Book Review : This Is Going to Hurt –– Secret Diaries of a Junior Doctor By Adam Kay
This Is Going to Hurt––Secret Diaries of a Junior Doctor tells the story of Adam Kay, who was a junior doctor from 2004 until 2010, before a devastating experience on a ward caused him to reconsider his future. He kept a diary throughout his training, and This Is Going to Hurt intersperses tales from the front line of the NHS with reflections on the current crisis. The result is a first-hand account of life as a junior doctor in all its joy, pain, sacrifice and maddening bureaucracy, and a love letter to those who might at any moment be holding our lives in their hands.
A Sneak Peek Into “This is Going to Hurt”
The decision to work in medicine is basically a version of the email you get in early October asking you to choose your menu options for the work Christmas party. No doubt you’ll choose the chicken, to be on the safe side, and it’s more than likely everything will be all right. But what if someone shares a ghastly factory farming video on Facebook the day before and you inadvertently witness a mass debeaking? What if Morrissey dies in November and, out of respect for him, you turn your back on a lifestyle thus far devoted almost exclusively to consuming meat? What if you develop a life-threatening allergy to escalopes? Ultimately, no one knows what they’ll fancy for dinner in sixty dinners’ time.
Every doctor makes their career choice aged sixteen, two years before they’re legally allowed to text a photo of their own genitals. When you sit down and pick your A levels, you’re set off on a trajectory that continues until you either retire or die and, unlike your work Christmas party, Janet from procurement won’t swap your chicken for her halloumi skewers – you’re stuck with it.
At sixteen, your reasons for wanting to pursue a career in medicine are generally along the lines of ‘My mum/dad’s a doctor’, ‘I quite like Holby City’ or ‘I want to cure cancer’. Reasons one and two are ludicrous, and reason three would be perfectly fine – if a little earnest – were it not for the fact that’s what research scientists do, not doctors. Besides, holding anyone to their word at that age seems a bit unfair, on a par with declaring the ‘I want to be an astronaut’ painting you did aged five a legally binding document.
Personally, I don’t remember medicine ever being an active career decision, more just the default setting for my life – the marimba ringtone, the stock photo of a mountain range as your computer background. I grew up in a Jewish family (although they were mostly in it for the food); went to the kind of school that’s essentially a sausage factory designed to churn out medics, lawyers and cabinet members; and my dad was a doctor. It was written on the walls.
“I realize everyone moans about their salary and thinks they deserve more, but I’m happy to look back on my time as an SHO with a bit of objectivity and declare I was profoundly underpaid.”
Because medical schools are oversubscribed ten-fold, all candidates must be interviewed, with only those who perform best under a grilling being awarded a place. It’s assumed all applicants are on course for straight As at A level, so universities base their decisions on nonacademic criteria. This, of course, makes sense: a doctor must be psychologically fit for the job – able to make decisions under a terrifying amount of pressure, able to break bad news to 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 through which pumps a vast lake of compassion and human kindness.
At least, that’s what you’d think. In reality, medical schools don’t give the shiniest shit about any of that. They don’t even check you’re OK with the sight of blood. Instead, they fixate on extracurricular activities. Their ideal student is captain of two sports teams, the county swimming champion, leader of the youth orchestra and editor of the school newspaper. It’s basically a Miss Congeniality contest without the sash. Look at the Wikipedia entry for any famous doctor, and you’ll see: ‘He proved himself an accomplished rugby player in youth leagues. He excelled as a distance runner and in his final year at school was vice-captain of the athletics team.’ This particular description is of a certain Dr H. Shipman, so perhaps it’s not a rock-solid system.
As you might imagine, learning every single aspect of the human body’s anatomy and physiology, plus each possible way it can malfunction, is a fairly gargantuan undertaking. But the buzz of knowing I was going to become a doctor one day – such a big deal you get to literally change your name, like a superhero or an international criminal – propelled me towards my goal through those six long years.
