This Is Going to Hurt by Adam Kay [Book Summary]

You may reason that the life of a doctor is a leisurely one, with a lot of games of golf, expensive cars, and payments from the pharmaceutical industry. However, for the most aspect, those people who work at the National Health Service (NHS) hospitals all through the UK, are really hard-working people who only get small rest and even less respect for the hard work they do. 

They work like 100-hour per week and decide on life or death choices each day while barely earning more than your normal bank teller. Also, they also need to frequently face some despicable patients and medical cases that may seem really -bizarre-to-be-real. Stories from Adam Kay’s time as a junior doctor confirm that things can get really weird at a hospital. A caution before we start: Chapters 2 and 4 explain a graphic injury and a particularly disgusting scene and really have sensitive or possibly triggering content.

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1 – New doctors are obliged to immediately learn on the job after their medical school.

Just like every other British 16-year-olds kid, Adam Kay had to choose what his main area of study for the whole of his academic career will be.  At this age, he didn’t give this thought a great deal of inspection because it constantly felt like he was fated to follow the paths of his dad, who was a doctor.

Therefore, in 1998, Adam went to South Kensington, where he joined and attended Imperial College in London for six years. After that, he started his career as a junior doctor, which is essentially the name the NHS names the entire doctor who isn’t a consultant – the highest rank a doctor could reach at the time. The average trajectory of an NHS doctor’s career path back in those days was as follows: house officer, senior house officer (SHO), registrar, senior registrar, and then, lastly, consultant.

On the 3rd of August 2004, Adam began his career as a house officer. It didn’t take a while for him to find out that all the entire memorizations he did in school would’ve turned him to a great contestant on Masterminds; however, it did a bit to get him ready to work for over 90 hours per week as a house officer.

In a day shift, a house officer was anything like a glorified personal assistant: they did many phone calls, booked MRI and ECG appointments, and prepared for patient referrals. However, during the night shift, it was a completely different thing

At night, while the SHO and registrar were working with arriving patients in the Accident and Emergency (A&E) department, house officers were supposed to take care of the patients in all the other ward of the hospital. They gave them a pager, called a bleep, that went off anytime there was an emergency to attend to – and there was continuously an emergency to attend to.

It was really like being thrown into the extreme end of the pool and understanding that you have to learn to swim instantly since the lives of patients can basically be determined by it. For instance, only a few months into his first year as a house officer, Adam was paged to assist with a man that was in his sixties who was close to his death. Functioning on autopilot, Adam started doing the procedures he understood by hooking up an IV, giving him diuretics, getting him some oxygen, installing a catheter, running tests and so on. 

Incredibly, the man responded nearly instantly and was pulled back from death’s door.

2 – As a house officer, Adam was nearly instantly exposed to a lot of absurd medical cases. 

Soon after being able to say he’d saved his first life, Adam faced his first “degloving” case.

This was about an 18-year-old man who’d been out drinking a few drinks with his friends. Sometime after last-call, he then decided to climb on top of a bus stop shelter and use it as a dance floor. When he wanted to go down, he believed it would be a great idea to use a lamp post like a firehouse pole. 

However, the young man didn’t know that the texture of a lamp post is smooth. Therefore, as he was sliding down, the gritty, rough texture of the pole eventually tear up the palms of both his hands and deglove (or remove the skin from) his penis. What Adam examined that night appeared more like a piece of spaghetti with a little tomato sauce stuck to it, and he had to tell the troubled young man that no, it wouldn’t be likely to reglove his penis because that glove had been broken by a lamp post.

There was also the remarkably high number of patients being admitted to the hospital because household items had one way or another entered where they possibly shouldn’t be. During the first year of the job, Adam alone was faced with four patients that required to have an item, removed from their rectum. 

On the 7th of June 2005, was a remote control, and the patient had a virtually believable story for how it mistakenly ended up there. That is until it was removed – a condom was found on the remote control.

August 2005, Adam made the first step up the career ladder when he became a senior house officer. At that moment, he had to choose the specialty his career was going to concentrate on. After some thought, Adam picked obstetrics and gynecology.

This choice was basically a result of Adam’s thesis at school which was on obstetrics and gynecology, and he loved the potentially good sense of helping people bring in new life to the world. Also because he’d also been told that working in the labor ward could result in four things: “caesareans, forceps, ventouses, and sewing up the mess you’ve created.”

If you don’t understand what ventouse is, don’t bother; you’ll get to know in the following chapter. 

