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

by Adam Kay

valiantly

macerator

colposcopy

Your stage persona evolves throughout your training but you generally settle on a way of dealing with patients a couple of years in and carry it through into your consultant career.

Being trusted is much more important than being liked,

First, do no harm—it’s

the anxiety and guilt mounted onto an already stressful working life, the unfairness of being accused of being terrible at my job, the fear that maybe I was terrible at my job. I always tried my absolute hardest for every patient I saw, and it was like a dagger through my heart for anyone to suggest otherwise.

litigious.

Two centuries of obstetricians have found no way of predicting the course of a labor, but a certain denomination of floaty-dressed mother seems to think she can manage it easily.

It’s a great shame our child-protection duties* don’t extend to vetoing some of the terrible names parents saddle their unfortunate babies with.

err

As the head advances, dad screams, “Oh my God—where’s its face?” Mum understandably also screams, her baby’s head shoots out uncontrolled, and her perineum explodes. I explain to them that babies are generally born facing downward,*

burka,

it’s a privilege to be allowed to play such an important role in people’s lives.

indelible

A low-grade superhero—your

half the time; just knowing you’ve made a difference is enough.

The midwife patiently explains that vitamin K isn’t a vaccine, it’s a vitamin that’s very important to help with baby’s blood clotting.

what happened on labor wards a hundred years ago, before emergency buzzers? Professor Carrow fixes him with a zero-degree Kelvin glare. “One in twenty women died in childbirth.”

Grief is grief—there’s no right way and no normal.

marsupialization.*

patients don’t actually think of doctors as being human.

McRoberts

I’d mocked consultants for being overcautious before, rolled my eyes the moment they turned their heads, but now I got it.

A bad day at work now is if my laptop crashes or a terrible sitcom gets terrible ratings—stuff that literally doesn’t matter in the scheme of things.

affinity

will know just how ridiculous that is. Why would any sane person do that job for anything other than the right reasons?

I have so much respect for those who work on the front line because, when it came down to it, I certainly couldn’t.

But promise me this. Next time a government tries to denigrate doctors or take a pickax to the health-care system, don’t just accept what the politicians feed you. Think about the toll the job takes on every medical professional, at home and at work.

Remember that all of them do an absolutely impossible job to the very best of their abilities.

It will be a major new comedy-drama for AMC (BBC in UK),

Venflon, or cannula, is the plastic tube that gets shoved into a vessel

Varices are a horrible complication of liver cirrhosis where you essentially get huge varicose veins inside your esophagus that can rupture at any point and bleed heavily.

Electrolytes are the salts in the blood, mostly sodium, potassium, chloride, and calcium. If levels become too high or too low, your body alerts you by making your heart stop or putting you in a coma. It’s clever like that.

Almost any abdominal operation can now be performed laparoscopically, which is Greek for “much slower” and involves inserting tiny cameras and instruments on long sticks through little holes. It’s fiddly and takes a long time to learn. Re-create the experience for yourself by tying your shoelaces with chopsticks. With your eyes closed. In space.

About a quarter of babies in the UK are delivered by cesarean section.

If there’s anything left in the uterus after delivery—placenta, amniotic membranes, a Lego Darth Vader—the uterus can’t contract back down properly, and this causes bleeding until the offending item is removed.

A myomectomy is the removal of fibroids, benign swirls of growth in the muscle of the uterus that you take out using what is essentially a corkscrew.

Ovarian torsion is where the ovary twists round on itself and cuts off its blood supply; if not operated on very quickly, it goes black and dies. And if not operated on at all, the entire patient becomes septic, then goes black and dies.

The only cure for preeclampsia is delivering the placenta (and necessarily the baby first).

An ectopic pregnancy is when an embryo attaches in the wrong place, most frequently in a fallopian tube. Left untreated, it will eventually rupture, and this is the most common cause of death in women in the first three months of pregnancy. Every woman with pain and a positive pregnancy test is considered to have an ectopic until proven otherwise by a scan.

The cardiotocograph, known as the CTG or “trace,”

Ascites is fluid in the abdomen and almost always very bad news.

Ordinarily you’d do a CT scan, but we try to avoid those in pregnancy as they involve a large quantity of X-ray exposure, and anyone who’s stayed up for the late-night horror movie can tell you that radiation plus baby is not a good idea. I’ve had the mechanism of MRIs explained to me any number of times and I’m still none the wiser, but no X-rays are involved; images are obtained using a combination of protons, magic, and an enormous fucking magnet. And I mean enormous, the size and weight of a one-bedroom flat. The MRI checklist asks if the patient’s got a metal heart valve (it would tear out of her now-dead chest at eighty miles an hour and splat onto the machine) or worked in a metal factory (tiny bits of metal would have found their way into her eyes, making both eyeballs explode when she opened the door to the MRI suite).

Hermaphroditism is a very rare intersex disorder in which an individual possesses both testicular and ovarian tissue.

If your heart stops, you’re probably going to die. God is fairly strict on that matter. If you collapse on the street and a bystander starts cardiopulmonary resuscitation (CPR), then your chance of survival is around 8 percent. In hospital, with trained personnel, drugs, and defibrillators, it’s only about twice that. People don’t realize quite how horrific resuscitation is—undignified, brutal, and with a fairly woeful success rate. When discussing Do Not Resuscitate orders, relatives often want “everything to be done” without truly knowing what that means. Really, the form should say, “If your mother’s heart stops, would you like us to break all her ribs and electrocute her?”

Pelvic inflammatory disease, or PID, is when untreated gonorrhea or chlamydia spreads north and gunks up the pelvic organs—it can be tricky to treat and even result in permanent pelvic pain. It’s also one of the main causes of female infertility. Basically, use condoms or you might end up not needing them at all.

If you lose blood, then your pulse usually speeds up—your heart needs to work extra hard to get oxygen around the body, given there’s less blood to transport it. When the pulse becomes slow in this situation, it generally means the body is getting exhausted and preparing to throw in the towel.

Having a baby can rip your undercarriage to shreds, there’s no getting around it, especially if you’re a first-time mum. Trojan should take its cue from cigarette manufacturers and show photos of postpartum perinea on its packaging—no woman would look at that and want to risk getting pregnant. A first-degree tear goes through the skin, a second-degree tear goes into the perineal muscles, a third-degree tear involves the anal sphincter, and a fourth-degree tear rips your leg off or something.

Cephalic means baby is head down—this is normal.