Introduction
Summary of the Book This is Going to Hurt by Adam Kay Before we proceed, let’s look into a brief overview of the book. Picture a world where hospitals bustle with life, where doctors and nurses work tirelessly to heal, and where each patient’s room might hold a story of hope or heartbreak. Within this universe, countless junior doctors enter eager to help, to learn, and to save lives. Yet, behind the sparkling image of white coats and confident smiles lies a landscape of sleepless nights, unimaginable pressure, and a system often at odds with those who serve it. This book dives into that hidden reality, following Adam Kay’s journey as a young doctor in the NHS. From the bizarre cases that make you gasp in disbelief to the tragic nights that leave tears on the operating floor, these chapters reveal a truth rarely spoken: that healing others sometimes shatters the healer’s own heart. Here begins the discovery.
Chapter 1: Peeking into the Secret Pressures and Hidden Everyday Realities Surrounding NHS Doctors.
Imagine walking through a hospital ward and seeing doctors in white coats moving swiftly from one bed to another, trying to look calm and steady, as if each patient’s emergency were perfectly under control. At first glance, you might think that these medical professionals live a comfortable, relaxed life. Perhaps you believe they spend their afternoons driving fancy cars, sipping expensive coffees, and enjoying endless appreciation from grateful patients. This dreamlike picture is often painted in movies or TV shows, making many people assume that doctors lead easy lives with countless rewards and luxuries. But the truth, especially inside the United Kingdom’s National Health Service (NHS), is far less glamorous. In reality, junior doctors often work extremely long shifts, sometimes hitting 90 or even 100 hours per week, with barely enough time for a proper meal, let alone rest.
Within these busy hospital corridors, young doctors fresh out of medical school are tossed right into the deep end of demanding and unforgiving schedules. Each hour is packed with critical decisions, complicated procedures, and unexpected patient emergencies. When a crisis hits, every passing second feels like a thunderbolt of responsibility. These doctors must be ready to respond even in the middle of the night, with minimal supervision and no room for serious mistakes. Their tasks range from simple blood tests to intensive treatments that can make the difference between life and death. Instead of leisurely golfing afternoons, they deal with endless paperwork, test results, urgent bleeps, and constant patient monitoring. Far from enjoying casual freebies, they struggle to maintain focus in a system that often values survival over comfort.
Despite their education and training, these junior doctors frequently feel unprepared for the harshness of reality. Years of memorizing textbooks and attending lectures do little to shield them from the shock of facing a roomful of patients in crisis. The human body rarely follows textbook rules, and each patient brings unique complexities. The stress is unrelenting, and the pace is punishing. It’s like stepping into a stormy sea, where the waves never stop crashing and you must keep swimming to stay afloat. The constant exposure to severe cases, combined with the fear of making a tragic error, can weigh heavily on their minds. With no pause button to catch their breath, they gradually learn that medical life is not a calm, sunny garden but a never-ending, high-stakes battlefield.
As a young person reading this, try to imagine having to grow up overnight. Instead of focusing on typical teenage worries, you suddenly face responsibilities that test your confidence and courage every single day. This is what many junior doctors in the NHS experience, discovering that their job is not about luxury but about carrying immense responsibility and pressure on their shoulders. While the public may think doctors live effortlessly, the truth is an exhausting schedule, mental strain, and emotional burdens that never truly disappear. They confront the grimmest moments of human life, witness miracles and tragedies, and somehow keep going. This hidden reality sets the stage for everything that follows: a deeper dive into the personal experiences of one particular doctor, Adam Kay, and the world he inhabited.
Chapter 2: Unraveling the Early Struggles as a New Doctor Rapidly Learning on the Job.
Imagine being just out of medical school, where your days were spent memorizing lists of diseases and treatments, passing exams, and imagining the bright future ahead. Now picture yourself standing in a hospital corridor, a freshly pressed coat on your back, faced with your very first shift as a junior doctor. This was exactly Adam Kay’s situation as he began his career in the early 2000s. Like many British teenagers at 16, he had to pick a path that would define his future. For Adam, following in his father’s footsteps as a doctor seemed natural. After six grueling years studying at Imperial College, he expected hard work but not the whirlwind of responsibility that arrived immediately. What he discovered was that theory and practice are very different worlds.