3 – As a senior house officer, Adam encountered more absurdity yet, as well as tensions on his romantic relationship. 

While being promoted from house officer to SHO indicated a promotion in the NHS hierarchy,  that doesn’t signify that Adam was getting a less demanding schedule or getting more money than a basic, junior professional’s salary. That wouldn’t occur for another few years – if and when he turned to a consultant.

All through his time as a junior doctor, Adam was in a relationship with a person he calls H, who had the tolerance and understanding of a saint. A lot of junior doctors can’t endure a long-term relationship since they’re always working more than 90 hours per week, and during the times they are not working, they are very tired. Also, most shots at planning dinner dates, vacations or even weddings have a tendency to just be fantasies that result in being canceled at the last minute because of work demands.

In 2005, on Christmas morning,  Adam woke up to a phone call from his registrar who asked him where he was – his shift had started and he wasn’t at work. Luckily, he wasn’t really far away. He’d unintentionally slept off in his car, which was in the parking lot of the hospital. The good thing was that Adam was just ten minutes late for his shift; however,  he’d missed eight calls and one text from H, which says, “Merry Christmas.” There was a clear lack of Xs, Os or smiley faces.

During his first few months as an SHO, Adam did his first cesarean section delivery and his first ventouse procedure, which basically entails a delivery that uses a suction cup joined to a vacuum cleaner. Though that might seem like an exaggeration, it isn’t. Both procedures were successfully, however, Adam was nearly 10 degrees off on the angle of the incision in his first cesarean, needing the registrar to tell the patient that they had to “go in at a bit of an angle.” Adam was grateful that the mother was so delighted with her new child that this news was taken in stride.

Also, he was meeting with patients in the labor ward who gave him no lack of Bizzare however real stories. 

One of those types of the story was a pregnant woman who got to the hospital at 3 a.m., stressing about the weird bumps she’d found on her tongue –also called taste buds. Also, there was a conversation with a married couple in which Adam found that the husband’s struggle using condoms came from the fact that he was attempting to put the condom all the way down around his testicles. 

Or the woman who, in an effort to pass her drug test, resulted in requiring medical assistance to get a bottle of another person’s urine out of her vagina. And that was Adam’s life as an SHO.

4 – While he was working as a registrar, Adam Kay had experienced his fair share of memorable incidences.

In 2007, skilled enough with the unending days and nights of the labor ward, Adam became a registrar. But, the biggest change, was that in some circumstances he’d be the most senior staff member in the ward and basically controlling the show. He attempted to balance the reality of enduring to be overworked and underpaid due to the fact that he was halfway to being a consultant.

At the same time, he was continuing to be surprised by some of the patients he’d encounter.

For instance, there was this mother that was delivering a baby who was so determined on eating the placenta that, when Adam’s turned his back, she took a bowl of blood clots he’d removed during the procedure, and put them in her mouth. She resembled some terrible hybrid between Dracula and the Cookie Monster and wasn’t really happy to know that it wasn’t placenta she stuffed in her mouth.

Also, there were patients who’d been listening to conspiracy theories and misinformation on the internet. One such patient had a pelvic inflammatory disease; however, she wouldn’t use antibiotics since she thought Adam was somehow in alliances with the pharmaceutical industry. He finally told her that he drove a five-year-old Peugeot 206, which the patient understood as a clear indication that he wasn’t getting payments from big pharma.

In another case, a new mother declined to let her baby get a shot of vitamins since she had heard that vitamins lead to arthritis. 

Definitely, there were still more memorable incidences of removing strange things from the common places. One woman wanted to surprise her boyfriend with an engagement ring by putting the ring in a Kinder Surprise Egg and then putting the egg in her vagina. When the egg changed position and when it was impossible to remove, the couple went to the hospital. When the egg was removed, the young woman still didn’t tell her boyfriend what was inside the egg. Therefore, there in the hospital room, with the surprise eventually told, she proposed and he accepted.

Sometimes, it was the actions of colleagues that would lead to confusion. One of such was where the doctors wheeled a bed on top of a catheter tube and then called Adam in to determine the reason why the patient hadn’t urinated at all lately. Or the student who came in with a hangover for his first cesarean operation and quickly passed out headfirst into the patient’s opened abdomen. You certainly couldn’t make these stories things up.

5 – While working as a junior doctor, Adam also faced a lot of problems with the UK’s medical system.

