This is Going to Hurt: Secret Diaries of a Junior Doctor

This originally appeared at The Irresponsible Reader.

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Doctors must be psychologically fit for the job — able to make decisions under a terrifying amount of pressure, able to break bad news to us anguished relatives, able to deal with death on a daily basis. They must have something that cannot be memorized and graded; a great doctor must have a huge heart and a distended aorta which pumps a vast lake of compassion and human kindness.

WHAT'S THIS IS GOING TO HURT ABOUT?

This book covers the years that doctor-turned-comedy writer Adam Kay spent as a junior obstetrics doctor in the NHS. I'm going to gloss over the various titles he had because it's a different system than I'm used to, and I'd botch it—but basically, it's the first few years post-medical school.

Essentially these are excerpts (details tweaked to everyone's privacy) from his diaries from that time showing the day-to-day realities he faced. Told with a comedic bent, sure, but it's just real life—a version of real-life that's more exhausted, more stressed, and covered in more and various bodily fluids than most of us have, sure. It's told very anecdotally, he's not trying to construct a narrative here, just "here's Day X, here's Day X +2," and so on.

He talks about preposterous situations he's put in because of his low-ranking status and/or NHS regulations, he talks about funny situations with patients, ridiculous colleagues, unsympathetic friends, harrowing experiences, and just strange ones. Given his specialty, he deals with expectant mothers, newborns, clueless fathers-to-be, and heartbreak. We get the gamut here.

BONUS MATERIAL

The audiobook I listened to was released with the paperback release and contained some bonus material—a few more diary entries and an afterword. The afterword was essentially a rallying cry for people to support the NHS's existence.

I don't have a dog in this fight—but I found his arguments compelling, and I thought his support of the NHS throughout the book (while freely critiquing aspects of it) added some good and necessary grounding to the humor. The life and death aspect of the book did, too—obviously—but that's common with medical memoirs, this is distinctive (at least in my limited experience)

SO, WHAT DID I THINK ABOUT THIS IS GOING TO HURT?

Called to the Early Pregnancy Unit by one of the SHOs to confirm a miscarriage at eight weeks—he’s new to scanning and wants a second pair of eyes. I remember that feeling only too well and scamper over. He’s managed the couple’s expectations very well, and clearly made them aware it doesn’t look good—they’re sad and silent as I walk in. What he hasn’t done very well is the ultrasound. He may as well have been scanning the back of his hand or a packet of Quavers. Not only is the baby fine, but so is the other baby that he hadn’t spotted.

I audibly laughed—twice—during the Introduction, so I was instantly on board with this book. The laughs really didn't let up. At times, I wondered if it was a little too jokey, and wished we got more of the narrative about his experience—but then he'd say something else funny and then I decided I didn't care because he's a good comedy writer. Bring on the jokes!

Like the best medical comedies (e.g., M*A*S*H (in all its forms), Scrubs), Kay intersperses the laughs with drama and tragedy—stories of hard-fought success and heartbreaking—even devastating—loss. That augments both ends of the spectrum—while you're chuckling, you're more open to feeling the empathy to appreciate the dramatic. When you're reeling from a hard experience, you need the laughter. If Kay's TV scripts are anything like this, I wish I could see some of his episodes.

Kay handles his own narration here and is great at it, wry detachment mixed with a no-nonsense delivery. He knows it's funny, so he's not trying to push the humor, he just trusts the material and lets it do the heavy lifting.

When the library told me that my hold for this was ready, I didn't remember requesting it—wasn't sure at all why I did. But I gave it a chance, and am so glad I did—it made for a very entertaining 5+ hours. I think you'll find the same if you give it a try.

funny and would've given it 4 stars if i didn't feel like crap for unrelated reasons when i was reading this.

I think there's such a fine line with making meaningful commentary while also being entertaining and funny, and the author does it so effortlessly in this book. I was absolutely laughing out loud at so many points but also i cannot even fathom what those low points must have felt like. 

An absolute must read, even if you're someone who knows nothing about medicine.

Ex-doctor's flippant and fairly crude diary of what it's like working for the NHS. It takes a depressing turn in in the last 5 pages as he explains how he left the job after the (unavoidable) death of a patient.

I understand he's probably used humour to deal with what is a very shitty job, but I wasn't really vibing with it.

This was a really good read. I personally didn't find it terribly funny (and I did wince a few times at a few bits of very dark humor), but I did find it poignant. It's the type of book that made me sit and reflect for a few minutes after I finished it, and that's a powerful thing.

I have to confess that I watched the series before reading the book. I liked the series more than the book because Shruti is an amazing character, and they discussed several ethical problems with the main character. Let me explain.

First things first, it's a really good book about a doctor's life. Adam Kay did a brilliant job of showing that doctors are as human as non-doctor people. We get angry, sad and hopeless, and cheerful when we diagnose or the treatment helps the patient. But we also make mistakes, some early on in our medical student formation, but they never stop. It's inevitable as human beings to make mistakes. This is the main reason we need to review patient conditions. Don't underestimate their complaints, and don't overestimate them either. Overdiagnosis is also a huge problem. Sometimes we need to understand that we can't do anything to make this patient better (read palliative care), and other times, it's just an accident that happened. Common people think that doctors always do the right thing, so the patient must get better or that the patient gets worse, so it's the doctor's fault. Nothing is more wrong than that.

