Adam Kay: ‘If you were casting yourself, wouldn’t you choose

When Adam Kay’s This is Going to Hurt was published in 2017 there were several acclaimed books by surgeons doing the rounds – Henry Marsh’s Do No Harm, Atul Gawande’s Being Mortal, When Breath Becomes Air by Paul Kalanithi. A diary about life as a junior doctor working on an obstetrics ward seemed an unlikely publishing bet. Wasn’t the market for medical memoirs already saturated? But This is Going to Hurt possessed what the others lacked: as well as being serious, it was indomitably entertaining and went on to sell more than two-and-a-half million copies, was translated into 37 languages and became a literary sensation. Most recently, it has been made into a major BBC series starring Ben Whishaw and Adam Kay has become the go-to medic of the day, the doctor in the house and on stage and screen.

We meet on a sunny morning in Oxfordshire, near to where he lives, to talk about his extraordinary new memoir, Undoctored: The Story of a Medic who Ran Out of Patients – super-readable, funny and disturbing. If you thought This is Going to Hurt was revealing, the new book makes the first seem discreet bordering on secretive. This is Going to Hurt was gender neutral, did not even make it clear he was gay (it was the television series that took that step). He wrote about the tragicomedy of his professional life, the insanity of 97-hour working weeks and the derisory wages while, in a deeper sense, he gave himself the slip. In Undoctored, the pendulum swings the other way: it is decisively personal. As well as writing about his marriage to a woman (not named) and his husband, James Kay (formerly Farrell), he gives a terrifying account of being raped while on a trip to a medical conference in New Zealand. He also reveals a serious eating disorder with which he struggled when younger.

Ben Whishaw as Adam, with Ambika Mod as Shruti in the BBC drama This Is Going to Hurt. Photograph: Anika Molnar/BBC/Sister/AMC

Comedy is Kay’s forte but, as the first memoir related, he hung up his stethoscope after a tragic event: one of his patients lost her baby because of an unforeseen complication with her pregnancy and had to go into ICU for an emergency hysterectomy – and while it was not his fault, he felt it to be his responsibility and the catastrophic nature of it affected him profoundly. On the strength of talking to him, I’d say it still does.

I knew in advance that Adam Kay might seem shy. In the new book, he writes: “Elton John was wrong about sorry being the hardest word – for me, it was ‘hello’. “How are you doing?” he asks hastily, as if wishing to skip the introduction altogether. He is 42 with an intelligent face and toffee-brown eyes with a dogged, anxious expression – he looks like a rather stressed cherub. He is immediately funny but it is not clear to what extent he amuses himself. He wears a T-shirt the colour of raspberry sorbet upon which is flirtatiously written, Not from Paris, Madame. He is from Brighton, born into a Polish Jewish family of medics (original name Strykowski) and grew up in London. And although he returned home on a delayed flight from Edinburgh at 3am (he has been trying out material there for a new touring show to be called: This is Going to Hurt … More), he shows no sign of fatigue. An old hand at sleeplessness, he denies himself coffee (explaining he has just given up caffeine). There are plenty of obvious adjectives one might apply to Adam Kay – clever, entertaining, articulate – but, as I listen, the one that keeps resurfacing is vulnerable.

“I’m terrified about the book coming out,” he says, before going on to describe how it became his confessional: “I found it easier to be open with the page. I’m a private person. I wrote a lot before I told anyone about it. My husband found out about some very big stuff only because I sent him chapters as I wrote them – and that isn’t the normal way to do it but it is better than not doing it.” Writing has led to talking: “I’ve only just begun to exorcise my demons about the shift that saw me leave the medical profession. I write about how it stayed with me and haunted me. It empowered me to speak to professionals.”

The “stuff” to which he refers includes the eating disorder that was triggered in his third year at medical school after a one-night stand with a fellow student who referred to him as a “big lad”. “I was chubby – still am,” he laughs. But he resolved to transform his appearance and developed “abhorrent damaging behaviour”. He would chew food without swallowing, then spit it out. People would tell him how well he looked while he was getting lighter (and sicker). His account of this is un-self-pitying – one can only guess at the suffering involved – and one of several subjects a less brave writer might have skipped. “I now have a much more comfortable relationship with food but I’d be lying if I said I don’t have actively to try not to fall back into those patterns.”

His hope is that his openness might help others to seek help. I ask how much he cares what people think (my hunch is that he minds keenly) and he replies: “It varies.” I ask whether he thinks of himself in terms of being a doctor or a writer and he replies: “I don’t really know what I am.”

Kay at the the National book awards, London, 2018.
Kay at the the National book awards, London, 2018. Photograph: David Fisher/Shutterstock

The most distressing part of the book is his description of being raped in a sauna in New Zealand. He cut this episode out “about 20 times” before steeling himself to go ahead with it. The clincher, once again, was the hope that including it might help others to seek help. He puts his head briefly in his hands. “I know it will cause me grief in all sorts of ways. I know what social media is like, I know I’m going to have to answer questions about it for ever. But I was writing a book about being honest … Time will tell if it was the right decision.”

When I ask whether there remain any closed doors within his narrative, he talks about how his comic gift serves him: “I still hide behind humour. It’s my coping mechanism.” At school, he was the class clown: “It was a way of being popular when I wasn’t the most friend-forming child.” In medicine, it became his “shield – effective but not healthy and not enough to deal with the bad stuff that happens”. In “real life”, he uses humour as “an excuse not to answer questions. When you were asking me emotional questions earlier, it was taking everything I could not just to think: what’s the glib line that will make you laugh and shut it down, move it on?”

