Boris Johnson is confronted in a London hospital by a father angry about his daughter's treatment. Photo / AP
Boris Johnson is confronted in a London hospital by a father angry about his daughter's treatment. Photo / AP
"When my shelf life as a writer is over, I think I'll go back to medicine — to teach". Interview by Matt Rudd.
Like most sane people who keep a diary, Adam Kay never intended for his musings on life as a junior doctor to be anything other than private."Diaries," as he puts it, "are like baby photos. You're aware they exist, but all things being equal, no one else will ever see them."
In the two years since an edited version was published — "of course it was edited … nobody wants to read about routine caesarean number 123" — it has been read by more than 1.5m people in 36 countries. They have shared the joyful highs and gut-wrenching lows of a young, overworked and frequently overwhelmed NHS doctor as he extracts objects from orifices, patches up burnt, electrocuted and degloved penises and is never, ever home in time for dinner. Not that he could ever have had much of an appetite.
Last year, This Is Going to Hurt outsold Michelle Obama's memoir. This year, it is still bed-blocking the bestseller lists. When we meet, he and his husband, the TV producer James Farrell, have spent the day working on the much-anticipated BBC adaptation of the book. Has he cast himself yet? "No, but I'm hoping for Judi Dench. She has the gravitas."
Kay is also gearing up to launch a sequel of sorts — a diary of his seven Christmases on the wards. Expect more of the same, only with the added intensity of the festive season. As he writes in the introduction: "Coming but once a year — and thank f*** for that — the Yuletide brings more than its rightful share of hospital drama. A&E departments are busier than turkey farms, thanks to black eyes from carelessly popped champagne corks, fleshy forearms seared by roasting tins, and children concussing themselves by hurtling down the stairs in the box their Scalextric came in. Not to mention the fairy-light electrocutions, turkey bones trapped in tracheas, and finger amputations from careless parsnip-chopping. Incidences of drunk driving go through the roof, often literally." That's before he gets into the fallout from lust, sloth, anger and all the other deadly sins catalysed by this joyful time. Praise be to the NHS.
Kay is this decade's Adrian Mole, albeit in scrubs, 39 (and a third) years old and (a little) less insecure. He never expected to find such a wide and adoring audience. His decision to bring those diaries out from under the bed came at the height of the junior doctors' strike of 2016.
Adam Kay with the awards for Popular Non-Fiction Book of the Year, New Writer of the Year Award and the Zoe Ball Book Club Book of the awards in 2018. Photo / Getty Images
"The government was trying to portray junior doctors as greedy," he says. "I wanted to make the public think differently." Indeed, at least part of the phenomenal sales of the book can be attributed to the number of readers who bought two copies: one for them, one for the then health secretary, Jeremy Hunt. A deluged Hunt eventually asked to meet Kay, but "no minds were changed in that half-hour". Kay has had considerably more success with the current health secretary, Matt Hancock. When Hancock described Kay's book in a rather toadying tweet as "illuminating & pertinent to the love and frustrations of working in our amazing NHS", the author was initially sceptical. "I truly hope you take something from it, and maybe even change the political stuck-record," he replied. Their ensuing meeting was more productive.
"There are hundreds of problems with the health service I could have listed — the biggest and most obvious of which is that it needs more money," Kay says. "But if you tell a health secretary that you need loads more money, you're not going to get anywhere. So I thought, if I just talked about one thing, bang on about that for the whole hour, there was a chance that it might have an effect."
He chose to bang on about the wellbeing of doctors and, shortly afterwards, Hancock announced more funding for the Practitioner Health Programme and an upgrade in mental-health training in the profession. "That was one of my proudest moments," Kay says. "The bloke who is literally in charge is now saying we need to focus on this. That's more mind-blowing than an email from my publisher telling me I'm No 1 in Poland."
If and when he gets a second hour with Hancock, Kay might broach his grander plan. "We need to have a bigger discussion about funding the NHS. And I think that discussion would be easier for the politicians if it was lifted one level above party politics. If it was a bit Bank of Englandy — where people who aren't worried about their re-election can say, we need to put two pence in the pound for five years, just for the NHS, to get out of the financial hole." He wants us to think about the next 50 years, not five. "We'll all be dead then, but hopefully the NHS won't be."