In medical school, students learn about diseases in a controlled, academic environment. They take tests, practice on mannequins, and simulate emergencies in quiet classrooms. But the moment they start working as a junior doctor, there is no pause button, no teacher whispering the correct answer. The hospital wards become their new classroom, filled with real patients who feel pain, fear, and confusion. On his first day, Adam Kay realized that knowing medical facts did not automatically translate into confidently handling real-life crises. Instead of simply recalling facts, he needed to think critically, solve problems quickly, and sometimes trust his instincts. Suddenly, every lesson from those six academic years had to be put into practical use within seconds, often without a senior doctor immediately available.
Being a new doctor also meant understanding the complex hierarchy of the hospital. Adam was a house officer, the first rung on a very long career ladder leading eventually to the esteemed position of consultant. It’s a journey that, in theory, progresses steadily from house officer to senior house officer, then to registrar, senior registrar, and finally consultant. But the day-to-day reality means that as a newly minted doctor, you are the one constantly being called for emergencies when everyone else is busy. Night shifts were the most intense, with a pager—called a bleep—going off seemingly nonstop. Each bleep could be a life-or-death situation waiting to be solved. This forced Adam to grow his professional muscles quickly, as there was little time to be uncertain.
In this environment, every experience became a lesson. A near-death patient? A frantic call in the middle of the night? A mysterious symptom that didn’t appear in the textbooks? All these challenges forced Adam to adapt, to think on his feet, and to make decisions rapidly. The pressure was enormous, and the feeling of always being on the edge of a cliff, trying not to slip, was overwhelming. Junior doctors like Adam learned the hard way—by doing, by making split-second decisions, and by facing the consequences if something went wrong. With colleagues equally swamped, support was sometimes scarce. The hospital’s atmosphere was one of survival, where each new shift brought fresh tests of courage and ability. It was a world where every moment counted, and hesitation could be costly.
Chapter 3: Inside the Endless Night Shifts Where New Doctors Sink or Swim Quickly.
At night, a hospital can feel eerily quiet in the hallways, but behind the scenes, chaos often reigns. For a new house officer like Adam Kay, the night shift was a trial by fire. During the daytime, you might find yourself acting like a personal assistant—making calls, scheduling tests, and following a consultant’s instructions. But after the sun sets, the hospital becomes a different universe. The senior doctors might be tied up with emergencies in Accident & Emergency (A&E), leaving you responsible for patients scattered across multiple wards. With one pager strapped to your belt, you could be summoned at any minute to a room where someone’s condition was suddenly declining.
Imagine spending hours dashing from one ward to another, the bleep demanding your immediate attention: a patient struggling to breathe here, another spiking a dangerous fever there, yet another complaining of intense pain. There’s no time to panic; you must act decisively, pulling from your memory what you learned in school and what you’ve witnessed during training. You might need to start an IV, administer a life-saving drug, or perform a quick examination to figure out what’s wrong. In these moments, Adam learned to rely on his instincts. He learned to trust his hands and eyes, feel the rhythm of a patient’s pulse, interpret their sudden changes in breathing, and think about possible causes, all in a matter of minutes.
These nights also taught him that successful medical care often depends on teamwork and good communication. Nurses, often the unsung heroes, would be crucial guides. They knew the wards, the patients, and the quiet signals that warned of trouble. Senior colleagues, when available, provided backup, but many times Adam worked alone, the weight of a patient’s fate resting heavily on him. After all, a hospital’s demands never sleep, and the pressure doesn’t take a holiday. Without anyone holding your hand, you must stand strong, keep your head clear, and push your exhaustion aside. Every successful intervention—like saving an older gentleman who was teetering at death’s door—boosted Adam’s confidence and convinced him that he was indeed growing into the role he once only imagined.
But these victories came at a cost. Long nights blurred into early mornings, and Adam could feel his body resisting the unnatural schedule. His mind was always racing: What if I had overlooked something? Did I handle that emergency correctly? The hospital’s fluorescent lights replaced the comfort of sunlight, and the sound of machines beeping replaced any sense of normal evening relaxation. Yet, through this challenging experience, Adam discovered not only his own capabilities but also the fragile line that doctors walk. He realized that the demands of this life are about adapting to chaos, constantly learning, and shouldering immense responsibility. In a place where seconds matter, he had no choice but to learn quickly and perform effectively, all while silently praying he would always make the right call.
