This Is Going to Hurt: Secret Diaries of a Junior Doctor

Content Warning: This section of the guide includes discussion of pregnancy loss and death.

Kay explains that it is difficult to leave a career in medicine as there is always a new role just around the corner. When he became a senior registrar, he felt the perks of being a consultant (better pay, fewer hours, and the stability of staying within one hospital) were within reach. However, the role was also highly stressful as, out of hours, he was the most senior staff member. He was called on when the SHO and registrar were unable to deal with a problem. Due to the weight of this responsibility, he would anxiously pace the labor ward, checking for potential problems before they arose. He also developed high blood pressure.

Monday, 9 August 2010 - Friday, 24 September 2010

For the first time, a couple named their baby Adam, after Kay. He was delighted until he learned that approximately 9 out of 1,200 babies in the UK were named Adam. As he had delivered at least 1,200 babies, Kay surmised that he had discouraged “eight sets of parents from naming their child after [him]” (235).

In his new post as senior registrar, Kay had to familiarize himself with new eligibility criteria for infertility treatment, as the regulations differed according to region. In his new area, patients were eligible for only one cycle of fertility treatment under the NHS. In his last posting, in a nearby neighborhood, couples were eligible for three cycles. Kay saw a couple whose first and only round of IVF was unsuccessful. When he told them that private treatment costs £4,000, they looked devastated. Age and BMI limitations were also applicable in this region. Kay, therefore, had to inform one woman she was too old for IVF and another that she was too heavy, although both patients would have been eligible in the neighboring district. When the latter patient cried, Kay subtracted a few kilos from her recorded weight.

One evening, Kay needed to leave work by 6 p.m. as he was taking H to an expensive restaurant to make up for the many date nights he had canceled. However, at 5:45, he had to perform emergency surgery for an ectopic pregnancy. The quickest option would have left the 25-year-old patient with an abdominal scar and required a longer stay in hospital. Kay knew that the best practice was a minimally invasive laparoscopy that would take more time. He opted for the laparoscopy.

Monday, 11 October 2010 - Monday, 8 November 2010

Kay was anxious when he received his first text from Simon in 18 months. However, he was relieved and moved when he saw the message was a wedding invitation.

Kay was sent for an HIV test after receiving a needle-stick injury from an HIV positive patient. Asking how a positive result would affect his job, he was told that an HIV-positive obstetrician would be restricted to clinic work as they could not perform clinical procedures or be on-call. Kay reflected that these advantages would make a positive diagnosis less devastating. The test result was negative.

Kay experienced a particularly exhausting and stressful night shift with a locum registrar who was of little help. After several emergency cesareans and numerous other labor complications, he was about to hand over to the morning shift when a trace suggested a fetus was in imminent danger of dying. Kay successfully delivered the baby by cesarean. However, he accidentally scratched the child’s cheek with his scalpel while opening the mother’s uterus. The baby’s parents were understanding and declined the leaflet explaining the hospital’s complaint procedures. Nevertheless, Kay reflected that the mistake, caused by exhaustion, could have left the baby with life-changing injuries. After recording his discussion with the parents, he filled in a clinical incident form. The author adds that when he worked at the same hospital as a secretary during university holidays, health and safety regulations required him to take a 20-minute break every two hours.

Sunday, 14 November 2010 - Sunday, 5 December 2010

Patient RZ required an emergency cesarean, but her husband, an Orthodox Muslim, did not want a male medic to perform the surgery. When Kay stated there were no female obstetricians available, the husband asked if a midwife could perform the surgery. Kay suggested that the Koran might contain a caveat stipulating that male doctors could be used in an emergency. After making some phone calls, the husband gave Kay permission to operate.

Having arranged to see H at 7 p.m. one evening, Kay finally left the hospital at 9:30 p.m. Consequently, he had to move his belongings to his “depressing new bachelor pad” (252).

Occupied by emergencies in the labor ward, Kay placed an A&E patient with minor abdominal pain at the bottom of his priority list. Consequently, he was bleeped by an angry A&E registrar who told him that the waiting patient was about to “breach the four-hour target” (253). The registrar was referring to a government target specifying that all patients must be processed within four hours. If more than 5% of cases breached this target, the hospital would be fined. Kay replied that he could meet the target, but his present patient would die.

Kay agreed to a capable SHO performing an emergency cesarean with his supervision. When the SHO made the uterus incision, the patient started bleeding profusely. Kay realized that the patient had an undiagnosed placenta previa, preventing the SHO from accessing the baby. By the time Kay delivered the baby, it was dead. Meanwhile, the patient lost 12 liters of blood, which Kay was unable to stop even with sutures. A consultant was called, who also could not stem the bleeding. Finally, a more experienced consultant arrived and performed a hysterectomy.