First published 2017. Picador paperback, 2018, pp 280, c.65,000 words.
Kay was a ‘junior’ doctor who quit after six years of training and six years working in a public hospital in England. He is now a comedian and writes scripts for television and film. In this book, he brings his skills from the latter to bear on notes he took while in his former career. It is structured as a set of very short stories: anecdotes of the life of a junior doctor. It makes for highly amusing, sometimes horrifying, and occasionally wince-making reading. It also raises some important questions over hospital management.
Is the best way to organise a medical service to force the most junior doctors to work excessively long hours – essentially exploiting their goodwill and desire to prosper in the profession? Kay suggests that when a check is done on staff hours, suddenly all the consultants are around to lighten the load. Of course it is desirable that doctors receive intensive training and gain wide experience, and that unsuitable persons are weeded out. Rostering of staff seems to be particularly poorly managed with consequent detrimental impact on doctor’s private lives. Kay’s relationship with his partner visibly and unsurprisingly crumbles in the background of these anecdotes.
Kay’s prose is clear and straight-forward; there is no literary over-varnishing. Consequently it is an easy read, and as the stories are short, there is a great temptation to keep reading – just one more… He is very good at injecting humour into the horrifying, and he doesn’t appear to be holding back in describing his experience – if he was then I’m glad of it. Some of the stories are quite graphic, and as he worked in obstetrics and gynaecology they are likely to be even more disturbing to women than to men. Sometimes patients’ problems are self-inflicted – it is surprising what ends up stuck inside people. Mostly the problems are a result of bad luck, and the doctors are desperately trying to make the best of whatever comes before them. Some might criticise the book for being jokes at patients’ expense, but I didn’t read it that way at all. All patients are anonymised and most of the laughs are a result of our thinking that I was glad it wasn’t me. Laughter is a way of coping with the horrifying. Doctors and other hospital staff have to develop thick skins and a degree of detachment – death is an everyday occurrence in hospitals, to state the obvious, and those who work there have to learn to live with it, or they quit, as Kay did. It wasn’t so much the ridiculous hours or the bad pay that forced him out but an operation that went wrong as a result of a failure in diagnosis. He comes across as someone who wanted to do their damnedest to ensure a successful outcome for each patient, and got great satisfaction from achieving that most of the time. Sometimes, with all the care and skill in the world, things don’t work out. It must be heartbreaking on those occasions.
Of course this book is special pleading. Plenty of other young people starting out on professional careers get paid poorly, work very long hours and can have their social lives interrupted: lawyers, software engineers and management consultants for example. They have to prove themselves by making that sacrifice. But as public sector employees here in the UK, junior doctors do seem to have a particularly rough ride. Kay has it in for health sector government politicians, but the people of the country elect these people, and so we get what we deserve. Unfortunately there is never enough money to give every patient all the treatments possible, staff hospitals satisfactorily and pay those staff well. As Kay says about a patient: ‘he just wants to know there’s someone out there who cares. And actually, that’s a very large part of what being a doctor is.’ [p74]
Wikipedia biography of Kay: https://en.wikipedia.org/wiki/Adam_Kay_(writer)
Wikipedia summary of the book: https://en.wikipedia.org/wiki/This_Is_Going_to_Hurt
Others’ reviews of the book: https://www.goodreads.com/book/show/35510008-this-is-going-to-hurt?ref=nav_sb_ss_1_17 (This book has one of the highest overall ratings I’ve ever seen on Goodreads, but as always, some people hated it.)
© William John Graham, July 2023