Originally published at: https://blog.12min.com/this-is-going-to-hurt-summary/
Secret Diaries of a Junior Doctor
Your doctor made a mistake? And you have something angry to say to him? What about him saying an angry thing to you?
Because it’s both painful and painfully funny.
Who Should Read “This Is Going to Hurt”? And Why?“This Is Going to Hurt” is the book you must read if you have anything against doctors. It’s also the one you should read if you view them as “low-grade superheroes.” It seems both lead to equally dangerous consequences.
Finally, don’t give yourself an option to skip this book if you are a British and want to understand better the health care system in your country.
About Adam KayAdam Kay is a British author, scriptwriter and former doctor.
Best known as part of the musical parody duo “Amateur Transplants,” Kay has co-created the BBC Three sitcom “Crims;” his TV writing credits also include “Mrs. Brown’s Boys,” “Watson & Oliver” and “Mitchell and Webb.”
Widely admired, “This Is Going to Hurt” is his first book.
“This Is Going to Hurt Summary”Since Adam Kay is British and since the objective of this (otherwise brilliant and universally accessible) book – published a year ago, almost to the day – is a bit topical, first the much necessary background.
In 2012 – two years after Kay resigned from his Senior Registrar job – the British Medical Association (BMA) and NHS Employees entered negotiations with an attempt to reach a new contract for junior doctors.
And everything was going well – or, better yet, civilized – until UK’s 2015 general election, after which Britain’s Health and Social Care Secretary, Jeremy Hunt, threatened to impose a few items from the Conservative Party’s election manifesto which directly concerned.
Hunt’s contract proposals made little to no sense to almost every BMA and NHS member, leading to a general junior doctors’ strike in January 2016 – the first of its kind in almost four decades!
Jeremy Hunt remained deaf to the demands, and, among other things, blamed junior doctors for being greedy and putting their needs in front of their patients’.
And that’s when Adam Kay decided to write This Is Going to Hurt. His aim was not just to expose the failings of modern health systems, but, even more, to reveal the extent to which doctors are continually misrepresented by the government, the media, and, well, us.
This Is Going to Hurt is actually a collection of diary entries Kay jotted down during the years of his medical training.
He started it (after attending Dulwich College and the Imperial College School of Medicine) as a House Officer in 2004; he ended it six years later as a Senior Registrar – the UK equivalent of USA’s Senior or Chief Resident in Surgery.
As expected, thousands of things happened in the meantime, all recollected with Kay’s now-famous down-to-earth and all-too-honest sense of humor.
(Yup, in case you skipped the bio, he’s the same guy who created “Crims” and a couple of other things; unsurprisingly, “This Is Going to Hurt” is also a BBC 2 comedy-drama series-in-development).
So, under different dates, you’ll read about Kay’s long nights spent in the emergency department, his attempts to save other people’s lives, and – well, at least we said that he was honest – four different objects he took from his patient’s rectums (of course, it was more than just one person).
And there are parts that are pure comedy gold and downright hilarious, such as, say, this memorable meeting with an old lady that happened to Kay on July 5, 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.’Very soon after this event, Kay decides to specialize in gynecology and obstetrics, and two years later – in August 2007 – he is promoted to Registrar.
And during this time Kay learns something about doctors that is usually taken for granted: “a great doctor must have a huge heart and a distended aorta through which pumps a vast lake of compassion and human kindness.”
Because, you see, in addition to all the happy faces surrounding those delivered babies and STD-infected teenagers, being a junior gynecologist also means sleeping just one or two hours in the parking lot and finding no gratitude for it – not even among your colleagues.
Of course, it also means being unpaid for all those overtime hours, which is kind of ironic once you realize that doctors save lives, and you’ll get paid overtime for saving (as in Ctrl+S) that Excel table of yours!
To make matter worse, taking a sick day is all but an impossibility because it’s difficult to find someone to cover you when he/she too is going through the same.
“It’s funny – you don’t think of doctors getting ill” – writes Kay remembering a remark.
And he goes on:
I think it’s part of something bigger: patients don’t actually think of doctors as being human. It’s why they’re so quick to complain if we make a mistake or if we get cross. It’s why they’ll bite our heads off when we finally call them into our over-running clinic room at 7 p.m., not thinking that we also have homes we’d rather be at. But it’s the flip side of not wanting your doctor to be fallible, capable of getting your diagnosis wrong. They don’t want to think of medicine as a subject that anyone on the planet can learn, a career choice their mouth-breathing cousin could have made.So, why didn’t Adam quit?
Well, because of the happy faces we mentioned above.
Managing to help infertile couples become pregnant or delivering a few babies during one night can be such a spine-tingling and rewarding experience that you’re bound to forget that you haven’t eaten for 37 hours once in a while!
However, being a “low-grade superhero” takes its toll; unfortunately, sometimes it’s too high a toll.
On August 2010, Kay was promoted to Senior Registrar, the second-highest ranking position just after Consultant. That, of course, brought with itself new responsibilities and anxieties.
Just three months later, on December 2, 2010, Adam Kay began to perform a cesarean section on a patient with an undiagnosed placenta praevia.
As a result, the baby comes out dead, and the mother experiences severe blood loss which another surgeon eventually manages to stop but only after performing a hysterectomy.
Adam’s faith in his capabilities is shaken to its very core. He is unable to do anything for the rest of the day, feeling depression and utter hopelessness.
However – he isn’t offered a proper therapy or given a day off! The next day, he needs to come back to work once again and is expected to deliver at his usual capacity.
As one could expect, Kay is unable to do that anymore.
Just several months later, he officially resigns from his job.
