Portal de Periódicos da CAPES

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

2020; Lippincott Williams & Wilkins; Volume: 130; Issue: 5 Linguagem: Inglês

10.1213/ane.0000000000004725

1526-7598

Peter G. Brindley,

Primary Care and Health Outcomes

Adam Kay was a doctor in the UK National Health Service (NHS). As becomes clear early in his memoire, This is Going to Hurt, he no longer is. After this early revelation, readers receive almost 300 rollicking pages of “What was it like? Why did I quit?” Kay divides the book into sections that correspond to post medical school training (ie, house officer, senior house officer, registrar, senior registrar) and his various postings. Each of these sections contain several dozen short—approximately 250–500 word—diary entries. He then ends with an open letter to the UK Minister of Health. This book can be consumed like snacks: a few diary entries during your own busy day or, as I did, in a single “can’t-put-this-down” feast. This is an easy read and is written as first-person narrative at the end of each shift. It is very funny, but that does not mean it is trivial. Kay is candid, insightful, emotional, and shocking. He exposes the health care system’s underbelly and his own trials and tragedies. A book that includes 90-hour workweeks, some ungrateful patients, and unforgiving administrators could have been maudlin or meanspirited; instead, it is recognizable, relatable, and riotous. Accordingly, the paperback edition was a UK number-one bestseller for over a year—selling over a million copies—and received the 2018 National Book Award. Kay is now an award-winning comedy writer for the British Broadcasting Corporation (BBC) (and was a former member of the medical musical duo, the Amateur Transplants). Regardless, this book generated widespread sympathy for doctors. It is important for anyone believing our system needs an overhaul or greater focus on practitioner wellbeing. Kay’s work is now available in North American bookshops. This initial relative lack of exposure is a shame given that doctors of all jurisdictions share a bond based on what we went through and often still do. This book is also no less useful for those who live with health care professionals. After all, my wife, family, and friends have endured my absences and moods but may not have understood them. This book is similarly informative for those joining our profession or for patients and politicians wanting to understand the medical mind. It even offers schadenfreude for anyone enduring exasperating jobs or mindless bureaucracy, that is, virtually all of us. Accordingly, I bought several copies to distribute to trainees, colleagues, and friends. Kay subsequently produced a 144-page 2019 sequel entitled Twas the nightshift before Christmas (Pan Macmillan/Picador, London, ISBN 978-1-529-01858-5) not yet available in the United States. This sophomore publication points out that, during the holidays while others look to rest, approximately 1.4 million NHS staff head into work. After all, births do not wait, pneumonia does not care, and—to give an example of his edgy prose—“elderly patients will go full jenga on the ice, shattering their hips like bags of biscuits.” Kay uses the same diary format but divides this book into his 6 NHS Christmases (2004–2009). A pocket-sized book likely designed for Christmas stockings could have been contrived and inferior. Regardless, I still found it insightful and amusing including his suggestion that anesthesia is like Santa: “he sees you when you’re sleeping, he knows when you’re awake.” If Kay attracts criticism, it will not be from me but might be from those who do not care to mix medicine and humor especially when it contains expletives and a plethora of impaled foreign objects. It is also UK-centric. Fortunately, there are doctor memoires to suit all tastes. Readers may even feel inspired, as I did after reading Kay, to revisit the book that kick-started the dystopian medical memoire genre: Dr Stephen Bergman’s House of God (Berkley Publishing, 432 pages, ISBN-10: 0425238091). Because Bergman’s 1978 book has stood the test of time, I think Kay’s will too. In the 1970s, Bergman released his book under a pseudonym: Dr Samuel Shem. Nowadays, doctors like Kay are happy to own their experiences and shortcomings, and we are still the beneficiaries. I heartily recommend any medical memoire that helps you reflect and rejuvenate. In my case, even if he has quit the profession, the erstwhile Dr Kay still dispenses much-needed medicine. Peter G. Brindley, MD, FRCPC, FRCP (Edin), FRCP (Lond)Departments of Critical Care Medicine and Anesthesiology and Pain MedicineDosseter Ethics CentreUniversity of AlbertaEdmonton, Alberta, Canada[email protected]