62 pages • 2-hour read
This Is Going to Hurt: Secret Diaries of a Junior Doctor
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Themes
The Personal Toll of Healthcare Work
Content Warning: This section of the guide includes discussion of illness and death, suicidal ideation and self-harm, and pregnancy loss.
This is Going to Hurt sheds light on the personal toll that working in the NHS takes on its staff—this is a reality that is often hidden from public view. Throughout his memoir, Kay details the strain that his role as a junior doctor puts on his relationships, physical well-being, and mental health. He argues that these challenges arise not only from the demands of the job but also from the structural flaws of the United Kingdom’s healthcare system.
Kay’s diary entries consistently describe long, grueling hours that leave him exhausted, sleep-deprived, and with little time or energy for a personal life. The effect on his body and mind is captured in the statement, “I’ve not sat down for twelve hours, let alone rested my eyes, my dinner’s sitting uneaten in my locker and I’ve just called a midwife ‘Mum’ by accident” (248). This is Going to Hurt charts the gradual erosion of his romantic relationship as he rarely sees H, despite living with them, and repeatedly cancels date nights. Kay’s friendships follow a similar trajectory, leading to his best friend asserting they have grown apart. This deterioration of Kay’s relationships illustrates how the medical profession requires a level of personal sacrifice that is difficult for non-healthcare workers to accept or understand.
Kay also delves into the emotional burden inherent in healthcare work. He conveys how breaking difficult news to patients—for instance, telling parents that their baby has died in utero—never gets easier. He also describes his desire to provide emotional support to grieving patients, even though obstetrics doctors are not trained to do so. Kay’s account of staying hours beyond his shift to oversee the delivery of a stillborn baby and take tissue samples from the infant illustrates his personal investment in such cases. Conversely, he also demonstrates the emotional toll of dealing with patients who are unreasonable or aggressive. The anecdote of a patient who throws a bin of used needles at Kay’s head illustrates how doctors suffer verbal abuse as well as occasional physical danger.
The memoir portrays the gradual decline of Kay’s mental health as he encounters the overwhelming stress of making life-and-death decisions on a daily basis. Describing night shifts that “made Dante look like Disney” (5), he highlights how junior doctors are expected to shoulder enormous responsibilities with minimal supervision or guidance. His account of the House Officer who takes an overdose of antidepressants implies that her actions are not unexpected, given the strain junior doctors experience. Since he is constantly dealing with stressful situations at work, Kay remains hypervigilant even outside work hours, which is illustrated by his anxious response to the beeper at a pizza restaurant. In addition to this stress, he frequently experiences trauma as an inevitable part of the job. The diary entry that records Kay witnessing his first death on the job conveys his horror and feelings of powerlessness as he becomes drenched in blood, unable to save the patient with a ruptured esophagus. Ultimately, it is this trauma, exacerbated by inadequate psychological support for NHS staff, which prompts his decision to quit the profession. While describing the aftermath of the death of a baby during delivery, Kay highlights how the culture of stoicism in medicine discourages healthcare professionals from seeking help, leaving them to suffer in silence.
In This is Going to Hurt, Kay captures the pressures faced by medical professionals and their significant sacrifices. The memoir is a tribute to the resilience of healthcare workers and a call for the reform of the systems that make their jobs more challenging. By humanizing the struggles of doctors, the author highlights the cost of caring for others in a system that ultimately neglects the health and safety of both staff and patients.
The Gap Between Public Perceptions of Healthcare and the Reality
This is Going to Hurt emphasizes the gap between public perceptions of healthcare and the harsh realities faced by medical professionals. Reflecting on the unrealistic expectations that patients sometimes have of the NHS, Kay illustrates how societal pressures and misunderstandings about the system can add to the burden on healthcare workers. The author exposes misconceptions about doctors by revealing the reality of healthcare workers’ lives.
Kay’s diary entries frequently describe encounters with patients who are seemingly unaware of the constraints of the NHS. As a doctor, he often takes the brunt of patients’ frustrations over waiting times, such as the man who threatens to break Kay’s legs when Kay tells him he will have to wait a week for an MRI scan. The author frequently uses humor to underscore the absurdity of public expectations. For example, when a husband asks if a midwife can perform a cesarean on his wife instead of a doctor, Kay responds, “No, and nor can the cleaner” (251). However, Kay’s sardonic tone reflects a deeper frustration with how the public underestimates the complexities and limitations of medical practice. He also highlights how medical staff have to deal with challenging patients who expect effective treatment while ignoring medical advice or refusing medication.
