Adam Kay’s blisteringly funny memoir of his British medical apprenticeship, “This Is Going to Hurt,” leaves you thinking that Kay missed his true calling, as a comedy writer. Mild spoiler alert: Kay apparently thought so, too.
His book’s blurb describes him as “an award-winning comedian and writer for TV and film.” Before that, he was a junior doctor for the taxpayer-funded National Health Service, specializing in obstetrics and gynecology. He often loved the work, and especially the feeling of making a difference in his patients’ lives. But in 2010, after six years in the hospital trenches, he quit, and the book’s modest mystery is why.
“This Is Going to Hurt” takes the form of a staccato series of wry anecdotes and punch lines. The brief diary entries offer a view of humanity, as well as medicine, in all its glorious imperfection. But they also point cumulatively to a systemic critique. They chronicle how, over time, a dedicated and gifted physician can be ground down by the profession’s unnecessarily brutal demands.
Punishing hours, constantly upended schedules, and stressful emergencies, coupled with Kay’s own conscientiousness (he routinely overstayed his shifts to track patients), destroyed any trace of what we call work-life balance. “The extra mile,” he writes, “was the normal distance.” Apart from a tolerant but often exasperated partner, Kay seems to have enjoyed virtually no nonprofessional life at all.
His “secret diaries” were jotted in hurried spurts, he says, in the midst of endless hours of doctoring. He describes himself as “a blood-spattered, epically tired Samuel Pepys.” His musings, since polished (one imagines) to a high comic gloss, retain a sense of spontaneity. The footnotes are exquisite. “Don’t worry, you’re not going to have to remember huge numbers of characters,” he writes. “It’s not Game of Thrones.”
In an introduction, Kay says he thought the book was merely a parochial look at the life of an NHS doctor. But it has since been translated into 37 languages. Though health systems vary, insane hours, challenging diagnoses, and medical mishaps — not to mention what Kay calls “the same baffling array of objects getting constantly inserted into orifices” — turn out to be cross-cultural.
Kay begins his post-medical school training as what the British call a “house officer,” the equivalent of an intern. After “mind-numbing” days, he writes, the night shifts “made Dante look like Disney — an unrelenting nightmare” in which a newly minted doctor functioned as “a one-man, mobile, essentially untrained ER.” He logs one weekly work shift as 97 hours.
Exasperations include patients who refuse to stop drinking or smoking, no matter the health risks, and doctors devoid of common sense. Kind gestures from a grateful patient or the occasional colleague — usually a nurse or midwife — help dispel his gloom. As a “senior house officer,” Kay chooses his specialty, noting that “in obstetrics you ended up with twice the number of patients you started with, which is an unusually good batting average.”
While polishing his cesarean technique, he also develops a keen eye for moral conundrums and absurdities. He derides a computer system that doesn’t work much better than Tarot cards, and an employment protocol that obliges him to find his own replacement on the one day when, stricken with food poisoning, he dares to call in sick. “I wonder,” he writes, “what level of illness would stop it from being my responsibility. Broken pelvis? Lymphoma? Or just when I was intubated in the ICU and denied the power of speech?”
He finds amusement where he can. A woman shouts at a nurse, “I pay your salary!” The nurse counters: “Can I have a raise, then?” Prior to a cesarean section, Kay asks a couple if they have questions. Their 6-year-old pipes up: “Do you think Jesus was black?” To avoid performing a procedure that will keep him past his shift, he pleads that it’s his birthday. The midwife, unimpressed, responds: “It’s a labor ward — it’s always someone’s birthday.”
Many diary entries lament the lack of time for anything but medicine. To study for a required exam, he writes, “I need to either give up my frivolous hobby of sleeping or cut out my commute by living in a storage closet at work.”
At one point, Kay stops running long enough to commune with a terminal cancer patient worried about the impact of her death on her loved ones — “a strange privilege, an honor I didn’t ask for.” He spends hours on the phone counseling a friend’s suicidal younger brother, even though he feels no more qualified for the job than if he were talking him through “replacing a gearbox or laying a parquet floor…”
However grueling the routine, Kay seems determined to persist and attain the rank of consultant — in US terms, an attending physician. The reward will be shorter hours, better pay, a more congenial lifestyle. But, just short of that goal, a hospital mishap discourages him so deeply that Kay loses the will to continue — a loss for medicine, but a boon for comedy.
By Adam Kay
Little, Brown Spark, 278 pages, $28
Julia M. Klein, a cultural reporter and critic in Philadelphia, has been a two-time finalist for the National Book Critics Circle’s Nona Balakian Citation for Excellence in Reviewing. Follow her on Twitter @JuliaMKlein.