Is It Goi Ng to Hurt Baby for Her Head to Be in My Ribs

  Adam Kay

This is Going to Hurt

Secret Diaries of a Junior Doctor

PICADOR

To James

for his wavering support

And to me

without whom this book would

not accept been possible

A Notation REGARDING FOOTNOTES

Read the fucking footnotes.

To respect the privacy of those friends and colleagues who might not wish to be recognized, I have altered various personal details. To maintain patient confidentiality, I have changed clinical information that might identify whatsoever individuals, altered dates* and anonymized names.† Although fuck knows why – they tin't threaten to strike me off whatsoever more.

* I worked a lot on labour wards, and people tend to remember the dates their kids were born.

† I have more often than not used the names of small Harry Potter characters, to substitute one legal nightmare for another.

Contents

Introduction

ane. House Officer

2. Senior Business firm Officer – Mail Ane

iii. Senior House Officeholder – Mail Two

4. Senior House Officer – Mail service Three

5. Registrar – Postal service One

6. Registrar – Postal service Two

7. Registrar – Post Three

8. Registrar – Post Four

9. Senior Registrar

ten. Backwash

An Open up Letter of the alphabet to the Secretary of Land for Health

Acknowledgements

Introduction

In 2010, after six years of training and a farther six years on the wards, I resigned from my task every bit a junior doctor. My parents still haven't forgiven me.

Last year, the General Medical Council wrote to me to say they were taking my proper noun off the medical register. It wasn't exactly a huge shock, equally I hadn't practised medicine in half a decade,* merely I institute it a big deal on an emotional level to permanently close this chapter of my life.

Information technology was, withal, excellent news for my spare room, as I cleared out box after box of onetime paperwork, shredding files faster than Jimmy Carr'south accountant. One affair I did rescue from the jaws of death was my training portfolio. All doctors are recommended to log their clinical experiences, in what'south known as 'reflective practice'. On looking through this portfolio for the first time in years, my reflective practice seemed to involve going up to my hospital on-telephone call room and writing down anything remotely interesting that had happened that mean solar day, like a medical Anne Frank (only with worse adaptation).

Among the funny and the mundane, the countless objects in orifices and the trivial bureaucracies, I was reminded of the brutal hours and the colossal bear on being a junior md had on my life. Reading dorsum, information technology felt extreme and unreasonable in terms of what was expected of me, but at the time I'd only accepted information technology as role of the job. There were points where I wouldn't have flinched if an entry read 'swam to Republic of iceland for antenatal clinic' or 'had to eat a helicopter today'.

Around the same fourth dimension that I was reliving all this through my diaries, junior doctors in the here and now were coming under fire from politicians. I couldn't help but feel doctors were struggling to get their side of the story across (probably considering they were at work the whole time) and it struck me that the public weren't hearing the truth about what it actually means to be a md. Rather than shrugging my shoulders and shredding the bear witness, I decided I had to do something to redress the residue.

So here they are: the diaries I kept during my time in the NHS, verrucas and all. What it'southward like working on the forepart line, the repercussions in my personal life, and how, one terrible day, it all became too much for me. (Deplorable for the spoiler, but you watched Titanic knowing how that was going to play out.)

Along the style, I'll assist you out with the medical terminology and provide a fleck of context well-nigh what each task involved. Different being a junior doctor, I won't simply drop you in the deep end and wait you lot to know exactly what you're doing.

* A written report by the Department of Health in 2006 plant that the public (quite reasonably) believed doctors were subject to annual appraisals. The truth was, at the time, doctors could quite happily go from the day they qualified until the day they retired without anyone checking they could still recollect which end of the syringe goes into the patient. Following an research into the Harold Shipman example, a process of revalidation was introduced in 2012, whereby doctors are now assessed every five years. Y'all'd be nervous about a lot of vehicles on the route if they only got an MOT every five years, but still, better than nothing I gauge.

