This is Going to Hurt Summary

"Medicine does its best to tell you that it’s not a job; it’s a vocation, it’s a life. But if that’s true, perhaps it shouldn’t treat its workforce like crap." Adam Kay leaves no stone unturned in revealing the highs, lows, and absurdities of working in the NHS.

1. The Transition from Medical School to Real-World Medicine is Overwhelming

Medical school equips students with theoretical knowledge but often leaves them unprepared for the relentless realities of hospital life. Adam Kay quickly discovered that his education barely scratched the surface of what he needed to survive as a house officer.

Kay’s first role as a house officer required him to work over 90 hours a week, running on minimal rest and adrenaline while performing tasks ranging from booking appointments to managing life-threatening emergencies. The stakes were incredibly high, forcing him to adapt rapidly. Early in his first year, he performed a whirlwind of procedures to save a man on the brink of death. The life-or-death experience left him both proud and shaken, reflecting how unprepared he felt for such responsibilities.

Yet his night shifts, characterized by a constant stream of acute emergencies, tested him the most. His training didn't cover the sheer logistical chaos or intensity of managing multiple crises simultaneously. The pager's relentless bleeps became a symbol of stress, urgency, and responsibility, pushing him to his limits.

Examples

• Kay saved a man in his sixties by instinctively following basic medical steps, despite feeling out of his depth.
• His schooling didn’t prepare him for handling an average of 100-hour workweeks.
• Night shifts placed him in charge of five or six wards, requiring him to juggle numerous emergencies at once.

2. Bizarre and Absurd Medical Cases Were Commonplace

Adam was regularly confronted with cases that blurred the line between tragic and absurd. It seemed the job description of a doctor didn't just include saving lives but also untangling jaw-dropping mistakes and bizarre situations.

In one example, he encountered a young man whose drunken antics led to horrific self-inflicted injuries, including a degloved penis. Then there were patients who arrived with household objects lodged in unexpected body parts, sparking awkward explanations. From remote controls wrapped in condoms to other equally questionable choices, such occurrences were frequent.

Even the labor ward, Kay’s eventual specialty, was full of oddities. He met patients with strange requests or beliefs, such as a woman who had misunderstood the role of taste buds or a couple confused about how to properly use condoms. These experiences, while often darkly humorous, underscore the unpredictable challenges doctors face.

Examples

• An 18-year-old man suffered a degloving injury after sliding down a lamp post.
• A patient claimed a remote control had somehow ended up rectally inserted "by accident."
• A woman mistook her taste buds for growths and showed up panicked at 3 a.m.

3. Relationships Were Nearly Impossible to Maintain

The intensity of hospital shifts wreaked havoc on Kay's ability to maintain personal relationships. Long hours meant canceled plans, missed milestones, and a growing emotional distance between him and his partner.

Kay’s partner, H, tried to remain supportive, but the lack of time together strained their bond. Christmas morning 2005 was emblematic of their struggles. Adam accidentally fell asleep in the hospital parking lot, late for his shift, and found eight missed calls from H. The lack of warmth in H’s holiday text that year reflected the strain in their relationship.

Even casual social plans or downtime were a rarity. Relationships required consistency, effort, and time, none of which a doctor’s schedule facilitates. Adam’s ambition to climb the NHS ladder often clashed with his personal needs, illustrating how grueling medical professions can destabilize one’s personal life.

Examples

• Kay missed multiple Christmas celebrations and personal moments with his partner.
• A simple dinner date required elaborate planning, only to often end up canceled.
• Falling asleep in his car due to exhaustion showed how even downtime was compromised.

4. The Labor Ward Was Both Rewarding and Bizarre

Kay thrived in the labor ward—a place defined by new life, intense emotions, and occasional oddities. His early foray into caesareans and ventouse deliveries let him experience both the joys and absurd challenges of childbirth.

One memorable incident involved a new mother mistakenly eating blood clots, thinking they were her own placenta. Another patient believed vitamins caused arthritis, refusing essential treatments for her baby. Such unorthodox moments highlighted the need for patience and humor amid chaos.

Kay’s successes brought moments of pride, but they were often intertwined with jaw-dropping tales. Despite occasional frustrations, he valued the experience of being part of people's lives during such pivotal moments.

Examples

• His first suction-assisted delivery (ventouse) worked, despite feeling crude and experimental.
• A patient ate a bowl of blood clots by mistake while determined to consume her placenta.
• A new mother refused vital vitamin injections for her newborn due to misinformation.

