This is Going to Hurt: Secret Diaries of a Junior Doctor by Adam Kay: book review
If you’ve ever required treatment at a National Health Service hospital, you’ll know how frustrating that can be:
- Lengthy waits to see a specialist/consultant.
- Clinic appointments running hours behind schedule
- Surgery dates postponed or cancelled.
It’s easy to feel after those experiences, that the much-lauded public health service in the UK has reached a breaking point. That it’s on the point of collapse.
Adam Kay’s memoirs make it evident it’s the selfless efforts of junior doctors that prevent it from collapsing.
Equally clear however is that their dedication comes at a huge personal cost.
This is Going to Hurt is a painfully honest memoir from one junior doctor on the frontline of the NHS. Adam Kay worked in hospitals for six years. He hung up his stethoscope in 2010 after a traumatic experience with a mother and baby in his surgery.
I’ve read enough newspaper reports to know that junior hospital doctors (those below consultant level) are poorly paid and over-worked. In 2016, in a bitter dispute over employment contracts, they staged the first strike in the history of the NHS. The dispute was settled only this week.
Undermined by bureaucracy
What I hadn’t realised until reading Adam Kay’s book was how much these professionals are undervalued and their expertise undermined.
Junior doctors give up their personal time and put marriages and friendships at risk rather than walk away from patients whose lives are in danger.
Yet scandalously ….
….they get charged for parking their car at the hospital. And fined when they over-stay ( even when their delay was caused by an emergency patient);
… doctors have to find their own cover when they inconveniently fall ill and
… they are not allowed to sleep on a spare patient bed after an 18 hour shift. They have to make do with a chair.
I was astounded to discover just how relentlessly gruelling are the lives of junior doctors. The system makes it virtually impossible for them to have any kind of life outside their work.
It was not unusual for Kay to work a 100 hour week.
He describes times when he fell asleep in his car, in the hospital grounds, or at the traffic lights. Once he nodded off while sitting on an operating theatre stool waiting for his patient to be wheeled in.
On one occasion he was recalled from a long overdue holiday in Mauritius because the doctor meant to be covering his shift was ill. The hospital refused to pay for a locum. He lost count of the number of anniversaries, birthdays, weddings and theatre performances he missed “because of work.”
What kept him going was the positive feeling he would get after a shift in which he delivered multiple babies or aided infertile couples to become parents.
Comedy amid the tragedy
Although Kay doesn’t hold back from describing tense situations, when the life of his patient hung on a thread, he balances the darkness with flippancy and witty repartee.
When the doctors and nurses are not attending to patients, they’re busy swapping jokes and anecdotes about the bizarre conditions presented by some of their patients. I suspect this is the kind of black humour often used by police officers and firemen. It’s a kind of release valve for people working in the emergency services.
Adam Kay has plenty of stories.
There’s the one about the drunken woman who climbed over a fence to get away from policemen. She slipped and ended up in emergency with a metal pole thrust through her vagina. After removal she calmly asked if she could take the pole home as a souvenir.
Or the tale of another woman who secreted a Kinder egg containing an engagement ring, intending to give her boyfriend the surprise of his life. It worked, though maybe not the way she intended, when the egg got stuck…
As a specialist in obstetrics and gynaecology he encountered a surprisingly large number of people who arrived at hospital with foreign objects in their rectums. The staff are so familiar with the problem they’ve even found a name for it: “Eiffel syndrome” (to understand the joke you need to say the following words aloud – “I fell, doctor! I fell!”).
Not all encounters generate humour. Medical staff are often confronted by aggressive patients and family members, or patients who make unreasonable demands. There’s a particularly yucky case he mentions in which an expectant mother wants to eat her placenta. He gets his revenge by ‘accidentally’ revealing the gender of the baby to the most aggressive of the expectant parents.
Lack of investment
This Is Going to Hurt swings between flippancy and frustration. Some of Adam Kay’s criticism is directed at hospital administrators for their propensity to introduce ever more new rules. But he lays the greatest blame on the shoulders of politicians who had failed to invest in the NHS over several years, leading to staff demoralisation.
My over-riding impression however is that Adam Kay loved the NHS and preferred to work in the public sector even when private practice would have been more financially rewarding.
Asked to represent the medical profession at a school’s careers event he decides honesty is the best approach:
So I told them the truth: the hours are terrible, the pay is terrible, the conditions are terrible; you’re under-appreciated, unsupported, disrespected and frequently physically endangered. But there’s no better job in the world.
This was a fabulously engaging book that was a good companion to Do No Harm by the neurosurgeon Henry Marsh that I read earlier this year.
Funny, informative and poignant it ends on a note of frustration, particularly when Kay describes the agonising event that prompted his resignation. It let to the death of both baby and mother following a caesarian operation. Although Kay had followed all the correct procedures, he still blamed himself. He suffered a period of depression but was not given any therapy by the hospital or allowed time off to recover. After a few months he handed in his resignation.
This Is Going to Hurt: footnotes
This is Going to Hurt was published in 2017 by Picador.
It’s written in the form of diary entries that were maintained by Kay during his medical training and his time as a hospital doctor. The diaries were intended as a “reflective practice” in which he could log any interesting clinical experiences he experienced. He used the material, suitably anonymised to write his book.
He has since embarked on a career as a comedian and scriptwriter. His new book Twas the Nightshift Before Christmas, is published in October 2019.
Read an interview with him in The Guardian newspaper.