Adam Kay couldn't agree more. He did medicine to save lives, but medicine isn't just about that. It's about care. Parents know this too well. You care for your children, and it doesn't mean they'll be president or an astronaut. You try your best to improve their lives, but there are so many other variables.

One of the things I missed in the book was about Evidence-Based Medicine. Talking about probabilities, risks, and chances is a better way to explain to patients and to ourselves about our profession. However, some people still wouldn't like the “medicine way,” and that's completely fine. I totally support the author's decision at the end. This is not a spoiler; he tells us at the beginning of the reading.

Let's talk about the ethical problems: the dolphin stories, the smoking patient, the placentophagy, and jokes about the patient's ignorance or decisions. I'm not saying that I'm a saint. The point is that early on in medicine, we're taught that we're not the patient's father, we're like an advisor. You tell me what's bothering you, and I tell you what options you have to deal with that problem, and I can help you with that decision. An informative decision, reasonable, based on evidence. You must trust me, and I mustn't judge you about your complaint and choice. Obviously, it's not an easy task, but you usually get there. You focus on doing your job, and the patient's political views don't matter to you. This is one of the main philosophies about our job. Otherwise, we'd never treat any criminals. And don't forget, patients aren't obliged to know common stuff. Before I was a medical student, I had a lot of thoughts about biology and other stuff that were totally wrong (‘m at the end of my 4th year). As I developed my skills and knowledge, I realized that many things I thought and did were wrong because I didn't have the information. This is one of the reasons I always like to talk to patients and ask if they have any doubts or if they know why they're in the hospital, how the treatment works. It's really worth it when they say “thank you” or “never change to be like this person you are.”

In conclusion, I highly recommend reading the book. Do a critical read about it. Adam Kay talks about the wrong things with public service, etc., but also tells us so much about what doctors shouldn't do.

Quick and funny, with some touching and heartbreaking moments.

I know I couldn't do it so I have a huge amount of respect for doctors and NHS staff.

Equally funny and heartfelt. A must-read for everyone.

Read in one sitting - this is how good this book is.

Grey's Anatomy without the romantic drama and with the bonus of having high quality British humour

Equal parts funny, sad, and wtf (as in, “wtf were they thinking when they put < insert object > up their bum?!”). This was a diary in the life of an OB/GYN working with the NHS as he describes life on the hospital floor delivering babies, stitching up mothers, and regaling the reader with an endless litany of things found in places they shouldn't be. Doctors the world over are overworked, underpaid, and criminally underappreciated for the things they have to put up with. If you know a doctor, or anyone who works in the medical industry, I think the afterword sums it up best. Ask them how their day was, give them an avenue to vent, and let them know they always can. Because they sure as hell don't get the support they need from the people they work for.

Just as a minor note, this book was written from the point of view of someone in the UK, so a lot of specific NHS stuff that's described may be different in the states. I don't have a medical background beyond being able to point at a stethoscope if asked, but it may be jarring for someone in a different location. I imagine the woes are the same the world over, though.

A great book, a short book, a funny book, a sad book.

A hilarious book, although sad in parts, the reality is it shows how mistreated the doctors (and I am sure other staff) of the (British) HNS are. Seriously overworked to the point of dangerous, it is a miracle any of them come out of their career with a spouse or friends, the way they are relentlessly overworked and underpaid.

To hammer home the lack of empathy they get from the government and the majority of the general public too, it is worth reading this book. However it comes into its own with the hilarious and brilliantly delivered anecdotes from his time on the wards, as recorded in his diary entries, the best of which Adam Kay shares with us.

I just copy and pasted a whole bunch that had me inappropriately laughing out loud when I read this over a few lunchtimes at work.

5 stars

“I notice that every patient on the ward has a pulse of 60 recorded in their observation chart so I surreptitiously inspect the healthcare assistant's measurement technique. He feels the patient's pulse, looks at his watch and meticulously counts the number of seconds per minute.” -“Tuesday, 5 July 2005 Trying to work out a seventy-year-old lady's alcohol consumption to record in the notes. I've established that wine is her poison. Me: ‘And how much wine do you drink per day, would you say?' Patient: ‘About three bottles on a good day.' Me: ‘OK . . . And on a bad day?' Patient: ‘On a bad day I only manage one.” -“Woman storms out of gynae outpatients screaming at the clinic sister, ‘I pay your salary! I pay your salary!' The sister yells back, ‘Can I have a raise then?” -“Three a.m. attendance at labour ward triage. Patient RO is twenty five years old and thirty weeks into her first pregnancy. She complains of a large number of painless spots on her tongue. Diagnosis: taste buds.”-“... and mild vaginal burns from a patient stuffing a string of lights inside and turning them on (bringing new meaning to the phrase ‘I put the Christmas lights up myself').” -“Her extremely posh eight year-old asks her a question about the economy (!), and before she answers it, she asks her extremely posh five year-old “Do you know what the economy is, darling?”“Yes mummy, it's the part of the plane that's terrible”.This is how revolutions start.”

