Going to Hurt?! Adam Kay's Medical Career

Some of the career goals Protagion supports our professional members with are related to transitions, including changing specialism or discipline within their profession, or even changing profession entirely. For example, we’ve shared stories before of a lawyer changing across to banking as well as a lawyer becoming a (famous) author… In this post, we share the experiences of Adam Kay, previously a doctor with the National Health Service (NHS) in the United Kingdom, before he shifted to become a comedian and writer for TV and film. 

In 2010, after six years of training and another six on the wards, Adam hung up his white coat and resigned from his job as a junior doctor. He set out his experiences in medicine in his often-hilarious book “This is Going to Hurt”*, described as a “no-holds-barred account of his time on the NHS front line”. 

97-hour weeks. Life and death decisions. A constant tsunami of bodily fluids. And the hospital parking meter earns more than you.
Welcome to the life of a junior doctor.”
FROM THE BACK COVER OF “THIS IS GOING TO HURT”*

I read the book myself over the Christmas break, and found its style reminiscent (to me at least) of another series of books I really enjoyed, which were set in a fictitious school much like the boarding school I attended in my teens: the “Spud” series*. While that series is primarily a nostalgic and amusing coming-of-age story, the underlying message in “This is Going to Hurt” runs far deeper...

​Both humorous and touching, Adam’s work is particularly timely given the significant pressure our doctors and nurses find themselves under with our global virus concerns this year. Adam acknowledges the positive impact recognition from patients can have: “I’ve kept every single card a patient has given me… They were the little fist-bumps that kept me going, rays of thoughtfulness from my patients that hit the spot when bosses couldn’t, or wouldn’t oblige.” While his book is primarily a humorous account, in this post we spotlight the undertones of his career journey, particularly the emotional and psychological toll of the ongoing stresses he faced.

The book is structured into chapters which follow Adam’s journey from starting work as a House Officer to becoming a Senior Registrar over a number of years, and shares anecdotes in the form of diary entries over his time at different hospitals. Read on to follow his career journey in medicine, including his reasoning for his choice of career and then of specialism, as well as the highs and lows he documented, including his burnout and decision to step away. In his introduction, Adam sets up the book with: “So here they are: the diaries I kept during my time in the NHS, verrucas and all. What it’s like working on the front line, the repercussions in my personal life, and how, one terrible day, it all became too much for me.”

Reflective Practice
A number of professions take continuing professional development and lifelong learning very seriously, including the medical profession which promotes “reflective practice”. This involves thinking back on your actions in order to continually learn, and is why doctors log their clinical experiences. These notes formed the basis of his book, and we have this established professional practice of documenting (and Adam’s sense of humour) to thank for his bestseller.

He makes these observations, reading back on his reflective practice notes: “Among the funny and the mundane, the countless objects in orifices and the petty bureaucracies, I was reminded of the brutal hours and the colossal impact being a junior doctor had on my life. Reading back, it felt extreme and unreasonable in terms of what was expected of me, but at the time I’d just accepted it as part of the job. There were points where I wouldn’t have flinched if an entry read ‘swam to Iceland for antenatal clinic’ or ‘had to eat a helicopter today’.”

Another example of Adam’s wit that permeates the book is in the dedication at the start: “To James, for his wavering support, and to me, without whom this book would not have been possible”.

Original career choice
Adam describes how medicine was the natural career choice for him: “Personally, I don’t remember medicine ever being an active career decision, more just the default setting for my life… I grew up in a Jewish family… went to the kind of school that’s essentially a sausage factory designed to churn out medics, lawyers and cabinet members; and my dad was a doctor. It was written on the walls.”

Every doctor makes their career choice aged sixteen… At sixteen your reasons for wanting to pursue a career in medicine are generally along the lines of ‘My mum/dad’s a doctor’, ‘I quite like [that TV medical drama]’ or ‘I want to cure cancer’. Reasons one and two are ludicrous, and reason three would be perfectly fine – if a little earnest – were it not for the fact that’s what research scientists do, not doctors. Besides, holding anyone to their word at that age seems a bit unfair, on a par with declaring the ‘I want to be an astronaut’ painting you did aged five a legally binding document.”
ADAM KAY

​He started training in 1998 at Imperial College in London, a process which took six years. He writes: “As you might imagine, learning every single aspect of the human body’s anatomy and physiology, plus each possible way it can malfunction, is a fairly gargantuan undertaking. But the buzz of knowing I was going to become a doctor one day – such a big deal you get to literally change your name, like a superhero or an international criminal – propelled me towards my goal through those long six years…”

Once that was done, “it was finally time to step out onto the ward armed with all this exhaustive knowledge and turn theory into practice... It came as quite the blow to discover that I’d spent a quarter of my life at medical school and it hadn’t remotely prepared me for the Jekyll and Hyde existence of a house officer.”

Choice of specialism
In the second year of work (now Senior House Officers), doctors choose their specialism. Adam chose to specialise in obstetrics and gynaecology, which excited him, and gave him “a career [he] could genuinely look forward to”. His choice took him months to make though: “I think the reason I hesitated was that I hadn’t made any significant life decisions since I chose which medical school to go to at the age of eighteen – and even that was mostly because I was impressed with the curly fries in the students’ union. Age twenty-five was the first point I actually got to make an active decision in the Choose Your Own Adventure book of my life. I not only had to learn how to make a decision, but also ensure I made the right one.”

