This Is Going to Hurt: Secret Diaries of a Junior Doctor

“The night-time SHO and registrar will be down in A&E reviewing and admitting patients while you’re up on the wards, sailing the ship alone. A ship that’s enormous, and on fire, and that no one has really taught you how to sail.”

Here, the author conveys the intimidating level of responsibility placed on junior doctors as soon as they graduate. Kay uses the metaphor of an inexperienced sailor captaining a ship to highlight the enormity of being tasked with sole responsibility for the night-time wards. The ship’s “enormous” size refers to the large number of patients in his care, while the “fire” references the numerous emergencies he must deal with.

“It was like a particularly avant-garde episode of Changing Rooms. The sound was the worst part. With every breath the poor man took you could hear the blood sucking down into his lungs, choking him.”

This passage illustrates Kay’s use of humor as a coping mechanism in the face of challenges and trauma. By figuratively comparing how the patient’s blood sprays the walls to a home makeover show, the author introduces a note of levity. However, the vivid description of the sound as the “poor man” chokes on his blood conveys Kay’s horror and empathy for the patient.

“Non-compliant doesn’t quite seem to cover it. My contract has taken the directive, dragged it screaming from its bed in the dead of night and water-boarded it.”

The author describes how his contract as a junior doctor in no way conforms to European directives on acceptable working hours. Kay evokes images associated with interrogation and torture in his figurative description of dragging the directive out of bed and waterboarding it. The metaphor suggests that his working hours are inhumane, pushing doctors’ endurance levels to the limits.

“I liked that in obstetrics you end up with twice the number of patients you started with, which is an unusually good batting average compared to other specialties (I’m looking at you, geriatrics).”

The author conveys his initial optimism and motivation as a junior doctor specializing in a field he perceives as rewarding and life-affirming. While Kay injects humor into his reference to geriatrics as the field in which death rates are the highest, the observation alludes to the serious emotional toll on doctors when faced with patients’ deaths on a regular basis. This passage foreshadows the incident at the end of Kay’s career where, instead of doubling his patient numbers, he almost loses both mother and child.

“There’s never one to hand, even though they’re required all the time and cost about a tenner in Boots. I was thinking of just buying my own one, but it feels like a slippery slope that ends with keeping an X-ray machine in the back of the car.”

Kay highlights the NHS’s lack of basic medical resources as he reflects on the scarcity of inexpensive glucose monitors at the hospital. The memoir explores The Constraints of Patient Care Within a Strained Medical System as Kay is tempted to buy his own glucose monitor but recognizes that if he takes this route, it is difficult to know where to draw the line. The image of transporting an X-ray machine in the back of his car humorously illustrates this “slippery slope.”

“I’m pretty sure this isn’t the protocol at Google or Glaxo-SmithKline or even Ginsters. Is there a single other workplace where you’d conceivably be asked to arrange your own sickness covers? The North Korean army maybe?”

Describing how he is instructed to find someone to cover his shift when he is sick, Kay emphasizes how medicine makes demands on doctors that would be considered unacceptable in any other profession. The author uses humor to emphasize the absurdity of this expectation. However, his suggestion that the North Korean army might be the only other employer with this policy hints at the NHS’s breach of human rights.

“I’m not entirely sure where these extra couple of hours a day are going to come from—either I need to give up my frivolous hobby of sleeping or cut out my commute by living in a store cupboard at work.”

Here, Kay refers to the added pressure of taking professional exams while working as a junior doctor. While he is advised to revise each day, his work schedule leaves no time to do so. Although the image he conjures of living in a store cupboard is amusing, his sarcastic tone reflects genuine indignation at the impossible expectations placed on doctors.

“The money is utterly out of step with the level of responsibility you have—literally life and death decisions—plus there’s the fact you’ve been to medical school for six years, worked as a doctor for three and started to accrue post-graduate qualifications. Even if you think it’s appropriate you take home less money per week than a train driver, there’s still the fact that these working weeks can involve over a hundred hours of unremitting slog, meaning the parking meters outside the hospital are on a better hourly rate.”

Throughout the memoir, Kay counters the myth that the challenges of a junior doctor’s job are compensated by the financial renumeration. The author clarifies that his pay rate in no way reflects his years of training, long hours, and responsibility for patients’ lives. The comparison to the earnings of parking meters and train drivers drives this point home to readers.

“I realized that most of my colleagues weren’t so lucky, especially when it came to their home lives. Mine was largely held together by superhuman levels of tolerance and understanding; most doctors’ crumbled after a year or so—the cracks that they all develop would appear far too early, like some bizarre premature ageing disorder.”

Kay reflects on The Personal Toll of Healthcare Work as he feels grateful that his relationship with H has endured against the odds. However, he acknowledges that it is only H’s “superhuman levels of tolerance and understanding” that has sustained them. The figurative comparison of doctors’ relationship breakups to a premature aging disorder emphasizes how couples’ issues become magnified due to the pressures of the job.