I ask what he thinks of Boris Johnson's recent run-in with a disgruntled father who confronted him during a walk-around of a hospital in northeast London. "I would always urge politicians to spend time on the front line, with no cameras, to get a better understanding of what healthcare professionals do," he says. "That said, I'm not sure Boris will ever do it — I suspect the more time he spends with the public, the less he'll want to do any more of it."
Johnson tweeted that he was glad he'd been called to task, saying the government was "investing an extra £1.8bn into our NHS, upgrading 20 hospitals across the country". Kay is not convinced. "The NHS requires about 3%-4% more every year in real terms just to tread water," he says. "Over the past eight years or so, the NHS has only received 1% a year, making a stretched system even more stretched. The new money amounts to a return to 3%-4%. It's good, but it doesn't undo any of the previous damage."
A recurrent theme of Kay's book — and his ensuing campaigning — is that doctors don't talk about the mental cost of their work. The culture is one of strength and silence, of stiff upper lips. There is no space for the concept of the second victim — that everyone, including medical professionals, can be affected ("of course to a lesser degree, but still affected"). His diaries are testament to that. He couldn't tell anyone else that he was struggling. He had to write it down. That the result reached a wider audience is down to serendipity. It was never planned.
Kay left the NHS in 2010, after what he describes with characteristic understatement as "a bad day". Newly promoted to senior registrar, he had to step in when a caesarean started to go wrong. The mother had an undiagnosed placenta praevia and began to bleed heavily. Kay was unable to save the baby and, in a desperate battle, the mother lost 12 litres of blood and ended up in intensive care. Kay, clearly traumatised, stopped writing his diary. It was no longer cathartic. "Everyone at the hospital was very kind to me and said all the right things," he wrote later. "And yet, at the same time, it felt a bit like I'd sprained my ankle. There was the definite expectation that I'd still come into work the next day, the reset button firmly pressed."
When he resigned, he didn't tell anyone — not his father, also a doctor, or mother, nor his partner — the real reason why. "I wasn't in a great place," he says. "I hadn't recovered. You're just expected to carry on. I couldn't and then, suddenly, I wasn't a doctor any more. I had lost my personality-defining trait. My first Christmas out was rotten. It was like I'd come back from the army. I was lost and bewildered. I don't know if I had PTSD, but if I didn't, I had something close. I was regularly waking up sweating, pulse racing, back in that operating theatre. As far as my body was concerned, I was back there."
Boris Johnson is confronted in a London hospital by a father angry about his daughter's treatment. Photo / AP
Shockingly, this continued for years. Why, given his medical training, didn't he seek help?
"There is evidence about how to cope with a traumatic experience," he says. "There's evidence for talking to people, there's evidence for tea, for mindfulness, for taking time out, all sorts of things, and doctors are generally evidence-based. They don't diagnose on a whim. But when it comes to this, there is no self-care." I ask, again, why Kay didn't tell James, and he shakes his head at his own reticence. "It was just a massive thing that I didn't talk about," he says. "And as the years went on, it became less and less relevant that I didn't. My brain was making me think about it — think about it more than I wanted to think about it. I was never going to volunteer to talk about it. It felt like a failure."
The serendipitous part came when he decided to read from his diaries at the Edinburgh festival in support of the striking junior doctors. "I did some preview shows in Islington and told my funny stories. I thought I was painting a picture, a death by a thousand cuts. But everyone just said, 'I don't really understand why you left.' " The next night, he did the show again and told everyone, including James, about that last traumatic case. "The audience left feeling awful, but it was good for me," he says. "It all came out and I cried." Later, when I mention this to his husband, he says, simply, that he was furious. Friends and family all wondered why Kay had never told them. It had taken six years for him to find his emotional honesty, as well as a powerful end to his book.
He still gets emotional talking about it. In a sea of rave reviews for the book, there is the occasional accusation that his black humour dehumanises his patients. Certainly, he doesn't spare those unfortunate souls who have arrived on his table through sexual misadventure, and his unvarnished descriptions of the miracle of childbirth won't help expectant mothers. "The humour was my coping mechanism," he says. "I was basically told not to speak to anyone, to put it away in a box. So I was looking for the light among the dark and I was writing it down, so that was what I remembered." He clearly cared deeply for his patients. He had to distance himself from them to survive.