Kay theorizes that the gap between the public’s expectations of healthcare and reality stems from the widespread perception that doctors are infallible and “roam the wards performing routine acts of heroism” (15). This view of healthcare professionals as superhuman figures is partly gleaned from TV dramas, but it also reflects what the public wants to believe. Patients place their lives in the hands of medical professionals, so they do not wish to acknowledge that doctors are flawed human beings juggling immense workloads. However, this means that the public is quick to complain or even take legal action over perceived lapses in service.
Kay’s description of being sued for medical negligence underlines how the pressure to meet unrealistic demands, coupled with a lack of understanding from the public, exacerbates the stress experienced by healthcare workers. This effect is amplified by impractical demands from the government and NHS management, whose members have little concept of the demands of frontline healthcare. Kay outlines the impossibility of meeting government-imposed targets while management departments introduce regulations that make his job harder, such as prohibiting doctors from napping between emergencies while on call. The author’s anecdote about being shadowed by a member of management who does not have the stamina to see out the shift underlines that those who make systemic decisions have no first-hand experience of the job’s demands.
Kay’s memoir aims to bridge the gap between public perceptions and the realities of healthcare. By providing an unflinching look at his experiences as a junior doctor, he invites readers to reconsider their assumptions about the medical profession and to appreciate the humanity and vulnerability of those who keep the NHS functioning despite immense pressures.
The Constraints of Patient Care Within Strained Medical Systems
This is Going to Hurt explores the constraints of providing patient care within the context of the UK’s National Health Service (NHS), a system under constant strain due to chronic underfunding, staff shortages, and bureaucratic inefficiencies. Kay highlights how these systemic issues force healthcare professionals to navigate complex ethical dilemmas, balancing the needs of their patients with the realities of limited resources and personal limitations. Consequently, it becomes impossible for doctors to provide optimal care.
One of the memoir’s central tensions is the clash between the ideal principles of patient care and the realities of the NHS. Kay’s medical training as a doctor instills the commitment to prioritize patient welfare, but his experiences reveal how systemic constraints often make this impossible. Long shifts, understaffed wards, and insufficient resources mean that he frequently faces situations where he must compromise on the quality of care he provides. Recounting a night shift as a junior doctor, the author describes “feeling like water is gushing into the hull of my boat and the only thing on hand to bail it out with is a Sylvanian Family rabbit’s contact lens” (436). The simile’s emphasis on the minute size of the contact lens compared to the boat full of gushing water captures the enormity of his task, given the limited resources available.
Kay’s diary entries describe numerous occasions where a lack of basic medical equipment, such as ultrasound scanners and glucose monitors, prevents him from providing optimal care. He also recounts instances where understaffing forces him to make difficult decisions about which patients to prioritize, knowing that his choices may have life-altering consequences. For example, after delivering a baby by emergency cesarean section, he leaves the patient’s uterus open while responding to several other emergencies, returning to close the wound over an hour and a half later. Such incidents underscore the moral burden on healthcare professionals in a strained system where every decision feels like a trade-off.
The memoir also highlights that another impact of this strained medical system is the inevitability of medical errors. Kay reveals how exhaustion at the end of a particularly demanding shift contributes to him accidentally scratching a baby’s cheek with his scalpel during surgery. While the injury is minor, Kay reflects that it could have easily been life-changing for the baby in a different area, such as his eye. The author conveys the emotional toll of these errors in a profession with the ethical imperative to do no harm. He also underlines the harsh scrutiny doctors face after making mistakes essentially caused by impossible working conditions.
By detailing his experiences as a junior doctor, Kay critiques the systemic failures that create the constraints and ethical dilemmas health workers face. He argues that the NHS’s chronic underfunding and mismanagement undermine doctors’ ability to uphold the highest ethical standards. Emphasizing the need for reform, Kay argues that the quality of patient care ultimately lies with policymakers and administrators.
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