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

by Adam Kay

There were points where I wouldn’t have flinched if an entry read ‘swam to Iceland for antenatal clinic’ or ‘had to eat a helicopter today’.

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 decision to work in medicine is basically a version of the email you get in early October asking you to choose your menu options for the work Christmas party.

What if Morrissey dies in November and, out of respect for him, you turn your back on a lifestyle thus far devoted almost exclusively to consuming meat?

A ship that’s enormous, and on fire, and that no one has really taught you how to sail.

I’m all for explaining terminology as we go along, but if you don’t know what a stethoscope is, this is probably a book to regift.

I don’t particularly know what I’m doing, and I don’t have vast depths of confidence even when I do, so it’s actually quite helpful to have a superannuated German cheerleader behind me shouting out, ‘Zat is brilliant!’ every so often.

The ‘doctors’ mess’ either refers to our communal area with a few sofas and a knackered pool table or the state of most of my patients in the first few months.

‘Apricot stones contain cyanide,’ he replies drily. ‘The death cap mushroom has a fifty per cent fatality rate. Natural does not equal safe. There’s a plant in my garden where if you simply sat under it for ten minutes then you’d be dead.’ Job done: she bins the tablets. I ask him about that plant over a colonoscopy later. ‘Water lily.’

His distress was only made worse when he asked if the penis could be ‘regloved’. Mr Binns, the consultant, calmly explained that the ‘glove’ was spread evenly up eight foot of lamp post in west London.

It’s come to something when the streets outside a hospital have a better reputation for cleanliness than the corridors within.

It would be unfair to label every single orthopaedic surgeon as a bone-crunching Neanderthal simply on the basis of the 99 per cent of them it applies to, but my heart does seem to sink with every night-time bleep to their ward.

I feel like running a teaching session for the orthopaedic department entitled, ‘Sometimes people fall over for a reason’.

If you thought # was a hashtag, you’re banned from reading the rest of the book.

Less than a year as a doctor and this is the fourth object I have removed from a rectum – professionally, at least.

Upon removal of the remote control in theatre, however, we notice it has a condom on it, so maybe it wasn’t a complete accident.

There should be a term for non-medics, the medical equivalent of ‘lay person’ or ‘civilian’. Patients, maybe?

And if not operated on at all, the entire patient becomes septic, then goes black and dies.

SCBU (pronounced Scaboo) is the Special Care Baby Unit, NICU is Neonatal Intensive Care, PICU is Paediatric Intensive Care, PIKACHU is a type of Pokémon.

Three a.m. attendance at labour ward triage. Patient RO is twenty-five years old and thirty weeks into her first pregnancy. She complains of a large number of painless spots on her tongue. Diagnosis: taste buds.

For me, the true miracle of childbirth is that smart, rational people with jobs and the ability to vote look at these half-melted fleshy blobs, their heads misshapen from being squeezed through a pelvis, covered in five types of horrendous gunk, looking like they’ve spent a good two hours rolling around on top of a deep-pan pizza, and honestly believe they look beautiful.

I answer a bleep and head to labour ward to review a woman at thirty weeks who decided she needed her eczema seen at 5 a.m. ‘I thought it would be quieter now than in the morning,’ she says.

The other thing I realize is that none of her many, many concerns are about herself; it’s all about the kids, her husband, her sister, her friends. Maybe that’s the definition of a good person.

Today crossed the line from everyday patient idiocy to me checking around the room for hidden cameras. After a lengthy discussion with a patient’s husband about how absolutely no condoms fit him, I establish he’s pulling them right down over his balls.

I missed what the argument was about, but a woman storms out of gynae outpatients screaming at the clinic sister, ‘I pay your salary! I pay your salary!’ The sister yells back, ‘Can I have a raise then?’

My poker face has served me well over the years. It’s seen me through an eighty-year-old telling me about his use of a colossal butt-plug called The Assmaster and gently explaining to a couple in infertility clinic that massaging semen into her navel isn’t quite going to cut it, conception-wise.

Most non-medical friends were clambering onto the second rung of the property ladder by then, and you know what it’s like when your friends are all doing something and you’re not. Whether it’s fingering someone at a party, taking your driving test or dropping hundreds of thousands of pounds on a dungeon with dry rot – nobody wants to be left behind.

The trust’s IT department has blocked the Royal College of Obstetrics and Gynaecology website and classified it as ‘pornography’.

Maybe it’s like when you’re in a proper relationship for the first time and you meet their family – and you see it’s not just your family that’s a miserable fucked-up mess with dozens of dark secrets and grotesque dinner-table habits.

