This is Going to Hurt
This is Going to Hurt: Secret Diaries of a Medical Resident
By: Adam Kay
[Fulfilling “A book about/in a hospital” as part of the 2021 Fall Reading Challenge.]
“However a health-care system might be set up or funded, the experience of being a doctor is utterly universal. The same heartbreak, the same hilarity, the same damaging work schedule, and, of course, the same baffling array of objects getting constantly inserted into orifices.”
Adam Kay, England native, shares his experience in the medical field— his career picked at the ripe age of 16 as is common in the UK— and all the ups and downs of working in a hospital with the NHS (National Health System). It concludes with the heartbreaking story that was the last straw and ultimately led to him leaving the profession.
“Here they are, the diaries I kept during my time as a doctor, genital warts and all. What it was really like on the front line, how my personal life became a hobby I never had time for, and how, one terrible day, it all became too much for me and I finally hit the iceberg. Come on in, the water’s lovely.”
First things first— there is indeed some humor in this book, but most of it is crude and irreverent. I understand the need for dark humor for people who do medical work in order to cope with the intensity and gravity of their jobs and the tragedies they see every day.
But there is a lot of f- and s-words in this book and given the nature of working in OB-GYN, content of a ‘sensitive’ nature often presented in a crude way.
Kay includes a lot of comments that show his heart for his patients and the fact that he does this job to help people and care for people and not for the money. But sometimes his comments make you second guess that a bit.
I really liked the formatting of the book done in brief diary entries. I’m not sure if he actually kept this diary or if he just created it this way for ease of reading and combining random events from a handful of years. Either way, it was an effective way to share his stories.
My Random Thoughts
I’m glad I already had all my kids. I am the kind of person who does not feel invincible. If something bad or weird happens to someone else, it will obviously happen to me. So many of his anecdotes take place with pregnant, delivering, or post-delivery patients and they’re not always pleasant experiences or they give a lot of details about how the process all works and I would not have wanted so much information.
One particular story he shares is of a c-section he was in the middle of sewing back up when an emergency alarm goes off. He goes off and delivers two other babies and by the time he comes back to finish the c-section 90 minutes have elapsed. I had my last delivery and first c-section in 2020 at 30 weeks and there is no way I would have tolerated laying on that table half-open for 90 minutes!!
He references his beeper as a bleeper. I’m not sure if this is a UK term or if it was used for comedic effect but it was kinda funny to read sentences that contained ‘bleeped’ or ‘bleeping’ when in my mind my brain automatically tries to figure out the ‘censored’ word (i.e. “Everything I’m bleeped about takes at least fifteen minutes to firefight”).
Kay definitely puts humanity on doctors for us. And I haven’t decided if that’s a good thing or bad thing. Obviously our doctors are humans with their own feelings and lives, but honestly, I don’t think I would want Adam Kay as my doctor knowing some of his thoughts or behaviors.
In a professional and medical setting, I want to be able to trust my doctor and not picture them drunk, complaining, smoking, or mocking their patients.
Kay makes me wonder what my doctors have thought of me— especially the three weeks I spent in the hospital pre-30-week delivery of twins. I tried not to be an annoying or weird patient, but I don’t like to think about my doctors or nurses talking about me or my situation in a negative way to other people.
The Funnies
Here are some appropriate quotes I can share to show some of the humor. There’s a lot, but if you don’t plan on reading the book for all the other crude humor, then at least you can enjoy the good parts!
“a great doctor must have a huge heart and a distended aorta through which pumps a vast lake of compassion and human kindness.”
“The nighttime Senior House Officer and registrar will be down in the ER seeing and admitting patients while you’re up on the wards, sailing the ship alone. A ship that’s enormous, and on fire, and that no one has really taught you how to sail.”
“I feel like running a teaching session for the orthopedic department entitled ‘Sometimes People Fall Over for a Reason.’” [He views orthopedic surgeons as the Toby of the hospital.]
“laparoscopically is Greek for ‘much slower’ and involves inserting tiny cameras and instruments on long sticks through little holes. It’s fiddly and takes a long time to learn. Re-create the experience for yourself by tying your shoelaces with chopsticks. With your eyes closed. In space.”
“I liked that in obstetrics you ended up with twice the number of patients you started with, which is an unusually good batting average compared to other specialities. (I’m looking at you, geriatrics.)”
“Our computer system has been upgraded and, as happens eleven times out of ten when the hospital tries to make life easier, they’ve made everything much more complicated.”
“It is an established fact that hospital death rates go up on Black Wednesday [when junior doctors change hospitals every 6-12 months]. Knowing this really takes the pressure off, so I’m not trying very hard.”
“You’ll hear ‘Could you just take a quick look?’ more than you’ll ever hear ‘Hey, it’s great to see you.’”
