62 pages • 2-hour read
This Is Going to Hurt: Secret Diaries of a Junior Doctor
A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Chapters 5-6Chapter Summaries & Analyses
Chapter 5 Summary: “Registrar—Post One”
Content Warning: This section of the guide includes discussion of mental illness and pregnancy loss.
Becoming a registrar involved even greater responsibility for Kay. He was usually “the most senior person in clinic” (108) and, therefore, expected to prioritize cases. At the same time, he was closer to achieving his goal of becoming a consultant, and he finally bought a flat with H.
Thursday, 16 August 2007 - Saturday, 19 January 2008
Patient “GL” declared that she wanted to eat the placenta after her delivery. Her baby was born, and while Kay was still delivering the placenta, he saw GL eating blot clots from a kidney dish like “Dracula.” The patient vomited when Kay pointed out her mistake.
Kay was performing an emergency cesarean when an SHO warned that another patient needed a forceps delivery, and the baby had a concerning heart rate. Leaving his first patient’s uterus half-stitched, Kay performed the forceps delivery, and he then responded to two more emergencies before returning to finish stitching up the uterus almost an hour and a half later. Kay recounted the events of his shift to the registrar, who eventually took over. The register replied, “Yeah, that happens” (116).
At the end of a grueling shift, Kay panicked when he saw missed calls and voicemails from Simon on his phone. Convinced that he was too late, Kay discovered Simon had accidentally pocket-dialed him.
An enormous new operating table was installed in the labor ward as a patient recently exceeded the weight limit for their “obese” table. The hospital’s surgical staff were also informed of a recent error where a patient died after the wrong kidney was removed. Consequently, the new protocol required arrows to be drawn on patients’ legs pre-surgery, indicating the correct side to operate on. Kay was reprimanded when he asked what would happen if the patient had an arrow tattoo on the wrong leg. However, the next day he received an email thanking him for his contribution and revealing that arrow tattoos should be covered with tape.
On a rare Saturday off, Kay went to work to check on a patient as he had performed his first total hysterectomy on her the previous day. H observed that Kay could tell them if he was having an affair. The patient was fine.
Friday, 29 February 2008 - Thursday, 5 June 2008
In A&E, Kay delivered a Kinder Surprise egg from patient JB’s vagina. Afterward, JB instructed her boyfriend to open the egg, which contained an engagement ring. The boyfriend accepted her marriage proposal.
Kay performed a cesarean with a hungover medical student assisting. As he was sewing up the patient’s uterus, the student fainted, landing face-first in the patient’s open abdomen. The anesthetist suggested giving the patient antibiotics.
During a pub quiz, Kay horrified his friends by admitting that he did not know the number of bones in a human body. He unsuccessfully tried to explain that this data is irrelevant to his daily practice.
A midwife asked Kay to review a patient in the antenatal clinic as she could not detect the baby’s heartbeat. Performing a second ultrasound, Kay confirmed the baby had died. A few days later, Kay saw the same patient in the labor ward, about to deliver her dead baby. Although his shift ended at 8 p.m., Kay stayed until the baby was delivered around midnight. The couple confirmed they wanted tests to try to determine the cause of the stillbirth. Kay took tissue samples from the dead baby, apologizing to the child as he did so.
Tuesday, 10 June 2008 - Thursday, 10 July 2008
Exhausted after a night shift, Kay inadvertently drove through a red light. Police officers issued him a fine and penalty points on his driver’s license. The officers were unmoved by Kay’s revelation that he had been working in a labor ward for 13 hours.
When patient TH told Kay her breast pump was bugged and accused him of conspiring “with the Russians” (132), he was convinced she had puerperal psychosis, a severe form of postnatal depression. However, the hospital’s psychiatry department refused to review TH, insisting she was not a danger to her baby. The psychiatry team was eventually forced to assess TH when she was arrested in the hospital’s Starbucks for standing naked on a table and singing “Holding Out for a Hero.”
When an SHO asked Kay to confirm a miscarriage, he anticipated breaking bad news to the parents. Noting the sad expression of the pregnant woman and her partner, Kay was pleased to see the SHO had prepared the couple for the worst. However, the ultrasound revealed that the SHO had somehow missed the presence of two healthy twins.
Kay and H booked a fortnight’s vacation in Mauritius to celebrate five years together. The week before they were due to leave, Kay received an email stating he must work during the middle weekend of the holiday. When he challenged the decision, it was suggested that he could “pop back” for a couple of days.
