by Adam Kay
I’d seen babies die before. I’d dealt with mothers on the brink of death before. But this was different. It was the first time I was the most senior person on the ward when something terrible happened, when I was the person everyone was relying on to sort it all out. It was on me, and I had failed.
Officially, I hadn’t been negligent and nobody suggested otherwise. The GMC will always judge medical negligence by asking the question ‘Would your peers have done anything differently in that situation?’ All my peers would have done exactly the same things and had exactly the same outcome. But this wasn’t good enough for me. 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 changes on the CTG. I might have saved the baby’s life, saved the mother from permanent compromise. That ‘might have’ was inescapable.
Yes, I came back to work the next day. I was in the same skin, but I was a different doctor – I couldn’t risk anything bad ever happening again. If a baby’s heart rate dropped by one beat per minute, I would perform a caesarean. And it would be me doing it, no SHOs or junior registrars. I knew women were having unnecessary caesareans and I knew colleagues were missing opportunities to improve their surgical skills, but if it meant everyone got out of there alive it was worth it. I’d mocked consultants for being over-cautious before, rolled my eyes the moment they turned their heads, but now I got it. They’d each had their own ‘might have’ moment, and this is how you dealt with it.
Except, I wasn’t really dealing with it, I was just getting on with it. I went six months without laughing, every smile was just an impression of one – I felt bereaved. I should have had counselling – in fact, my hospital should have arranged it. But there’s a mutual code of silence that keeps help from those who need it most.
No matter how vigilant I was, another tragedy would have happened eventually. It has to – you can’t prevent the unpreventable. One brilliant consultant tells her trainees that by the time they retire there’ll be a bus full of dead kids and kids with cerebral palsy, and that bus is going to have their name on the side. A huge number of ‘adverse outcomes’, as they say in hospitalese, will occur on their watch. She tells them if they can’t deal with that, they’re in the wrong profession. Maybe if someone had said that to me a bit earlier I’d have thought twice. Ideally, back when I was choosing my A levels and getting myself into this mess.
I asked if I could go part-time (‘not unless you’re pregnant’) and investigated switching to general practice. But first I’d have to drop right down to SHO grade for a couple of years to work in A&E, paediatrics and psychiatry. I didn’t want to take a long journey backwards in order to start moving forwards again, only to find I didn’t like that either.
I paused my training with the deanery and did some half-hearted research and lazy locum shifts on private units, but after a few months I hung up my stethoscope. I was done.
I didn’t tell anyone the reason why I left. Maybe I should have; maybe they’d have understood. My parents reacted like I’d told them I was being tried for arson. At first I couldn’t talk about it, then it became something I just didn’t talk about. When cornered, I would reach for my red nose and clown horn, and bring out my anecdotes about objects in anuses and patients ‘saying the funniest things’. Some of my closest friends will read this book and hear that story for the first time.
These days, the only doctoring I do is other people’s words – I write and script-edit comedy for television. 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. I don’t miss the doctor’s version of a bad day, but I do miss the good days. I miss my colleagues and I miss helping people. I miss that feeling on the drive home that you’ve done something worthwhile. And I feel guilty the country spent so much money training me up for me just to walk away.
I still have a very strong affinity with the profession – you never totally stop being a doctor. You still run to the injured cyclist sprawled across the road, you still reply to the text messages from friends of friends cadging fertility advice. So in 2016, when the government started waging war on doctors – forcing them to work harder than ever for less money than ever – I felt huge solidarity with them. And when the government repeatedly lied that doctors were simply being greedy, that they do medicine for the money – for anything other than the best interests of the patient – I was livid. Because I knew it wasn’t true.
The junior doctors lost that particular battle, largely because the government’s booming, baleful voice drowned out their own reasonable, experienced, quiet one. I realized that every healthcare professional – every single doctor, nurse, midwife, pharmacist, physio and paramedic – needs to shout about the reality of their work, so the next time the health secretary lies that doctors are in it for the money, the public will know just how ridiculous that is. Why would any sane person do that job for anything other than the right reasons? Because I wouldn’t wish it on anyone. I have so much respect for those who work on the front line of the NHS because, when it came down to it, I certainly couldn’t.
