This is Going to Hurt

Yesterday, before and after work, I read ‘This is Going to Hurt- Secret Diaries of a Junior Doctor’ (Picador, 2017). The author, Adam Kay, does not offer a spoonful of sugar to help the medicine go down, the medicine in this case being some of the realities of life as a hospital doctor. His memoir records, through diary entries and link pieces,  an unsentimental love for what the NHS does, although often not for how it does it. The book is critical of bureaucracy, of UK government and its policies, and a culture in which a lack of care for its workforce is endemic.
It is a funny, sometimes caustic, sometimes horrifying, sometimes tender book.

Along with presenting reasons why private alternatives to the NHS will not provide the same levels of care ( particularly with regard to emergency provision and the specialist back up available when things don’t go according to expensive plan in elective procedures) the book provides an insight into the sheer hardship of life as a junior doctor; the lack of support, insane relationship-wrecking hours, and often terrifying situations that the relatively inexperienced find themselves in.

Reading the book jogged memories of my nursing career; the first death after attempted resuscitation; a young child crying out in pain in the lift; my incredulity at the staffing levels on a care of the elderly ward where people were constantly incontinent, falling out of bed or wandering around in a daze; the most silent of silences after an eighteen-year-old, admitted to A and E with dirty bare feet, had an inexplicable cardiac arrest and died after half an hour of trying to resuscitate him. There were thousands of good moments too, like gliding around with my mate Hemi as we drew up IV drugs in the treatment room to the sound of a newspaper giveaway CD that included  ”When Will I See You Again’ by the Three Degrees.

I remember resenting the unhelpful autocracy that would remove from staff the use of the car park, a small but important facility previously available to those of us working at night, while the slow encroachment of yellow lines and residents-only parking in the streets around the hospital meant the walk from the car to the hospital became the best part of a mile, unless one could afford parking charges that would compromise income. I remember visiting a fraught medical admissions ward and seeing one of the girls I’d trained with there, massively pregnant and looking unwell on a run of seven consecutive night shifts. I remember a colleague losing all confidence for while after giving the wrong drug to a patient as instructed by a doctor in a life or death emergency. Drug errors make nurses and doctors feel very bad. Being chastised (there is meant to be a ‘no blame culture’ where professionals are supported in order to reflect on what went wrong and what they would do differently) and told ‘you could have killed the patient,’ (in this case not true) in the aftermath was not helpful. Thankfully, my friend is a great nurse and a brave and resilient character and recovered from this episode, later becoming a specialist in her field.

I worked with some lovely doctors from all over the world. Some were funny and kind and compassionate to a fault. Others were aloof and uncommunicative. It takes all sorts. The atmosphere in one unit I worked in was wonderfully un-hierarchical. New junior doctors, coming from other places, often looked surprised when our consultants joked with us and came to us first to ask how the patient was, listening carefully to what we had to say before beginning their round.  I worked with some wonderful, resilient people. I remember a pregnant colleague matter of factly telling me she had thrown up out of the car window (morning sickness) on the way to work but was fine to complete her twelve-hour night shift. Once, when I was nurse in charge of a cardiology ward, I remember refusing to stop and discuss when beds might become available with two (they never appeared alone) bed managers carrying clip boards. I was speaking from behind a curtain, pressing on an artery to prevent fatal blood loss and respectfully requested the pair of them looked up discharge details in the notes from that morning’s ward round themselves. This didn’t go down well.

Working in a service that runs around the clock, 365 days a year, means there is the disparity between your working world and those of your friends; for example, keeping schtum while a teacher friend (another tough job) complains about the quantity of marking they have to do when you’ve just found out you are working over your new-born’s first Christmas morning after a night in which you were covered in four types of body fluid, none of them your own.

Much like Adam Kay, I have my reasons for feeling privileged to have worked in the National Health service.  I wouldn’t have missed it for the world. Also like him, I wrote about my experiences some years afterwards, not in memoir but in a short story and the poem sequence in my last book, The Great Animator.

The poem below is one of twelve in the sequence.
The photograph of the canal was taken some years later.

AM

We leave together, me in wrap-around shades
that set the others laughing. I’m photophobic
I explain, as we step from the lift through lethargic
sliding doors, past a girl in blue pyjamas,
drip-stand in one cannulated hand, cigarette
in the other, cross a mosaic of gum on tarmac
and out of hospital gates, three
shadow-less figures that separate on the corner
while the city exhales the first exhaust of day.
Seven streets to my parked car, across a canal’s
creased green V, the wake from swans
that glow through black iron railings,
home to cold sheets and dreamless sleep.