Kay does get letters from parents angry that his diary has dissuaded their children from medical school. A look of pure fury flashes across his otherwise cherubic face as he explains this. "You want me to apologise?" he asks. "Know what the job is. Do it with your eyes wide open. Quit medicine before you start." Prospective Tube drivers have more of a "psych eval" before taking the job, he adds. So do contestants on Love Island. "If you want to be a doctor, it's just not discussed. No one asks if you can handle these things on a daily basis."
Kay attended Dulwich College — "single-sex education needs to go" — and as the son of a doctor found himself "kind of funnelled into medicine." Two of his three siblings chose, or were also funnelled, the same way. One brother is still a GP. The other "escaped" into digital marketing. His younger sister is now a registrar, shouldering the same responsibilities in the same speciality that led to Kay's abrupt departure. "She is more emotionally intelligent than me," he says. "She's got a better handle on what the job involves."
Kay admits that he knew he might have made a mistake before he even graduated. "I realised I didn't adore med school, but by then it was too late," he says. "It would have been such a failure to admit that it wasn't necessarily for me. We should do more than just check applicants have x number of A-levels and play the cello. One of the ways to improve the quality of the doctors we get is to drop the grade requirements a bit. Because the best doctors are not the cleverest doctors."
I'd argue that this plea for more thought before setting off into a profession has relevance beyond medicine. Surely young people in general are under pressure to succeed, to pass exams and find a path. How many of them have enough time or space to worry about anything as luxurious as their future wellbeing? Kay's experience is, perhaps, just an extreme example. He chose to specialise in obstetrics and gynaecology — "brats and twats" — because "you start with one patient and end up with two". Although he now wishes he had chosen something "less high octane … like dermatology", he still lights up at the memory of the happier days in the NHS. "I do miss it," he admits. "There are no highs like it, but there are no lows like it either." He now does a variation on that original show to audiences in their thousands. "It's wild," he says, "but my buzz is stunted. My barometer is f*****."
For now, he is still adjusting to another rollercoaster life after not only medicine but also his life crisis. Having met James on Twitter in 2010 ("back when social media wasn't full of Nazis"), they finally married last year. The ceremony was at Hammersmith & Fulham Register Office, and "originally we didn't want to do anything to acknowledge it because public displays of affection are sort of …" he trails off. "Anyway, we had a party in the end. Then we went to the Seychelles and were both working."
Kay happily admits that, in his new life as a bestselling author, he is the plus one to his younger, more illustrious husband. Farrell was head of development at BBC Studios and his shows have won a string of Baftas. (He was also a producer on Mrs Brown's Boys.)
They divide their time between Chiswick in west London and Belfast, where Farrell is now producing the Game of Thrones prequel. They mix in celebrity circles — a far cry from stolen, solitary Tupperware dinners in the ward kitchen — but Kay, increasingly recognised in the street, is uncomfortable with the thought of fame. "You can't go to Nando's," he says. "When you go to restaurants with famous people, you end up at a table round the corner at the back, or in a room upstairs. I'm baffled by the people who decide they want to be famous."
He turns 40 next year and is already cultivating the resigned pessimism of a midlifer. He marked the wedding of his younger sister by contracting pneumonia and, for the first time, has started taking his health seriously. "I've started running and I can remember the last time I ate a tomato," he says. When his doctor asked about hydration, he confessed that he drank only Coke Zero and white wine. "The GP really thought that a good percentage of my water consumption could be through water." Doctors have the worst health-seeking behaviours. Former doctors are little better.
He expects his second career to "peter out" in a year, or three, or 10. What then? It is apparent from our evening together that behind the lurid stories and the bad ending, he retains a love of medicine and of the highs and lows of life in the NHS. Would he go back?
"I think I will go back. I've done my last caesarean section, I've probably seen my last patient. I was a couple of years off becoming a consultant. I could get to the end of that — or I could spend four or five years becoming a GP. Although I suppose that's not a relaxing job. You're seeing, what, 70 patients a day? I think really that when my shelf life as a writer is over, I'd go into education — teaching medical students. Saying the stuff I wanted to hear."
Helping the doctors of tomorrow — it all sounds very commendable. "It does sound quite worthy, doesn't it?" he says, laughing. "But it's selfish. Giving back is selfish. That's why I do it.
"I'm now much more happiness-focused than success-focused. Which is much easier when you've been successful, I realise, but ultimately the point of a job is evenings, weekends and holidays. What I should really do is retire."