Key Lessons from “This Is Going to Hurt”1. Everybody Thinks That Doctors Are Superhumans (Spoiler Alert: They Are Not!) 2. Doctors Are Mistreated… and More Than You Can Imagine 3. Doctors Really Do Deserve More
Everybody Thinks That Doctors Are Superhumans (Spoiler Alert: They Are Not!)If you have ever watched merely one “House” episode, chances are you already know how the next one is going to unravel. (This just for the example’s sake: almost needless to say, we really love “House”).
First, a patient comes with a symptom pretty much everyone but the condescending and arrogant House sees for the first time in their lives; then, things get worse since the initial diagnosis turns out to be wrong and the patient’s condition only gets worse; and, finally, Dr. House puts two and two together and comes up with a brilliant and brilliantly simple solution which makes everybody and everything all right.
Now, we don’t need to tell you that this doesn’t’ happen much too often in real life. Not only because most doctors don’t really have the time to act as if they are Sherlock Holmes in a white coat; but, also because they are (just like you and me) nothing more than humans.
The main problem?
Well, you and me.
You see, we don’t think of doctors as humans.
Oh, no – we think of them as if they are nothing less than Dr. House, and that is, without his cynicism and misanthropy!
We want them to be both available and understanding at all times, and we want them to treat every patient around them with equal care, compassion, and expertise.
And we want them to always know the solution.
It should be merely obvious, warns Adam Kay, that this is all but impossible.
Just like us, doctors have to take good 8-hour naps and eat enough food; and just like us, they want to spend significant portions of their time around their loved ones; finally – and this is, probably, the most important thing – just like us, doctors make mistakes.
Kay decided to end his career after he made one – endangering the life of a pregnant woman after missing a placenta praevia diagnosis – but every doctor that has ever treated you, at a certain point of his life, had no option but to find the will to carry on after making a similar mistake.
Now, be honest – do you possess the mental strength to do the same?
Doctors Are Mistreated… and More Than You Can ImagineThings get only worse from there.
If you want us to paint you a picture, here’s a comparison we’d like you to think over:
- What would the word “failure” mean in the dictionary of a great director?
- What would the same word mean in the dictionary of an average doctor?
- What would “failure” mean for, say, Superman?
“The difference,” writes Adam Kay, “is obviously the whole ‘life and death’ thing, which is what separates this job from all others, and makes it so unfathomable to people on the outside.”
In other words, the three types of failures we asked you to ponder about above – a bad movie, a lost life, the end of the whole universe – don’t weigh even remotely the same. And yet – we use the same word for all of them.
We expect too much from certain people, and it is impossible for them to live up to these expectations; but, unfortunately, our expectations are precisely what makes their lives miserable.
Just like Superman, doctors don’t have the luxury to ignore calls or emergencies, even if they come past work hours; unfortunately, they usually don’t get paid for that; and it seems that they don’t get paid a lot for their regular working hours as well.
Also, sick days and vacations are not exactly something they can take speedily, or even straightforwardly plan them in advance: as Kay explains, it is not that easy to find someone to cover your shift, when everybody is working two of them each day.
Kay found out about this the hard way, after being unable to take any time off following his career-ending mistake to recover emotionally. Just imagine how you felt after, say, missing your boyfriend’s birthday or failing your driver’s exam and how much time and solitude you needed to come back to your best.
Well, Kay wasn’t allowed either to come back to even his regular self after possibly causing the death of an infant!
Hell, he was expected to deliver other babies even though – as expected – he couldn’t even get a single hour of sleep which is a debilitating factor in itself!
Even so, when all’s said and done, Adam Kay delivers his verdict on his job with a heartwarming twist:
The hours are terrible, the pay is terrible, the conditions are terrible; you’re underappreciated, unsupported, disrespected and frequently physically endangered. But there’s no better job in the world.
Doctors Really Do Deserve MoreAs we stated above, Kay decided to publish this book after Jeremy Hunt – current Secretary of State for Foreign and Commonwealth Affairs – labeled junior doctors as “greedy” during their contract dispute with the British Medical Association.
Well, if you are like us, reading this book will probably make you more sympathetic to the doctors. And give you several reasons why you should take their side, even if their strikes affect you personally.
Because, the bottom line is, doctors have one of the most mentally (and even physically) exhausting, accountable and blamable professions of all.
And whatever they get – they certainly deserve more.
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“This Is Going to Hurt Quotes”[bctt tweet="A great doctor must have a huge heart and a distended aorta through which pumps a vast lake of compassion and human kindness." username="get12min"]
[bctt tweet="The depth of the lows is the price you pay for the height of the highs. " username=“get12min”]
[bctt tweet=“As the patient flailed around, resisting this awful thing going down his throat, the blood jetted everywhere: on me, on Hugo, on the walls, curtains, ceiling. It was like a particularly avant-garde episode of Changing Rooms.” username=“get12min”]
[bctt tweet=“Bleeped awake at 3AM from my first half hour shut-eye in three shifts to prescribe a sleeping pill to a patient whose sleep is evidently much more important than mine. My powers are greater than I realized; I arrive on the ward to find the patient is asleep.” username=“get12min”]
[bctt tweet=“But it’s a Saturday night and the NHS runs a skeleton service. Actually, that’s unfair on 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.” username=“get12min”]
Our Critical Review“This Is Going to Hurt” is a highly personal, unputdownable book that has the power to both make you laugh out loud and touch you deeply. “Hilarious and heartbreaking” – sums these effects Black Mirror’s Charlie Brooker; “very funny with a sobering message” adds comedian Chris Addison. "Witty, gruesome, alarming and touching," concludes British presenter Jonathan Dimbleby.
It’s all those things and more.