Chapter 4: Surprising Oddities, Astonishing Injuries, and Truly Bizarre Emergencies Nobody Warned About.
As Adam settled into his role, he realized the hospital wasn’t just about standard surgeries and typical illnesses. Some cases would leave him wondering if he was still on Earth. He encountered injuries so strange they seemed ripped from the pages of a wild comic book. One night, he faced something called a de-gloving injury, where a patient’s skin was peeled back in a horrifying manner. In this case, a young man had disastrously tried to slide down a gritty lamppost after a night of drinking. He injured not only his hands but also the delicate skin covering his most sensitive body parts. This was not something medical school had prepared Adam for; textbooks rarely discuss individuals who attempt to pole-dance on rough street fixtures.
But it didn’t stop there. Adam discovered that emergency rooms attract a bizarre range of accidents and misadventures. He saw people who needed foreign objects removed from places they definitely shouldn’t be. Everything from TV remotes to other random household items managed to end up lodged in body parts that left Adam speechless. Patients presented ridiculous explanations—like accidentally sitting on a remote—only for the truth to emerge once the object was removed, often wrapped in a condom. This opened Adam’s eyes to human nature’s peculiarities. People do strange things, and doctors must find a way to help them without judgment. Each bizarre case tested not only Adam’s medical skills but also his ability to stay composed and compassionate.
These strange incidents highlighted that being a doctor involves dealing with the unexpected, the embarrassing, and sometimes the downright hilarious. It also taught him that medicine cannot be practiced with a stern face alone. Humor, when used kindly, can help ease tension for both doctor and patient. Still, no amount of laughter could fully prepare him for encountering so many surreal scenarios. He learned that doctors need flexible minds. One moment you’re diagnosing a heart condition; the next moment you’re helping remove a foreign object that defies logic. This balance between the serious and the absurd became a defining characteristic of his daily work environment, reminding him that the human body and human behavior are equally unpredictable.
Amid these oddities, Adam made a crucial career decision. He decided to specialize in obstetrics and gynaecology (often called OBGYN), partly inspired by his previous academic focus and partly attracted to the idea of guiding new life into the world. He believed it would be a relatively straightforward field: deliveries, caesareans, and helping mothers through childbirth. But life rarely goes as planned. Although he imagined a noble profession filled with joyous cries of newborns and tearful parents, he would soon realize that even in the miracle of birth, complications arise, misunderstandings occur, and incredible oddities persist. The following steps in his career would show him that the world of OBGYN also carries heavy burdens, challenging his patience, skill, and emotional resilience.
Chapter 5: Entering the Realm of Obstetrics and Gynaecology Where Miracles and Mayhem Collide.
As Adam moved up the ladder to a Senior House Officer (SHO), he stepped into the labor ward, expecting a structured routine. He hoped that assisting in childbirth would bring a sense of purpose and positivity. After all, helping a healthy baby take its first breath seems like one of the world’s greatest joys. Yet, he soon found himself in a place where unpredictability ruled. While he learned to perform caesarean sections—cutting into the womb to deliver a baby in emergencies—he also had to master a device known as a vontuse, essentially a suction cup to help pull a baby out. Imagine a gentle tug-of-war, except the stakes are a human life. Every procedure was intense, every decision critical, and every second ticking loudly in his mind.
During these months, he encountered mothers who brought their own sets of surprises. Some arrived at absurd hours, panicking over normal bodily features like taste buds, fearing they were dangerous lumps. Others misunderstood basic instructions, like a husband who found using condoms so confusing he tried to roll them down over his testicles. Still others took desperate measures, like a woman trying to sneak someone else’s urine into a drug test by hiding it inside her body, only to need medical help to get it out. The labor ward wasn’t just about delivering babies; it became a stage for human quirks, fears, and sometimes misguided attempts at problem-solving.