Chapter 6 Summary: “Registrar—Post Two”
Kay asserts that he was always proud to work for the NHS, a healthcare system that has provided lifelong free healthcare for UK citizens since its inception in 1948. He predicts that UK politicians will privatize the NHS slowly and healthcare will become as expensive as it is in the United States.
Kay explains how his view of private healthcare changed while undertaking private locum work as a registrar. Previously, he thought of private hospitals as an option for the rich, which ultimately saved taxpayers’ money. He also anticipated that occasional private work when he became a consultant would buy him a Mercedes and similar luxuries. However, after working in private facilities, he realized that labor units were one of the few areas where money did not secure better service. He acknowledges that private hospitals offer elective caesareans, private rooms, and good food, but he states the medical service patients receive is significantly worse than in NHS hospitals. Inexperienced locum SHOs are often the only staff available to deal with emergencies. If a situation is life-threatening, private patients are taken to an NHS hospital because it is better equipped to cope. For these reasons, Kay stopped accepting private locum jobs.
Monday, 11 August 2008 - Thursday, 6 November 2008
While Kay was performing a locum shift on a private ward, a baby’s heartbeat dropped dangerously while the mother was in labor. The patient confirmed she was happy for Kay to deliver the baby instead of waiting for the consultant. However, Mr. Dolohov, the consultant, insisted that he was close by, and Kay must leave the delivery to him. Kay delivered the baby, regardless, and blood taken from the umbilical cord confirmed that this likely saved the baby’s life. Mr. Dolohov finally appeared after Kay had cleaned up the patient and changed into clean scrubs.
One evening, Kay received a call from his friend Lee who asked him to assess the injury of his roommate, Terry. Kay discovered that Terry had severed an artery in his thumb while opening a can of beans. The profusely bleeding wound required hospital treatment, but Terry refused to go. Lee gave Kay a box of medical supplies containing everything needed to clean and stitch the wound—except anesthetic. Kay sewed up the thumb while Terry bit on a wooden spoon.
As Kay ended a busy NHS shift, he met the locum registrar due to take over. Noting the locum looked terrified at the prospect of performing a cesarean, he established that the locum had never worked on a labor ward before. Sending the locum away, Kay worked the next 12-hour shift without pay.
Despite numerous tests, no medical cause had been found for patient HT’s pelvic pain. She maintained that she wanted a full hysterectomy, regardless of medical advice. When Kay tried to discharge her from the clinic, HT refused to go and threw a sharps bin at his head. The used needles shot out of the bin, just missing Kay.
Kay was almost moved to tears by a handmade card from a patient that featured her baby’s footprint. However, while Kay was delivering another baby, the patient, or a member of her family, stole his Montblanc pen (which was a birthday present from H). Hearing of Kay’s misfortune, a consultant, Mr. Lockhart, revealed that his beloved blue MGB convertible was once stolen from a parking lot while he was at work. One day, he mentioned the theft to a patient who happened to belong to a gangster family. The patient assured Mr. Lockhart he would find the perpetrator and make them return the car. Shortly afterward, Lockhart discovered a blue MGB convertible and its keys waiting for him in the parking lot. He was immensely grateful until he realized the car was not his.
Monday, 17 November 2008 - Tuesday, 3 February 2009
Kay enjoyed his quietest shift as a locum at a private maternity unit. The registrar explained that a royal from a Gulf state had just given birth and had booked out the entire unit.
Ron told Kay that his father was having difficulty swallowing, had lost weight, and was experiencing chest pain. Their GP had urgently referred his father to a specialist, but Ron wanted Kay’s diagnostic opinion. Kay knew that the symptoms suggested metastatic esophageal cancer. If he were with a patient, he would have said that urgent tests were required to rule out cancer. However, Kay lied to Ron, assuring him that the symptoms might not be serious and that they should follow the GP’s advice.
Kay was shocked when he was called to A&E to see a 19-year-old woman with heavy vaginal bleeding. He discovered the patient had attempted to perform “her own labial reduction surgery” with scissors (156). The young woman told Kay she wanted her labia to look “normal” and did not expect to bleed. After repairing the patient, Kay assured her that her labia were “normal”. However, she insisted she did not resemble pornographic images of women.