“For me, the true miracle of childbirth is that smart, rational people with jobs and the ability to vote look at these half-melted fleshy blobs, their heads misshapen from being squeezed through a pelvis, covered in five types of horrendous gunk, looking like they’ve spent a good two hours rolling around on top of a deep-pan pizza, and honestly believe they look beautiful.”
Then there I was, a junior doctor. I could have gone on Mastermind with the specialist subject ‘the human body’. Everyone at home would be yelling at their TVs that the subject I’d chosen was too vast and wide-ranging, that I should have gone for something like ‘atherosclerosis’ or ‘bunions’, but they’d have been wrong. I’d have nailed it.
During the day, the job was manageable, if mind-numbing and insanely time-consuming. You turn up every morning for the ‘ward round’, where your whole team of doctors pootles past each of their patients. You trail behind like a hypnotized duckling, your head cocked to one side in a caring manner, noting down every pronouncement from your seniors – book an MRI, refer to rheumatology, arrange an ECG. Then you spend the rest of your working day (plus generally a further unpaid four hours) completing these dozens, sometimes hundreds of tasks – filling in forms, making phone calls. Essentially, you’re a glorified PA. Not really what I’d trained so hard for, but whatever.
The night shifts, on the other hand, made Dante look like Disney – an unrelenting nightmare that made me regret ever thinking my education was being underutilized. At night, the house officer is given a little paging device affectionately called a bleep and responsibility for every patient in the hospital. The fucking lot of them. The night-time SHO and registrar will be down in A&E reviewing 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. You’ve been trained how to examine a patient’s cardiovascular system, you know the physiology of the coronary vasculature, but even when you can recognize every sign and symptom of a heart attack, it’s very different to actually managing one for the first time.
It’s sink or swim, and you have to learn how to swim because otherwise a ton of patients sink with you. I actually found it all perversely exhilarating. Sure it was hard work, sure the hours were bordering on inhumane and sure I saw things that have scarred my retinas to this day, but I was a doctor now.
3 Words to Sum Up This Book
BRILLIANT, EXHILARATING, FUNNY
Back in 2019, after only reading non-stop romance novels for a good 5 years, your girl decided that it was time for change. You now how usually goes. Some decided to chop of half of their mane, others decided to start going to the gym, and me…well, I decided that I’ve had enough of predictable romance novels and that it’s time for me to spread my cockroach wings and fly.
At first, the transition wasn’t easy. As with most things that I put my mind upon, I loathe instructions and starting off slow. So predictably, your girl decided to jump off the deep end and dive right into the most serious and depressing books ever to be written. And you already guessed it, after that traumatic experience, my brain quite literally abstain from reading for the whole fucking year. And I went through 2019 sad and listless.
So for 2020, I decided to slow down and slowly dip my toes into different genres of books. I tried a little bit of everything that I could fit in my kindle (which is a lot), and nothing really wowed me until this book.
It might be a surprise to some, but this is actually my first non-fiction novel in years. Yes, yes, I know. Despite me constantly yapping that I’d like to read more non-fictions, the allure of the fiction world sometimes turn me into a hypocrite. What can I say? Life is short, YOLO?
Me being a hypocrite aside however, I really enjoy how Adam Kay wrote This Is Going to Hurt. Despite the most-of-the-time tongue twisting and difficult medical words, Adam still manages to have this air of cheerful sarcasm in this writing that made everything easier to digest.
As a character he doesn’t come off as holier-than-thou what with his medical knowledge, yet he wasn’t flat and boring like you’d expect most doctors to be––generalization I know, forgive me. As far as autobiography goes (this is actually my first), This Is Going to Hurt is absolutely fantastic. It gave the readers a peek into what a life of a medical health care provider with all the nitty gritty truth wrapped in a funny and sarcastic delivery.
When I was around 12 years old, I actually wanted to be a doctor. I was so into it, reading books on human biology day and night for years, until I was 15 years of age when I found out that I couldn’t stand the sight of blood. Now after reading this book, I am glad I didn’t decide to push through with my then career choice, because I would have hate it more than anything in the world.
