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

This is Going to Hurt: Secret Diaries of a Junior Doctor by Adam Kay is a 2017 memoir chronicling the highs and lows of the author’s life as a junior doctor in the British National Health Service (NHS). Compiled from the diaries he kept during his medical training, the book gives readers an insider’s view of the grueling hours, difficult patients, and life-altering decisions that doctors face daily. The memoir is both a celebration of healthcare professionals’ dedication and a sharp critique of the structural failings that make their work so challenging. This is Going to Hurt has been widely praised for its combination of sharp wit and poignancy. Kay also created a television miniseries based on this memoir and won a BAFTA TV award for writing for a drama series.

This guide uses the 2017 paperback edition published by Picador.

Content Warning: The source material and guide feature depictions of pregnancy loss and termination, suicidal ideation and self-harm, mental illness, addiction, illness, and death.

Summary

After studying medicine at Imperial College, London, for six years, Adam Kay became a House Officer for the UK’s National Health Service (NHS) in 2004. As a newly graduated doctor, he anticipated a rewarding career devoted to helping others. However, he quickly discovered the harsh reality of hospital life. Junior doctors were required to opt out of the European Working-Time Directive as their working hours far exceeded the maximum 48-hour week. In addition to long hours and inadequate sleep, Kay also experienced immense pressure. Underutilized by more senior doctors by day, he was often solely responsible for the hospital’s wards at night when senior staff were working in the Accident and Emergency Department (A&E). During this time, Kay witnessed his first death when a patient bled to death from a ruptured esophagus.

The memoir charts Kay’s career, describing how he specialized in obstetrics and gynecology and progressed from House Officer to senior House Officer to registrar. With each new role, his responsibilities grew, and the NHS’s chronic understaffing, low pay, and relentless workloads created an environment where burnout was inevitable. He describes 12-hour shifts that stretched far beyond their scheduled hours, leaving him sleep-deprived. On Christmas Day 2005, he woke up in his car in the hospital parking lot after falling asleep at the end of his shift on Christmas Eve. He also fell asleep at traffic lights and was fined for inadvertently driving through a red light.

Kay’s personal life suffered as he rarely saw his partner, “H.” His relationship with his best friend Ron also deteriorated as Ron struggled to believe that work prevented Kay from attending important events such as Ron’s stag weekend, wedding, and father’s funeral. Kay felt responsibility for the well-being of his friend Simon, who frequently called him to describe his depression. He feared that if he missed a call from Simon while working, his friend might end his life.

Kay was saddened but unsurprised to learn that a House Officer had been treated in A&E after a suicide attempt. The hospital’s management did not launch an inquiry into the working conditions that might have led her to take this step, and they were also not transparent about the excessive workload shouldered by junior doctors. During an exercise where doctors had to officially record their working hours, consultants such as Prof. Carrow, who were rarely seen on the wards, temporarily lightened the load of more junior staff.

Kay’s diary entries describe patients who arrived at the hospital with embarrassing yet amusing injuries. He also recounts how he and his coworkers laughed over patients’ imaginary symptoms. Kay found it intensely rewarding when he safely delivered healthy babies. He cherished the thank you cards he received and occasionally broke with hospital protocol, attending the funeral of a favorite patient and visiting a premature baby in the Special Baby Care Unit daily. He also recounts highly traumatic incidents, such as breaking the news to a couple that their baby had died in utero. He describes taking tissue samples from the dead fetus as one of the saddest tasks he performed.

Throughout his career, Kay experienced recurring professional frustrations. Lack of resources and poor management decisions often made a difficult job harder. His diary entries recount a scarcity of basic equipment, a faulty emergency buzzer that would not turn off, and how a clinic roof caved in when an emergency cord was pulled too hard. Meanwhile, new software slowed down rather than improved the hospitals’ computer systems. Kay became increasingly aware that the expectations placed on doctors were not comparable to any other profession. While taking professional exams, he was granted no time off for revision and was not promoted when he passed. Furthermore, he was expected to arrange cover for sick leave.

The memoir recounts many incidents when patients were difficult, ungrateful, or aggressive. Kay narrowly escaped injury when a woman threw a bin full of used needles at his head. His Montblanc pen (a gift from H) was stolen by a patient whose baby he was delivering. The author confesses how he took revenge on a patient who had racially abused the midwives. While making a cesarean incision, he deliberately decapitated her dolphin tattoo. Nevertheless, he was honest with patients when he made mistakes. His errors included scratching a baby’s cheek with a scalpel and damaging a patient’s bladder during surgery. In the latter case, the patient sued for medical negligence despite the mistake being quickly rectified. The legal case caused Kay anxiety and insomnia as he began to doubt his professional competency.

By 2010, Kay was a senior registrar, which was just one step away from the desirable and lucrative role of a consultant. However, the pressures of his work finally led to the end of his relationship with H. He also experienced the most traumatic incident of his career when an undiagnosed placenta previa caused complications during an emergency cesarean. The baby died, and the mother lost 12 liters of blood, endangering her life. Although traumatized by this incident, Kay was expected to return to work and continue as normal. Consequently, he became overcautious, terrified of another tragedy occurring. After six months, he quit medicine and became a TV script writer. 

In 2016, the author became angry when politicians portrayed junior doctors as greedy during a period of job action. Kay decided to publish his diary entries to give the public insight into the grueling nature of a doctor’s life. In the memoir’s conclusion, Kay warns that the NHS is under threat from politicians who intend to gradually privatize the UK’s healthcare. The author urges readers to value the NHS and its doctors before it is too late.