Book review: This is Going to Hurt, by Adam Kay

Adam Kay PIC: Martinovic and Noble Photo Agency
Adam Kay PIC: Martinovic and Noble Photo Agency
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The Scotsman’s monthly review of a book about health, promoted by Wellcome

There’s no point in being churlish, the disclaimer is right there in the title. Reading This is Going to Hurt is indeed painful. It will make your eyes water (an account of a patient who suffered vaginal burns from stuffing her lady garden with Christmas lights and then, of course, turning them on) and it may well make you choke on hot tea (it’s very, very funny), but it might cause a different kind of pain too, an ache connected to the parlous state of the beleaguered NHS.

Adam Kay was a junior doctor for six years. This is Going to Hurt is a collection of his diary entries from 2004 to 2010. It was borne of a Fringe show Kay did, having hung up his stethoscope, which an editor saw and encouraged Kay to use as the basis for a book. It’s Kay’s attempt to make sense of his medical career before it ended suddenly and sadly (as Kay writes, “sorry for the spoiler – but you watched Titanic knowing how that was going to play out”) and he decided he’d rather take risks on the more manageable scale of laptops crashing and shows being panned - he’s now a successful comedy writer – than life or death. The book is also an impassioned plea for us to wake up to what goes on in hospitals and how they are increasingly being held together by not much more than goodwill and bloody mindedness.

It is a truly laudable book, hilarious, moving and caustic. If you’ve been disappointed by the NHS, it will give you a way to contextualise your feeling. If you’re a fan of our (for now) free, universal healthcare you will find much to bolster your belief. And if you can hardly believe Nye Bevan’s creation has survived, albeit clinging on by bloodied stumps, now that the fingernails have gone, you’ll find plenty to explain how we got here. It also happens to contain the best footnotes I’ve ever come across – packed with information, medical and otherwise, and dripping with sardonic wit.

“Every doctor makes their career choice aged sixteen, two years before they’re legally allowed to text a photo of their own genitals,” Kay writes. “When you sit down and pick your A levels, you’re set off on a trajectory that continues until you either retire or die.” His own medical career was settled by an expensive education and a father who also happened to be a medic. When he had to specialise he chose obstetrics and gynaecology, “brats and twats” as it was known. And he did a good job, progressing from House Officer to Senior Registrar. He put up with the idiocy and eccentricity of the great British public, bureaucracy that would leave Kafka speechless and a workplace culture that might reasonably be described as the sickest patient on the ward.

I want to be clear: I love the NHS. And yet I know the experience of using it can be frustrating and difficult. Kay explains why: an unwieldy structure, anachronistic managerial and working practices, resources completely out of kilter with the demands placed upon them. The patient stories impact and linger in the mind, but so too does the question of how junior doctors have managed to put up with working as they do for so long. There’s the constant unpaid overtime, the cancelled holidays (leave is impossible to organise), the nonexistent social lives (working a 97-hour week pretty much knocks that on the head), the failed relationships and the kind of pressure that’d make the average corporate HR policy spontaneously combust. Kay notes the outrageousness of it all. So when a young house officer arrives in A&E one night having attempted suicide by overdosing on antidepressants Kay’s take is simple: “The 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.” The house officer survived but Kay reflects that had

she died, “I doubt we’d have got so much as an email… I’m pretty unshockable, but I’ll never cease to be amazed by hospitals’ wilful ineptitude when it comes to caring for their own staff.”

Kay’s book is vital and timely. It should be required reading for anyone who ever has any political or financial responsibility for our health services. Kay presents the countless patients he treated but also his own story, the sacrifices, the successes and then the final straw. “I should have had counselling – in fact, my hospital should have arranged it,” Kay writes of the traumatic incident that marked the end of his career. “But there’s a mutual code of silence that keeps help from those who need it most.” And if that doesn’t make you wince, I’m not sure what would.

*Claire Black is a Gestalt Therapist based in Edinburgh

*This is Going to Hurt is published by Picador, £16.99. Adam Kay will be talking about the book at venues across Scotland from 5 October, including Waterstones Glasgow, Mainstreet Trading, St Boswells and Toppings, St Andrews. For more details go to www.panmacmillan.com/events