minutes to work? - Yeah.
- OK.
Tom begins to suspect something is seriously wrong.
- You feeling clammy and sweaty? - Yeah.
- Do you feel like that now? - I do, yes.
- You do.
- I'm really sweating now, though.
- Are you? - Yes.
- Tell you what, I'll just - Really uncomfortable.
You're uncomfortable? Hang on, just give me two minutes.
Tom quickly alerts 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 getting some morphine and having his ECG now.
He's also sweaty and clammy and really grey.
- FEMALE DOCTOR: - Oh, really? - Yeah.
Has the blood pressure changed? Guys, his blood pressure is dropping.
If the man is having a heart attack, a drop in blood pressure could be 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 is ticking.
And this time, there is no margin for error.
Sorry.
Tom fails with his first attempt.
And the patient's blood pressure is still dropping, meaning his veins are getting thinner by the second.
He needs to fit the cannula now.
You just relax your hand and let me move it around a bit.
Yep, that one's in.
Can I get, erthe flush? The cannula's in, much to everyone's relief.
And the team manage to stabilise the patient.
Had we left him, there's every chance he could have had a full-blown heart attack.
No-one could say whether or not we prevented it.
No-one could say that.
But what is important was that we reacted quickly and, you know, we've just got to monitor him now to see what happened during that time.
Over the next 12 hours we should get a better picture of what's just happened.
So we'll see.
Now that Emily's off nights, she's back on her own ward doing what she loves most - building relationships with her patients.
- You feeling better today? - Oh, a lot better.
Are you? Good, good.
Must be tea time! SHE LAUGHS For the vampires! You're doing brilliantly.
Well done.
And since she started as a junior doctor, Emily's favourite patient has been 83 year-old Doris.
You're in the wars a bit, aren't you, Doris? You're bloodless.
I've taken it all.
I really like Doris, because she's so lovely.
That's her, really.
She's just so nice to everybody.
She always seems really happy, no matter what's going on.
She's never got a bad word about anyone.
So she's just lovely.
But Doris isn't responding to treatment, and her condition has become critical.
Why does her temperature go up and down like that? Doris' family and doctors now need to plan the best possible care for her in the last days of her life.
I think the end outcome is that she's going to die.
OK.
So it's more of a pragmatic decision in terms of, what is the end of her life going to be like? End of life care.
Are we going to make the end of her life comfortable? So for Doris, there's a difference between stopping all her medications and just carrying on, but not doing anything else.
The point is that we're not escalating her care.
All the treatment we're giving her isn't making her better.
It's a natural part of life, is death, and it's something that is sort of you have to work out when it's a priority to make sure that somebody's comfortable, rather than trying to treat them.
A few days later, Emily has to deal with the news that Doris has died.
And she has chance to reflect on the decisions made about her final days.
Doris and her family were really prepared for her to die.
They all thought it was the best thing for her to pass away peacefully rather than struggling on with active treatment.
So I'm really happy with how it happened.
I feel that she had a really dignified death, and she passed away peacefully and comfortably.
Emily must do one last thing for Doris - register her death.
It's a difficult job for any junior doctor at the beginning of their career.
I'm not 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.
But I'm glad that it's me who's got to come and say goodbye to her, because I feel like we've got to know her really well and it's quite important to me that we kind of finish off the whole process and close the book on it.
Emily isn't the only doctor struggling to deal with death.
First year Tristan works on a ward where all the patients are elderly.
The dilemma of when to stop escalating the care of those who are at the end of their lives is an issue of some debate, and one he'll regularly face.
I think there's already been a couple of patients where the senior doctors have, um I guess diagnosed dying, and I found it really hard to adjust to that.
Sort of saying, "This is what we've been able to do, "It hasn't worked, and "this is just the natural progression of things.
" Tristan's come for some advice from his senior, Dr Scott, about when to make the call to accept that a patient is dying.
