During the early 2000s, Adam Kay studied and worked as a doctor in the UK, moving from hospital to hospital as he moved his way up from house officer to senior registrar. This is Going to Hurt presents entries from Kay’s diaries, kept during that time. Many of the entries are vignettes or impressions of illnesses and injuries. Kay writes so vividly that I had no trouble imagining him racing through the maternity ward to being baffled by weird symptoms. Over time, however, Kay develops themes about how much doctors and medical staff want to help their patients only to be stymied by bureaucracy, fatigue, and idiocy.
Kay spends much of his early years as a doctor terrified almost out of his mind by how much he doesn’t know and how little he can control—especially after he decides to specialize in obstetrics and gynecology. Babies clearly arrive in their own time and in their own fashion, leaving doctors to debate between vaginal births, assisted births, and caesarian sections. How do you keep from panicking if an infant is stuck in the vagina and won’t move in any direction? What are you supposed to do with a highly religious couple who only want a female doctor to do their c-section and the only female doctor isn’t available? How do you explain to the husband why your hand is where it is when the laboring mother is experiencing an umbilical prolapse? If I ever had any doubts, This is Going to Hurt confirms for me that I would never be able to cut it as a doctor. I much prefer being a librarian, where no one is going to die on me and there are far fewer bodily fluids.
The tone of This is Going to Hurt shifts toward the end as Kay becomes more and more tired of everything. He never gets enough rest. None of his coworkers do, either, and yet they are constantly expected to do more with less as funding decreases, positions are cut, and services wither on the vine. When a patient who could not have been saved dies, Kay finds himself unable to continue any longer and quits. Much of this book is hysterically funny (especially if you don’t mind bodily fluids), but the humor is very much tempered by the costs doctors, nurses, and other health professionals have to pay every day to help a neverending tide of patients.
The end of the book includes Kay’s open letter to the Health Secretary who, at the time, was arguing to cut the National Health Service even further and railing against greedy doctors. This letter argues vehemently against both of those short-sighted, harmful positions. Without something like the NHS and its dedicated staff, the United Kingdom would look a lot more like the United States with its medical bankruptcies, people who are too afraid of the cost to call for an ambulance when they need one, and sick people who’ve put off preventative care for so long that their outcomes are exponentially worse. Even Americans don’t want the American health insurance system (except for the few who are making money off it).