1

House Officer

The decision to work in medicine is basically a version of the email yous get in early October asking you to choose your bill of fare options for the work Christmas party. No doubtfulness you lot'll choose the chicken, to exist on the safety side, and it'south more than likely everything will be all correct. Only what if someone shares a ghastly manufactory farming video on Facebook the day before and you inadvertently witness a mass debeaking? What if Morrissey dies in November and, out of respect for him, you turn your back on a lifestyle thus far devoted nigh exclusively to consuming meat? What if you develop a life-threatening allergy to escalopes? Ultimately, no one knows what they'll fancy for dinner in lx dinners' time.

Every dr. makes their career choice aged 16, two years earlier they're legally allowed to text a photo of their own genitals. When you sit downwardly and pick your A levels, yous're prepare off on a trajectory that continues until y'all either retire or die and, unlike your work Christmas party, Janet from procurement won't swap your chicken for her halloumi skewers – yous're stuck with it.

At 16, your reasons for wanting to pursue a career in medicine are generally forth the lines of 'My mum/dad'due south a doctor', 'I quite like Holby City' or 'I want to cure cancer'. Reasons one and two are ludicrous, and reason three would be perfectly fine – if a footling earnest – were it not for the fact that's what inquiry scientists do, not doctors. Also, holding anyone to their word at that age seems a bit unfair, on a par with declaring the 'I want to exist an astronaut' painting y'all did aged v a legally binding document.

Personally, I don't remember medicine ever being an active career decision, more just the default setting for my life – the marimba ringtone, the stock photo of a mountain range every bit your computer background. I grew up in a Jewish family (although they were mostly in information technology for the food); went to the kind of school that's essentially a sausage manufacturing plant designed to churn out medics, lawyers and chiffonier members; and my dad was a doctor. It was written on the walls.

Considering medical schools are oversubscribed x-fold, all candidates must be interviewed, with only those who perform best nether a grilling being awarded a place. Information technology'due south assumed all applicants are on course for straight As at A level, so universities base of operations their decisions on nonacademic criteria. This, of form, makes sense: a doctor must exist psychologically fit for the job – able to make decisions nether a terrifying amount of pressure, able to intermission bad news to anguished relatives, able to deal with death on a daily basis. They must have something that cannot be memorized and graded: a great doc must have a huge heart and a distended aorta through which pumps a vast lake of pity and human kindness.

At least, that'due south what you'd remember. In reality, medical schools don't give the shiniest shit about whatever of that. They don't even check you're OK with the sight of claret. Instead, they fixate on extracurricular activities. Their ideal student is helm of 2 sports teams, the county pond champion, leader of the youth orchestra and editor of the school newspaper. It'due south basically a Miss Congeniality contest without the sash. Wait at the Wikipedia entry for any famous doctor, and you'll see: 'He proved himself an accomplished rugby role player in youth

leagues. He excelled as a distance runner and in his last yr at school was vice-captain of the athletics team.' This particular clarification is of a sure Dr H. Shipman, so perhaps information technology'south non a rock-solid arrangement.

Royal College in London were satisfied that my distinctions in grade eight piano and saxophone, alongside some half-arsed theatre reviews for the school magazine, qualified me perfectly for life on the wards, and so in 1998 I packed my bags and embarked upon the treacherous 6-mile journey from Dulwich to Southward Kensington.

As you lot might imagine, learning every single aspect of the human body'south anatomy and physiology, plus each possible manner it can malfunction, is a fairly gargantuan undertaking. But the buzz of knowing I was going to become a physician one mean solar day – such a large deal you lot get to literally change your name, similar a superhero or an international criminal – propelled me towards my goal through those six long years.

Then in that location I was, a junior physician.* I could have gone on Mastermind with the specialist subject 'the human body'. Anybody at home would be yelling at their TVs that the subject I'd chosen was too vast and wide-ranging, that I should have gone for something like 'atherosclerosis' or 'bunions', just they'd have been wrong. I'd have nailed it.

