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

There are few books that have made me laugh so hard that I have had tears rolling down my cheeks, fewer still those that have moved me to tears and, until now, none that has done both. Adam Kay’s unflinching, no-holds-barred, often brutal yet elegiac and humane memoir of his time as a junior obstetrician did both.

This is Going to Hurt chronicles the life and times of one junior doctor, Dr Adam Kay, from a house job in 2004 to a senior registrar post in 2010. Kay writes with a razor-sharp wit coupled with a knowing melancholy that will strike a chord with all of his readers, lay and doctor alike. Every chapter has its own gems but some of my favourites include the deceptively simple task of trying to establish how many weeks pregnant a patient is: ‘I ask a patient in antenatal clinic how many weeks she is now. There’s a long pause. Cogs turn. A camera slowly pans across a wasteland … has she got amnesia? … I start to ask when her last period was, and she interrupts’“Well I’m 32 in June so that’s got to be more than a thousand weeks…” Christ.’

Another is Kay lamenting in his uniquely funny way about today’s on-call consultant: ‘Prof Carrow is the consultant on call for labour ward today, which is about as much use as having a cardboard cutout of Cher on call for labour ward. In fact, Cardboard Cher might at least raise morale a bit.’

Underneath the laughs and between the lines This is Going to Hurt is not just a working memoir, it is a political essay raising questions that if looked at objectively and perhaps outside of medicine beggar belief. Running an antenatal clinic one registrar down and seeing twice the number of patients one has the time or the capacity for, Kay ruminates: ‘I strongly suspect that if I was a pilot and my co-pilot didn’t turn up, the airline might find a better solution than “plough ahead and see what happens”.’

Further musings on the creeping increasing privatisation of the NHS and a concluding open letter to the Secretary of State for Health read like a call to arms for all of us who work in this beloved yet beleaguered institution: the NHS.

It would not be a spoiler alert to reveal that ultimately, after 6 years of study and a further 6 gruelling years on the wards, Kay walked away from medicine because he discloses this within the first sentence of the book; in the final chapter however he narrates with painstaking detail the case that acted as a catalyst for his resignation.

The harrowing nature of the case and the damning indictment of the way the NHS supports — or rather fails to support — its frontline staff leave you feeling that what is Kay’s gain by walking away is surely the NHS’s and his patients’ loss.

• © British Journal of General Practice 2018