We sort of made the decision to only provide supportive treatment, so that they can have a more comfortable and dignified time and the family can have that precious time with them before they died.
I don't know, I felt it was really difficult.
That's exactly the way you should be feeling at the minute.
You have this kind of conflict between what you have been trained to do, which is to make people better and get them home, versus actually then encountering the reality.
What you're learning now is not so much the science of being a doctor, but the art of being a doctor.
'The fact that he's actually thinking about that' and coming to talk to me about that at this early stage, I think, is a very good sign.
There will come a point in anybody who's severely ill where if you've got to the stage where treatment's not working, you've got to make a judgement.
Your patient relies on you to do that.
Your patient's family relies on you to do that.
But if you're worth your salt as a doctor, you will then go away and you will probably agonise over that.
The junior doctors are learning to deal with the emotional challenges of the job.
And after five years of hard study, one of the rewards is just round the corner.
Payday.
I can't really process the idea of having money at the moment.
It seems so alien.
The starting salary for a first year junior doctor is £22,500.
And their first slice of it can't come quick enough.
Because they're all skint, and resorting to desperate measures.
This one went off on the 10th of August.
- Can I have it still? - What? Lentil mousakka.
It might be all right? Yeah, you kill the bacteria, don't you, when you heat it up? Yeah.
It's not got meat in or anything that can go wormy, has it? I'm so excited about getting paid now.
I didn't genuinely think payday would be such a big deal to me until I became the poorest person I know.
And now, that's why we're having stir fry, because this entire meal probably cost me about 5 quid.
As the first years enjoy a budget stir fry, the only thing second year, Oli, will be eating tonight is hospital catering.
He's about to start a run of night shifts, so he'll be putting his social life on hold.
I went and saw some of my friends before nights, and we were just sitting around, playing a bit of FIFA, and I was thinking, "Ugh! "That would be a lovely way to spend this weekend.
" A few beers with some friends.
But instead, I will be with the fine residents of the Royal Liverpool and Broadgreen University Hospital.
Being the on-call medic on nights is a tough test for any new junior doctor, but for laidback Oli, a night shift is all in a day's work.
So I was brought up in Reading.
Went to school there.
I'm the first in my immediate family to go to university.
He was quite young, eight or nine, when we were at the dinner table one night and he said, "I'd really love to be a doctor when I'm older.
" And we all kind of laughed and said, "Oh, that would be a really good idea!" He worked hard.
I think he played hard too.
How would I describe myself? I'm probably a secretly competitive person.
Although, I don't know, my friends might say it's not so secret.
Smart, sleepy.
I'd go for lazy! I'm quite a laidback person.
I don't let things get on top of me.
I try not to get stressed out too much.
The chances of getting your full ten hours of sleep is highly unlikely, so I tend to make up for it with, yeah, napping in the evening or during the day, if I can get away with it.
When you start off, it's all a bit new and you're not quite sure how to handle it and you worry a bit.
- Is that the first one you've done? - Yeah, that was the first one, yeah.
'But as time goes on, you begin to take it more in your stride 'and, you know, you still take it seriously,' but it becomes a bit more routine and easier to deal with.
ALARM SOUNDS You're often thrown in at the deep end and you're just expected to be able to deal with these really difficult situations at times, yeah.
ALARM SOUNDS Where is it? Straight away, Oli's called into action.
It's an emergency.
This floor's fine.
But it turns out to be a false alarm.
The routine tasks Oli faces on a nightshift all need to be done during demanding 12-hour stints.
Something of a struggle for a man who likes his sleep.
You do, occasionally, when you're walking round on wards, you see an empty bed, and you're like, "Mmm, I could sleep the shit out of you!" But then, you're not allowed.
So you just carry on working! But night shifts are unpredictable.
And unfortunately for Oli, it's never long before there's another challenge to deal with.
Yet again, it's a crash bleep.
And this one is for real.
'When the call comes through, you forget how tired you are.