Sense of Purpose
Adam greatly enjoyed working as a doctor, and he describes his pitch at a careers fair at his old school, where he was representing medicine among a group of other professionals: “...I told them the truth: the hours are terrible, the pay is terrible, the conditions are terrible; you’re underappreciated, unsupported, disrespected and frequently physically endangered. But there’s no better job in the world.”

...There’s no feeling like knowing you’ve saved a life. Not even that, half the time; just knowing you’ve made a difference is enough. You go home – however tired, late and blood-spattered – with a spring in your step that’s hard to describe, feeling like you have a useful part to play in the world.”
ADAM KAY

For him too, working for the National Health Service was a calling: “...Knowing you were working for the NHS took the sting out of so many things about the job: the vicious hours, the bureaucracy, the understaffing… I knew I was part of something good, important, irreplaceable, so I did my bit. I don’t have an amazing inbuilt work ethic, it’s not applied to anything I’ve done since (as my publisher will attest), but the NHS is something special, and the alternative is horrifying.” 

Stress and Pressure
Over time, the stress layered on, and the pressure increased… He writes: “By the time I was six years deep into medicine, the shine had definitely rubbed off the surface. On more than one occasion my finger had hovered over the ‘fuck it’ button – days where things had gone wrong, patients had complained, rotas had changed at the last minute – and my resolve wavered… But there were two things keeping me there. Firstly, I’d worked long and hard to get as far as I had. Secondly – and I realise it might sound a bit worthy – it’s a privilege to be allowed to play such an important role in people’s lives. You may be an hour late home, but you’re an hour late home because you stopped a mother bleeding to death. You may have had forty women in an antenatal clinic designed for twenty, but that’s forty women relying on you for the health of their babies.”

​The realisation that he was not in the optimal career for him took many years to dawn on him: “One day I realised – as if blinking awake after a serious accident – that I was now in my thirties, still in a career I’d signed up for fourteen years earlier, based on the very flimsiest of reasons.” Being accused of medical negligence by a patient also took its toll: “I always tried my absolute hardest for every patient I saw and it was like a dagger to the heart for anyone to suggest otherwise.” Adam shares too throughout the book the impact of long hours, emergencies, last-minute rescheduled rotas and emotionally draining experiences on his friendships and personal relationships.

He recognises that these pressures apply across the medical profession: “[A] recurrent theme, doctor after doctor, is how everyone remembers the sad stuff, the bad stuff, so vividly… I’m not the right person to talk about dealing with grief though – that’s not what this book is about. It’s simply one doctor’s experiences, some degree of insight on an individual level into what the job really entails.”

​Leaving the medical profession
After a harrowing Sunday afternoon surgery involving multiple doctors, where the baby died and the mother required a hysterectomy to stop her very heavy bleeding, Adam was devastated. He stopped writing diary notes, and a few months later gave up being a doctor. 

...It’s a problem that’s baked into the profession. You can’t wear a black armband every time something goes wrong, you can’t take a month’s compassionate leave – it happens too often.
It’s a system that barely has enough slack to allow for sick leave, let alone something as intangible as recovering from an awful day. And, in truth, doctors can’t acknowledge how devastating these moments really are. If you’re going to survive working in this profession, you have to convince yourself these horrors are just part of the job. You can’t pay any attention to the man behind the curtain – your own sanity relies on it.”
ADAM KAY

​Adam explains: “I’d seen babies die before. I’d dealt with mothers on the brink of death before. But this was different. It was the first time I was the most senior person on the ward when something terrible happened, when I was the person everyone was relying on to sort it all out. It was on me, and I had failed. Officially, I hadn’t been negligent and nobody suggested otherwise… All my peers would have done exactly the same things and had exactly the same outcome. But this wasn’t good enough for me. I knew that if I’d been better – super-diligent, super-observant, super-something – I might have gone into that room an hour earlier. I might have noticed some subtle changes on the CTG. I might have saved the baby’s life, saved the mother from permanent compromise. That ‘might have’ was inescapable.”

Since then, Adam has managed a very successful transition into being a comedian and writer for TV and film. He writes: “...These days the only doctoring I do is other people’s words – I write and script-edit comedy for television. A bad day at work now is if my laptop crashes or a terrible sitcom gets terrible ratings – stuff that 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… I still have a very strong affinity for the profession – you never totally stop being a doctor… I have so much respect for those who work on the front line of the NHS because, when it came down to it, I certainly couldn’t.”

Thank you Adam for writing “This is Going to Hurt”* and sharing your experiences and struggles over those years in such a witty and authentic way. Your book has helped so many of us with understanding what it's really like for our medical professionals. And, while it was laugh-out-loud funny in many places, it was also indeed painful and heartbreaking.

* PROTAGION is a participant in the Amazon EU Associates Programme, an affiliate advertising programme designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.co.uk. The links with * participate in this programme. ​