“The NHS does the most amazing job and we’ve all benefitted from it. They delivered you when you were born and one day they’ll zip you up in a bag, but not until they’ve done everything that medical science will allow to keep you on the road. From cradle to grave, just like your man Bevan promised back in 1948.”

While highlighting its systemic failings, Kay also celebrates the NHS in his memoir. Addressing readers directly, the author encourages those who live in the UK to reflect on how they have benefitted from the privilege of free healthcare throughout their lives. The reference to “your man Bevan” refers to the politician Aneurin Bevan, who spearheaded the founding of the NHS in the aftermath of World War II.

“We should see the skyscraper-high bills of America as the ghost of Christmas future when it comes to NHS privatization. Politicians may act dumb, but they’re not, and we’ll be lured very stealthily into this particular gingerbread house. We’ll be promised it’s only little corners of the NHS that are changing, but there’ll be no trail of breadcrumbs to help us find our way back to the forest. One day you’ll blink and the NHS will have completely evaporated—and if that blink turns out to be a stroke then you’re totally screwed.”

Here, Kay uses a blend of literary metaphors to raise readers’ awareness of the endangerment of the NHS. The author’s comparison of America’s expensive healthcare system to the ghost of Christmas future in A Christmas Carol warns of what lies ahead for UK citizens if they do not take positive action. Meanwhile, the author’s reference to a “gingerbread house” alludes to the story of “Hansel and Gretel” from Grimms’ Fairy Tales. Kay suggests that, like the witch’s gingerbread house, the concept of partial privatization of the NHS may appear attractive but conceals a nightmare in which free healthcare will gradually disappear. Furthermore, there will be no “trail of breadcrumbs” to follow and escape from the nightmare.

“The feeling is that doctors are expert problem-solvers, who pull together a constellation of symptoms to deduce a unique diagnosis. The reality is we’re more Dr Nick than Dr House. We learn to recognize a limited set of specific problems from patterns we’ve seen before—like a two-year-old who can point and say ‘cat’ and ‘duck,’ but would struggle to identify a breeze block or a chaise longue.”

Kay highlights The Gap Between Public Perceptions of Healthcare and the Reality in this passage. He says that patients unrealistically expect doctors to possess the Sherlock Holmes-like diagnostic abilities of Dr. House from the TV drama series House. However, the reality is much more mundane. Kay humorously underplays most doctors’ abilities by comparing them to that of a toddler or Dr. Nick, the quack physician from the TV show The Simpsons. In doing so, he emphasizes that doctors are human and therefore fallible.

“Patients frequently attend clinic with reams of paper they’ve googled, printed off and highlighted, and it’s pretty tedious spending an extra ten minutes per patient explaining why a blogger in Copenhagen who uses a pink hearts WordPress theme might not be a reliable source. Then again, if it wasn’t for Google I wouldn’t be able to send patients off for a urine sample while I look up things in a panic.”

The author explains how patients’ limitless access to medical information makes his job more difficult. His reference to “a blogger in Copenhagen who uses a pink hearts WordPress theme” emphasizes how websites, blogs, and social media platforms allow anyone to publish content without requiring expertise or verification. This can result in unverified or erroneous medical advice being widely shared. However, the passage ends on a self-deprecatory note with Kay’s admission that, when stuck, he consults the internet himself.

“You’d think they might come up with a more high-tech system given lives are at stake, but we’re stuck with the aeroplane passenger call set-up. One person presses a button, the entire place hears a piercing beep every couple of seconds, and then the cabin crew/obstetric team has to traipse up and down looking for a light.”

Kay highlights The Constraints of Patient Care Within Strained Healthcare Systems. He uses humor to describe the hospital’s low-grade technology, comparing the patient emergency buzzer system to the passenger call buttons used to summon cabin crew on an aircraft. At the same time, the account emphasizes how the inefficiency of the system wastes medical staff’s time and puts patients at potential risk.

“I want to ask management if they’ve heard of that big ball of fire in the sky that makes it slightly harder to sleep during the day than at night? Or how easy they think it is to suddenly switch from working during the day and sleeping at night, to the exact opposite within twenty-four hours? But most of all I want to ask: if they or their wife needed an emergency caesarean section at 7 a.m., would they rather the registrar doing it had caught forty minutes’ sleep when things were quiet, or had been forced to stay awake every second of their shift?”

Kay’s tone is angry as he comments on the management directive that doctors must not nap when they are on call. His sarcastic reference to the “big ball of fire in the sky” that makes sleeping during the day difficult emphasizes the harmful decisions made by management staff who have no concept of the physical and emotional toll of shift work. The rhetorical question at the end of the passage suggests that policymakers might think twice about the impact of sleep-deprived doctors if their own lives or those of their loved ones were at stake.

“You don’t see Prof. Carrow during the day, you don’t phone him at night—he’s far too important for all that nonsense. When he appears on the ward this evening I can only assume that he’s got lost or one of his first-degree relatives is currently giving birth.”

