Behind the White Coat: A Book Review on ‘This is Going to Hurt’ by Adam Kay

-Divya Samat
Final Year MBBS,
KJ Somaiya Medical College, Mumbai

The title is an apt if not an adequate description of the emotional rollercoaster that awaits you in the pages of this book. Hilarious, horrifying and heartbreaking, Adam Kay’s ‘This is Going to Hurt’ is everything you wanted to know (and a few things you didn’t) about life on and off the
hospital ward. This book is sure to leave you with a heavy heart and a fresh perspective on what it truly means to be a doctor.
This book was written in 2015, as a response to doctors being called ‘greedy’ by Secretary of State for Health and Social Care, Jeremy Hunt when junior doctors entered contractual disputes with the NHS. Adam felt that doctors were struggling to get their story across, and that the public wasn’t hearing the truth about what it actually means to be a doctor. To redress the
balance, he decided to write of his experiences working as a junior doctor in the NHS.
While this is not the first medical non-fiction book to be written, it differs from others in the genre in the honest, (almost too) straightforward and comical manner Adam uses to narrate his experiences. You are seldom more than a paragraph away from a punchline, and the descriptions err on the side of comic exaggeration. But what makes it truly believable is the
oscillation between comedy and tragedy- tense situations and life and death decisions which don’t always have the desired outcome.
Throughout his book, Adam dwells deep into a few recurring themes, one of them being how starkly medicine differs from other professions. Adam marvels at the selection criteria for getting into these much sought after medical colleges. If it’s not based almost entirely on one’s
academic prowess then nonacademic criteria such as extracurricular activities serve as the determining factor while almost no attention is paid to whether the student is psychologically fit, able to make decisions under pressure, break bad news to relatives, deal with death on a daily basis or even comfortable with the sight of blood-qualities which are important if not essential fora future doctor.While attempting to learn ‘every single aspect of the human body’s anatomy and physiology and every possible way it can malfunction’ in a mere 5 years is quickly deemed part and parcel of this career choice. The reality is that knowing the theory and managing an actual patient is as different as watching a documentary on bombs and then being asked to diffuse one. Adam Kayaptly describes this experience of being thrown in the deep end as ‘sailing a ship alone. A ship that’s enormous and on fire and that no one really taught you how to sail. ‘It’s sink or swim and if you sink, your patients sink with you.

On one hand, Adam has to manage studying along with his hectic work schedule and jokes that this would only be possible if he gave up on his ‘hobby of sleeping’ or stayed in a store cupboard at the hospital. On the other hand, one of Adam’s friends, a non medic has been given time off work to study, the course material and fees are paid for by his employer and he is even granted a promotion at successful completion of the course. What’s even more shocking is an instance where Adam is suffering from a bad bout of food poisoning and informs the authorities in order to apply for sick leave. In place of compassion and sympathy, he is asked if he can come in to work nevertheless and if that’s not possible, to arrange for his own sickness cover! Another theme that’s brought to light is the flaws of a broken system, often catering to the needs of the patients but failing the doctors themselves. Understaffed and with a pecking order in place, 100-hour weeks are often the norm for those at the bottom of the hierarchy. It should also be kept in mind that a significant number of these hours are unpaid overtime. The hourly pay is about £6.60 per hour, ‘slightly more than McDonald’s till staff get, though significantly less than a shift supervisor’. Even as he works his way up the ladder to the position of Senior Registrar, Adam’s salary could be comparable to that of a bank cashier or a ‘reasonably experienced milkman’. It is at this instance that you realize how inaccurate if not a joke Hunt’s comment of doctors being ‘greedy’ was. Unforgiving hours and an ever-changing schedule leave little time for social and romantic relationships. The impact of this colossal workload on Adam’s social life has been depicted in various instances in the book as he talks of missed dates, birthdays, weddings, and funerals.
His relationship with his partner grows increasingly strained and when he tries to get off early from work for a day, he is told that ‘It would be easier to find a new partner than a new job’. An incident which particularly caught my attention is when Adam meets his medical school friends at a bar and after a game of ‘Never Have I Ever’ we find that most of them have cried because of work as well as while at work, ended relationships and missed major family events due to work. This incident speaks volumes of strain, burden and often unspoken personal sacrifice of doctors.
The hectic lifestyle begins to take a toll on his physical and mental health and our heart goes out to him as he recalls falling asleep in the most unlikely of places due to sheer exhaustion- the hospital parking lot on Christmas eve, a theatre stool and even while driving the car! Moreover,
he finds his blood pressure elevated and jokes that he can now quantify the stress of being a Senior Registrar.

An incident is described wherein a young house officer arrives in A&E one night having attempted suicide by overdosing on antidepressants and the surprise is not at the incident itself but given the working conditions that it doesn’t happen more often. This brings us to another theme spoken about in the book- mental health problems among medical professionals. Adam
marvels at the hospital’s ‘willful ineptitude when it comes to caring for their own staff.’ This ineptitude is further magnified when Kay writes of the traumatic incident that marked the end of his career. He speaks out about how his hospital should have offered him therapy but instead he was not even given time to recover from the trauma and expected to be back at work the next day, only to repeat the inevitable cycle.

This incident along with many others contributes to Kay’s aim of ‘humanizing’ doctors. Kay discusses how the public expects doctors to be more than human. Part of this notion stems from the fact that you want to think of your doctor as ‘infallible’, incapable of giving a wrong diagnosis
or making mistakes. Doctors are expected to be always available at their full efficiency, disregarding the fact that they too require sleep, time to take care of themselves and have friends and family of their own. When Kay writes about how he spends the night by the side of a young couple who have lost
their child, the pang of pain he feels as he has to take tissue samples from the dead baby, the day he spent talking to a woman recently diagnosed with ovarian cancer as she spoke of her lost hopes and dreams, and thereafter when he broke the rules to attend her funeral and honor her memory, our heart warms and we realize that the personal and professional boundaries
may not always be as clearly delineated as we think them to be. It may be the story of a junior doctor, but it touches on things that matter to all of us, like relationships, family, mental health, work-life balance and the significant but somehow often overlooked fact that doctors too are human beings who have a right to it all.

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