Review: This Is Going To Hurt: Secret Diaries of a Junior Doctor

I have a terrible habit of carefully selecting a new book—often one that’s been sitting on my bedside table for some time—to read on longhaul flights, only to be distracted by a shiny new book at the airport while waiting to board. I invariably end up rather guiltily but compulsively buying said distracting book and squishing it into my backpack.

Adam Kay’s This Is Going To Hurt: Secret Diaries of a Junior Doctor was one such impulse airport purchase. I was loitering in a bookshop in Heathrow airport waiting for the airline to announce from which gate the first of my interminably long flights to get back to Australia would depart. (Why they couldn’t announce it more than 30 minutes before the plane left, I don’t know. Surely they knew where an A380 was going park. But I digress.)

I get to call myself a doctor these days, but I’m of the non-medical variety because my family is genetically, pathologically squeamish. That doesn’t stop me gravitating toward books that are about not so much gruesome medical details as the experience of what it’s like to work a medical doctor’s job.

This Is Going To Hurt features, as the subtitle suggests, excerpts from diaries Kay kept during his years navigating the UK’s National Health Service (NHS) junior and slightly more senior doctor positions. (He’s long departed the medical world to be a writer and comedian—presumably much more fun jobs that still manage to leverage all that hard-learnt knowledge.)

And it is, to be concise: achingly insightful and funny. I read the book non-stop during my flights, foregoing sleep and new-release movies for it, closing it up only briefly to ingest airline food, and only then because space and awkwardness temporarily prevented me wielding both a book and cutlery. The book is ab-clenchingly hilarious, although the best bits—of which there are many—are probably not entirely suitable to discuss on this family friendly blog, or simply require a little more context than I can provide.

Essentially, the book provides a glimpse into the bright-eyed, bushy-tailed junior doctor experience. Specifically, how nothing could quite prepare (Adam) Kay for the NHS’ bureaucratic efficiency slash inefficiency: ‘Day one. H [his then-girlfriend whose identity has been protected] has made me a packed lunch. I have a new stethoscope, a new shirt, and a new email address: [email protected]. It’s good to know that no matter what happens today, nobody could accuse me of being the most incompetent person in the hospital,’ Kay writes. ‘And even if I am, I can blame it on Atom.’

But his email address is trumped by that of his friend Amanda Saunders-Vest, whose hyphen they spelt out: [email protected].

This Is Going To Hurt also outlines the kinds of truth-is-stranger than fiction moments Kay frequently experienced, such as receiving an all-staff email about ensuring all samples were sent to the lab, stat. What prompted the broadcast was a psych patient who had been transferred to the respiratory ward with pneumonia. He’d been discovered scavenging and ingesting sputum samples the previous day.

There are some slightly more serious undertones to the book too.

The book blurb says: ‘Welcome to 97-hour weeks. Welcome to life-and-death decisions. Welcome to a constant tsunami of bodily fluids. Welcome to earning less than the hospital parking meter. Wave goodbye to your friends and relationships…’

This Is Going To Hurt shows the slow unravelling of Kay’s relationship and documents myriad missed family or generally fun occasions through unending work commitments and last-minute emergencies. Also, I learnt from this book that (in the UK, at least) all junior doctors change hospitals on precisely the same day every six or 12 months—on what is known as ‘Black Wednesday’. I *think* this happens in Australia every January. ‘You might think it would be a terrible idea to exchange all your Scrabble tiles in one go and expect the hospital to run exactly as it did the day before,’ Kay writes. ‘And you’d be quite right.’

One review I read of This Is Going To Hurt (or rather Kay’s related show, which draws on much of the same material), mentions that the reviewer spent the first 40 minutes laughing and the next 10 crying. That’s an accurate summation of what I experienced.

Kay’s penned an open letter (in what could possibly be considered a rethink of the equivalent of an epilogue) to the Secretary of State for Health at the book’s end. Its opening sentence discusses how a Harvard Law professor once suggested we should seal the nuclear codes in a live human’s heart. The thinking was that if the president wanted to wipe out a bunch of people from a distance, he first had to cut open and likely kill one person up close and personal. Likewise, Kay argues, the Secretary of State for Health should truly comprehend what junior doctors are subjected to in terms of punishingly gruelling hours, comparably low pay, and terrifyingly enormous responsibility.

Apart from wondering how Kay found the time or energy to keep these diaries along the way, but eternally grateful that he did, I wholly recommend reading This Is Going To Hurt. It’s relevant even to those of us based outside the UK because the experience—and the pressures—is undoubtedly transferable.

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Fiona Crawford

Fiona Crawford is a freelance writer, editor, blogger, proofreader, and voracious reader. She regularly appears as a book reviewer in Australian BOOKSELLER+PUBLISHER magazine. Fiona is also (unfairly) known as the Book Burglar due to her penchant for buying family members—then permanently borrowing—books she wants to read herself.

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