Adam Kay (2018), Picador, London.
280 pages, £4.99. ISBN: 978-1-5098-5863-7.
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.
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.