A news story in the paper about a hospital porter who’s been jailed for pretending to be a doctor for the last few years. Just finished one of those shifts where I wondered if I could get away with pretending to be a porter.

I’m pretty unshockable, but I’ll never cease to be amazed by hospitals’ wilful ineptitude when it comes to caring for their own staff.

Not since the day I qualified had I felt so optimistic – I was practically shitting confetti.

A horror story. Patient GL, whose genetic make-up appears to be 50 per cent goji berry recipes and 50 per cent Mumsnet posts, has announced she wants to eat her placenta. The midwife and I both pretend not to hear this – firstly because we don’t know what the hospital protocol is, and secondly because it’s completely revolting. GL calls it ‘placentophagia’ to make it sound more official, which doesn’t particularly wash; you can make anything sound official by translating it into the ancient Greek.* She explains how natural it is among other mammals, which is another somewhat defective argument – we don’t let other mammals do things like run for parliament or drive buses, nor do we normalize other things they do like fucking the furniture or eating their young (or ‘paedophagia’, as she’d presumably call it).

‘Craniophallic anastamosis’ – dickhead.

The population is getting fatter faster than a mobility scooter hurtling towards Greggs at closing time.

‘Don’t blame you,’ Fred said, shrugging, and told me his first major op died in hospital. He’d reviewed her obsessively and planned her post-op care meticulously. Then, on the day she was meant to go home, she choked to death on an egg and cress sandwich.

For the past few months, whenever someone has asked, ‘What’s the worst that could happen?’ I’ve replied, ‘The world could explode.’ This generally has the effect of making the patient realize they’re catastrophizing, and breaks the ice a little. Plus, it’s not a lie – one day it will, and doubtless I’ll be working on labour ward when it does. On this occasion, FR is a fervent believer that the world is going to end in the next five years and invites me to a David Icke† lecture at Brixton Academy next week. I might even go. What’s the worst that could happen?

Special occasions tend to call for patients to insert special types of object into their vaginas and recta. Christmas in particular has rewarded me well, with a stuck fairy (‘Do you want it back?’ ‘Yeah, bit of a rinse and she’ll be grand’), a grossly swollen vulva from a mistletoe contact allergy and mild vaginal burns from a patient stuffing a string of lights inside and turning them on (bringing new meaning to the phrase ‘I put the Christmas lights up myself’).

‘If I ever have to go to hospital, madam,’ one of the midwives calmly tells her, ‘I want to be seen last. Because that means everyone else there is sicker than me.’

Percy and Marietta’s wedding today felt like a huge triumph against the odds. Not one, but two doctors able to get their big day off work.

I accidentally dropped the on-call bleep into the labour ward macerator this evening, sending it off to a crunchy death. A feeling very similar to pissing your jeans – that wonderful warm sensation of enormous relief, followed almost immediately with, ‘Fuck, what do I do now?!’

You don’t cure depression, the same way you don’t cure asthma; you manage it. I’m the inhaler he’s decided to go with and I should be pleased he’s gone this long without an attack.

This morning I delivered little baby Sayton – pronounced Satan, as in King of the Underworld. It’s hard to believe he’ll get through his school career unbullied, and yet we merrily wave him off on that journey. (Or maybe he’s actually the devil and I should have just shoved him back in.)

He continues. ‘Better not come out black, eh? Ever had a baby come out a different colour to the parents?’ ‘Does blue count?’ I offer. Banter over.

‘Michael Jackson’s dead!’ One of the nurses sighs and stands up. ‘Which cubicle?’

Yes, madam, you will shit during labour. Yes, it’s completely normal. It’s a pressure thing. No, there’s nothing I can do to stop it. Although if you’d asked me yesterday I’d have suggested that the massive curry you ate to ‘induce labour’* probably wasn’t going to help matters.

I’m as big a fan of recycling as the next man, but if you turn a used condom inside out and put it back on for round two, it’s probably not going to be that effective.†

Patients frequently attend clinic with reams of paper they’ve googled, printed off and highlighted, and it’s pretty tedious spending an extra ten minutes per patient explaining why a blogger in Copenhagen who uses a pink hearts Wordpress theme might not be a reliable source. Then again, if it wasn’t for Google I wouldn’t be able to send patients off for a urine sample while I look things up in a panic.

At the end of the meal, the waiter brings over a pair of heart-shaped sweets in a beautifully carved wooden box. I eat mine whole. Turns out it was actually a candle.

I tell a woman in antenatal clinic that she has to give up smoking. She shoots me a look that makes me wonder if I’ve accidentally just said, ‘I want to fuck your cat,’ or ‘They’re closing Lidl’.