Putting this book together, six years after quitting medicine, I met up with dozens of former colleagues. Their dispatches from labour ward tell of an NHS on its knees. Every one of them spoke of an exodus from medicine. When I left, I was a glitch in the matrix, an aberration. Now every rota bears the scars of doctors who’ve activated their Plan B – working in Canada or Australia, in pharmaceutical companies or in the City. Most of my old colleagues were themselves desperately groping for a ripcord to parachute out of the profession – brilliant, passionate doctors who’ve had their reasons to stay bullied out of them by politicians. Once upon a time, these people were rescheduling their own weddings for this job.
The other recurrent theme, doctor after doctor, is how everyone remembers the sad stuff, the bad stuff, so vividly. Your brain presses record in HD. They can tell you the number of the room it happened in, on a labour ward they last saw a decade ago. The shoes the patient’s husband was wearing, the song playing on the radio. Senior consultants’ voices shake when they talk about their disasters – six-foot-tall former prop forwards on the verge of tears. A friend told me about a perimortem caesarean he performed: a mum dropped dead in front of him and he cut the baby out on the floor. It survived. ‘You saved the wrong one! You saved the wrong one!’ was all the dad could cry.
I’m not the right person to talk about dealing with grief though – that’s not what this book is about. It’s simply one doctor’s experiences, some degree of insight on an individual level into what the job really entails.
But promise me this: next time the government takes its pickaxe to the NHS, don’t just accept what the politicians try to feed you. Think about the toll the job takes on every healthcare professional, at home and at work. Remember they do an absolutely impossible job, to the very best of their abilities. Your time in hospital may well hurt them a lot more than it hurts you.
AN OPEN LETTER TO
THE SECRETARY OF STATE FOR HEALTH
Roger Fisher was a professor of law at Harvard University, who suggested back in 1981 that they should implant the American nuclear codes in the heart of a volunteer. If the President wanted to press the big red button and kill hundreds of thousands of innocent people, then first he’d have to take a butcher’s knife and dig it out of the volunteer’s chest himself; so that he realizes what death actually means first-hand, and understands the implications of his actions. Because the President would never press the button if he had to do that.
Similarly, you and your successor and their successors for ever more should have to work some shifts alongside junior doctors. Not the thing you already do, where a chief executive shows you round a brand-new ward that’s gleaming like a space station. No: palliate a cancer patient; watch a trauma victim have their leg amputated; deliver a dead baby. Because I defy a
ny human being, even you, to know what the job really entails and question a single doctor’s motivation. If you knew, you would be applauding them, you’d be proud of them, you’d be humbled by them, and you’d be eternally grateful for everything they do.
The way you treat junior doctors demonstrably doesn’t work. I strongly suggest you seek a second opinion.
ACKNOWLEDGEMENTS
With love and thanks to Jess Cooper and Cath Summerhayes at Curtis Brown. Jess, I’m sorry you had to read it so many times while heavily pregnant. To Francesca Main, my most incredible editor – I don’t have the words. As usual.
To James, my co-pilot throughout.
To Drs Kay, Kay, Kay and Kay. Sophie – you’ll be a much better obstetrician than I was. And Dan, you made the right choice by rebelling (and studying law). To my parents, Naomi and Stewart – love you really.
To everyone at Picador: particularly Ami Smithson, Dusty Miller, Paul Martinovic, Tom Noble, Paul Baggaley, Kish Widyaratna, Christine Jones, Stuart Dwyer, Caitriona Row, Lucy Hine and Kate Tolley.
