by Adam Kay
No one else can ever really understand how hard it is to be a doctor, or how much it affects your life. I did lie about the christening, though. Fuck that.
Monday, 2 August 2010
It’s my last shift in this hospital. A night shift, of course. My new job starts an hour before this one is due to end, and is about ten miles away. I guess I am going to be late.
I am on the stairs at 12.10 a.m. when my swipe card refuses to let me back onto the ward. This job was meant to end at midnight, and I realize the card must have been cut off as soon as the clock struck 12. I am basically Cinderella in scrubs.
If you ask a hospital to provide enough staff, or chairs, or a fast computer, then they will be useless. But when it comes to locking you in and out of wards, they suddenly find a way. I spend the next fifteen minutes banging on the doors and praying no one dies before someone spots me and lets me back on the ward.
Monday, 9 August 2010
A patient named their baby after me today. After I delivered it, I said, ‘Adam’s a good name,’ and the parents agreed.
I say ‘Adam’s a good name’ after every single birth and this was the first time that anyone has ever said yes. I’ve not even had a middle name before. Once I have enough Adams named after me, maybe I can ask them to work my shifts instead of me.
The student helping me asked how many babies I have delivered. I guessed around 1,200. He then looked up some facts and told me that nine babies out of every 1,200 born in the UK are called Adam. So it would seem that out of nine sets of parents intending to name their child Adam, I have managed to put off eight of them.
Wednesday, 25 August 2010
An eighty-five-year-old cancer patient broke my heart yesterday. She told me she misses her dead husband. Her children have not been to visit since she has been in hospital. And she can’t even have her usual bedtime drink of whisky in here.
I decided to do a good deed. I added whisky to her drug chart and gave one of the nurses £20 to get a bottle from the supermarket.
This morning the nurse told me the patient would not take the drink because ‘Jack Daniel’s tastes like fucking cat piss.’
Friday, 24 September 2010
The emergency alarm sounds. It’s Friday night and five minutes before I am due to go home.
Tonight is date night. I am meant to be taking H somewhere very expensive to make up for the fact that I have had to work for the last six date nights. I should be fine if I leave by 6 p.m., I tell myself. It is 5.45 and my patient needs an operation.
There are two ways of dealing with this. The first way – keyhole surgery – will take over an hour of my time, but the patient will be more comfortable and can go home tomorrow. The second way – a normal operation – will take a matter of minutes, but the patient will end up with a scar and will need to stay in hospital for a few days. The second way will mean I get to go home on time and keep H happy. And maybe the patient likes hospital food?
I pause for a moment and then decide to do the right thing. Good news for the patient, bad news for me.
Monday, 11 October 2010
I get a text from Simon. I’ve not heard from him for the last eighteen months so I worry when I see his name pop up. He is asking for my address as he wants to invite me to his wedding. I’m touched that he thought of me. I look forward to saying yes, and then having to cancel at the last minute due to work.
Thursday, 14 October 2010
The first time a patient started texting while I was doing a smear test, I found it quite weird. But now it happens all the time. Today a patient did a FaceTime call with her friend while I was down there.
Monday, 8 November 2010
I have just had the night shift from hell. We were short of staff and I ran from one crisis to another all night. I lost count of the number of babies I delivered in the end.
I don’t think I have ever been this tired. I have not shut my eyes or sat down for twelve hours. My dinner is still in my locker, and I just called a midwife ‘Mum’ by mistake.
I do one last emergency c-section. The baby is limp, but gets some urgent care and is soon making the right noises. I sew up the patient, feeling glad it has all ended well.
After I leave the room, another doctor grabs me and says I have cut the baby’s cheek. I must have done it with the knife when I cut open the mum. It’s not a bad cut but they had to let me know.
I go straight back in to see the baby and its parents. The cut won’t leave a scar but it was still my fault. I tell the parents how sorry I am. They are in love with their beautiful little girl and say they understand. They know she had to come out in a hurry and these things happen.
I want to say that these things aren’t meant to happen. I’ve not done anything like this before and I don’t think it would have happened at the start of the shift, when I was less tired.