Amid these peculiar encounters, Adam sharpened his skills. The more unusual the situation, the more he learned that a good doctor needs patience, empathy, and the willingness to gently explain the truth. He realized many patients are scared or embarrassed, and what seems ridiculous to a medical professional might be a terrifying mystery to a patient. Keeping a compassionate tone while firmly guiding them toward proper care was a fine art he had to master quickly. Over time, he saw that no one can fully predict what happens in a hospital ward, not the doctors, not the patients. Underneath the absurdity, there was always a human story—someone’s son, daughter, spouse, or parent looking for help and reassurance.
But this life came at a price. Adam’s personal relationships, especially with his long-term partner—known as H—began to strain under the weight of his hectic schedule. Too often, special occasions were forgotten or cut short. Even the simplest plans, like a dinner date, became almost impossible to keep. As Christmas morning arrived one year, Adam found himself waking up not at home but in his car in the hospital parking lot. He had been so exhausted that he never managed to drive away. This meant missing warm holiday messages, ignoring calls, and returning only the barest of greetings. All these personal sacrifices piled up, showing that while the miracle of helping new lives enter the world might be heartwarming, it did not protect him from the relentless toll of hospital life.
Chapter 6: Rising to Registrar, Leading a Ward While Facing Shocking Twists and Unthinkable Scenes.
In 2007, Adam rose to the level of a registrar. This meant that at times, he was the senior figure on the ward. Suddenly, his shoulders carried more responsibility than ever before. No longer could he fully rely on someone higher up to step in when things got complicated. When complicated births or emergencies arose, all eyes might turn to him. Being in charge sounded like a milestone of success, but it often felt like stepping into quicksand, where any wrong move could have dreadful consequences. He learned that leadership in the hospital isn’t about barking orders; it’s about maintaining calm in chaos and guiding everyone through nerve-wracking moments.
The labor ward brought him face-to-face with extraordinary events. One mother was so determined to consume her own placenta, believing it carried health benefits, that when Adam’s back was turned, she mistakenly ate a bowl of blood clots, causing a gory and appalling scene. Another patient refused antibiotics, convinced that Adam was secretly working for the pharmaceutical industry. He had to explain that he drove an old, modest car, which hardly screamed Big Pharma payoffs. Yet another mother wouldn’t let her baby have a simple vitamin shot because she worried it would cause arthritis. In a world increasingly influenced by strange rumors and internet conspiracies, Adam struggled to help his patients choose medically sound paths.
There were also bizarre romantic surprises. Once, a woman tried to propose marriage to her boyfriend by hiding a ring inside a chocolate egg and placing it in a deeply personal location. When the egg got stuck, the hospital staff had to remove it. The boyfriend, stunned by the unexpected hospital adventure, received his marriage proposal in the middle of a medical procedure. He accepted, making this one of the strangest love stories Adam ever witnessed. These odd incidents reminded him that beneath the white walls and antiseptic smells, hospitals are filled with raw human emotions—fear, love, desperation, and sometimes joy in the most unlikely circumstances.
But not all surprises were humorous. Sometimes colleagues made jaw-dropping errors. Beds were sometimes rolled over catheter tubes, causing patients severe discomfort and confusion. A student once came into a caesarean surgery hungover and fainted straight into the patient’s open abdomen. These events shocked Adam, proving that doctors are human, capable of mistakes and misjudgments. They also reminded him that no matter his rank, he must remain vigilant and double-check everything. The hospital could be a place of miracles and laughter, but also of terrible errors. Adam realized his growing experience and knowledge only partly shielded him from unexpected disasters. To survive in this environment, he needed constant alertness, resilience, and the humility to accept that every day could teach a new lesson.
Chapter 7: Unveiling the Cracks in a System Straining Under Outdated Technology and Endless Pressure.
As time passed, Adam became more aware of the flawed system he worked in. While trying to save lives and bring new ones safely into the world, he battled not only medical emergencies but also a healthcare environment loaded with inefficiencies. On his very first day, he received an email address with his name spelled incorrectly—atom.k instead of adam.k—an omen suggesting that basic administration wasn’t always handled smoothly. The NHS, though filled with dedicated people, struggled with technology that was years out of date, slow computer systems that froze at crucial moments, and endless bureaucratic hoops to jump through.