To Mark Watson for making it all happen. To Jane Goldman for teaching me how to write long stuff. To Dan Swimer for the Knob-in-fan Persie joke. To Justin Myers for his wisdom of words. To Gerry Farrell for the title. To Stephen McCrum for that first TV writing job when I stumbled out of medicine. To Caroline Knight, my medical adviser (‘Leave this bit out – it might actually stop people wanting children.’) To whoever makes Diplomático rum.
To so many former colleagues for jogging and sharing memories. Especially Drs Jones, Tanner, Gibson, Norbury, Trever, Henderson, van Hegan, Bonsall, Harvey, Heeps, Rehman, Bayliss, Saundershyphenvest, Laycock, McGinn, Lillie, Mansoori, Kupelian, Steingold, O’Neill, Biswas, Lieberman, Webster, Khan, Whitlock and Moore.
And to Anna Welander, Megan McCluskie, Karl Webster, Zoe Waterman, Nikki Williams, Tim Bittlestone, Mike Wozniak, Jackson Sargeant, Cath Gagon, James Seabright, Paul Sullivan, Annie Cullum, Michael Howard, Trish Farrell and everyone I’ve forgotten.
With no thanks whatsoever to Jeremy Hunt.
‘I’m not a doctor (despite what I sometimes say) but I’d prescribe this book to anyone and everyone. It’s laugh-out-loud funny, heartbreakingly sad and gives you the low-down on what it’s like to be holding it together while serving on the front line of our beloved but beleaguered NHS. It’s wonderful’
Jonathan Ross
‘This is a ferociously funny book, but beneath the sheen of brilliant one-liners is a passionate, acutely personal examination of what the health service does for us, and what we’re in danger of doing to it’
Mark Watson
‘As a hypochondriac I was worried about reading Adam Kay’s book. Luckily it’s incredibly funny – so funny, in fact, that it gave me a hernia from laughing’
Joe Lycett
‘I have been waiting for ages for a book about the NHS that dispenses with the normal twee whimsy and delves right down into the rich comic and tragic caves beneath – and here it is. A blisteringly funny account of the lot of the junior doctor shot through with harrowing detail, many pertinent truths and the humanity we all hope doctors conceal behind their unflappable exteriors’
Jo Brand
‘By turns hilarious, shocking, heartbreaking and humbling. If you don’t put this book down with a sheer sense of marvel at what NHS doctors do then you are either illiterate or a Tory MP’
John Niven
‘If we lose the NHS, Adam Kay’s diary of him as a junior doctor will become a historical record of a unique, empathy-powered machine, and make it not just one of the funniest books I’ve ever read, but one of the saddest, too’
David Whitehouse
‘A scurrilously funny, poignant and fascinatingly horrific tale of being torn to pieces and spat out by the strangely loveable but graceless monster that is the NHS’
Milton Jones
‘What a hilarious, stomach-churning, thought-provoking heartbreaker of a book. I loved every single page’
Jill Mansell
‘Hilarious from the first page – very, very funny. I loved it’
Kit Wharton, author of Emergency Admissions
‘This should be required reading for anyone who works in, uses or even voices an opinion about the NHS. You’ll laugh, you’ll cry, you’ll laugh some more, you’ll think twice about ever reproducing’
Dean Burnett, author of The Idiot Brain
‘This made me laugh out loud and cry in equal measures. Adam’s book weaves in and out of his patients’ lives and in so doing he tells, in a better narrative than I have ever seen before, of the pain and joy of working so close to despair, disease and death. It’s a quite brilliant book’
Prof Clare Gerada MBE, past chair of the Royal College of General Practitioners
Adam Kay is an award-winning comedian and writer for TV and film. He previously worked as a junior doctor, although you’ve probably worked that bit out already. He lives in west London.
First published 2017 by Picador
This electronic edition published 2017 by Picador
an imprint of Pan Macmillan
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ISBN 978-1-5098-5864-4
Copyright © Adam Kay 2017
Jacket photograph © Aaron Tilley Photography
Author photograph © Idil Sukan
The right of Adam Kay to be identified as the author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988.
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