This Is Going to Hurt – ARC review

Author: Adam Kay
Publication date: December 3, 2019
Genre: nonfiction, humor
My rating: 4.5/5 stars

This book was…laugh-out-loud hilarious? Painfully sad? Excellent validation that I made the right choice in not becoming a doctor? Honestly, all of the above. With candor and a never-ending stream of (often dark) humor, this collection of journal entries by a former medical resident paints a vivid picture of all parts of the medical profession: the funny, the bizarre, the awful, the heartwarming, the disgusting, the personal.

First, a brief disclaimer: the original version of this book was published in 2017 in the UK. After its wild success, and comments that it resonated with doctors in other countries as well, who had copies imported from across the pond (or across the globe), someone had the fantastic idea to make a US version of it. You know, change some of the British-isms to American vernacular, add some more context for bits about the British government and health system, and so on. So while this is an ARC for a book releasing in December, it has been around for a while, just in a different form.

As is often the case with nonfiction, a summary won’t do you much good here. Basically, Adam Kay decided he wanted to go into medicine somewhat arbitrarily while in high school, because, you know, we expect kids to know what they want to do with the rest of their lives already even when their brains aren’t fully formed yet. Common sense, right? He elected to go into obstetrics and gynecology, having heard that this was the easiest branch to go into. Over his years as a house officer and/or registrar (the UK version of what Americans call a resident and/or intern), he kept a journal of all the goings-on at his place of work. This book is a compilation of those journal entries.

Right off the bat, in case I haven’t made it clear enough yet, this book is, in many places, laugh-out-loud hilarious. I had to be careful about reading it in public sometimes for fear that I would burst out in a stupid grin or an actual snort of laughter. Even as he describes his experiences going to hell and back (which is almost a literal definition; he did once deliver a baby named “Sayton,” pronounced like Satan), he manages to infuse all but the most serious moments with snark and self-awareness of the sheer insanity of it all.

SCBU (pronounced “Scaboo”) is the Special Care Baby Unit; NICU is the Neonatal Intensive Care Unit; PICU is the Pediatric Intensive Care Unit; and PIKACHU is a type of Pokémon.

Seriously, patients do dumb stuff. Objectively, we know this to be true, but you don’t really understand it until you are reading about the doctors who see it all: the things people put up various orifices (a Kinder egg with a wedding ring inside, placed inside a certain part of female anatomy?), the absurd questions they ask, the stupid things they do just to prove a point (yes, there was a literal dick-in-a-fan incident)…it’s hard to comprehend just how insane doctors must think people are until you really see it all in one place. Especially when that one place is narrated by an incredulous physician who peppers the whole thing with footnotes both clarifying points and adding his own opinions.

If you describe a grandparent as being old-fashioned, it’s a euphemism for “casually racist.” In a hospital setting, it means “unsupportive.” You’re on your own.

That’s not to say that this book is all “hardy-har-har-let’s-laugh-at-medical-nonsense,” though. What makes this book really work, and what keeps it from being a nonstop stream of jokes without real substance, is its recognition of the flaws inherent in the British medical system. To my understanding, many of these flaws are pervasive in medical systems across the globe, too, so this isn’t overly Anglo-centric. The hours are awful, with long shifts that don’t allow for enough sleep. You’re expected to stay for extra hours past the end of your shift if needed, and you don’t get paid overtime for that. Heck, the pay isn’t even that good to begin with. Requesting a day off is rarely going to actually work, as you can (and probably will) still be called in at the last minute.

I told a patient that his MRI wouldn’t be until next week and he threatened to break both my legs. My first thought was Well, it’ll be a couple weeks off work. I was this close to offering him a baseball bat.

These shortcomings mean that being a doctor, while you are in theory helping people, is likely to cause you personal harm in the process. Kay missed major events in both his own life and his friends’ lives because of his work schedule. It wreaked havoc on his relationships, both personal and romantic. While the stories in this book are not focused much on his outside life, his jabs at the system and comments here and there about his personal problems weave an underlying narrative of a man who, like so many others in his profession, is being drained by a job that asks too much. We like to think of doctors as being selfless, noble, well-paid, and respected, but in reality, they’re no better off than most of us–and, in many case, actually have it worse.

I should have had counseling–in fact, my hospital should have arranged it. But there’s a mutual code of silence that keeps help from those who need it most.

And as if the job isn’t enough, another recurring theme throughout the book is when his personal life and career would overlap. Apparently, being a doctor means your friends think you are the person to call and ask about any medical problem they have, never mind that you may specialize in only one area that has literally nothing to do with their issue. Sketchy consultations? Check. Awkward surgery? Been there, done that. Recognized by former patients in public? Yup. Again, it’s a very strange juxtaposition that you don’t often see in other careers, and even the tamer stories in this book are nothing short of eye-opening and revelatory.

Quick note: the ending of the book is actually very sad, culminating with the event that made Kay decide to leave medicine and move on to a completely different job (writing comedy, which is what he does now!), and you can probably guess what sort of story that is. Poignant, upsetting, and illuminating the disastrous toll that the medical profession can take on the mental health of practitioners. Though, to be fair, you can tell even from the skillful narration of this book, with pitch-perfect jokes on every page, that humor is more of a strong suit for Kay than medicine ever was.

So why not a full five stars? As much as I enjoyed the humor in this book, there were a few moments where I felt like maybe the author took it a little too far. For instance, there was one joke about how being a doctor is more stressful than piloting a plane when a terrorist tries to take over, and there were several sex-related jokes that were more uncomfortable than humorous to me. (That said, there were also quite a few on the same topic that were still incredibly funny, but some missed the mark. I guess that’s going to be the case in most comedy–not every joke is for everyone.)

Still, I strongly recommend this one. It makes you laugh, and it makes you think. It is the medical equivalent of the “Don’t Be a Lawyer” song from Crazy Ex-Girlfriend–which is definitely a good thing. And if you’re considering going into medicine, this will help you make sure you go into it clear-eyed and disillusioned, because yes: this job is going to hurt, in more ways than one.

TRIGGER/CONTENT WARNINGS: death of a child, death of a parent, lots of blood, lots of genital-related content (all in a medical context, of course), side character with depression

Thank you to the publisher, Little, Brown Spark, for providing me with an eARC of this book via NetGalley in exchange for an honest review!

2 thoughts on “This Is Going to Hurt – ARC review

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