Being a doctor seems like a good life. They get to save lives, make loads of money and have the respect of many. Well, that’s what it seems like to most of us. However, doctors who work in National Health Services (NHS) hospitals in the UK beg to differ. They are known to work 100 hour weeks with salaries that just about match those of bank tellers. Shocking, right?
Adam Kay was just one of these doctors and he decided to write about his experience. This is Going to Hurt is his account of what life as an NHS doctor is like and what he had to deal with throughout his career.
In this book summary readers will discover:
- The end of medical school just means the beginning of a new learning curve
- The strain on personal relationships
- Weird cases never end
- Even doctors have to deal with politics
Key lesson one: The end of medical school just means the beginning of a new learning curve
In Britain, you are required to decide the subject that will become the primary area of study at the age of 16. This seems like a pretty tough decision to make when you are that young. For Adam, he just thought he’d follow his dad and be a doctor. So began his journey of six years at Imperial College. Once his studies were completed, he entered the NHS as a house officer which is the starting level for any junior doctor. Adam quickly discovered that medical school did not prepare him for the job. House officers work about 90 hours a week. Day shifts were centred around basically being personal assistants – making phone calls, patient referrals and booking appointments. Night shifts, however, was something different.
Senior staff members were in charge of incoming patients in the Accident and Emergent department. This left Adam, along with other house officers to deal with every other patient in the hospital. They were given a pager and when it went off, they had to deal with any patient emergencies that occurred. Without any senior doctors, this meant that they had to make decisions in a blink of an eye. Adam quickly learned that these decisions could save lives and he had to act quickly. One such case saw Adam being paged when a man in his sixties was close to dying. He worked quickly doing everything he thought would help and eventually managed to bring the man back from the brink of death. This was in the first few months of him working at a hospital. It became very clear that working at a hospital was a learning curve in itself.
Adam also had to deal with some shocking emergencies as well. He was faced with his first degloving case not long after he save the dying patient. If you haven’t heard of degloving before, may this be your first and last time. It is when the skin from a penis is removed. In the case Adam was faced with, an 18-year-old decided that dancing on top of a bus stop would be a great idea. He then decided to make a grand exit by sliding down a lamp post. The teen failed to notice that the lamp post was anything but smooth and was bought to the hospital with skin missing from his hands and yes, his penis. But this was not the only absurd case that Adam had to deal with. No, it was only the start. A somewhat surprising thing for him was the number of patients that had to be admitted because seemingly harmless objects were somehow in places where they shouldn’t have ended up. In his first year alone, there had been four patients who needed objects removed from their rectum – including a remote control!
After his first year, Adam then became a senior house officer and had to decide which speciality to pursue. After some thought, he decided on obstetrics and gynaecology. It was what he based his thesis on at school and he liked the idea of bringing life into the world.
Key lesson two: The strain on personal relationships
Despite his move to a senior house officer, Adam did not get a less demanding schedule or a salary increase. This would only occur when he reached consultant level which was still a good couple of years away. Adam had managed to maintain a relationship whilst still a junior doctor. He refers to them as H in the book. It is really difficult for doctors to maintain personal relationships because of their hectic schedules and the exhaustion that follows. Adam refers to H as having the patience of a saint for having put up with this. It was virtually impossible to schedule dates or even vacations because of last-minute work demands.
One particularly difficult morning was when Adam was awoken by his phone. The registrar called to ask where he was. He was scheduled to work that morning and was late for work. Luckily Adam was close to the hospital. He had fallen asleep in his car in the parking lot and made it to work only being ten minutes late. The difficult bit was that his phone also had eight missed calls and a message from H. The message simply read ‘Merry Christmas”. Adam had fallen asleep in his car on Christmas eve without even seeing his partner.
His career in obstetrics and gynaecology was progressing though. Adam had successfully performed his first solo caesarean section and ventouse procedure. The latter being a procedure that uses a suction cup and glorified vacuum cleaner to deliver a baby. The labor ward was not without its own strange cases though but Adam had learned to take it in his stride.
Key lesson three: Weird cases never end
When Adam became a registrar, he found himself running the ward being the most senior staff member. He was still overworked and underpaid, however, he was at the halfway mark to being a consultant. That gave him the motivation he needed when all seemed lost. The number of weird cases never ceased though and Adam was continuously amazed in the labor ward.
