Review: This is Going to Hurt by Adam Kay

In 2015-2016, junior doctors were entrenched in a war of words with the Health Secretary, Jeremy Hunt, leading to an unprecedented series of strikes. It is not unusual for NHS workers to decry the performance of the Health Secretary but it is rare to see the Government – followed by some of the media – push back as hard. Step up Adam Kay. A former doctor, Kay had been recounting his experiences of the NHS (based on his personal diaries) for laughs at the Edinburgh Fringe as part of his new career as a comedian, when, seeing the pasting former colleagues were taking in the press, he decided to turn his show into a memoir of life as a junior doctor. This is Going to Hurt (2017) was born.

If the campaign to paint junior doctors as money-hungry elites who were selfishly striking while patients needed them had gained any traction at all, Kay’s inside scoop on life in the NHS dispelled a few myths. Not least when, calculating his own wage, he discovered that, taking into account the additional hours he worked daily, he was earning less per hour than a McDonalds shift supervisor, and certainly less than the hospital parking meter. What a money-grabbing upstart.

But while This is Going to Hurt might have been born of a political struggle, Kay manages to make it a very human memoir that doesn’t overburden the reader with the message that, you know, the NHS is being propped up by the good will of its staff and any Health Secretary is ill-advised to disregard this fact. Instead, Kay’s narrative is a cheeky – arguably cocky – look at the pressures and the pleasures of being a junior doctor and some of the small absurdities of working in the NHS ("In gynae clinic, I go online to look up some management guidelines for a patient. The trust's IT department has blocked the Royal College of Obstetrics and Gynaecology website and classified it as 'pornography'."). Stories of missed social appointments, sleeping in hospital car parks, and being undermined by consultants are interspersed with amusing anecdotes of patients that presented to Kay in his various roles, but also bruising moments where the outcomes were not what doctor or patient desired. In so doing, Kay sidesteps the archetype of the doctor as a noble saviour and instead demonstrates that doctors are just as prone to stupidity, vanity, and inanity as the rest of us. And probably twice as likely to use the f-word, judging by the expletives found here.

The fallible and sweary picture of young medics that Kay paints won’t be for everyone. Each time a colleague or a patient – all anonymised, of course – are the punchline to one of his jokes, you can feel the illusion of this young doctor being thought of as a ‘nice young man’ by your nan slowly dying. Some of this bravado is, doubtless, part of Kay’s comedy shtick so it is best not to take it too seriously. We all have our coping mechanisms, after all.

Following Kay through his early years onto his chosen specialism of obstetrics and gynaecology ("brats and twats” as it is, according to Kay, affectionately known), the anecdotes come thick and fast. One minute, Kay is attending a patient who has managed to unsheathe his member by drunkenly sliding down an abrasive pole; the next, he is delivering a stillborn baby. He jumps rapidly from professional to personal, uplifting to devastating, and the book’s roots as a one-man comedy show are evident. At times it would be nice to linger on certain scenes he sets, but the junior doctor has no time to dwell on a moment, so why should the reader? This is the hectic and eclectic representation of a career where there is rarely time to breath out.

Through the patchwork of rapid-fire anecdotes and the smartly delivered quips, Kay’s humanity is exposed. He emphasises that picking a career in one’s mid-teens is always likely to lead to a higher than desirable attrition rate as young people simultaneously discover the reality of working in the NHS, and their personalities as burgeoning adults (because yes, even into their twenties, taking responsibility for others’ lives is still a lot to ask of someone who has probably learnt to save a patient’s life before they have learned how to take care of themselves).

To emphasise the absurdity of this, Kay writes: “Every doctor makes their career choice aged sixteen, two years before they’re legally allowed to text a photo of their own genitals... When you sit down and pick your A levels, you’re set off on a trajectory that continues until you either retire or die.”

It isn’t a great surprise, then, when a particularly difficult day proves the tipping point for Dr. Kay. Unable to overcome an especially traumatic case, he is forced to evaluate his career choice and finds himself growing away from the profession to become another member of the ex-NHS fraternity. Few of those will have gone onto a career as a comedian but each one’s absence is keenly felt by colleagues and by a service held together by its people.

This is Going to Hurt declares its intention for both reader and author from the title itself. It is an amusing book but it is painful too. It tells of a life being crushed by the weight of serving in the NHS, of a service failing its staff and showing stress fractures all over the place – between staff that leave and those that remain, between public and private sector health services, doctors and politicians, life and death, and, most importantly, between people, among those that serve but also between those that love someone who gives everything they have to a service and the impenetrable profession that asks so much.

One of the most cutting observations comes when Kay witnesses a young house officer returning to work after attempting suicide. He writes, “[t]he only surprise is that it doesn’t happen more often – you’re given huge responsibility, minimal supervision and absolutely no pastoral support. You work yourself to exhaustion, pushing yourself beyond what could be reasonably expected of you, and end up constantly feeling like you don’t know what you’re doing.” When he hit his own brick wall, Kay didn’t receive, or ask, for any help either: “there’s a mutual code of silence that keeps help from those who need it most.”

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