I give the parents a leaflet that tells them how to write and complain. But they don’t want it. It’s a relief for me, but I keep thinking about the poor baby. A little higher and I could have taken her eye out. A little deeper and I could have caused a scar and major blood loss. Babies have even died this way in the past.
I write up the notes and fill in a form. Soon I will be sat down and told off about this. But no one will stop and think about the real problem. These long hours are dangerous for staff and patients alike.
Thursday, 18 November 2010
I was meant to be home at 7 p.m., but it is now 9.30 p.m. and I have only just left labour ward. It seems fitting that work means I have to text H and cancel picking up all my stuff from the house. We have now broken up and I’m living in a tiny little flat. One good thing: at least it’s only ten minutes away from the hospital.
Monday, 22 November 2010
A patient in A&E with mild stomach pain has sunk lower and lower down my to-do list this afternoon. Labour ward is very busy today. I am in the middle of seeing a patient who is seriously ill when I get a call from an angry doctor in A&E.
‘If you don’t come here right now, this patient is going to break our four-hour target,’ he says.
‘OK,’ I say. ‘But if I do come right now, my current patient is going to die.’
He is silent for a good five seconds. Which is time neither of us can really afford to waste.
‘Fine. Just come when you can,’ he snaps. ‘But I am really not happy about this.’ When my seriously ill patient feels better, I must ask her to write an apology.
Sunday, 5 December 2010
It is Sunday afternoon on labour ward. I am working with an excellent junior doctor. She asks me to look at a patient and I agree that she will need a c-section. The baby is clearly in distress. They are a lovely couple and only got married last year. It’s their first baby. They understand when we tell them what needs to be done.
The junior doctor asks if she can do the c-section while I help her. She begins to cut through the skin and then the layers beneath. When she cuts into the womb, there is a huge amount of blood.
I stay calm and ask the junior doctor to deliver the baby. She says she can’t because there is something in the way. I take over. I soon realize there is something seriously wrong. It should have been picked up when the patient had her pregnancy scans. She should never have been allowed to go into labour.
I deliver the baby. But the baby is dead. The baby doctors try to save it but, sadly, they can’t.
The patient is losing a lot of blood. One litre. Two litres. Nothing I try will stop it. I call for urgent help. We are doing all we can and the husband has been sent out of the room.
She has now lost five litres of blood. I am holding her womb tightly in both hands to try to stop the bleeding.
My boss arrives and tries to help but nothing works. I see panic in her eyes. We are told there is now a chance that the patient’s organs will be damaged. We wait for the most senior doctor to arrive. He has no choice but to remove the patient’s womb. The patient has now lost twelve litres of blood.
The p
atient is moved to Intensive Care and I am told to expect the worst. My boss talks to the husband. I start to write up my notes, but instead I just cry for an hour.
After
That was the last diary entry I wrote, and the reason there aren’t any more jokes in this book.
Everyone at the hospital was very nice to me. They said all the right things. They told me it wasn’t my fault and that I could not have done anything more. I got sent home for the rest of the shift.
A number of people asked if I was OK. But everyone still expected me to come into work the next day and carry on as though nothing had happened. No one was unkind about it. It’s just a problem that comes with the job. You can’t wear black every time something goes wrong. You can’t take a month off to recover. Bad things happen too often. And there is not even enough space in the rota for anyone to take a sick day.
It is difficult for doctors to admit just how badly terrible things like this affect them. The only way to survive is to tell yourself that it is all just part of the job.
I had seen babies die before. I had seen patients die before. But this was different. It was the first time I was the most senior person on the ward when something awful happened. I was the person everyone turned to, and I failed.
I had not broken any of the rules or done anything wrong. Other doctors would have done exactly the same things with exactly the same result. But this wasn’t good enough for me. I kept wondering what might have happened differently. I might have prevented this tragedy. It was hard to think about anything else.
I went back to work the next day. I was in the same skin, but I was a different doctor. I knew I could not risk anything bad ever happening again. If a baby’s heart rate dropped even a tiny bit, I would do a c-section. I knew this meant women were having c-sections they didn’t really need. But if everyone got out of the room alive, it was worth it.