'Adrenalin 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.
' 5A.
We'll go through 5X.
Arriving at the scene of the emergency, Oli finds nurses working on an elderly woman who has stopped breathing.
Is there an output? She's got a pulse.
She's got a strong pulse.
Good output.
What's going in? Is that just normal fluids, or is there any antibiotics? - No, dextrose.
- Dextrose? Yeah, could we get a glucose? Oli takes charge of the team and they soon manage to stabilise the patient.
She's breathing now.
Just get the stats monitor on.
Have we got a drug card around here at all? With the patient beginning to recover, the situation no longer seems as bad as first feared.
It's not a cardiac arrest, but it is somebody who's maybe had a fit.
Sounds like they're known to have seizures, so Don't need any more of them tonight.
That'll do for me! One crash call per night is enough, I think.
Oli's made it to the end of his shift.
But just when he thought it was safe to go home .
.
there's another crash bleep.
And it's on Emily's ward.
What's going on? She's been on shift for less than an hour, but one of her patients is in cardiac arrest.
Does anyone know about this patient? As the on-call medic, second year, Oli, is needed to assist at the scene.
Could I get one of you two to get me an Ambu bag and a mask, please? Is there a pulse? Is thereI'll get gas.
Despite the teams' efforts, the man is showing no signs of improvement.
As Oli takes some blood, Emily continues chest compressions on her patient.
Nothing seems to be working.
And as the monitor shows no signs of a heartbeat, the doctor in charge has a difficult decision to make.
As the team tries one last time to restart the man's heart, Emily does another round of compressions.
The team pause, to check whether the monitor shows the patient's heart has started working on its own again.
But there's still no change.
It's been a tragic end to an otherwise routine night shift for Oli.
It was unexpected, a bit of a shock, bit of a downer to the night shift, to be honest.
For Emily, it's the second of her patients to die this week.
It's always much harder when it's your own patients.
She has a day job to get on with as well, so I don't think she'll let it affect her too much.
I think maybe wait until you get home, then let the emotional sidehave a think about that, otherwise, you can't get on with your day, can you? Emily was the first doctor on the scene when her patient went into cardiac arrest, and she's reliving the events with Tristan and Jen.
I hate being the first person there.
I hate it so much.
And I did not know what I was doing.
How long were you on your own for? I wasn't really on my own, I had the nurses with me, but I feel like I needed somebody very senior and calm just to direct everything, cos we were all rushing about, trying to get oxygen and start compressions and start timing.
I didn't know how to organise it, I wasn't organising it well.
You did the best you could do at the time, which is all anyone can expect of you.
Sounds like you did a really good job.
But Tristan's words are cold comfort to Emily.
When the senior doctor said, "Does everybody agree "that this is futile?" Then everybody took a step back and he was just laying there and got really pale and his eyes were open and he wasn't breathing, and I had to check on his chest that he was breathing' Do you think it will ever get easier? I hope it doesn't, in a way.
I don't want to get blase about crashes.
I hope that I get over crying, that I stop crying.
But I hope that I always feel a little bit for them.
After a shaky start yesterday, Ed's back for another shift on the Acute Medical Ward.
He trained in Italy, so his lack of practical experience of working in a British hospital means the learning curve has been that bit steeper.
He's in B2.
He's ready in B2? You go round the corner.
OK.
His first job is treating a patient with a severe headache.
- Do you feel anything at the back of your eyes? - A bit, yeah.
The man suffers from migraines, but Ed must rule out anything more serious by doing a neurological examination.
Can you give me some qualities of this pain? Is it throbbing? Is it continuous? Does it come and go during the day? Do you have peaks? It just throbs up there.
- It's been throbbing ever since yesterday? - Since yesterday, yeah.
I saw you marked your pain from zero to ten around ten.
- That must be very painful.
- Yeah, it was very painful.
How is it now? It's subsiding a little bit but it's still there.
