This is Going to Hurt by Adam Kay

Reviewed by Annabel

I love reading medical memoirs; we’ve featured neurosurgeon Henry Marsh’s two volumes here at Shiny, and heart surgeon Stephen Westaby’s book Fragile Lives was a great read for me earlier this year. These books were written by surgeons who’ve reached the zenith of their careers. The chapters within concentrate on particular operations, often pioneering, and we meet the teams involved as well as the patients, whom the surgeons often get to know over months or years of treatment. These consultant surgeons really are the superheroes of the medical world, but don’t forget they also had a long slog to get to there too. They too started off fresh from medical school as junior doctors.

The memoirs of ‘junior doctors’ – an all-encompassing term that includes all doctors except consultants – are completely different.

Some years ago, I remember enjoying Max Pemberton’s columns for the Daily Telegraph, which started in his first year as a junior doctor. These were later collected into several books published between 2008 and 2012 and they combined wry humour with more sombre scenes and a bit of politics. Pemberton came across as a big fan of the NHS, even though critical of its governance, and is still practising within it as a psychiatrist.

Adam Kay left the medical profession as a senior registrar before reaching a consultancy post. The system burned him out and he has since become a comedian and award-winning scriptwriter. His Secret Diaries of a Junior Doctor were irresistible to me. Kay left the medical profession in 2010, after six years of working through the ranks of junior doctorship, so he was finishing as Pemberton was getting into his stride.

We skip through Kay’s first year as a House Officer quickly, reaching his first Senior House Officer post a year later – this is the point at which specialties are chosen and Kay opts for one of those that isn’t quite medicine or surgery:

I chose obs and gynae – or ‘brats and twats’ as it was charmingly known at my medical school…

I liked that in obstetrics you end up with twice the number of patients you started out with, which is an unusually good batting average compared with other specialties. …

Of course, the job would be difficult emotionally when things went wrong – not every stork has a happy landing – but unfortunately the depths of the lows is the price you pay for the height of the highs.

Kay gets stuck into his new world, and before long gets to be lead surgeon on his first caesarean. He also has to do more mundane things of course, like admin after a gynae clinic, writing GP letters. Ernie, a registrar peers over his shoulder:

‘You’re going to get struck off if you write that. Change it to “pus-like” or put a hyphen in that somewhere.’

I look down at the offending phrase. ‘She has a pussy discharge.’

Obs and gynae being one of the specialties where there are a lot of bodily fluids splashed around, we get a lot of side-splitting jokes about bodily fluids, objects found where they shouldn’t be, plus all the daft things patients say. To give Kay his due, he respects female anatomy and although this is a no-holds-barred account – so we get an eyeful in words so to speak – he doesn’t make fun of it.

Many of the jokes are to be found in Kay’s footnotes, which define medical terms as well as containing some great asides. Kay’s family is of Polish descent – named Strykowski – and he wryly comments in a footnote:

Strykowski is pronounced Strike-Offski, so I’m not convinced it’s a great name for a doctor.

This hilarity is tempered by the sheer hard work, night shifts, and the amount of unpaid overtime that Kay works for such low pay. For some years, there is no way he and his girlfriend H can afford to buy a small flat, especially as he must change jobs and move hospitals within their area ‘deanery’ every six months until he’s a senior registrar. Health Minister Jeremy Hunt is emphatically given ‘no thanks’ in the books acknowledgements.

The lack of a social life for junior doctors is telling too. Kay must pull out of stag nights, weddings, family gatherings at short notice, work at Christmas of course, and cancel a rare two-week vacation because he is put on the rota for the middle weekend despite having worked it all out. H is impossibly understanding – but can their relationship last under these pressures?

The worst thing for a doctor must surely have to be carrying on after a distressing death. They are rostered for the next shift and must put the semblance of a normal face on for the next patients. There is no-one to take care of the doctors, and Kay brings home the ‘depth of the lows’ he referred to back at the beginning of the memoir. This necessary detachment means that few of the patients are remembered, continuity of care is rare, and most patients flit through the pages as anonymous initials.

The pioneering consultant surgeons may be the superheroes of the medical world, but we must take more time to consider the plight of the everyday heroes – the myriad junior doctors who do most of the work, often for few thanks and as we’ve seen, not enough money.

This is Going to Hurt is such a thought-provoking book. Underneath its painful wit is a cry for help – crying and laughter are not so far apart after all.

Annabel is one of the editors of Shiny New Books.

Adam Kay, This is Going to Hurt: Secret Diaries of a Junior Doctor (Picador, 2017). 978-1472623782, 288pp., hardback.

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