Category Archives: Non fiction
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.
Time for another WWW Wednesday hosted by Sam at Taking on a World of Words.
What are you currently reading?
I’m almost at the end of The Salt Path by Raynor Winn. This was one of the books I received as a present last Christmas having heard about it via one of the national newspapers in the UK. It’s proving as superb as their review indicated. It’s the true story of a couple in their fifties who lose their farm, their home and their business after an investment in a friend’s company went belly up. Then they get told the husband (who labours under the strange name of Moth) has a serious brain disease for which there is no cure. Homeless and penniless they decide to walk the South West Coastal Path – a trail of 630 miles, camping wild as they tramped. It’s a fantastic tale about courage but also makes some insightful comments about the way in which homeless people are viewed in the UK.
I’m also reading Punch, a collection of short stories by Kate North, one of the authors from Wales I’ve highlighted in my Cwtch Corner feature. Kate described the book as “A collection of strange and unsettling stories exploring the unexpected in the everyday.” I’ve read two so far and they are definitely strange – one involves an author who takes a rental cottage in France to complete her latest commission but has to share the premises with a very unfriendly mask. Another is about a man who develops a weird growth on his hand….
What did you recently finish reading?
Mary Barton was the first novel by Elizabeth Gaskell although her authorship was not known at the time of its publication in 1849. It’s set in Manchester and is partly a romance but, far more interesting, is that depicts the problems experienced by the working class in the city and the growth of trade unionism. The final sections do become a little heavy on the message of redemption and the need for increased understanding between workers and employers but otherwise this was a beautifully written and constructed tale.
What do you think you’ll read next?
I don’t have to think too hard about this for once. We have a book club meeting at the weekend and I haven’t yet opened the chosen novel – Kate Atkinson’s Transcription. My last experience with Atkinson via Life After Life wasn’t a good one so I’m hoping Transcription proves to be more akin to the earlier Atkinson novels that I loved.
After that comes Evelina by Francis Burney which was the novel I ended up with as a result of the last Classics Club spin and which I’m *supposed* to read by end of May. But I won’t feel compelled to read it if I don’t feel in the mood at the time. I keep eyeing all the books I’ve bought in recent weeks and they’re calling to me more than Miss Burney.
I first came across the term “mindfullness” in the context of a new safety campaign at work. At the time I thought it was yet another buzz term winging its way across the Atlantic; a new trend about which we would hear endlessly for a year or so before it fizzled out like so many others.
But I kept bumping up against the term in newspapers and magazines and in radio interviews although these didn’t seem to have anything to do with safety awareness. Various ‘celebs’ seemed to be getting super excited about this mindfulness malarky (a development which is guaranteed to get my eyes rolling). Over time certain expressions associated with this concept wormed their way into my head, the chief one of which was “being in the moment” whatever that meant. Sounded very hippy drippy to me.
It’s taken a while for me to get over that initial suspicion and I don’t claim to be anything like an expert but this year I’ve come round to thinking that there is after all more to mindfulness than I’d expected.
My ‘ah ha’ moment (conversion is far too strong a term) came during a mindfulness introductory day run by my local authority. I decided to go with an open mind. Fortunately the tutor was someone who had extensive research evidence to back up claims about the ability of the regular practice of mindfulness techniques to affect our brains, our sense of well being and our health.
Fresh with that new found insight, but wanting more, I went in search of some sitble reading material.
Oh dear. There is an awful lot of dross out there on this topic. Some books I came across contained about as much useful information as a box of detergent. Massive claims about how the practice can change your life. But little evidence about how….
But then, via NetGalley I came across a book by a man who is considered the leading expert on mindfulness, the man credited with starting the whole shabang.
Jon Kabat-Zinn has a Ph.D. in molecular biology. His work in the area of stress reduction and what became known as mindfulness, began in 1979 when he founded the Stress Reduction Clinic at the University of Massachusetts Medical School. He’s developed the practice based on extensive research studies.
In his book, The Healing Power of Mindfulness, he shares examples from his decades of experience working with people suffering anxiety, depression and stress. He’s clear that it isn’t a cure for all situations – he doesn’t claim it cures serious illness for example – though it can boost the immune system to make you less susceptible to certain diseases. It’s more a case that the regular practice of mindfulness techniques helps rewire the mind so we can each deal with our particular challenges and make the most of what we have, whatever that might be.
Through the book we learn about a concept called brain plasticity (the astonishing ability of the brain change and reorganise itself – as evidenced by studies showing the effects of meditation of Buddhist monks. Now in case you were alarmed, thinking that you’d have to become a monk to reap the benefits of mindfullness, rest assured Kabat-Zinn isn’t expecting that of you. In fact, some years ago he deliberately removed the Buddhist element to his teachings so that it would have wider appeal.
Reading The Healing Power of Mindfulness, I also, finally, got to understand what that phrase “being in the moment” really means – it’s about coming to terms with things as they are, not worrying about the future or revisiting the past. But just thinking about the present moment.
Stress is cause by being here, but wanting to be there, or being in the present but wanting to be in the future. It’s a split that tears you apart inside. … It takes a huge amount of fortitude and motivation to accept what is ….
