Olivia: Jackson, what’s the first thing you think of when you hear the word 'doctor'? Jackson: Hmm, saving lives? Long hours, maybe? Definitely someone you trust. The person in the room who has it all under control. Olivia: What if I told you that in the UK, a young female doctor is two and a half times more likely to take her own life than any other woman? And the system itself is a huge part of the reason why. Jackson: Whoa. That's... a horrifying statistic. Where does that even come from? Olivia: It comes from the world we're diving into today with Adam Kay's This is Going to Hurt. Kay was a junior doctor in the UK's National Health Service, and he kept a diary. What's fascinating is that after a traumatic event forced him out of medicine, he became an award-winning comedy writer. This book is that diary—raw, hilarious, and absolutely devastating. Jackson: A doctor turned comedy writer. That explains a lot about the title. I have a feeling this is going to be a wild ride. Olivia: You have no idea. And Kay throws you right into the deep end of that reality. His first year as a House Officer is a masterclass in chaos.

Jackson: Okay, so what does that chaos actually look like? Give me the unvarnished truth. Olivia: How about this for your first few months on the job? A diary entry from February 2005. An eighteen-year-old kid, let's call him WM, comes into A&E. He'd been out celebrating, got drunk, and decided it would be a brilliant idea to slide down a lamppost like a fireman. Jackson: I can already see where this is going, and I don't like it. Olivia: It's worse. He comes in with severely grazed palms, but that's not the main event. He has, and this is the medical term, a "complete degloving of the penis." Jackson: Oh, man. No. What does that even mean? Olivia: It means exactly what it sounds like. The skin is… gone. The poor kid, in absolute agony, looks up at Kay and asks, "Can it be... regloved?" Jackson: Please tell me they could. Olivia: The consultant, a Mr. Binns, had to deliver the bad news. He explained that the 'glove,' as it were, was spread evenly up about eight feet of a lamppost in West London. Jackson: That is simultaneously the most horrific and darkly funny thing I have ever heard. How do you even maintain a straight face in that situation? Is this what they prepare you for in medical school? Olivia: Not even close. Kay has this brilliant line where he says medical schools don't give a damn if you're okay with the sight of blood. They fixate on your extracurriculars. Did you play the saxophone? Great, you're in. It’s a total sink-or-swim environment, and as he puts it, "you have to learn how to swim because otherwise a ton of patients sink with you." Jackson: So there’s no gentle breaking-in period. It’s just… chaos and degloved body parts from day one. Olivia: Pretty much. But it's not all gruesome. Sometimes it's just bizarre. He tells another story about an elderly patient with dementia, Patient OM, who was a retired heating engineer but, due to a urinary tract infection, was convinced he was an eccentric German professor. Jackson: Okay, I'm intrigued. Olivia: This man would follow the doctors on their ward rounds, wearing his hospital gown backwards like a white coat. And every time a doctor made a diagnosis or a point, he’d interject with these booming German phrases: "Yes!", "Zat is correct!", "Genius!" Kay was so new and insecure that he actually found it encouraging. He had his own personal hype-man. Jackson: I love that. A little confidence booster in the middle of the madness. Olivia: Exactly. Until one day, during a round, Patient OM gets a bit too excited, squats down, and defecates on the floor right next to Kay. And that, Kay writes, was the sad end of the professor's active duty on the ward. Jackson: Of course it ended that way. It had to. But surely there's some heroism in there, right? It can't all be bodily fluids and bizarre accidents. Olivia: That's the tragic irony. The system is so broken it barely leaves room for heroism. It's more about survival. And that relentless grind is where the humor starts to fade and the real pain of the job emerges.

