Hazel McHaffie

The sad state of our NHS

A relative of mine is currently struggling with the intransigencies of a creaking NHS. I’m doing my best to find a way through that gets the patient the much-needed attention without further demoralising a team of professionals fighting fire because of impossible targets and too few resources. After all, I, more than many, appreciate both sides: I was a small cog in the healthcare machine myself for donkeys’ years, and I’ve been on the receiving end many times too. So perhaps a book by someone who buckled under the burden of working in such an environment was bound to resonate for me.

Adam Kay‘s This is Going to Hurt is absolutely brilliant. One of a family of doctors, his ‘default decision’ as a teenager was to follow in their footsteps, but nothing prepared him for the reality of life post-qualification, the life of a junior doctor.

Recording thoughts and experiences is a recommended part of ‘reflective practice’, and This is Going to Hurt is based on Adam’s diary scribbled in secret after endless days, sleepless nights and missed weekends.¬† It’s a no-holds barred account of his time on the front line. 97-hour weeks. Life and death decisions. Ingratitude and complaint. Raw experience. Terror. Failure. Success. Innumerable objects in assorted orifices. A tsunami of bodily fluids drenching his person and his imagination. All recounted with honest brutality and a fabulous line in whacky humour.

Kay spent six years training and a further six years practising medicine, specialising in obstetrics and gynaecology. But eventually the price he was paying was simply too high. When something terrible happened on his watch, he finally crumbled. The patient suffered a torrential haemorrhage during a caesarean section – she had an undiagnosed placenta praevia. Dr Kay hadn’t been negligent and there was no suggestion otherwise; any other competent doctor in such circumstances would have done exactly what he did. But he expected more of himself. He was the most senior doctor involved and everyone was relying on him to sort out the horror. He felt overwhelmed by the tragedy.
I knew that if I’d been better – super-diligent, super-observant, super-something – I might have gone into that room an hour earlier. I might have noticed some subtle change on the CTG. I might have saved the baby’s life, saved the mother from permanent compromise. That ‘might-have’ was inescapable.

Much like the NHS itself, the book is filled with hope and despair, miracles and disasters, catastrophes and absurdities, intense sadness and riotous gallows humour. I defy anyone to read it without laughing out loud, or more importantly, without a sinking heart. It’s a damning indictment of a system that expects its practitioners to work impossible hours, assume phenomenal responsibility, compromise their health and relationships, for less pay than ‘the hospital parking meter earns’.

No wonder it won Book of the Year in the 2018 National Book Awards.

It’s difficult to avoid technical terms in such a book, so the author offers helpful footnotes –
I’ll help you out with the medical terminology and provide a bit of context about what each job involved. Unlike being a junior doctor, I won’t just drop you in the deep end and expect you to know exactly what you’re doing.

The footnotes themselves are often hilarious.
Diathermy is essentially a soldering iron – it heats up the area you touch it on and stops small blood vessels from bleeding by sealing them off. It is important not to clean the skin with alcohol-based antiseptic before the operation, otherwise diathermy sparks can set the patient on fire.

Swabs (used in surgery) are designed with a radio-opaque thread running through them as a marker, which shows up on X-rays as a line. A bit unimaginative – I’d have gone for a radio-opaque ‘WHOOPS!’

But I think my favourite one is:
I once put another of these standard dementia questions to a man in his nineties – ‘Spell WORLD backwards’. He paused and said, ‘As in “the planet” or “the past participle of ‘to whirl'”?’

Having spent years delivering babies myself as well as caring for the very sick and small ones, many of Kay’s obstetric stories rang bells for me personally. And I was moved by the care and empathy that this young doctor felt, that had him sneaking back to check patients were OK, or weeping for an hour when things went wrong. What a shame that this sensitivity cost him too dearly to remain on the giving end. We needs practitioners who really care.

Medicine’s loss is the entertainment industry’s gain. Adam Kay has gone on to become¬† an award-winning comedian and writer for TV and film. Indeed he’s actually performing in the Edinburgh Fringe this year! But his book conveys in the best way I’ve ever seen the pain and the joy of working alongside disease, despair and death. And finding the humour and words and humility to share the emotional costs. It’s already been a No 1 best-seller, attracted over 6,500 reviews on Amazon. I devoutly hope it’s on the essential reading list for the new Secretary of State/Cabinet Secretary for Health and Social Care/Welfare. Changes have been made since Adam Kay was practising, but not enough. Not nearly enough.

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