There was a mother who was so determined to eat her placenta that she grabbed a bowl of blood clots that Adam removed thinking it was the organ. Adam turned around and described what he saw as a mix between Dracula and the Cookie Monster. She had stuffed the clots into her mouth! He also had a patient who refused the antibiotics she needed because she believed Adam to be working with the pharmaceutical industry. Adam explained that he wasn’t getting huge payouts from any big pharma and used his five-year-old car as proof of his lack of money. However, nothing compares to his most memorable patient. At this point in his career, Adam was not surprised when he had to remove strange objects from not so strange places. A woman wanted to propose to her boyfriend by placing an engagement ring in a Kinder Surprise Egg and then placing it in her vagina! The egg shifted making it impossible to remove and landed her in the hospital. Throughout this entire ordeal, the woman never told her boyfriend what was in the egg and when it was removed, she proposed in the hospital room.
Of course, it was not only the patients who caused Adam to be amazed. Some of the staff members also proved incredulous over the years. Adam was once called to check why a patient had not passed any urine due to an empty bag. He was horrified to find that his colleagues had wheeled a hospital bed over the catheter tube! But it doesn’t get any more cringe-worthy than the student who showed up to a caesarean hungover and passed out into the patient’s open abdomen! Yes, Adam had seen a lot in his first three years on the job.
Key lesson four: Even doctors have to deal with politics
On Adam’s first day, he got the first red flag that working for the NHS would be filled with incompetence. His assigned email address was [email protected]. They had misspelt his very common first name. As expected, as Adam continued his career, the incompetence continued to accumulate.
Not only were doctors forced to work long hours, but they also had to deal with numerous technology issues. They had once tried to upgrade their outdated system but instead of helping, it only made things harder. Adam, along with other doctors had to spend precious time scrolling through endless lists if they wanted to prescribe a specific treatment. This made doctors hesitate to prescribe something if they knew it was too far down the list. They even reduced the number of computers in the labor ward to one. This meant that staff had to try and schedule time just to use the computer which in the labor ward is especially hard to do because you could not predict when an emergency would come up.
These were only a few decisions made by the NHS and government that made work-life even harder for the medical staff. Couple this with twelve-hour shifts that left doctors exhausted, the lives of patients and staff were in danger. Adam experienced this firsthand. He had worked a twelve-hour shift, without eating or having a break and had to perform a caesarean. Whilst doing it, he accidentally nicked the baby’s cheek. It was small and would not scar but it was a mistake that should not have happened and surely would not have happened at the start of his shift. Then a month later, he performed an emergency caesarean on a woman with undiagnosed placenta praevia. It went unnoticed in the patient’s previous scans and people with this condition cannot have a caesarean because of the uncontrollable bleeding that occurs. Adam removed the unresponsive baby and was left holding the woman’s uterus in his hands as he tried to stop the bleeding. An emergency hysterectomy stopped the bleeding but the baby died and the woman’s chances of recovery were very slim.
Adam could not keep it together when he had to write up the report. He could no longer see the silver lining to his job. Even though he was so close to becoming a consultant, he could not bear what he was going through any longer. The system was working against doctors and patients and it was not something he could deal with. He quit his job, hoping to make a fresh start.
And that he did. Adam became a comedy writer. Over the years he has still kept in contact with his former colleagues. They are still battling to cop and things only seem to be going downhill. Further pay cuts were issued and doctors were labelled greedy for complaining. However, considering what they have to cope with and the lack of respect they have to deal with, it does not seem that outrageous.
The key takeaway from This is Going to Hurt is:
Adam Kay decided to follow in his father’s footsteps and become a doctor. When he finished medical school he quickly realised that it would be a lot more work than he expected. Even though his years were filled with laughter and good times, the exhaustion, poor salary and lack of respect for doctors and what they have to deal with took its toll. He left for the sake of his own well being and has not looked back since.
How can I implement the lessons learned in This is Going to Hurt:
Other than to not shove things where they don’t belong, the main lesson one can learn from this book summary is that doctors have a bigger burden than anyone can realise. They have to make decisions that can either save a life or lose it. This takes a toll on their mental health, couple this with exhaustion and this is a recipe for disaster.
