This is Going to Hurt – Secret Diaries of a Junior Doctor
Adam Kay (2018), Picador, London.
280 pages, £4.99.  ISBN: 978-1-5098-5863-7.

Within the last month, my reading has gone from the admirable to the matchless to the madcap – from The Penguin Book of the British Short Story to The Inimitable Jeeves to This is Going to Hurt.  In my defence, I needed a book for about £5 to make up an Amazon package to avoid the cost of postage and Adam Kay’s book fitted that bill.

The author
Adam Kay was born in Brighton into a family of doctors and educated at Dulwich College, Imperial College School of Medicine and Imperial College, London.  He self-identifies as a Jewish homosexual, who lives with his partner, James Farrell, known throughout the book as H.  And Kay is an abortionist – ‘I performed a large number of TOPs [termination of pregnancies] in this job’ (p. 198).  And no, I am neither anti-Semitic nor homophobic, but I am pro-life.  Even so, I think I would enjoy dinner with the author one evening, especially as he can now afford to pay.  Perhaps we should make it a light lunch because Kay has a BMI of 24 (p. 211).

The book
We have a fascination and a fixation with the world of medicine and hospitals and doctors.  For example, think TV shows like Dr Kildare and M*A*S*H through to Casualty and Holby City.  Books about doctors, by doctors, are also much in vogue.  Think Atul Gawande, Henry Marsh, Oliver Sacks and Kathryn Mannix.  But This is Going to Hurt is rather different.  It is serious medicine with serious humour, droll doctoring, but with an intense undertone and a sad, sad ending.  What also makes it different is its phenomenal success.  Published in 2017, This is Going to Hurt was Kay’s first book and it has remained in the Sunday Times bestseller list for almost 100 weeks with sales of well over one million.  His second book, Twas the Nightshift before Christmas, appeared in October 2019.

The book consists of a collection of diary notes, apparently secretly written while Kay progressed from lowly medical student and house officer through the NHS promotional system of senior house officer, registrar to senior registrar.  He chose to specialise in obstetrics and gynaecology – 'I liked that in obstetrics you end up with twice the number of patients you started with’ (p. 32).  Yet, in 2010, after six years of medical school and another six on the wards of various hospitals, Kay resigned.

This is Going to Hurt is a book of two parts, or with two interwoven themes.  First, there is the very witty account of life on the NHS frontline.  Second, there is the very heartfelt account of the struggles – medical, bureaucratic and personal – of a junior doctor.

First, the witticisms appear on every page.  Some are so bizarre they seem fabricated, if not just a little overegged, for publication purposes.  For instance, there are accounts of various peculiar objects that get stuck in various bodily orifices, as well as the astonishing ignorance and naivety of some expectant mothers and fathers.  Then, since Kay specialised in obstetrics and gynaecology, there are alarming accounts of life and death situations, especially those involving Caesarean sections, which mostly involve jolly, if not always jovial, outcomes.  Perhaps to try and de-stress under his enormous pressure of work, much of his humour is school boyish and genitally themed.  On the other hand, there are numerous educational footnotes giving opportunity to brush up on obs and gynae terminology, such as, colposcopy, cord gases, puerperal psychosis, primiparous and ascites.  And readers will have to endure repeated gratuitous swearing – sadly, it has become the lingua franca of our entertainment world and beyond.

Second, Kay’s personal struggles appear on almost every page.  Twelve-hour shifts, endless overtime, lack of sleep, disrupted personal life, privation of food, inordinate stress and strain, mindless bureaucracy, grumpy colleagues and much, much more.  As clients/users/patients of the NHS we are typically delighted with its staff and their performance.  We routinely go into hospital sick and come out better.  The NHS is our national treasure.  But there is this other side.  That free treatment for us comes at a price to them.  Here is Kay’s perspective (p. 198), ‘The hours are terrible, the pay is terrible, the conditions are terrible, you’re unappreciated, unsupported, disrespected and frequently physically endangered.  But there’s is no better job in the world.’

In conclusion
Suddenly, on p. 254, the diary format ends with an entry for Sunday, 5 December 2010.  There has been a crisis and Kay is in the thick of it.  He is the senior doctor on the labour ward.  A patient needs a Caesarean section for foetal distress.  His senior house officer wields the scalpel and disastrously hits the uterus.  Rather than amniotic fluid, blood pours out, twelve litres of it in total.  There has been an abruption – the placenta has separated from the uterus because of a previously undiagnosed placenta praevia.  Kay takes over, delivers the placenta and the baby.  The baby is dead.  Kay and colleagues fight to preserve the life of the mother.  They do, just.  Kay cries for an hour.

This is the turning point of the book – there are no more laughs.  It is also Kay’s personal crossroads.  Though not negligent, he has failed himself.  He is now a different doctor.  Bad stuff, sad stuff inevitably happens in human medicine, but this was the deal breaker.  Kay could not continue with what he came to regard as an absolutely impossible task.  He took less demanding jobs, ‘but after a few months I hung up my stethoscope.  I was done’ (p. 260).

Six years later, this book appeared.  It closes with a plea for the UK population to lobby the media and their MPs to save and improve and fund our dear old NHS.  Kay now writes and script-edits comedy for TV.

Yet Kay’s call to arms may well fall on deaf ears.  In the week I finished reading this book, The Times of 25 February carried a piece by Carrie MacEwen, chairwoman of the Academy of Medical Royal Colleges, which brings together 23 medical royal colleges and faculties.  She stated that doctors need to stop moaning and take responsibility for improving the NHS.  She said ministers have given the NHS a ‘substantial sum’ of money and doctors must now stop blaming the government for all its problems.  Britain’s 220,000 doctors have a professional duty to make the health service’s ten-year plan work and can no longer ‘sit on their hands’, Professor MacEwen continued.  After years in which the loudest medical voices have tended to complain about government funding and staffing levels, she said that doctors should take advantage of a ‘golden opportunity’.

Kay and MacEwen are at loggerheads.  They cannot surely both be right.  MacEwen is a consultant ophthalmologist.  One wonders, has she read Kay’s book and when did she last work as a hospital senior registrar on a hectically busy ward?  And when does her current job ‘hurt’?  We know when Kay’s did.  And it ‘hurt’ him so much it became too much.  This is Going to Hurt delivers an amusing read, but also a hefty emotional jolt.

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