This is Going to Hurt
Adam Kay
48 min
8 Key Points
4.5 RateWhat's inside?
Dive into the humorous yet heart-wrenching personal diaries of a young doctor, revealing the hidden realities of life in the medical field.
You'll learn
1. What's it like working in the UK's NHS?2. How do doctors handle the emotional stress?3. How do medics keep their spirits up?4. Why is being kind and understanding so important in healthcare?5. What's wrong with our healthcare system and how can we fix it?6. What's it really like to be a young doctor?Key points
01Welcome to the Frontline of Chaos
Stepping out of medical school and into the wards for the first time is a transition that no textbook can properly prepare you for. You spend half a decade in lecture halls, memorizing the intricate pathways of the Krebs cycle, studying the precise anatomy of the human nervous system, and learning the Latin names of every bone in the body. You graduate feeling like a conqueror of science, armed with a stethoscope and a head full of noble ideals about saving humanity. But the moment you badge into the hospital for your very first shift as a House Officer—the absolute bottom rung of the medical hierarchy—you realize that medical school is like learning to sail on dry land. The ward is a raging hurricane, and you have just been tossed directly into the eye of the storm. The reality of being a junior doctor is entirely stripped of the glamour you see in television medical dramas. There are no dramatic pauses, no perfectly lit moments of epiphany, and certainly no time to sit by a patient’s bedside having profound philosophical conversations about the meaning of life. Instead, your existence is instantly defined by a small, tyrannical piece of black plastic clipped to your belt: the bleep. This pager dictates your every move, your every meal, and your every bathroom break. When it goes off, it is a shrill, demanding noise that sends a spike of pure adrenaline straight into your heart. You quickly learn to fear that sound, because it usually means someone, somewhere in the massive, labyrinthine hospital, is deteriorating, and you are the only person available to fix it. During the day, a House Officer is essentially a glorified, highly stressed administrator. You are part of a massive team, trailing behind the senior consultants like a flock of terrified ducklings. Your job is to perform the endless, mundane tasks that keep the hospital machinery grinding forward. You take blood, you insert intravenous cannulas into veins that refuse to cooperate, you write endless reams of discharge letters, and you spend an inordinate amount of time trying to track down a working printer. It is exhausting, but there is a safety net. If something goes catastrophically wrong, you can always turn around and find a senior doctor to take the reins. There are adults in the room. But everything changes when the sun goes down. Night shifts are a profound exercise in human endurance and psychological terror. The senior doctors go home to their beds, the staffing levels plummet to dangerously low numbers, and suddenly, the safety net is gone. The hospital at night is a totally different beast. The fluorescent lights overhead hum with a sterile, relentless energy, casting a pale, ghostly glow over the linoleum floors. You are running on a dangerous, volatile cocktail of terrible instant coffee, stale vending machine chocolate, and pure, unfiltered panic. The sheer volume of patients you are responsible for is staggering. A single junior doctor might be covering hundreds of beds across multiple wards. Imagine being twenty-three years old, severely sleep-deprived, and holding the lives of four hundred sick strangers in your hands. You are sprinting down endless corridors, your mind racing through emergency algorithms and drug dosages, praying that you do not make a fatal calculation error. Every time you arrive at a ward, a nurse thrusts a chart into your hands, demanding immediate decisions. A patient’s blood pressure is crashing; another is struggling to breathe; a third is having a severe allergic reaction. You have to prioritize who gets your attention first, essentially performing a mental triage of who is most likely to die if you do not intervene in the next three minutes. The physical toll of this lifestyle is immediate and brutal. You forget what it feels like to have a normal circadian rhythm. You sleep in bizarre, uncomfortable positions in whatever quiet corner you can find—slumped over a desk in the doctors' mess, curled up in a broken office chair, or leaning against a wall in the radiology department. Your diet consists entirely of whatever can be consumed in under two minutes while simultaneously walking down a hallway. You become intimately familiar with the exact location of every vending machine in a five-mile radius, measuring your nutritional intake in terms of processed sugar and caffeine. Yet, amidst this terrifying baptism by fire, a strange sort of camaraderie begins to form. You bond with the other junior doctors through the shared trauma of the trenches. You learn to rely on the phenomenal experience of the senior nurses, who often know far more about practical medicine than you do and will quietly save you from making catastrophic mistakes if you have the humility to listen to them. You begin to develop a thick skin, learning to mask your internal panic with a calm, authoritative exterior. The patients look at you and see a doctor—a trusted professional in a white coat or scrubs—and they have no idea that beneath that professional facade, you are desperately trying to remember the correct protocol for managing a pulmonary embolism while silently begging the universe not to let anyone die on your watch. This is the chaotic, terrifying, and profoundly humbling beginning of a medical career. It is the crucible in which doctors are forged. The illusions of grandeur are violently stripped away, replaced by the gritty, exhausting reality of keeping human beings alive against the odds. It is a terrifying way to live, but as you survive your first few months, a tiny, resilient spark of confidence begins to grow. You realize that despite the chaos, the exhaustion, and the sheer terror of the bleep, you are actually doing it. You are practicing medicine. And as you will soon discover, the bizarre, messy reality of the human body is about to provide you with an education far more shocking than anything you could have ever imagined.