In the past I had not understood why my bosses were afraid of taking risks. But now I could see why. They had all been through something that left them thinking about what might have been. And this was how you dealt with it.
Except I wasn’t really dealing with it. I was just getting on with it. In the next six months I didn’t laugh once. My smiles weren’t real. I was broken by this experience.
I should have been able to talk to someone. In fact, the hospital should have made sure of it. But there is a code of silence that keeps help from those who need it most.
No matter how hard I tried, I knew another terrible thing would happen at some point in the future. There is no way to avoid it. One senior doctor tells her students that by the time they retire there will be a bus full of dead kids and kids with brain damage, and that bus is going to have their name on the side. She tells them that if they can’t deal with this then they are in the wrong job.
Maybe if someone had said that to me a bit earlier, I would have thought twice about becoming a doctor. Maybe I would not have become a doctor at all.
I asked if I could go part-time but they said no, not unless I was pregnant. I thought about becoming a GP instead. But it would mean I would have to start my training from scratch, and I didn’t know if I even wanted to be a GP.
A few months later, I hung up my white coat. I was done.
I didn’t tell anyone why I left. Maybe I should have. They might have understood. When I told my parents, they looked at me as though I’d just said I was going to prison.
At first, it was something I couldn’t talk about. But then it became something I just didn’t talk about. I would simply change the subject and tell some funny stories about things patients had said or done. Some of my closest friends will read this book and hear that sad story for the first time.
These days I work as a writer. A bad day at work now is when my laptop crashes or I get a bad review – things that really don’t matter at all. I don’t miss the doctor’s version of a bad day. But I do miss the good days. I miss the other doctors I worked with and I miss helping people. I miss that feeling on the drive home that you have made a difference to someone’s life.
I have learnt that you never really stop being a doctor. You still run to help if you see someone come off their bike. You still reply to texts from pregnant friends who need advice.
In 2016, the government started forcing doctors to work harder than ever for less money than ever. I knew I had to stand up for the doctors. There were MPs who lied again and again, and said that doctors were being greedy. This made me angry because I knew it wasn’t true. Doctors only ever care about the best interests of their patients.
Unfortunately, the junior doctors lost their battle. The government’s loud voice drowned out their very quiet one. I suddenly realized that everyone who works for the NHS needs to shout about what their work is really like. Next time a government minister lies and says doctors are just in it for the money, we need the public to know that this is nonsense.
Why would anyone do that job for anything other than good reasons? I wouldn’t wish the job on anyone. I have a lot of respect for those who work on the front line of the NHS, because in the end it was too much for me.
I wrote this book six years after I quit. When I meet up with doctors I used to work with, their stories from hospitals still show the NHS in a sad state. When I left, it was very rare for a doctor to change career. Now it happens extremely often. The job is so stressful and so difficult these days that they often move abroad or work in the City. These same doctors were the ones who used to do anything for the job. They would even miss the morning of their own wedding day.
The other thing I notice when I speak to doctors now is how everyone remembers the sad stuff and the bad stuff so clearly. They can remember every detail and their voices shake when they talk about it.
I’m not here to tell their stories, though. That’s not what this book is about. It is simply one doctor’s point of view. I hope it will give a glimpse of what the job really involves.
But promise me this. The next time an MP attacks the NHS, don’t just accept what they try to feed you. Think about the toll the job takes on every doctor, nurse and midwife. Think about what they must go through at home and at work. Don’t forget that they do an impossible job and try to do their very best every day. Your time in hospital may well hurt them a lot more than it hurts you.
Quick Reads
This is Going to Hurt
Adam Kay is an award-winning comedian and writer for TV and film. Before this, he worked for many years as a junior doctor. He lives in London.
First published 2020 by Picador
This electronic edition first published 2020 by Picador
an imprint of Pan Macmillan
The Smithson, 6 Briset Street, London EC1M 5NR
Associated companies throughout the world
www.panmacmillan.com
ISBN 978-1-5290-3763-0
Copyright © Adam Kay 2020
Cover design: Ami Smithson, Picador Art Department
The right of Adam Kay to be identified as the author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988.
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