REVIEW: ‘This is Going to Hurt: Secret Diaries of a Junior Doctor’

This is Going to Hurt: Secret Diaries of a Junior Doctor is a non-fiction book written by former junior doctor Adam Kay. Released in 2017 and published by Picador, Kay exposes the reader to the secret diaries he wrote while serving as a junior doctor within the National Health Service (NHS), from the posts of House Officer to Senior Registrar.

The book is separated into chapters each representing a different position as Kay progresses through his career, up until his departure from the profession. He has now become an established comedy writer. Within each chapter are journal entries, each one dated. The entries vary in length from a paragraph to several pages. The structure of the book makes it incredibly easy to just pick up and read from. The format gives each story its own weight and power, as the small stories often lead up to a hysterical payoff. Not every entry is a patient, some of them may be an update on something that happened within the hospital or a conversation the author has with another member of staff. Sometimes, the journal entry describes something the author is doing before being summoned to an emergency, which gets funnier every time it happens

Kay’s writing style is what separates this book from others in the genre. He has an ability to make sarcasm seep out of every word he writes. This is Going to Hurt: Secret Diaries of a Junior Doctor’s comedic style varies from absurdism to deadpan. Throughout the book, there are ludicrous examples of the things that can happen to the human body, and what people can do to their own. Tales of the things patients have attempted while drunk or used towards the aim of sexual gratification are not only hilarious but also examples of the cases that occupy the time of medical staff during normal shifts. And these stories are laced with the dry humor of Kay. His sense of humor and lack of restraint is reminiscent of Charlie Brooker. Not only is his style of comedy dry, but it’s also incredibly crass. This book is not for the faint of heart anyway, but after reading the phrase “Cock-au-fan”, you may be surprised to find that’s the mildest curse word used in these pages.

While This is Going to Hurt is side-splittingly funny, it is also achingly heartbreaking. The book exposes the reader to the fact that doctors interact with people at their most vulnerable and are witness to death and sadness daily. The author’s ability to write comedy is evident, but he is also brilliant at portraying a real, unfiltered sadness. There are segments where it looks like there is no room for laughter at all. Kay’s blunt writing style often results in incredibly visceral descriptions.

When someone starts bleeding or a baby isn’t breathing, the sense of urgency and peril is perfectly described.  But where he may come across as cold towards patients when they are annoying, Kay is suddenly warm and touching when they are affronted with tragedy. One moment that sticks out is when he has a long, honest conversation with a woman with terminal cancer. It’s written with delicacy and is incredibly poignant. 

What I found most devastating was reading about the damage done to the mental, emotional, and often physical health of those that work within the NHS. Every chapter comments on the work healthcare workers put in while fighting the cuts and increasing demands of the boards and government. The 97-hour week. The lack of counselling or support when experiencing trauma. The endless hassle caused by matters beyond their control.  This peaks in the second half of the book in an entry that really did make me cry. 

Kay’s career is presented in chronological order, meaning that the reader is able to see him grow and evolve as the book goes on. The journal entries are mostly untouched from when they were written, bar the changing of names, so the emotions that he feels on the day is often evident within the segment. If he’s in a jolly mood, that will come through. If he’s angry. that appears. If he’s tired, it shows.

One of the benefits of how the book is written is that there are character arcs that are created through the narration. The most evident one is the impact Kay’s commitment to his job had on his personal life. As he progresses through his career, the reader sees the disintegration of his relationship with his partner and with his friends. One particularly powerful extract details Kay’s instant assessment that his best friend’s father is terminally ill, but having to remain optimistic and lie to his friend. These segments show how destructive his career is to every other aspect of his life.

The less obvious change that happens over the pages of This is Going to Hurt is the change in Kay’s personality and emotional state. At the start of his career, he is lenient and positive towards his profession. Towards the latter stages of his time within the National Health Service, through his journal, there is distinct anger and exhaustion that has settled into his personality. As he says,  “I’m sure I used to be nice before I started this job.” All of this changes again right at the tail end of the book when he becomes dejected, ultimately quitting his job. The journals are small glimpses into life within hospital wards, but the book is a detailed character study of the consequences of what every one of those journals and more has on the person living through these events.

It is important to stress that this book is not the bitter destruction of the NHS, but the opposite. Kay shows the reader just how much of their lives junior doctors leave inside the hospitals for the purpose of making other people’s lives better. And something the author also alludes to is the nearly 300 pages of entries barely touch the surface of what he went through over his tenure. I always had respect for junior doctors, but this book made me weep for them. And cry with laughter.

This is Going to Hurt: Secret Diaries of a Junior Doctor is an extremely funny but somber insight into the daily life of junior doctors and is about a subject matter that will forever be relevant.  The variation in the entries, from explaining parts of hospital culture to describing gut-wrenching procedures to consoling wailing parents, means that the reader is completely unaware of what the next entry may entail. Kay’s uncensored language doesn’t shield you from any of the gory details, and his scintillating wit makes each chapter completely addictive to read.

This is Going To Hurt: Secret Diaries of a Junior Doctor is available where books are sold.