Still throbbing, OK.
For Ed, there's a lot riding on this.
His last neurological examination was one of the reasons he left the emergency department.
So he can't afford to get it wrong.
If you could please follow the pen.
Look at my hands.
OK.
- Say, "Ah".
- Ah.
Can you feel? The examination requires Ed's full concentration.
And there's a lot to tick off his mental checklist.
Can you stick out your tongue? Lift up your shoulders against my force.
Grab my hands as firmly as you can.
Right.
Erm That, I think, isperfectly fine.
Look at me again.
Your right eye does seem redder than your left eye, so that also makes me think more towards some kinds of migraine.
I've had a migraine before and it's nothing like it.
I've never had flashing lights in my vision.
The patient is unsure of the diagnosis, so Ed gets a senior doctor to do a second assessment, which confirms he's got it right.
- SENIOR DOCTOR: - Your blood tests have all come back normal.
Good, good.
It sounds like a migraine.
We went over the history of the patient and the clinical examination and it was confirmed what I'd found, so it looks like I didn't miss out anything relevant, so that's good.
Now he's got the backing of his seniors, Ed goes to discharge the patient.
But he's got fed up of waiting, and has gone home.
There's nothing much I can do about that.
He's gone, he decided to go, he goes.
After a bumpy start to life as a junior doctor in Liverpool, Italian Ed's finally tasted success.
Just in time for a catch up with his mentor, Dr Pickles.
You are going in the right direction and that's encouraging.
Certainly when you've presented cases to me, I've been pleased with your initial diagnosis, your management plan, your examination.
- Obviously - There's loads of space for improvement.
- Absolutely.
At least I know I'm not working in a bad way.
I think this is a culture shock to him.
My understanding is that he was pretty much the only doctor in a rural area and didn't get too much hands-on experience.
I think coming to a hospital as big as the Royal, where you've got such a vast turnover of patients, where you're expected to see a lot of patients quickly, to do a lot of things in a short period of time.
It's going to be so hard for him, but he'll get there.
It's been a challenging week, and Ed's relieved that Dr Pickles has ended it on a positive note.
All in all, I'm feeling a bit worn out because it has been a long and busy day.
Certainly I've gained a little bit of confidence at least from my meeting.
I'm not worried about confidence, I'm just worried about working in the right direction and doing things as I should be doing them at my level, and that seems to be OK.
Plenty of space for improvement.
Ed's not the only junior doctor feeling upbeat.
They've all made it through their first stressful month on the wards.
And the moment they've all been waiting for has finally arrived.
- It's payday! - It's payday! - It's payday! ALL: It's payday! And after all their years of training, there can be only one way to mark such a milestone - cocktails.
Happy payday, guys.
Happy payday! Almost the first bit of gratification.
You've just got paid.
"Oh, good.
"It's a job, I'm settled, I've had my first pay cheque.
"I feel a little bit established.
" It's nice! It's really nice.
We've been working for a month now, so it's nice to see some money in the bank and stop scrimping and saving for the time being.
I need a handbag, some clothes, some new shoes, a bike, and I'm going to take my nan up some dinner.
- SHE LAUGHS - Cos she's helped me through uni.
The best thing about payday is being independent.
I want to buy my mum flowers because she's supported me for ages and now we can sever the cord and cut the standing order.
I can actually look after myself now.
Next week, on Junior Doctors can they handle the pressure of being doctors in one of Britain's booziest cities? You think of it as normal, going out with friends, but you see the real extreme end of it in hospital.
It's a race against the clock for Tristan as he takes on his very first ward round.
15 minutes behind already.
You can't switch off and let your seniors give you a list of things to do.
You have to make some decisions.
And Tom comes under fire in his very first presentation to senior consultants.
It's obviously irregular.
It's the irreg-, irreg-, irregularity of it.
There was no doubt I was going to get grilled when I was doing it.
There's no doubt I wouldn't get everything right.