Read from January 17th to 30th 2019
Written by an author who was not meant to be a doctor or who was defeated by the system (the jury is still out on this one), This Is Going to Hurt is, despite its somehow menacing title, generally a funny book. In fact, Adam Kay is nowadays, according to his own disclosure, “only doctoring… other people’s words”, writing and editing tv comedy scripts, that is.
The book takes, for the most part, the form of a diary covering the narrator’s experiences as a young doctor in the British public system for six years (from August 3rd 2004 to December 2nd 2010, to be more precise). Its light tone is captured just from the beginning for it is dedicated “To James – for his wavering support And to me – without whom this book would not have been possible.”
In the “Introduction” he explains how the idea of the book came to him: five years after he resigned, he received a letter from the General Medical Council announcing him that his name had been erased from the medical register. Consequently, he went through his old papers and shredded all the documents except for his training portfolio, a log of the clinical experiences all doctors are supposed to keep as a sort of ‘reflective practice’:
On looking through this portfolio for the first time in years, my reflective practice seemed to involve going up to my hospital on-call room and writing down anything remotely interesting that had happened that day, like a medical Anne Frank (only with worse accommodation).
Probably afraid that his tone has become too dark, he goes on promising to explain the medical terminology for dummies and announcing he changed the real names with those of some minor characters in Harry Potter.
I won’t try and enumerate the motives that led him to the decision to leave the profession, they are easy to find in this bittersweet confession, in which are blended with a sure hand (we see the editor behind it all right) the gory and the funny, the light and the dark. I will just re-tell some hilarious facts that I think will stay with me forever. If you think this is a spoiler, you are, to quote the author, “banned from reading” the rest of the review.
As a junior gynaecologist he trained in an overcrowded, understaffed public clinic, where doctors were few and rules were many, the latter sometimes deliciously absurd, like in that circumstance when, wanting to search something online, he finds that the IT department had decided to block the Royal College of Obstetrics and Gynaecology website, categorizing it as pornography.
True to his promise, he explains in footnotes every medical term he uses, sometimes overzealously:
SCBU (pronounced Scaboo) is the Special Care Baby Unit, NICU is Neonatal Intensive Care, PICU is Paediatric Intensive Care, PIKACHU is a type of Pokémon.
And since we are already talking about terminology, if you didn’t know, there are three names of a medical condition: the formal Latin or Greek one (for example, “obesity”), the euphemistic one (not obese, but “overweight”) and the invented one, to say before a patient in order to sound credible and scientific, without really telling him anything (not obesity, but “chronic glucose poisoning”). Of course this third category proves to be the most inventive:
Q sign – Tongue hanging out of side of mouth, in the shape of a Q. Prognostically-speaking, a very bad sign, though not as bad as the Dotted Q sign, where there’s a fly on the tongue.Status dramaticus – Medically well but over-emotional.Transferred to the fifteenth floor – Dead. (NB The number should be one higher than number of floors in the hospital.)
A, and patients who worry they are ill because they think they have symptoms they read about on line, are called cyberchondriacs (so this is the name of my condition 😊).
One of the job hazards is to deal with unexpected haemorrhages. Often, not only his trousers but also his boxers become soaked in his patients’ blood, and once he found blood even on his penis, happenstance that left him with some philosophical doubt:
I’m not sure which is worse: the realization I could have caught HIV or the knowledge that none of my friends would ever believe this is how I got it.
All in all, the book is full of such savvy comments on some incredible stories that reveal the human nature in all its splendour: irrational, overemotional, impulsive, boasting and sometimes plainly stupid. Here you have the patient who comes with a peeled-off penis after he decided to jump to use a lamppost as a fireman’s pole without considering its rough texture. This is a “degloving injury”, whose name, the narrator informs us in the foot note, comes from the motorcycle accidents, when hands drag along the ground and the skin is torn. (He supplements the information with the one that rats are known to deglove their tails when captured, wondering why the medical school provided them with it):
Perhaps not surprisingly, WM was upset. His distress was only made worse when he asked if the penis could be ‘regloved’. Mr Binns, the consultant, calmly explained that the ‘glove’ was spread evenly up eight foot of lamp post in west London.
Another cock-related accident concerns this time a patient who wanted to show his girlfriend his erection was so stiff it “could stop the rotary blades of a desk fan. His hypothesis was monumentally incorrect and the desk fan proved the clear winner”. To comfort him, the doctor suggests to the patient to change his name for a more spectacular one, such as Cock au Fan; Tony Fancock, or Knob-in-Fan Persie.
And speaking of names, here are some weird ones for babies, proving that the parents’ imagination is (unfortunately) boundless: Sayton (pronounced like Satan); LeSanya (pronounced Lasagne), Clive (for a girl), Princess Michael (also for a girl).
There are many other stories like these, which made me laugh out loud more than once, like the complaint of a man who couldn’t find a condom to fit him given that he was pulling them over his balls, or the innocent question of a woman who, after having slept with three men the other night, was worried if one morning after pill would be enough, but I leave you to discover them all at your leisure.
I will finish with a quote that is a perfect example of how the comedy only conceals the graver message of the book (which will be explicitly stated in the Open Letter to the Secretary of State for Health included at the very end of it):
Down in A&E around 11 p.m. to review a patient, and thumbing through Twitter while I work up the strength to see her. There’s a big news story breaking, but so far only gossip-merchants TMZ have reported it. ‘Oh Christ,’ I gasp. ‘Michael Jackson’s dead!’ One of the nurses sighs and stands up. ‘Which cubicle?’