Upgrades intended to improve efficiency often made things worse. A new computer interface introduced around 2006 forced doctors to spend minutes scrolling through endless menus just to prescribe a single medication. It tested their patience and wasted precious time. In a place where seconds could mean the difference between life and death, fiddling with clumsy software felt like a cruel joke. Another so-called improvement replaced two stable computers with a single wheeled machine that everyone had to share. This meant doctors had to compete for time on the computer, pushing the device down corridors like a stubborn shopping cart. Meanwhile, a thick metal keyboard required fierce finger-jabbing to register each letter, turning a simple task into a marathon of frustrating key presses.
All these inefficiencies took their toll. Adam saw that exhausted doctors, already running on empty, lost more energy wrestling with malfunctioning systems. Patients waited longer for tests and treatments because doctors spent extra minutes dealing with technical hiccups. Communication grew strained as overworked staff tried to maintain their composure despite increasing friction. In a space meant to heal, internal obstacles created confusion and delay. It was hard enough to make calm, thoughtful decisions in a high-stakes environment. Layering on technical nightmares and poor resource management made it feel like trying to run a race while tied to a boulder.
Worst of all, the people in power seemed unaware or uninterested in fixing these fundamental issues. They expected perfect performance from doctors, who were human beings stretched to their limits. Instead of providing robust support, the system choked itself with preventable complications. For Adam, who had once dreamed of smoothly advancing toward a consultant role, these problems began to feel like insurmountable mountains. He realized that not only were doctors not enjoying respect or fair compensation, but they were also hamstrung by broken tools and outdated methods. This growing awareness would plant seeds of doubt, making him question whether he could continue working in an environment that didn’t seem to value the well-being of either its staff or its patients.
Chapter 8: Facing Exhaustion, Unfair Expectations, and the Heartbreaking Toll on Doctor’s Minds and Spirits.
As the years rolled on, Adam found himself more frequently confronting the darkest sides of medical life. The joy of delivering a healthy baby could vanish in an instant when a stillbirth occurred. Comforting families who had just lost a child shook him to his core. Sometimes he had to discover the cause of death in a newborn, performing painful tests and writing reports that no parent should ever have to read. Each loss carved a scar into his memory. Alongside these tragedies, he bore witness to unspeakable stressors: limited resources, political accusations, and unrealistic public expectations.
At times, a doctor’s shift could stretch beyond twelve hours without a proper meal break. After working through the night and into the next day, simple tasks could feel like monumental challenges. Concentration wavered, hands shook from fatigue, and the mind became foggy. Yet mistakes were not allowed. People’s lives depended on precision and calm. The system demanded perfection from drained humans who were never given the chance to recharge properly. Such conditions sowed seeds of anxiety, guilt, and frustration. Doctors are not robots; they need rest, nutrition, and emotional support to function at their best.
This reality hit Adam hard on a cold November day in 2010. Exhausted and starving, he performed a caesarean and accidentally nicked the newborn’s cheek. It was a small injury, one that would heal, but it represented an error that weighed heavily on his conscience. He wondered if, under kinder conditions, he would have been more alert, more careful. Another horrific event followed in December, involving a mother with an undiagnosed condition. An emergency caesarean led to uncontrollable bleeding. Adam held her uterus in his hands, fighting to save her life while the baby, sadly, did not survive. In that moment, the weight of unrelenting pressure and insufficient support crushed him like never before.
These incidents showed Adam that no matter his good intentions, he was part of a flawed system that often left doctors feeling broken. He realized that consistent overwork, lack of sleep, and poor staff-to-patient ratios were not only dangerous for patients but also unsustainable for doctors. The myth of doctors as tireless superheroes crumbled. He could not ignore how the system’s cracks ran deep, endangering both those giving care and those receiving it. As these scars multiplied, Adam found it harder to find satisfaction or pride in his work. The balance had tipped. He once believed that each new skill learned and each successful delivery would carry him toward a fulfilling medical career. Instead, his love for the profession was suffocated by the weight of endless strain.
Chapter 9: Reaching the Breaking Point and Choosing to Walk Away from a Broken Dream.