It was finally fourth dimension to step out onto the ward armed with all this exhaustive knowledge and turn theory into practice. My spring couldn't have been coiled whatever tighter. And then information technology came as quite the accident to discover that I'd spent a quarter of my life at medical school and it hadn't remotely prepared me for the Jekyll and Hyde existence of a house officer.†

During the twenty-four hour period, the job was manageable, if mind-numbing and insanely time-consuming. You turn upwardly every morning time for the 'ward circular', where your whole team of doctors pootles past each of their patients. You trail behind similar a hypnotized duckling, your head cocked to i side in a caring manner, noting down every pronouncement from your seniors – volume an MRI, refer to rheumatology, suit an ECG. And so y'all spend the rest of your working day (plus generally a further unpaid four hours) completing these dozens, sometimes hundreds of tasks – filling in forms, making phone calls. Essentially, you're a glorified PA. Non actually what I'd trained so hard for, but any.

The night shifts, on the other hand, made Dante look similar Disney – an unrelenting nightmare that made me regret ever thinking my education was being underutilized. At dark, the firm officeholder is given a little paging device affectionately called a blip and responsibility for every patient in the infirmary. The fucking lot of them. The night-time SHO and registrar volition be down in A&Eastward reviewing and admitting patients while you're upwards on the wards, sailing the ship alone. A ship that's enormous, and on burn, and that no one has really taught you how to sail. You've been trained how to examine a patient's cardiovascular system, you know the physiology of the coronary vasculature, only even when yous tin recognize every sign and symptom of a heart assail, information technology'south very different to really managing one for the first time.

You lot're bleeped by ward later ward, nurse after nurse with emergency later emergency – information technology never stops, all night long. Your senior colleagues are seeing patients in A&E with a specific problem, similar pneumonia or a broken leg. Your patients are having like emergencies, simply they're infirmary inpatients, meaning they already had something significantly wrong with them in the get-go place. Information technology's a 'build your own burger' of symptoms layered on conditions layered on diseases: you see a patient with pneumonia who was admitted with liver failure, or a patient who'southward broken their leg falling out of bed after another epileptic fit. Y'all're a one-human, mobile, essentially untrained A&E department, getting drenched in bodily fluids (not even the fun kind), reviewing an endless stream of worryingly sick patients who, twelve hours earlier, had an entire squad of doctors caring for them. You of a sudden long for the sixteen-hour admin sessions. (Or, ideally, some kind of compromise chore, that's neither massively across nor beneath your abilities.)

It's sink or swim, and you have to learn how to swim considering otherwise a ton of patients sink with you. I really found it all perversely exhilarating. Certain information technology was difficult work, sure the hours were bordering on inhumane and certain I saw things that have scarred my retinas to this day, but I was a doc now.

* 'Junior medico' refers to anyone who isn't a consultant. It'due south a flake confusing as a lot of these 'junior doctors' are actually pretty senior – some take been working for fifteen years, picking upwardly PhDs and diverse other postgraduate qualifications. It's a bit similar calling everyone in Westminster apart from the prime minister a 'junior politician'.

† The hierarchy goes: house officeholder, senior house officeholder (SHO), registrar, senior registrar, consultant. They've recently renamed the ranks: it's now F1, F2, ST1–7. Everyone withal uses the old terminology though, similar when Coco Pops were briefly rebranded equally Choco Krispies.

Tuesday, three Baronial 2004

Day one. H* has made me a packed dejeuner. I accept a new stethoscope,† a new shirt and a new email address: atom.kay@nhs.cyberspace. It'due south good to know that no matter what happens today, nobody could accuse me of existence the most incompetent person in the hospital. And fifty-fifty if I am, I can blame information technology on Atom.

I'm enjoying the ice-breaking potential of the story, only in the pub afterwards, my chestnut is rather trumped by my friend Amanda. Amanda's surname is Saunders-Vest. They accept spelled out the hyphen in her name, making her amanda.saundershyphenvest@nhs.internet.

* H is my short-suffering partner of vi months. Don't worry – you're not going to take to recall huge numbers of characters. Information technology's not Game of Thrones.

† I'chiliad all for explaining terminology as we become forth, but if you don't know what a stethoscope is, this is probably a book to regift.