“I finish explaining the risks of a cesarean section to a couple. ‘Any questions at all?’ I ask the room. ‘Yes,’ chimes in their six-year-old. ‘Do you think Jesus was black?’”
“We’re reminded that in the last three years, neurosurgeons in the UK have drilled holes in the wrong side of a patient’s skull fifteen times. Fifteen times they couldn’t tell left from right while holding a Black and Decker to someone’s cranium. Feels like grounds for retiring the ‘It’s hardly brain surgery’ maxim.”
“At a pub quiz with Ron and a few others and one of the questions is ‘How many bones are there in the human body?’ I’m off by about sixty, to the general outrage of my teammates.” [Doesn’t everyone know it’s 206?]
“Waited until the radio station had moved on to the next song before making the uterine incision for a cesarean. As appropriate as Cutting Crew may be for a surgeon, I refuse to deliver a baby to the refrain of ‘I just died in your arms tonight.’”
“It’s a Saturday night and the NHS runs a skeleton service. Actually, that’s unfair to skeletons— it’s more like when they dig up remains of Neolithic Man and reconstruct what he might have looked like from a piece of clavicle and a thumb joint.”
[watching the news] “I gasp. ‘Michael Jackson’s dead!’ One of the nurses sighs and stands up. ‘Which cubicle?’”
“What should I have brought to entice people into a career in medicine? Toy stethoscopes? Amniotic-fluid smoothies? Diaries with all your weekends, evenings, and Christmases handily crossed out?”
“I never volunteer my opinions on home births, but if, as today, a patient specifically asks me what I think of them, what I’d have if it were me, then I’ll be honest. It’s a five-minute speech, as follows: …. Unfortunately, today’s clinic is running massively late, and I’ve got a dinner date so I don’t have time for all this. Instead I give the abbreviated version: ‘Home delivery is for pizzas.’”
The Cringe-ys
There are many anecdotes of things that were stuck in different orifices- including one where a woman is running from the police and tries to jump a fence but one of the rails goes up between her legs and out her abdomen. She survives.
Before the whole process was complete, a woman who had just delivered a baby started eating her placenta. Turns out it was just a bowl of blood clots.
There is a lot of blood and bodily fluid-involved stories. I’ll stop now. But these are just a few of many cringe-worthy stories.
He is not transparent about his frustrations with his long hours and staying late on shifts, etc. Some reviewers were turned off by the ‘complaining.’ I can definitely allow for some complaining, but as a patient, you don’t want your doctor to be irritated they have to be there helping you when they don’t want to be.
Also here was a sobering quote:
“I assured her there was absolutely nothing wrong with her labia; they really, honestly, did look normal. ‘Not like porn, though,’ she said.”
This girl had ended up mutilating her genitals in an attempt to make it look more like what she saw on porn. Yet another reason (among many) why the porn industry is a problem.
The Ethics/Politics
The NHS is a government-run universal health-care system that is clear from Kay’s book, creates resource and staffing shortages and low pay which affects the quality of care people receive because of overworked and exhausted caregivers and the limited access to what they need.
Kay is trying to be a voice to change that.
I’m not entirely sure how the US system compares to the UK. Neither is perfect. I want everyone to have access to the health care they need but I also don’t want it controlled by the government. I feel like the privatization of medical care would help because it creates competition which would drive costs down but also incentivize hospitals to provide the best care in order to profit.
I read a quote on an article from Berkeley about health care that said, “Complete nationalization of healthcare means that there is no incentive for the market forces to achieve a better-quality healthcare system: lack of incentives almost always leads to a sacrifice in quality.”
I think I agree with this. I don’t have any answers to create the perfect health care system but the point is— this book has a not-so-subtle opinion thread throughout that criticizes the problems in the NHS system.
Ethically, I’m not sure how I feel about Kay sharing all of these stories with the world. He has changed names and dates, etc to provide confidentiality. But still, these are sensitive and often embarrassing moments for people and I don’t know if it’s right for him to present them for people to laugh at. I wouldn’t want my hospital experiences to be mocked or joked about without my consent, even if people didn’t know it was me.
A hospital is supposed to be a safe place and what happens there is usually a big deal for people there. This book kinda cheapens that in a lot of his anecdotes.
Conclusion
I thought this book was interesting and I read it because I thought it would be funny and I wanted some behind-the-scenes look at the goings-on of a hospital.
But the swearing, crude humor, and ethical misgivings are too much for me to get through for the amount of appropriate humor and knowledge you read.
However, if you are in the medical field, maybe you need this book because it will resonate with you in a way that it doesn’t for me. Maybe you will feel seen and it will help you cope with what you deal with at your hospital. I don’t know.
Normally I would say this is just one I wouldn’t read for some of the content, but because of my uncertainty of the ethics of it, I’m hesitant to recommend it to anyone.
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