The hospital’s staff were asked to perform a “diary card exercise” (157), recording the number of hours they worked in a week. Consequently, the usual routine was disrupted as consultants who were rarely seen at work took on more hours, thereby reducing the shift lengths of junior colleagues. Kay knew that as soon as the diary card exercise ended, his schedule would return to its grueling norm. He, therefore, made the most of it. After Kay arrived home on time three days in a row, H asked if he had been sacked. During one night shift, Kay was shadowed by a member of management. She eventually left at 10:30 p.m., declaring that she was exhausted.
Attending the wedding of two doctors, Kay viewed the marriage as a “huge triumph.” Not only had the couple weathered the pressures the profession places on relationships, but they had also managed to get the day off. Nevertheless, the best man had to leave for a night shift shortly after delivering his speech.
On his last day at the hospital before his new posting, Kay expected the occasion to go unremarked, as usual. However, Mr. Lockhart gave him a thank you card and a new Montblanc pen.
Chapters 5-6 Analysis
Kay’s narrative trajectory undergoes a subtle shift in these chapters after he becomes a registrar. After several years of feeling he was in limbo as a junior doctor, he comes closer to achieving his personal and professional goals. He recounts how he “felt like the exception who proved the rule—the one guy who had his shit together in some small way, plates all spinning away nicely” (111). However, the aside, “Now I just had to make sure none of them smashed …” (111), foreshadows future events that will shatter this optimism.
In this section of the memoir, Kay provides further insight into The Personal Toll of Healthcare Work. Although his romantic relationship has so far withstood the pressures of his job, he suggests this is largely due to H’s extraordinary tolerance. Kay presents the wedding of two friends who are doctors as a “miracle,” considering they both work in “a system seemingly designed to ruin their relationship” (159). Delving into why doctors’ marriages or partnerships so often fail, he emphasizes that the issue is more complex than just long working hours. Doctors inevitably make poor partners as they are exhausted, stressed, and irritable. The only alternative to bringing the stresses of work home is to “develop a hardened exoskeleton” (111), which ultimately requires becoming a less compassionate human being.
Several of Kay’s diary entries explore The Gap Between Public Perceptions of Healthcare and the Reality. His description of his friends’ horror when he admits to not knowing the number of bones in a human skeleton illustrates how the public sees doctors as infallible medical encyclopedias. Although he tries to explain that this information is of no practical use in his day-to-day work, his friends’ confidence in him as a doctor is shaken. Kay also challenges the notion that many “non-medics” hold about doctors having a choice to leave work early if they want to and that they adhere to their prescribed working hours. Kay explains that if doctors strictly adhered to their shift times, patients would die due to the understaffing of the NHS. In both cases, the memoir underlines the difficulty of conveying the realities of the job to those who have not experienced it.
Kay’s descriptions of the consequences of chronic understaffing in these chapters underline The Constraints of Patient Care Within Strained Medical Systems. While emphasizing the outwardly humorous behavior of patient TH, who experiences puerperal psychosis, the author also conveys the seriousness of the case. The anecdote highlights that the psychiatry department’s initial decision that TH does not require an assessment is unsafe. Kay also must negotiate a “moral maze” when an agency sends a locum with no experience in obstetrics. He is forced to make a judgment call, weighing his own exhaustion after a 12-hour shift against the locum’s inexperience. Ultimately, he decides that working a second shift is the marginally less dangerous option. Surprisingly, Kay also encounters an ethical dilemma related to understaffing while working in a private hospital. He emphasizes that while private patients pay for the reassurance of a consultant delivering their baby, this is often not the safest option if the consult is not on the hospital’s premises. In the case when the baby’s heart rate was dropping, Kay’s decision to deliver the baby instead of waiting for the consultant likely saved the child’s life.
Kay’s description of the diary card exercise provides a damning critique of NHS management. He emphasizes the hospital’s lack of transparency as consultants ensure that junior doctors do not work excessively long shifts for one week only. Situational irony underlines the absurdities of the system as a member of management does not have the stamina to shadow Kay for his entire night shift even though his hours are significantly reduced from usual. Nevertheless, in his introduction to Chapter 6, Kay emphasizes his love of the NHS, arguing that the free healthcare system should be cherished. He clarifies that his memoir is not a critique of the NHS as an institution but of the way it has been underfunded and mismanaged, leading to an endangered future. His account of the dangers of non-routine births in private hospitals supports his argument that the gradual privatization of the health system is ill-advised.
Unlock all 62 pages of this Study Guide
Get in-depth, chapter-by-chapter summaries and analysis from our literary experts.
- Grasp challenging concepts with clear, comprehensive explanations
- Revisit key plot points and ideas without rereading the book
- Share impressive insights in classes and book clubs