During his first day as a junior doctor, one of the things he was provided was an email address: Somehow, this administrative mistake – the misspelling of a really popular first name – was reassuring. It signified that Adam wouldn’t be the most incompetent person working for the NHS that day.

However, as Adam’s time as a junior doctor went by, the incompetencies within the NHS kept increasing. 

One of the more disturbing problems, apart from the fact that doctors were being made to work shifts that generally ended up lasting a risky long period of time, was the technology problem. At some time, there was a system upgrade that went completely wrong.

It was commendable that the NHS was making an attempt to change an old system that reminded Adam of the old DOS programs he used while he was a child. However, the new system that was installed in 2006 wasn’t really so much of an upgrade as it was hitting on a new interface that just made things really worse. Now, for example, if he needed to prescribe a treatment, he had to work through drop-down lists that could basically take more than three minutes to scroll down. Due to that, Adam began to think through before prescribing something that showed at the end of the list.

In a different wrong effort at improvement, the two main computers in the labor ward were ultimately decreased to one computer that was bolted to a rack on wheels. Everybody was now required to attempt and book time on the computer during the day as if you could correctly foretell if you’d be in an emergency or not at any time during a shift. In addition, the keyboard was some kind of industrial metal contraption that required you powerfully press one button at a time, denoting that everyone used a lot of time to perform the easiest tasks.

These were only a few of the ways that the choices being made at the upper ranks of the NHS and by the government, were making it hard for the staff to perform their duty. Also, by forcing doctors to work more than twelve-hour shifts for days continuously, they weren’t just risking the health of the staff, there were also putting the lives of the patients at risk.

Adam found just how real those risks were in 2010.

6 – Adam Kay quit the medical profession, feeling drained by problems that appear to have just gotten worse within the NHS. 

From stillbirths to serious complications during pregnancies, Adam experienced his fair share of death in the labor ward. There were times where he had to give bad news to families or do tests on dead babies to know the root of their death. These are the hardest aspects of the job; however, all doctor understands that they’re unavoidable, irrespective of how great the hospital.

An additional, particular problem to know in the life of an NHS doctor, is the influence of being obliged to work endlessly for more than twelve hours, without meals and rest, with the expectation of not making errors. Regardless of what some people may think, doctors are just as human as anyone else, and this kind of situation is a blueprint for adversity.

On the 8th of November 2010, Adam had been working for 12 hours non-stop, he didn’t eat dinner when he was performing a cesarean and mistakenly cut the cheek of the baby. It was a little cut that wouldn’t leave a scar; it was an accident that almost definitely wouldn’t have happened, had he been at the beginning of his shift.

Also, on the 2nd of December, 2010, a patient with undiagnosed placenta praevia undertook an emergency cesarean although she should never have been permitted to go into labor. With this situation, the placenta has detached from the uterus and it can make a cesarean procedure to lead to uncontrollable bleeding. Somehow, the condition went undetected in the patient’s previous scans and after taking out the placenta and unresponsive baby, Adam was obliged to hold together the woman’s uterus in his hands in an effort to stop the bleeding.

An emergency hysterectomy eventually stopped the bleeding; however, the woman had lost about seven liters of blood. They told him that the child had died and that the woman might not even get well. When trying to write up the report, Adam fell apart and was devastated for one hour.

After this event, Adam wasn’t able to see the positive aspect of his job. Fourteen years later he decided to become a doctor, he was now very close to becoming a consultant. However, he couldn’t withstand being part of a system that was apparently working against him and the patients.

A few months after, he left his job and followed a new career as a comedy writer for television shows. The years after, he was still in touch with some of his colleagues and discovered that things were just getting worse, with the Secretary of State for Health issuing salary cuts in 2016, and saying the doctors were greedy for complaining. 

The people on the front lines of the NHS are not greedy. They just want an amount that isn’t discouraging and maybe even respects the extent of the stress and life or death duty that each bares on their shoulders. 

This Is Going to Hurt: Secret Diaries of a Junior Doctor by Adam Kay Book Review

Adam Kay went through terrific highs and lows while working as a doctor in the UK’s National Health Service. On the one hand, he could save lives and another he could be faced with death at any time. In between these difficulties, there were a lot of great unforeseen and frequently bizarre or absurd circumstances, like removing strange objects from people’s orifices. For Adam Kay, the delight of delivering babies and assisting people couldn’t bear the difficulty of working in a system that forced doctors to work risky long shifts, with small pay and also less respect. 

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