Medical education

The DO Book Club, May 2020: This is Going to Hurt: Secret Diaries of a Medical Resident

Adam Kay, a former resident physician who is now a comedy writer, published a diary describing all the highs and lows of his six years working in NHS labor wards.

Welcome back to The DO Book Club! For May, I read This is Going to Hurt: Secret Diaries of a Medical Resident by Adam Kay. If you’ve read this one, please share your thoughts in the comments below. And if you’d like to write a book review for a future month, please email Andy Brown at abrown@osteopathic.org.

Plot summary

Adam Kay, an accomplished comedy writer and comedian, spent six years training to be an OB-GYN with the National Health Service (NHS) in England before deciding to leave the profession. During his training, from 2004 to 2010, he progressed through the UK equivalents of internship, residency and fellowship and documented all the highs and lows of the labor ward in a diary, which eventually became this extremely popular book.

It’s so popular, he reports, that it’s been translated into 35 languages, proving that “the experience of being a doctor is utterly universal. The same heartbreak, the same hilarity” (p. 3). 

Beginning with his time as a house officer (in U.S. terms, a hospital intern), the book is broken up into vignettes of each of the phases of his training. From his days trailing behind a team of doctors in the labor ward “like a hypnotized duckling, [his] head cocked to one side in a caring manner, noting down every pronouncement from [his] seniors” (p. 11), to his final entries as a senior registrar (fellow), his stories are mostly humorous, but always earnest.

It’s not just a list of patient scenarios, either. Kay peppers in poignant details about how all the hours he spent in the hospital put a strain on his personal life because friends and his significant other sometimes struggled to understand his workload.

Sadly, Kay reveals at the end that his regrets over a tragic patient outcome, though not entirely his fault, drove him to resign, and that’s where this story ends, right before he would have transitioned out of training. But it is nonetheless a thorough, entertaining retelling of life as a young physician.

Interesting tidbits for DOs

As Kay reflects on his time as a physician-in-training, he makes several observations on working in medicine that DOs might find heartwarming and feel similarly about.

One concept he explores frequently is the perception that doctors perform individualized acts of heroism daily in hospitals and labor wards, and how different it really is on the front lines.

“Lives are saved every day on hospital wards, but almost every time it happens, it’s in a … low-key, team-based way. It’s not a doctor performing a single action so much as them implementing a sensible plan that gets carried out by any number of colleagues who at every stage check to see if the patient is getting better and modify the plan if they are not” (p. 22).

He later says it was “a privilege to be allowed to play such an important role in people’s lives” (p. 206), which is why even though he is now on a different path, he says he still feels a strong affinity for the profession. 

“I don’t miss the doctor’s version of a bad day, but I do miss the good days. I miss my colleagues and I miss helping people. I miss that feeling on the drive home that you’ve done something worthwhile … you never totally stop being a doctor” (p. 272). 

Notable quotes

The medical training timeline in the UK is a little different from that of the U.S., in that students decide to enter it before they start college, where they immediately begin training. Kay jokingly claims he decided to pursue a medical career because he enjoyed the french fries in the medical college’s cafeteria.

“Getting a medical degree is a decision you should make in your early twenties, not as a teenager. When you’re sixteen, your reasons for wanting to pursue a career in medicine are generally along the lines of ‘My mum/dad’s a doctor,’ ‘I quite like Grey’s Anatomy,’ or ‘I want to cure cancer’” (p. 9). 

And as a then-future comedy writer, he shows a distinct talent for punchlines.

“Almost any abdominal operation can now be performed laparoscopically, which is Greek for “much slower” and involves inserting tiny cameras and instruments on long sticks through little holes. It’s fiddly and takes a long time to learn. Re-create the experience for yourself by tying your shoelaces with chopsticks. With your eyes closed. In space” (p. 36). 

“It’s a Saturday night and the NHS runs a skeleton service. Actually, that’s unfair to skeletons—it’s more like when they dig up remains of Neolithic Man and reconstruct what he might have looked like from a piece of clavicle and a thumb joint” (p. 186). 

Takeaways

Though it’s a book partially intended for the general public to get a look at day-to-day life as a physician-in-training, DOs will find some parts are written in terms only they can easily understand. For the rest of us, Kay provides thorough, very funny footnotes that are worth reading regardless of your baseline knowledge:

“The notation #NOF means ‘fractured neck of femur.’ If you thought # was a hashtag, you’re banned from reading the rest of the book” (p. 36).

Though I was thus disqualified from continuing the book, I enjoyed it from start to finish. 

Be warned going in that Kay is at times critical of the profession, patients, and health care systems both in the UK and U.S., and writes pretty graphically in both his language and descriptions. But I found that his genuine voice added excellent color to the story. It’s a quick read (great for summer months!), and even for American physicians, I’d imagine much of it will jog many memories from residency.

June’s book

For June, The DO Book Club will be reading The Ghost Map: The Story of London’s Most Terrifying Epidemic — and How it Changed Science, Cities and the Modern World by Steven Johnson. We encourage all who are interested to read along! If you are unable to get out to a local library or bookstore due to COVID-19, we recommend checking out eBook options for rent or purchase.

As a reminder, if you read This is Going to Hurt or any previous Book Club selection and want your reflections to be shared in future posts, or want to write your own book review for a future month, please leave a comment below or email abrown@osteopathic.org.

Happy reading!

Related reading:

The DO Book Club, April 2020: The Body: A Guide for Occupants

The DO Book Club, March 2020: Brain on Fire

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