If there’s anything that I take away from This Is Going to Hurt, it’s the fact that people who decided to work in the medical field, they do it because they wholeheartedly love what they do. And it’s definitely not because of the money. All this time, I’ve always thought that doctors earn an immense amount of money––which logically makes sense when you think of all those years and money that they have to spend on studying alone.
“But unfortunately the depth of the lows is the price you pay for the height of the highs.”
However, after reading this book, I realized that if one was into being a doctor for the monetary value alone, they would have jumped ship years ago and pursue another career. Lord knows that’s what I would have done in the face of all the things one would have to deal with on the daily basis being a doctor in the hospital. Because the amount of stress, pressure and the lack of sleep these people get daily from their job really doesn’t equal to how much they’re paid.
I don’t know about you, but for the longest time, I have always perceived doctors as this professional immaculate geniuses who live on a whole another level than most of us do. In my mind, they feel so detached to me to the point where they don’t even feel close to human.
You’re in pain? Go see a doctor. Sick? Go see a doctor. Feel like something is not right? See a doctor. Who do you see when you just don’t feel like 100%? A doctor. It’s mind boggling to me that a human could know the root to all my pains and problems, and still solve it without even panicking in the slightest.
“He must realize we have the same chat every time, but it clearly doesn’t matter – 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.”
By reading This Is Going to Hurt, Adam Kay opened my eyes and heart to doctors all around the world. Despite their tough outer shell, every single doctors out there actually only want what’s best for their patients. They care––sometimes too much––but because of how much pressure is riding on their shoulder, and how they should be professional at all times, they hide those feelings deep down and will only let it out when they’re out of the public eye.
First off, I just want to congratulate all the partners of doctors/doctor-to-bes out there, because you’re the real MVP.
Before reading This Is Going to Hurt, sure I have a small inkling of how demanding being a medical health care provider could be, but in reality it is actually way, way, way worse than what I thought. Going into work early, working days and nights, hours upon hours of overtime with barely any time for sleep or rest in between. And then once your shift is done, all you want to do is find a bed and crash until your next shift again.
“It always feels odd to leave a job where you’ve watched lives begin and end, spent more hours than at your own house, seen the ward clerk more than your partner, and have your departure go all but unacknowledged – but I’ve hardened to it by now.”
Before reading this novel, I sympathize but never really truly understand what it’s like to date a doctor or a nurse. However, after finishing this novel, I now understand it truly takes a whole another level of trust and patience when being in a relationship with people who work in the medical field. It is truly commendable how much these doctors and nurses must have liked their job to sacrifice so much for it.
Needless to say, This Is Going to Hurt by Adam Kay is an interesting read as I have never read anything of the likes of it before. It opened the eyes of the public as to what’s going on behind the scenes. All this time, I’m sure a lot of us believes that being a doctor is the ticket to get filthy rich, but this novel really gave me the reality check that I didn’t know I needed. Although Adam Kay complained a lot about his job and his low pay being a doctor, you could clearly see just how much he enjoys what he does. Sure, days are tough sometimes, but despite all of that, every time he lays his head on the pillow, he could go to bed with a smile in his face knowing that he’s saved a life, or a few.
Despite being an autobiography, Adam Kay managed to write this book in a way that is easy to understand even for people like me who has no medical background whatsoever. Sure, sometimes the days get repetitive but no days are predictable. I suppose that’s also another aspect that Adam liked while being a doctor.
Would I recommend this book? Definitely. If you’re anything like me, it’s a fun break from all the fiction that I’ve been drowning in recently. And if you’re basically me 2.0, don’t worry, the graphic scenes aren’t so graphic that it’d make you gag and want to hide in a dark hole forever. However, there are some scenes in this novel that are brutal enough to make you cringe and curl up into yourself.
But after all, that’s just a life of a doctor, isn’t it?
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