Adam Kay: ‘If I had kids I would put them off studying medicine’

The morning I was due to interview Adam Kay I awoke with heavy flu symptoms and a painfully frozen neck and shoulder. I was in perspiring agony and, even before I got out of bed, utterly exhausted. But I thought: what would a junior doctor do? Of course, if he or she were suffering from flu, the correct answer would be: not go anywhere near a hospital. But that’s not the sense you get from Kay’s bestselling diary of his time as a doctor training in obstetrics and gynaecology – or, as it was referred to at his medical school, brats and twats.

In This Is Going to Hurt: Secret Diaries of a Junior Doctor, hospital doctors, and in particular the author, are depicted as poorly paid, undervalued and grossly neglected professionals who are unfailingly willing to give up their own time for free to do battle with the health of the nation. That is, when they’re not trading stories about their patients’ bizarre sexual proclivities.

Doctors in Kay’s book don’t have time to be ill, because everyone else is sick and they’re busy having to deal with it. So it was in that dogged spirit that I eased myself into a vertical setting, waving away the doubts of my wife and concerned looks of strangers in the street, and gingerly made my way to meet Kay at the Wellcome Foundation in Euston, London.

Kay is now a 37-year-old comedian and scriptwriter. He’s got a round, serious face that breaks occasionally into shoulder-shaking laughter. Half-cherubic, half devilish, he looks a bit like a clean and sober John Belushi.

“How are you?” he asks politely when we meet.

This is a trick question, of course, the answer to which no doctor, or even former doctor, ever wants to hear in detail. Kay grew fed up of friends and people he met at parties recounting their ailments for his expert attention. But as he notes in his book, he prefers it to people asking him to read their scripts.

“No one’s sent me their book yet,” he says. “It’s bad enough finding time to read books I want to read, let alone those of friends of my aunt who decided they’ve an autobiography in them.”

The medical memoir is not a new idea. There have been several notable additions to the genre in recent years, including the brain surgeon Henry Marsh’s Do No Harm. But they’ve tended to focus on the ethical and the surgical, and as a consequence have conformed to a scrupulous style of writing.

That is not Kay’s approach. His is a much more personal and, not infrequently, flippant recounting of his experiences. You’re rarely a paragraph away from a punchline, and the descriptions err on the side of comic exaggeration. But it’s also full of tense situations that sometimes end in death or disability. It makes for an odd and rapid-fire oscillation between the comic and the tragic that has obviously struck a chord with the reading public.

Was he surprised by the book’s success?

“Yes,” he says immediately. “I thought that if it got an audience it would be because we all use the NHS. But the majority of people who write to me say they didn’t realise it was that bad. The NHS is such a big employer that everyone knows someone who works for it. And people are thinking, ‘I know someone who’s in that position”, rather than ‘Isn’t the human body marvellous?’”

And if Kay’s account is halfway accurate, any doctor below the level of consultant deserves the sympathy that readers appear to be giving them. The problem about assessing its accuracy is that Kay writes a lot for laughs, and his particular style of humour is to ramp up events until they seem too anecdotally perfect to be true.

But he insists the book is “reasonably accurate”, and that the main sleight of hand was to bolt the clinical data of patients to the biographical details of other patients, and change everyone’s names.

“I wanted it to be more accurate but the publisher didn’t want me to go to prison,” he explains.

Nonetheless there are many situations that test plausibility. After he is gazumped in trying to buy a flat that he and his boyfriend have set their hearts on, the couple who gazumped them turn up at his antenatal clinic. His fantasies of revenge are limited to revealing the baby’s sex to the unknowing parents. All true, he says.

On another occasion he deals with a difficult and racist patient undergoing surgery by sewing her up after the operation in such a way as to disfigure her dolphin tattoo. Did that really happen?

“I don’t want to talk about that one because that’s one I wasn’t meant to put in the book,” he says, adding, “but that obviously did happen.”

If anything, he says, it’s the stuff he left out that is really outlandish. “I’ve got some amazing stories about celebrities, which couldn’t go in.”

In his first year as a doctor, he writes, he removed four foreign objects – including a toilet brush and TV remote control – from different patients’ rectums. They all suffer from what he terms Eiffel syndrome – “I fell, doctor! I fell!” In the book he’s told that the remote control insertion occurred while sitting down on the sofa, which he concedes is a possibility. Cue the punchline. When the remote control is removed in theatre, “we notice it has a condom on it, so maybe it wasn’t a complete accident”.

I wonder if seeing the absurd lengths to which people go in an effort to find pleasure or stimulation affected how he looked at his fellow humans?