5. The NHS’s Flawed Systems Often Made Life Harder

Working for the NHS meant battling antiquated technology and systemic inefficiencies that compounded the pressures of medical life. These administrative and technological quirks frustrated Kay and endangered productivity.

When the NHS upgraded its computer systems in 2006, it introduced a poorly designed interface that slowed down basic processes. Tasks as simple as prescribing medication became maddeningly inefficient. Additionally, labor wards shared a single computer on a wheeled rack, forcing constant coordination.

These hurdles went beyond annoyance. They spoke to a larger issue—the NHS’s mismanagement of resources and its toll on staff performance. The failings in infrastructure echoed a broader mismatch between the system’s demands on its workers and the support they needed.

Examples

• Kay spent over three minutes scrolling through drop-down menus due to clunky software.
• Shared ward computers created needless competition for resources.
• System inefficiencies forced Kay to rethink simple medical decisions for expediency’s sake.

6. Humor Was Essential for Coping

Dark humor and absurdity were Adam’s coping mechanisms. Without them, the stress, exhaustion, and emotional strain of the job might have been unbearable.

Instances of humor often revolved around misunderstandings or surreal patient behavior. A woman’s bungled engagement ring storage in a Kinder Surprise Egg or a medical student’s fainting into a patient’s abdomen were moments that highlighted the improbable theater of daily life in the hospital. Humor gave Adam psychological relief in an unrelenting environment.

Far from trivial, humor turned out to be a vital survival tool. It helped navigate grim situations and reminded Adam of the resilience required to keep going.

Examples

• A patient proposed to her boyfriend in the hospital after a Kinder Surprise Egg mishap.
• A medical student passed out into an open surgical abdomen after showing up hungover.
• Cases of bizarre injuries helped make surreal days slightly more palatable.

7. Exhaustion and Systemic Issues Led to Mistakes

The most devastating moments of Kay’s career revolved around errors exacerbated by exhaustion. Long hours, snapped focus, and slim margins for error created situations no doctor wishes to face.

One painful memory involved nicking a baby’s cheek during a caesarean, a mistake Kay attributed to sheer fatigue after over 12 hours on the job. Worse still was a case involving a patient with placenta praevia, where a procedural error endangered both mother and baby. These moments broke Kay’s spirit and revealed the human toll of medical staffing practices.

Examples

• A minor surgical mistake ruined Kay’s confidence due to exhaustion.
• The placenta praevia case left Adam inconsolable after complications resulted in loss.
• Twelve-hour shifts continued to degrade medical focus, inching risks higher incrementally.

8. NHS Doctors Face Misplaced Blame

Beyond understaffing and poor pay, NHS doctors also bore the brunt of public criticisms often rooted in political rhetoric. Public narratives shaped by budget cuts and mismanagement unfairly painted doctors as greedy or entitled when demanding fair compensation.

Kay highlights a 2016 pay dispute where the UK Health Secretary criticized doctors for asking for wages that matched their workloads. Such attacks demoralized medical professionals, making them feel unappreciated and creating barriers to retaining talented staff.

The disconnect between political narratives and NHS reality widened the gap between doctors and public trust, leading to lower morale and more strained conditions.

Examples

• Budget strains forced NHS doctors into pay disputes while politicians vilified them.
• Criticisms portrayed doctors asking for living wages as unreasonable.
• The narrative overlooked doctors’ sacrifices, including sleepless nights and emotional tolls.

9. Ultimately, the System Drove Kay Away

After years of hard work, Kay chose to step away from medicine, burned out by a profession he once loved. The breaking point came after an emotionally devastating loss in 2010.

The pressure of staffing failures, compounded with personal guilt and exhaustion, forced Kay to reflect on whether the system was worth staying in. Though he was on the brink of becoming a consultant, the overwhelming drawbacks outweighed the fulfillment for him.

Today, as a writer, Kay remains an advocate for NHS reform but knows firsthand the challenges of meaningful change.

Examples

• Adam could no longer reconcile his personal health with the system’s demands after a fatal case.
• His decision to quit reflected the mental toll of prolonged exposure to the NHS’s flaws.
• Kay’s later career as a comedian and writer showcased how he processed these experiences.

Takeaways

1. Invest in self-care and professional boundaries, even in high-pressure roles.
2. Advocate for systemic change in workplaces where inefficiency or mismanagement endangers safety.
3. Find humor and moments of connection in challenging environments to sustain emotional well-being.