Kay’s description of Prof. Carrow conveys the gulf between junior doctors and consultants in the hierarchy of the NHS. While junior doctors take the majority of the strain, working long grueling shifts on the wards, consultants reap the rewards of their position. Prof. Carrow typifies the type of consultant who exploits his power by making it clear that he should not be contacted, even when on call.

“Last time I saw the patient, I said I didn’t have the faintest idea about her condition, and now she’s sitting opposite me, having given up another afternoon to be here, expecting answers, needing help. Do I say I was just being modest last time? That I’ve been on a course since then? Do I put on an accent? Fake moustache?”

Kay underlines the impact of understaffing as he covers the endocrinology clinic for an absent colleague and is faced with a patient he sent to the clinic due to his lack of specialist knowledge. A list of humorous rhetorical questions conveys the range of absurd devices he could employ to convince the patient that he is qualified to advise her. However, the author’s consciousness that the patient is “expecting answers, needing help” articulates his frustration at the strained systems that prevent doctors from delivering quality care.

“Having gone to medical school you might as well finish and become a House Officer, then you might as well become an SHO, then you might as well become a registrar, then you might as well become a senior registrar and by then you’re practically a consultant. There almost certainly don’t need to be so many different grades; I strongly suspect it’s designed so that the next step is always just round the corner. It’s the £50 note you chase down the street, swept up by another gust of wind the millisecond before your hand makes contact.”

The author explains how the benefits of becoming a consultant are every junior doctor’s ultimate goal. Consequently, he implies that the professional grading of the NHS is deliberately designed to discourage doctors from giving up while enduring almost impossible conditions. The metaphor of chasing a £50 note down the road that remains tantalizingly out of reach foreshadows Kay’s own failure to reach the goal of consultant despite coming so close.

“Patients don’t actually think of doctors as being human. It’s why they’re so quick to complain if we make a mistake or if we get cross. It’s why they’ll bite our heads off when we finally call them into our over-running clinic room at 7 p.m., not thinking that we also have homes we’d rather be at. But it’s the flip side of not wanting your doctor to be fallible, capable of getting a diagnosis wrong. They don’t want to think of medicine as a subject that anyone on the planet can learn, a career choice their mouth-breathing cousin could have made.”

The memoir explores the Gap Between Public Perceptions of Healthcare and the Reality as Kay reflects on the unrealistically high standards patients expect from doctors. The author argues that the belief that doctors are infallible makes the public more unreasonable and litigious. However, he also understands that patients would rather not acknowledge that their lives are in the hands of flawed and unremarkable human beings.

“The cherry on top of a record-breakingly hellish night shift (with a locum registrar who was of barely more than ornamental value) was a crash caesarean at 7.45 a.m., fifteen minutes from the supposed finish line. Caesarean, then another caesarean, then ventouse, then forceps, then caesarean, then I lost count, but a bunch more babies, and now a final caesarean. I’m absolutely exhausted, and would gladly have dragged my feet and handed it over to the morning shift were the trace not pre-terminal.”

The author conveys the pace and pressure of a shift as a junior doctor through the syntax of this passage. The length of the first sentence, and the repetition of “then” captures how the shift seems endless to Kay as he encounters emergency after emergency. Meanwhile, the final sentence describes how, at the end of it, he feels ethically compelled to stay longer when faced with the potential death of a baby.

“Feels appropriate that work commitments mean I have to reschedule collecting all my belongings from the flat. On the plus side, my depressing new bachelor pad is only ten minutes from the hospital.”

Kay’s diary entry highlights The Personal Toll of Healthcare Work as he sums up the end of his relationship with H in two sentences. The author’s failure to give reasons for the breakup underlines its inevitability, given the pressures of his job. Demonstrating his humor even in painful circumstances, Kay points out the aptness that the cause of the split also prevents him from collecting his belongings on time.

“One brilliant consultant tells her trainees that by the time they retire there’ll be a bus full of dead kids and kids with cerebral palsy, and that bus is going to have their name on the side. A huge number of ‘adverse outcomes’, as they say in hospitalese, will occur on their watch. She tells them if they can’t deal with that, they’re in the wrong profession. Maybe if someone had said that to me a bit earlier I’d have thought twice. Ideally, back when I was choosing my A levels and getting myself in this mess.”

Kay conveys the emotional toll of a doctor’s life through the metaphor of a bus full of dead children. While the image is horrific, the author argues that this is an accurate representation of the harm a doctor will inadvertently cause to patients during their career. The sobering concept starkly contrasts with idealistic perceptions of doctors as heroic lifesavers. Kay suggests that this knowledge would be useful to all potential medical students (including his former self) before they embark on a career as a doctor.

“A bad day at work now is if my laptop crashes or a terrible sitcom gets terrible ratings—stuff that literally doesn’t matter in the scheme of things. 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. And I feel guilty the country spent so much money training me up for me just to walk away.”

Kay describes his mixed feelings about abandoning his medical career. He is relieved that he can no longer be responsible for a patient’s death. However, the triple repetition of “I miss” conveys the intensity of his sadness and regret at giving up a job that rewarded him with the purpose of helping others.