“No, it’s like when you get into your first serious relationship and you meet someone’s family and realise everyone’s family is really weird as well – not just my one. We’ve all got our hidden stories. One of the strange privileges of being a doctor is finding out what everyone’s up to. Working in sexual health you stop being surprised about the things people do.”

The book is based on diaries he kept while he was a junior doctor, and he thinks he may have overrepresented the comic incidents because he used to write about them to ease the sense of pressure he felt. Kay is at his most vivid as a writer when describing what that pressure involved. We see him working 97-hour weeks, falling asleep in his car, unable to maintain friendships because he’s never able to see friends, driving long distances to work at ever-changing hospitals and having to pay extortionate parking fees, and struggling to find decent accommodation on a paltry salary.

On top of that he’s admonished if he makes mistakes, but never commended if he does well. And whereas he has to cancel holidays, wedding invitations and much else besides to fit in with changing rotas, one of his consultants takes two weeks of compassionate leave when her dog dies, while other consultants are almost strangers to their wards.

Towards the end of the book, Kay is in charge of an operation that, owing to an unforeseen complication in the patient’s pregnancy, goes tragically wrong. And although he’s only one rung down from being a consultant, he realises that he can’t go on and walks away from the profession.

He says now that he was probably suffering from undiagnosed post traumatic stress disorder, and that little understanding was shown by the medical authorities. He believes that in such circumstances, doctors should immediately be offered a week off work if they want it. Instead, he didn’t discuss what had happened with anyone, even his family, who are all doctors.

He was in a state of depression for about a year, not going out, not seeing anyone, and losing a great deal of weight. It was only when he began getting work as a comedy writer that he got his “life back on track”.

Kay had enjoyed a longstanding interest in comedy, performing in medical student revues, and later in corporate gigs for pharmaceutical companies. He’d also been on Radio 4 and performed at the Edinburgh festival, so comedy was the obvious way to go, though he found it difficult to turn his back on medicine, and briefly considered retraining as a GP.

Although he has forged a successful new career, it would be wrong to say he never looked back. He still misses that “non-specific feeling of doing something good and useful”. And he maintains a great respect for those who do the job he once did.

This is why he was so upset about what he sees as the misrepresentation of junior doctors in last year’s contractual dispute with the health secretary, Jeremy Hunt. At the time the British Medical Association recommended the new contracts being offered by the department for health as “safe” and “fair”. But junior doctors disagreed and the BMA then supported strike action.

Kay believes the doctors were portrayed as money-grabbing and irresponsible when, he argues, precisely the opposite is true. So he saw the book as a chance not only to set the record straight but “an opportunity to make a pre-emptive strike … for the next time around, and there will be a next time around.”

Indeed, Kay believes the situation has got much worse since he left medicine in 2010.

“I spoke to various colleagues and people when I was putting it together to make sure I was still adequately representing the plight of a junior doctor. The system is one that never had a lot of slack in it but is now stretched to absolute breaking point. They’ve got a fraction of the number of doctors they need to adequately perform the job. The biggest problem at the moment is the retention of doctors and that’s simply because the working conditions are so bad.”

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At the conclusion of the book, Kay writes an open letter to Jeremy Hunt in which he suggests he should have to work shifts alongside junior doctors, so that their motivation was never again questioned.

This message has obviously worked with readers. At book signings Kay says he has often been asked to sign an extra copy that people then send on to Hunt. Whether or not it was receiving these books that did it, Hunt asked to see Kay a few weeks ago.

“It really confused me,” says Kay. “I don’t understand why he wanted to meet. All he was going to do was give me publicity should I want it.”

Presumably he wanted to put his case across, which, it turns out, is exactly what happened. “He genuinely thought he could change my mind,” Kay says, mystified by the idea. “It was as if he was explaining to someone who didn’t know the facts.”

The meeting lasted just over half an hour and, by Kay’s reckoning, neither party was much impressed by the other.

“Let’s not forget that this is a man who got into a fight about statistics with Stephen Hawking, so the chance that I was going to change his worldview was slim.”

The trouble with the book is that even if it did persuade Hunt to recruit more doctors, it would also probably discourage students from applying. As Kay admits: “I think if I had kids I would put them off medicine.”

The book certainly confirms the popular belief that the NHS has been financially starved and its staff is demoralised. There is a more complex story that could be told about organisational reform, ever-expanding medical demands and expectations, and how much tax we’re prepared to pay to finance massive investment in healthcare.

But this is a personal story, and one that resonates in a time of austerity and stasis. It’s a tale of hidden self-sacrifice in an age of naked self-enrichment.

Inspired by such stoicism, I never do get around to telling Kay about my various illnesses. Given that he’s now a comedy writer and he used to specialise in obstetrics, I think, from my sick bed, that it was probably the right choice.