02Bodily Fluids and Sleep Deprivation
If medical school teaches you the pristine, idealized mechanics of human anatomy, the hospital ward forcefully introduces you to the messy, foul-smelling, and profoundly undignified reality of what bodies actually do. Medicine, at its core, is not a glamorous pursuit of intellectual puzzle-solving; it is a visceral, hands-on battle against the endless tide of bodily fluids. As a junior doctor, you quickly realize that your entire existence revolves around blood, vomit, feces, urine, pus, and various other unidentifiable substances that the human body produces in moments of distress. You are no longer just a scholar of science; you are an incredibly over-educated plumber dealing with the most complex and fragile pipes in the world. The sheer gross-out factor of the job is something that outsiders simply cannot comprehend. Normal people go about their lives blissfully unaware of the horrific things their bodies are capable of. But in the emergency department and the surgical wards, the veil is lifted. You are confronted with the absolute extremes of human vulnerability. You have to manually disimpact the bowels of elderly patients who have not been to the toilet in weeks. You have to drain massive, angry abscesses that smell so vile they can clear a room in seconds. You have to manage horrific lacerations, shattered bones, and wounds that defy logical explanation. To survive this daily onslaught of gore and tragedy, medical professionals develop a very specific, fiercely dark sense of humor. It is a psychological shield, a necessary coping mechanism that allows them to process the bizarre and often horrific things they witness without completely losing their minds. To an outsider, this humor might seem callous or deeply inappropriate, but within the walls of the hospital, it is the only thing keeping the staff sane. When you see the absolute worst moments of people's lives on a daily Tuesday afternoon, you either laugh or you cry. And if you start crying, you will never be able to stop, and you will never be able to finish your shift. The general public, it turns out, is endlessly creative when it comes to inflicting bizarre injuries upon themselves. The emergency department is a revolving door of human absurdity. Take, for example, the astonishing phenomenon of things getting stuck in places they absolutely do not belong. There is a running joke in medicine about the classic patient excuse: "I slipped and fell on it." The sheer variety of household objects that doctors have had to surgically remove from patients' rectums is mind-boggling. From remote controls to various fruits and vegetables, the medical staff has seen it all. One of the most perfectly absurd anecdotes involves a patient who decided to propose to his girlfriend in a uniquely terrible way. He hid an engagement ring inside a plastic Kinder Surprise egg capsule, and then, for reasons known only to him, decided to insert that capsule into a certain bodily orifice, planning to retrieve it later for a romantic surprise. Unsurprisingly, physics and human anatomy conspired against him, the capsule became irretrievably stuck, and the grand romantic gesture ended in a highly embarrassing trip to the emergency room, complete with surgical intervention and a very confused, unamused girlfriend. These are the moments where you have to bite the inside of your cheek until it bleeds to maintain a professional, unsmiling facade while explaining the medical procedure to remove the plastic egg. And then there are the injuries that are simply horrifying, yet tinged with an absurd kind of tragedy. Consider the concept of a "degloved" finger. It sounds almost polite, like taking off a winter accessory. The reality is far more gruesome. It happens when a ring catches on a fast-moving object—like a fence you are jumping over, or machinery you are working with. The force pulls the ring with such violence that it strips the skin, tissue, and nerves right off the bone, leaving behind a skeletal finger. It is a horrific, agonizing injury, yet it is often the result of something as mundane as trying to catch a bus. Dealing with a screaming patient, a severed piece of flesh, and the absolute chaos of the trauma room requires a level of emotional detachment that is deeply unnatural. This emotional detachment is the double-edged sword of the medical profession. On one hand, you absolutely must compartmentalize. If you deeply internalize the pain and suffering of every single patient you treat, you will burn out in a matter of weeks. You have to view the illness as an abstract problem to be solved, almost like a mechanic viewing a broken engine. You focus on the puzzle: the blood test results, the X-rays, the surgical techniques. You treat the symptom, you stabilize the vitals, and you move on to the next bed. But on the other hand, this constant exposure to trauma and the necessity of detachment begins to fundamentally alter how you view the world. The boundary between the hospital and the outside world thickens. You start to see ordinary people on the street not as humans, but as walking collections of potential medical emergencies. You look at a man coughing on the bus and mentally diagnose him with tuberculosis. You see a child riding a bicycle without a helmet and instantly picture the skull fractures you treated the night before. The sleep deprivation amplifies this surreal perspective. When you are working ninety hours a week, oscillating wildly between day shifts and night shifts, your brain begins to misfire. You experience micro-sleeps while standing up. You hallucinate the sound of your pager going off when you are miles away from the hospital. The chronic fatigue settles into your bones, a deep, heavy exhaustion that no amount of sleep on your rare days off can ever truly cure. You are permanently jet-lagged, operating in a twilight zone where the only things that feel real are the sterile walls of the ward, the smell of antiseptic, and the relentless, driving need to keep the fragile human bodies in your care from falling apart. It is a bizarre, exhausting existence, but you push through it, because you have finally chosen a specialty. You have decided which specific corner of the medical battlefield you are going to dedicate your life to.
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03Choosing Life, Death, and Obstetrics
04The Crumbling Illusion of a Personal Life
05Rising the Ranks and Faking Confidence
06The Absurdity of the Hospital Bureaucracy
07The Day the Laughter Suddenly Stopped
08Conclusion
About Adam Kay
Adam Kay is a British author, comedian, and former doctor. He gained fame with his bestselling memoir "This is Going to Hurt," which chronicles his experiences in the UK's National Health Service. Kay's unique blend of humor and poignant commentary offers a revealing look at the medical profession.