Jackson: What do you mean by the grind of the system? Is it just the long hours? Olivia: The hours are a big part of it, but it's more than that. It's the systemic neglect. There's a diary entry from December 2004 where Kay notes he’d worked 97 hours that week. Jackson: Ninety-seven? In one week? That's more than two full-time jobs. How is that even legal? Olivia: It isn't. The European Working Time Directive was supposed to limit shifts to 48 hours a week. But on that same week, the hospital administration sent around a document for all junior doctors to sign, opting out of the protection of that directive. They were essentially being asked to formally agree to their own exploitation. Jackson: That’s unbelievable. You’re forced to choose between your job and your basic well-being. Olivia: And it bleeds into every aspect of your life. The NHS has this system where junior doctors are rotated to different hospitals every six or twelve months. It's meant to give them broad experience, but it makes having a personal life impossible. Kay and his partner, H, were constantly moving, signing year-long leases in places that were inconvenient for both of them. He has this heartbreaking line where he describes his partner as a "medical widow, post-shift counsellor and now nomad." Jackson: You can't build a life like that. You're just constantly uprooted. Olivia: And the stress becomes a part of you. He tells this story about being out for dinner at a pizza place. They have one of those buzzers that vibrates and beeps when your order is ready. When it went off, Kay, without thinking, reflexively jumped to his feet, heart pounding, ready to run to an emergency. He thought it was his hospital bleep. Jackson: Wow. That's not just stress. That's a trauma response. Olivia: He says it himself in the diary: "Work has pretty much given me PTSD." The constant alerts, the life-or-death pressure… it rewires your brain. Jackson: Okay, so the funny, absurd stories from the beginning are actually symptoms of this insane pressure. The humor is a coping mechanism for living in a state of constant, low-grade trauma. Olivia: Precisely. It’s the only way to survive a system that demands so much and gives so little in return. Jackson: This book was a massive bestseller and even became a hit TV series. Did it actually change anything? Or did it just entertain people with a doctor's misery? Olivia: That's the million-dollar question. It definitely raised awareness. It was published right around the time of major disputes over junior doctor contracts in the UK, and it gave a powerful, human voice to the doctors' side of the story. It became essential reading for anyone talking about healthcare policy. Jackson: So it had a real cultural impact. Olivia: A huge one. But for Kay himself, and for many doctors like him, the damage was already done. The book's title is a misdirection. The person it hurts most isn't the patient. It's the doctor.

Jackson: What do you mean by that? How did it end for him? Olivia: The book is structured as diary entries, so you're laughing along with these insane stories for years. But then you get to the final chapter, "Aftermath," and the tone shifts completely. He reveals the real reason he quit medicine. Jackson: It wasn't just the burnout? Olivia: The burnout was the kindling, but there was a specific spark. He was a senior registrar by this point, running the labor ward. A patient came in for a caesarean section. The procedure was complicated by an undiagnosed placenta praevia, a condition where the placenta blocks the cervix. It led to a catastrophic hemorrhage. Jackson: Oh no. Olivia: He did everything he could, everything by the book. But the mother sustained life-changing injuries, and the baby was delivered stillborn. Jackson: That's devastating. Olivia: And even though an official review cleared him of any negligence, he couldn't shake the feeling that he had failed. He writes, "I was in the same skin, but I was a different doctor." He became terrified of making another mistake, performing unnecessary procedures just to be safe. The joy and confidence were gone, replaced by fear. Jackson: And the system had no way of helping him process that? Olivia: None. He quotes a consultant who once told him that by the time you retire, you'll have a "bus full of dead kids and kids with cerebral palsy" with your name on the side. The message was: get used to it. Kay has this brutal line: "You can’t wear a black armband every time something goes wrong, it happens too often." There's no space for grief or recovery. Jackson: So the whole book, all the jokes... it's all a prelude to this one moment that ends his career. Olivia: Exactly. It's the crystallization of years of accumulated stress, trauma, and lack of support. It’s a story about a system that takes dedicated, brilliant people, grinds them down, and then acts surprised when they break. Jackson: It’s interesting, because the book has been praised for its honesty, but it's also faced some serious criticism, right? Olivia: It has. While it’s a powerful critique of the NHS, some critics have pointed out a misogynistic undercurrent in how Kay describes his female patients. They argue that women are often reduced to their body parts or presented as hysterical or difficult, which reinforces a certain kind of medical condescension. The TV show even invented a major female character, presumably to try and balance this out. Jackson: Is that a fair criticism? Or is it just the raw, unfiltered diary of a stressed-out doctor in a high-pressure, male-dominated specialty? Olivia: I think it's a valid point to raise. The book is a product of its time and of a specific culture within medicine. It's brutally honest, and that honesty sometimes includes unflattering or problematic perspectives. It doesn't undo the book's power in exposing the systemic failures, but it adds a layer of complexity to it. It reminds us that even our heroes can have blind spots.

Jackson: So when you put it all together, it’s a story about a system that takes dedicated people, grinds them down with impossible demands, offers no support, and then acts surprised when they break. The humor is just the armor they wear to survive. Olivia: Perfectly put. And in the end, Kay's message isn't just for doctors; it's for all of us who rely on them. He includes an open letter to the UK's Secretary of State for Health, and in it, he says, "I defy any human being, even you, to know what the job really entails and question a single doctor’s motivation." Jackson: He’s basically challenging them to walk a mile in his shoes. Olivia: Exactly. He’s saying that if policymakers actually saw what doctors see—the trauma, the grief, the sheer exhaustion—they would treat them with the respect and gratitude they deserve. It really makes you wonder, what do we owe the people who care for us at our most vulnerable moments? Jackson: That’s a powerful question. It reframes the whole conversation from one about contracts and budgets to one about basic human decency and support. Olivia: We'd love to hear your thoughts on this. Have you had experiences that changed your perspective on healthcare workers? Share your stories with the Aibrary community. Jackson: This is Aibrary, signing off.