Kay - This Is Going to Hurt: Secret Diaries of a Junior Doctor

Adam Kay

This is Going to Hurt

Secret Diaries of a Junior Doctor

PICADOR

To James

for his wavering support

And to me

without whom this book would

not have been possible

A NOTE REGARDING FOOTNOTES

Read the fucking footnotes.

Although fuck knows why they cant threaten to strike me off any more.

Contents

Introduction

In 2010, after six years of training and a further six years on the wards, I resigned from my job as a junior doctor. My parents still havent forgiven me.

Last year, the General Medical Council wrote to me to say they were taking my name off the medical register. It wasnt exactly a huge shock, as I hadnt practised but I found it a big deal on an emotional level to permanently close this chapter of my life.

It was, however, excellent news for my spare room, as I cleared out box after box of old paperwork, shredding files faster than Jimmy Carrs accountant. One thing I did rescue from the jaws of death was my training portfolio. All doctors are recommended to log their clinical experiences, in whats known as reflective practice. On looking through this portfolio for the first time in years, my reflective practice seemed to involve going up to my hospital on-call room and writing down anything remotely interesting that had happened that day, like a medical Anne Frank (only with worse accommodation).

Among the funny and the mundane, the countless objects in orifices and the petty bureaucracies, I was reminded of the brutal hours and the colossal impact being a junior doctor had on my life. Reading back, it felt extreme and unreasonable in terms of what was expected of me, but at the time Id just accepted it as part of the job. There were points where I wouldnt have flinched if an entry read swam to Iceland for antenatal clinic or had to eat a helicopter today.

Around the same time that I was reliving all this through my diaries, junior doctors in the here and now were coming under fire from politicians. I couldnt help but feel doctors were struggling to get their side of the story across (probably because they were at work the whole time) and it struck me that the public werent hearing the truth about what it actually means to be a doctor. Rather than shrugging my shoulders and shredding the evidence, I decided I had to do something to redress the balance.

So here they are: the diaries I kept during my time in the NHS, verrucas and all. What its like working on the front line, the repercussions in my personal life, and how, one terrible day, it all became too much for me. (Sorry for the spoiler, but you watched Titanic knowing how that was going to play out.)

Along the way, Ill help you out with the medical terminology and provide a bit of context about what each job involved. Unlike being a junior doctor, I wont just drop you in the deep end and expect you to know exactly what youre doing.

House Officer

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 youll choose the chicken, to be on the safe side, and its 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 theyll fancy for dinner in sixty dinners time.

Every doctor makes their career choice aged sixteen, two years before theyre legally allowed to text a photo of their own genitals. When you sit down and pick your A levels, youre set off on a trajectory that continues until you either retire or die and, unlike your work Christmas party, Janet from procurement wont swap your chicken for her halloumi skewers youre stuck with it.

At sixteen, your reasons for wanting to pursue a career in medicine are generally along the lines of My mum/dads 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 thats 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 dont 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 thats 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.

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. Its 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, thats what youd think. In reality, medical schools dont give the shiniest shit about any of that. They dont even check youre 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. Its basically a Miss Congeniality contest without the sash. Look at the Wikipedia entry for any famous doctor, and youll 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 its not a rock-solid system.

Imperial College in London were satisfied that my distinctions in grade eight piano and saxophone, alongside some half-arsed theatre reviews for the school magazine, qualified me perfectly for life on the wards, and so in 1998 I packed my bags and embarked upon the treacherous six-mile journey from Dulwich to South Kensington.

As you might imagine, learning every single aspect of the human bodys 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.

Then there 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 Id chosen was too vast and wide-ranging, that I should have gone for something like atherosclerosis or bunions, but theyd have been wrong. Id have nailed it.

It was finally time to step out onto the ward armed with all this exhaustive knowledge and turn theory into practice. My spring couldnt have been coiled any tighter. So it came as quite the blow to discover that Id spent a quarter of my life at medical school and it hadnt remotely prepared me for the Jekyll and Hyde