Wed, xviii August 2004

Patient OM is a seventy-year-old retired heating engineer from Stoke-on-Trent. But this evening, Matthew, he's going to be an eccentric High german professor with ze unconvinzing agzent. Not but tonight in fact, but this morn, this afternoon and every twenty-four hour period of his admission; thanks to his dementia, exacerbated by a urinary tract infection.*

Prof OM's favourite routine is to follow behind the ward round, his hospital gown on dorsum-to-front, similar a white coat (plus or minus underwear, for a bit of morning Bratwurst), and chip in with 'Yes!', 'Zat is correct!' and the occasional 'Genius!' whenever a doc says something.

On consultant and registrar ward rounds, I escort him back to his bed immediately and make sure the nursing staff go on him tucked in for a couple of hours. On my solo rounds, I let him tag forth for a flake. I don't particularly know what I'chiliad doing, and I don't have vast depths of confidence even when I practise, so it's actually quite helpful to accept a superannuated German cheerleader behind me shouting out, 'Zat is brilliant!' every so often.

Today he took a dump on the floor next to me and so I sadly had to retire him from agile duty.

* In the elderly, urinary tract infections, or any kind of depression-grade sepsis, oft make them become a scrap basics.

Monday, 30 August 2004

Whatever we lack in free time, we more than than make upward for in stories nearly patients. Today in the mess* over lunch we're trading stories nearly nonsense 'symptoms' that people have presented with. Between u.s.a. in the last few weeks we've seen patients with itchy teeth, sudden improvement in hearing and arm pain during urination. Each one gets a polite ripple of laughter, like a local dignitary's speech at a graduation anniversary. We go round the table sharing our version of campfire ghost stories until information technology's Seamus's turn. He tells united states he saw someone in A&E this morning who thought they were but sweating from half of their face.

He sits back in anticipation of bringing the house down, but at that place'southward merely silence. Until pretty much everyone chimes in with: 'Then, Horner's syndrome then?' He's never heard of information technology, specifically not the fact that it likely indicates a lung tumour. Seamus scrapes his chair back with an ear-splitting screech and dashes off to make a telephone call to get the patient back to the department. I end his Twix.

* 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 beginning few months.

Friday, 10 September 2004

I notice that every patient on the ward has a pulse of threescore recorded in their observation chart then I surreptitiously inspect the healthcare assistant'due south measurement technique. He feels the patient's pulse, looks at his watch and meticulously counts the number of seconds per minute. To give myself a bit of credit, I didn't panic when the patient I was reviewing on the ward unexpectedly started hosing enormous quantities of claret out of his mouth and onto my shirt.

Sunday, 17 October 2004

To requite myself no credit whatever, I didn't know what else to exercise. I asked the nearest nurse to go Hugo, my registrar, who was on the side by side ward, and meantime I put in a Venflon* and ran some fluids. Hugo arrived earlier I could do annihilation else, which was handy as I was completely out of ideas by that point. Start looking for the patient's stopcock? Shove loads of kitchen roll down his throat? Bladder some basil in information technology and declare it gazpacho?

Hugo diagnosed oesophageal varices,† which made sense as the patient was the color of Homer Simpson – from the early serial, when the dissimilarity was much more farthermost and everyone looked like a cave painting – and tried to control the bleeding with a Sengstacken tube.‡ As the patient flailed around, resisting this awful thing going down his throat, the blood jetted everywhere: on me, on Hugo, on the walls, defunction, ceiling. Information technology was similar a especially avant-garde episode of Changing Rooms. The audio was the worst office. With every jiff the poor man took you could hear the blood sucking down into his lungs, choking him.

By the time the tube was inserted, he'd stopped haemorrhage. Haemorrhage always stops eventually, and this was for the saddest reason. Hugo pronounced the patient's expiry, wrote up the notes and asked the nurse to inform the family. I peeled off my claret-soaked wearing apparel and we silently changed into scrubs for the rest of the shift. So there nosotros go, the first expiry I've ever witnessed and every bit as horrific every bit information technology could possibly have been. Naught romantic or beautiful virtually information technology. That audio. Hugo took me exterior for a cigarette – we both badly needed one afterward that. And I'd never smoked earlier.

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