An at times humorous and sad and at all times interesting and informative tale of life as a doctor. A great insight into life as a doctor within the hospital system.

»This morning I delivered little baby Sayton – pronounced Satan, as in King of the Underworld.«Wow, what a ride! [a:Adam Kay 17160706 Adam Kay https://images.gr-assets.com/authors/1594843517p2/17160706.jpg], doctor gone writer, describes what he experienced in six years of medical practice in the United Kingdom.In about 10 chapters, Adam first introduces us to the new position or posting he's in now. He then proceeds to write in usually short passages in anecdotal style to explain the manifold lows and highs of his profession.There were passages I laughed out loud at (something I rarely do and which garnered me curious and worried looks from my family), some that I thought couldn't be true and others again that really truly hurt.So, first information if you want to read this book: On multiple levels, the title is extremely well chosen.Definitely dominant, though, is a wonderfully dry humour that, I imagine, in part allowed Adam to pull through those obviously at least partly hard, harsh years.»Clearly blood isn't the delicious post-delivery snack she imagines placenta might be.«(She probably simply hasn't read the right cookbooks!)Another part seems to be Adam's deeply ingrained empathy for his patients - even though the latter ultimately drove him out of his profession.He honestly describes some horrible experiences, e. g. when having to take samples from a still-born baby:»I dress him again, look up to a God I don't believe in and say, ‘Look after him.'«It's this kind of doctor I would wish to treat me or my family. One that will, like Adam explains his doctor persona, go »for a ‘straight to the point' vibe – no nonsense, no small talk, let's deal with the matter in hand, a bit of sarcasm thrown into the mix.« This kind of approach is applied in “[b:This is Going to Hurt: Secret Diaries of a Junior Doctor 35510008 This is Going to Hurt Secret Diaries of a Junior Doctor Adam Kay https://i.gr-assets.com/images/S/compressed.photo.goodreads.com/books/1498340278l/35510008.SY75.jpg 56583337]” as well: You get dumped straight into the “action” - be it sweet (as in the case of the baby named after him) or bitter (as the incident that made Adam leave his medical profession). Every word he writes feels honest and rings true in every respect. And just like that, Adam Kay single-handedly improved my opinion on doctors - because I don't see a huge influx from the UK to my country, Germany, I suspect things aren't all that much better over here either... If you just want to read an excellent book beyond all its merits mentioned before, you're on the right track as well: Instead of “just one more page” I was like “just one more diary entry” and kept repeating that till I noticed I had read the same diary entry a few times already and I simply couldn't concentrate anymore - it's just that good.If you remember (and hopefully like) [a:James Herriot 18062 James Herriot https://images.gr-assets.com/authors/1258249907p2/18062.jpg]'s wonderful stories from his life as a country vet in Yorkshire, you might, at times at least, feel reminded of Herriot - a younger, sharper and more sarcastic version, though.A brilliant, hilarious, heart-breaking book. Unreservedly recommended to anyone who reads. Five out of five stars. Blog Facebook Twitter Instagram

Funny, painful and emotional.

4/4.5. A brilliantly funny and poignant read on the state of our NHS. A must read for everyone who supports our NHS. We need to acknowledge the positions we are putting our NHS staff into. We need to invest in better mental health for NHS staff. The NHS is for the staff who work there. Not just the patients. Invest in the future of the NHS. If we don't want more people to leave their careers in the NHS like Adam Kay, we need to put their needs first. Such a powerful memoir on Kay's experience working as a junior doctor.

When I first got the book I wanted to avoid reading the many reviews that covered the first few pages. I wanted to start with fresh eyes, but there was one review on the cover impossible to avoid reading. All it said was ???heart-breaking??? and I could not agree more. Its an amazingly funny book, a real look into the life of health worker, the funny, the good, the bad and the terrible. 

None of the entries had really hit me until the last. I knew he no longer practiced medicine so there had to be a reason. And that reason hit me like a truck. I would recommend this book to absolutely everyone. It is beautiful and it really makes you think.

Absolutely hilarious and heartbreaking at the same time.

I was sceptical about the reviewer who said they both laughed and cried, and now here I am, a wreck at the end of this laugh-out-loud-in-public book.
Obviously entertaining in the extreme - and I can see myself dipping back in to enjoy an anecdote or two - but this book's longest lasting impression on me will be awe at what our medical professionals on the NHS do and go through, and without proper renumeration, support or adequate rest. Absolute saints.

M.A.S.H meets James Herriot meets the evil empire (bureaucrats and politicians). Hilarious, awful, unbelievable ( although I believe every word of it), terribly sad, brilliant.

Great, often funny, ultimately sad read. I love medical books and this one of the best I've read.

The experiences Kay talks about feel altogether realistic, strengthened by the lack of sleep from not being able to put the book down.

Hilarious, captivating, realistic