This Is Going To Hurt by Adam Kay

by Alex Yard · December 29, 2019

Little Brown Spark, 2019.

★★★★☆

There are numerous ways that various countries structure their healthcare system, but Adam Kay tackles the universal attributes of the physician experience. Regardless of geographic region, if you’re a doctor, you’re probably overworked, stressed out, and privy to medical scenarios both gruesome and hilarious. Yet despite the hardships, there’s a unique pride that fuels this particular calling, empowering healthcare providers with the superhuman ability to soldier through 100-hour workweeks. Adam Kay might be the UK’s Ken Jeong, hanging up his stethoscope as a doctor-turned-comedian and TV writer. In This Is Going To Hurt: Secret Diaries of a Medical Resident, he offers an entertaining and informative retrospective on his six years in the practice, which makes for an eye-opening glimpse into the perils and laughs of one of society’s most distinguished professions.

Kay extensively challenges the perception that doctors have it made in the shade, resting atop a pedestal of dignity and comfort. Most of his waking hours are spent at work; he and his colleagues witness personal relationships crumble over missed weddings, anniversaries and birthdays. Multiple scenes explore the profound stress of assessing a patient whose life is on the line, feeling slightly under-prepared and without a senior member on call to help, but powering through out of necessity. One of the more surprising realities is the near-absence of encouragement from colleagues and superiors. Kay might save a life in a flash of inspired intuition, but is immediately summoned to another emergency without even a pat on the back. Adding insult to injury, at the end of the day he often learns that in fact he must work a double shift due to someone else calling out. Exhaustive duties like these remind readers to appreciate any positive reinforcement they might receive at their own job. Medicine is one of society’s most crucial institutions, yet these doctors are fueled mostly by intrinsic motivation, in the absence of a tangible support system.

Each chapter corresponds to one of the many posts of Kay’s lengthy residency, of which there are no less than nine. The book is presented as a sequence of diary entries, which seems at least slightly dishonest, since they are clearly written with laypeople in mind. Kay may have kept his own “secret” diary throughout his residency, but if he did, it’s likely he reworked the material from the ground up once publication became a possibility. There are frequent footnotes to explain medical terminology, which attempts the illusion of a pure source material supplemented by after-the-fact additions. Which is unfortunate, because these breaks repeatedly interrupt the momentum of each entry with long explanations (and jokes) which could have flowed better if integrated into the main text itself. Ultimately, calling this manuscript a “Secret Diary” seems fueled by sensationalism rather than honesty. (Plus, isn’t the term “Secret Diary” redundant anyway?)

But any minor duplicity of format is negligible because the book’s greatest strengths are its numerous anecdotes—many funny, many wince-inducing, most quite entertaining. One patient presents for evaluation because he can’t find a brand of condom large enough to fit him. The Dr. House eureka moment was the realization that the patient was trying to cover not just his member but his testicles, too. Other stories illustrate the job’s strenuous gauntlet with hilarious irony: Once, while catching Z’s in between shifts, Kay is awoken, summoned to prescribe sleeping pills for a patient with insomnia. But upon arrival at the scene, the patient is…asleep. Other stories don’t end so happily. One woman accidentally lands on a fence, and one of its upward spikes enters her vagina and pierces out her abdomen. Another patient loses much of his penis skin in a “degloving” incident that occurs during a fireman-style slide down a pole. Every few pages, you’re bound to find a story that’s either shocking, hilarious, or a combination of the two, making for a highly readable experience.

For all his storytelling talents, Kay’s occasionally insensitive remarks make minor dents in his credibility. He opens the book by (rightly) stating that patients’ names have been changed to protect anonymity, yet admits he doesn’t see the point of withholding—he’s left the practice, so his license can’t be revoked—as if there is no inherent value in protecting patient confidentiality. He also includes a couple of tone-deaf bits surrounding heavy topics. When recalling the first time he ever had to pronounce a patient dead, he muses over the announcement’s performance aspect, joking that it almost felt suitable to lay out refreshments. Another upsetting moment involves a cesarean incision that he makes on an angle in error. Instead of honestly disclosing the mistake to the patient, he decides to lie by omission by informing the patient about the angled cut without identifying it as an oversight, relying on the patient’s ignorance as his out. It’s one thing to recall bizarre anecdotes and celebrate their absurdity, but having a laugh over the hindered welfare of innocent patients isn’t something to have a robust chuckle about.

Ultimately, This Is Going To Hurt’s more notable insights deconstruct the myth of the immortal doctor who’s figured everything out. Kay explains the odd phenomenon by which medicine was a career he woke up to find himself in, not really knowing quite how he got there. Would-be doctors in the UK begin the medicine track at age sixteen, still in the throes of an underdeveloped teenage brain. Considering that nearly everyone on the planet has had experiences with doctors, this book is a relevant way to peer behind the curtain to realize that they’re human mortals, just like us. This book would be especially valuable for prospective physicians to read, but not just because it may scare a percentage of them away from medicine. Rather, it’s because underneath all the chaos and grievances, a distinctive pride forms a strong foundation of the entire ordeal. A doctor might be two hours late for yet another anniversary dinner, but it’s because he was busy saving the life of someone who might have otherwise died. Despite the herculean challenges, fulfillment of this kind fuels doctors through the brutal gauntlets of the profession.