In the wake of these devastating events, Adam realized that his career path no longer felt like a calling—it felt like a trap. He had entered medicine hoping to help people and make a difference, but now he stood at a crossroads. Fourteen years after starting on this journey, he was close to becoming a consultant, a position he had once imagined as a pinnacle of achievement. Yet, the glittering vision had dulled. He saw colleagues burn out, relationships crumble, and patients suffer from systemic failings. The government’s response was to blame doctors, accusing them of being greedy when they rightly asked for fair wages and reasonable working hours.
Adam understood that no pay raise could heal his aching heart or silence the haunting memories of lost patients. The problem ran deeper than money. The NHS, overburdened and poorly managed, had chipped away at his optimism, leaving him emotionally drained. He could no longer bear the thought of turning up each day, fighting not only disease and tragedy but also a system that seemed unwilling to improve. He needed to reclaim his humanity, to protect his mental health, and to find a way of living that didn’t crush his spirit.
So he made a choice that many would find shocking: he left medicine. He walked away from years of training, sleepless nights, and life-changing responsibilities. Instead, he turned to a new career in writing, finding a place where he could use his wit and intelligence without risking people’s lives in the process. While he missed the joy of helping others, he did not miss the impossible demands, the tragic losses, or the suffocating fatigue. In time, he saw the NHS continue to struggle. Colleagues still fought for better conditions, facing accusations of selfishness from leaders who refused to listen.
Today, Adam’s story lives on as a testament to the incredible dedication required to become a doctor and the heartbreaking reality of working in a strained health system. He showed that laughter and bizarre moments can color the profession, but so can pain and despair. His departure sent a message: doctors are human beings who need fair treatment, support, and understanding. Without these, even the most passionate physician can be forced to surrender their stethoscope. His experiences highlight that, behind every medical miracle, there may be a weary soul struggling to carry the heavy load. And when it becomes too much to bear, walking away might be the only way to salvage what remains of one’s spirit.
All about the Book
Dive into the hilarious and heartbreaking world of medicine with ‘This is Going to Hurt’ by Adam Kay. This compelling memoir reveals the realities of life as a junior doctor, blending humor and profound insights.
Adam Kay is a talented writer and former doctor whose captivating storytelling illuminates the trials of healthcare, providing readers with a rare glimpse behind the NHS curtain.
Medical Professionals, Nurses, Healthcare Administrators, Medical Students, Mental Health Professionals
Reading Memoirs, Medical History, Humor Writing, Health Advocacy, Stand-Up Comedy
NHS Pressures, Mental Health in Medicine, Work-Life Balance, The Reality of Junior Doctors
I think it’s fair to say that everyone working in the NHS has their own coping mechanism; mine is writing.
Stephen Fry, Emma Thompson, David Tennant
Book of the Year at the National Book Awards, British Book Awards – Non-Fiction Narrative, Specsavers National Book Award for Autobiography
1. What challenges do doctors face in their daily work? #2. How does humor help cope with medical stress? #3. What shocking realities do medical professionals encounter daily? #4. How does the NHS impact healthcare workers’ lives? #5. What ethical dilemmas arise in hospital settings? #6. How do medical professionals balance work and personal life? #7. What are the emotional impacts of patient interactions? #8. How does teamwork function in high-pressure environments? #9. What role does bureaucracy play in healthcare challenges? #10. How is patient care prioritized amidst overwhelming workloads? #11. What can we learn about compassion in medicine? #12. How does medical training prepare doctors for reality? #13. What humorous moments lighten the burden of work? #14. How do doctors handle their own mental health? #15. What surprising skills are essential for medical staff? #16. How do family dynamics influence a doctor’s career? #17. What stories illustrate the resilience of healthcare workers? #18. How do patient stories shape a doctor’s perspective? #19. What misconceptions about doctors does the book challenge? #20. How can we support healthcare workers better?
This is Going to Hurt, Adam Kay books, medical memoir, humor in medicine, doctor’s experience, healthcare stories, funny medical book, best selling memoir, UK doctor, hospital life stories, non-fiction books, inspiring medical stories
https://www.amazon.com/This-Going-Hurt-Adam-Kay/dp/1509858622
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