This is not an easy book to read. Originally published in 2005 as part of a larger book titled Coming to Our Senses, The Healing Power of Mindfulness is written often in a complex style that means I had to read passages more than once before I grasped the meaning. It wouldn’t be the book to read if you had no prior knowledge of mindfulness. But if you have some knowledge, and want to go further, this would be great resource. If your appetite is still not satisfied by the time you to the end, there is an extensive bibliography of additional material to explore.
I lead a gentleman’s life. Listen to Mozart, read many, many books. I’m a voracious reader. History, in particular the British Navy, is my subject. The Nelson era and World War II are top of my list, but I do the ancient Romans too. I have a fine library furnished with these works, with dark wooden shelves reaching to the ceiling. This is where I hole up.
This is not perhaps how most people would picture the leisure days of one of rock and roll’s most famously debauched characters. Yet in his 2010 autobiography Life (there were surely more compelling title options than that!), Keith Richards comes across as a surprisingly erudite, intelligent and articulate individual. And yes, in his own way, he seems to be a gentleman – and a gentle man.
‘Surprisingly’ sounds condescending and perhaps a little naive – swallowing the druggie, dissolute showman image whole and not giving too much thought to the fact that that there is a person underneath this facade.
And this autobiography reveals a person who is thoughtful, perceptive, caring and seemingly completely without prejudices and the baggage of judgement. Naturally his background means that he is not a great respecter of ‘suits’ – the Establishment. The 75-year-old (67 when the book came out) has always been ready to ‘stick it to the man’ both in song, gesture, verbal exchange and – in previous years – in deed (he’s had a few punch-ups along the way and admits to habitually carrying a knife).
The writing style here is engaging. How much credit is due to the co-author James Fox is difficult to judge. The former Sunday Times journalist has been a friend of the rock star since the early 1970s and would certainly be able to bring an authentic authorial tone to the writing. But to me the voice (and certainly the view of life) belongs largely to the man himself. Fox is perhaps not so much ghosting and tidying up the prose – putting apostrophes where they should be and reworking sentences which lost their way.
First meeting with Jagger
We begin in 1940s Dartford, Kent, birthplace of Richards and a certain Mick Jagger. The family history background, often rather tedious in works such as these, is illuminating and entertaining. By sticking to the salient, Richards keeps the reader engaged.
From a boyhood love of the guitar and hours of finger-bleeding practice, his story leads us through the famous railway station meeting with Jagger – where a profound affinity in musical taste is established – to the early days of playing for beer (or for nothing) in seedy clubs and grimy pubs. Band members come and go; Brian Jones appears and stays; Jagger and Richards really want a drummer called Charlie Watts and they manage to snare him; a bassist called Bill Perks completes the line-up under the name of Wyman.
Years of poverty (getting the deposit back on stolen beer bottles) in squalid houses and flats precede a sudden propulsion – under the management of Andrew Oldham – to modest fame, notoriety (urinating at the roadside) and ultimately world-dominating rock deity.
The career-span of The Rolling Stones is unprecedented in the world of showbiz. In the 1989 documentary 25×5, Richards (then a mere 46 years old) said the band was travelling ‘without maps’. No other group had lasted that long; there was no model, no template to follow. Amazingly the Stones continue to tour to this day filling gigantic stadia the world over. They’ve gone from ‘Lock up your daughters’ through ‘Lock up your mums’ to ‘Lock up your grannies’ and still (replacing a guitarist or two) they rock on.
The rise-to-fame part of the story Richards tells without pretensions of grandeur. He knows the band is unique and very good at what they do. He doesn’t have to work the message. His engaging, chat-over-a-pint style is never affected. He is proud of his achievements but not boastful.
An unreliable narrator?
There is, however, a point in the book where Richards becomes less engaging and develops the feels of an unreliable narrator. For most of the 1970s he was catastrophically involved with drugs. Heroin, in particular, created turmoil in his life. Though he somehow managed to make the gigs and turn up in the recording studio, his life was formed around drugs and the necessity to have them available. It took several years, in and out of cold turkey, to free himself from smack. When he came round, it was the 80s.
It is in this passage of Life that Richards loses my good will. He complains about Jagger’s insistence on controlling the band and making the decisions – conveniently forgetting that for a decade he was more or less out of his wits and his band mate had stepped up to the mark to keep the show on the road. Until then Richards had always been the glue, keeping the best interests of the group at heart and pushing forward.
Though there had been some disagreements between the two before (an unavoidable clash of two massive egos) this was the start of a rift between the boyhood friends which endures to this day. Richards complains that Jagger became ‘a control freak’ but doesn’t acknowledge that there was probably good reason for Mick taking the reins – doubting, as he must have done, the mental capabilities of his junkie partner.
Earlier in the book Richards complains that Brian Jones had become unpredictable and unreliable because of his drug habit. Regarded as an embarrassment and dead weight, he wanted Jones gone. Jagger can’t be blamed for feeling Richards had become a similar encumbrance, though the loss of this gifted songwriting partner would probably have dealt a lethal blow to the band.
But Richards pulled out of his nosedive and the band played on. The group’s legendary globe-trotting tours continue to this day with all four frontmen well into their 70s, travelling without maps and, seemingly – bar the odd accident with a coconut tree – without care. As they once observed: it’s only rock n roll.