Retrospectively, he concedes that he probably married a woman and became a doctor because of conventional expectations. I ask him to describe James, a television producer who was an executive on This is Going to Hurt and who seems to look after Kay better than he looks after himself. “Everyone likes James, people meet him for 20 seconds and it’s: ‘Oooh, isn’t he nice?’ I suspect I don’t create that immediate response necessarily. James’s superpower is his empathy. He knows when people are sad or struggling. He spots it more quickly in me than I do in myself. Without him, I wouldn’t have written this book because I wouldn’t have got to the place where I realised I needed to open up.”

Towards the end of Undoctored, there is a bid for a new sort of convention, as he and James plan to have children. But at the very last moment, their plan is put on hold. Could the delay be explained by the hope that a third book and a child might conveniently coincide? His startled laugh makes me repent my calculation. And as to that future child: “It might happen – but we’re not there now.” Moving away from the subject of unborn children, I inquire after his dog and watch him relax. He shows me a photo on his mobile of a hairy, charming, two-year-old Airedale in an armchair: “She’s called Pippin and we absolutely love her.” Does he find it odd to have become a spokesperson for the NHS? “Where I’ve ended up is absolutely bizarre. There is a version of my life where I don’t do any shouting or supporting of causes or being noisy on social media or harassing politicians. But I’ve been given a platform and it might help others. Selfishly, it might also assuage some of my guilt at leaving – and about my colleagues who are still working so hard.” Would it be accurate to add that he has recreated the pressure of being a doctor in his new life? “There’s part of me that has to prove myself. I’m still the seven-year-old who has to do his best at his homework.” And one can see how true this is in the industrious attention he brings to every question put to him from celebrities and from readers.

Rachel Clarke

Rachel Clarke

British palliative care doctor and writer

You’re made health secretary tomorrow. Truss won’t give you any more money. What’s the very first thing you will do?
Resign. I couldn’t do the job working with people who weren’t prepared to support it effectively. It’s not a job that can be done without more money. The NHS is coming up to its 75th birthday, it’s our greatest achievement as a nation, the fairest way to deliver healthcare. Over the years, it has not had enough money and is in the toughest corner it’s ever been in. We need grownup discussion about its future. If we want, and I really hope we do, the NHS to continue delivering what it was set up for, then it needs adequate resources and staffing, and you can’t get either without putting your hand in your pocket.

I just started work in foundation year 1 and didn’t realise it would be this brutal. I’ve been a doctor for about a week-and-a-half and have already worked 120 hours, told someone’s family that their relative is going to die soon, verified two deaths and cried on the way home more times than not. I know you eventually left medicine, but does this next bit get any easier? Also, any tips for getting out of medicine?
Junior doctor, Liverpool

Congratulations on qualifying and I’m sorry you’ve had such a rough start. Some bits get easier as you get better and slicker at your job. But in my personal experience, breaking bad news to a relative is never not awful, but the thing you can get better at is making sure you’ve got a way of dealing with it. Speaking to people, whether they’re professionals or not. Taking time out if you need it, finding out what works for you. There’s evidence that everything from religion to yoga to hobbies can help deal with tough stuff. But the main thing is not going through it alone. You’re lucky to be in the early days, where your life can branch off into different types of medicine from public health, to sports medicine, to aeronautic medicine, to something more academic in a lab. Think about what brought you into medicine in the first place and see if there is something that could see you through. And don’t be ashamed, it’s not a cult, you are allowed to leave if it’s not right.

Ambika Mod

Ambika Mod

How can we better support struggling NHS staff and prevent real-life cases of suicide like Shruti’s [Mod played junior doctor Shruti Acharya in the TV version of This is Going to Hurt]?

The rates of suicide among doctors and healthcare professionals are way above the population average. One doctor takes their life every three weeks, two healthcare professionals take their lives every single week. Somewhere at the heart of it, there is a stigma and shame, and it just gets brushed under the carpet. The first stage of smashing a taboo is to talk about it. We planted a tree at Ealing hospital in the same spot a tree was planted during the memorial scene for Shruti in This is Going to Hurt – the UK’s first memorial to the healthcare professionals who have taken their own lives. It needs to be a headline every time it happens and we just don’t hear about it. We need to be open about the pressures and make sure support is readily accessible for people who need it. There is a multi-layered lasagne of issues that cause people within healthcare to take their own lives, from the way complaints are dealt with to the profoundly unhelpful culture of just-getting-on-with-it.

Do you feel any guilt about leaving the NHS and finding fame by monetising the experiences that all NHS doctors live through and still experience on a daily basis, despite not working as an NHS doctor for more than a decade?
Doctor, London, name withheld

I have huge guilt about leaving the profession and miss it a lot. I miss the reason doctors ultimately do the job, which is to help people. For me, it’s a case of using my powers for good rather than evil, and I’ve had a huge amount of positivity. People have written to say that until they read the book, they thought they were the first person who had ever cried in the locker room. It has, I hope, brought the mental health of doctors to the forefront.

Mark Gatiss

Mark Gatiss

Actor, writer and director

It’s difficult not to despair but is there anything in the current situation with the NHS that gives you hope?
Something that gave me hope through the pandemic – and continues to – is the public love for the NHS. I feel strongly that, were the NHS to come under any major existential threat, people would get to their feet and fight for it. I’m fortunate to get to meet medical students, nursing students and midwifery students, and get enormous hope from their energy. The NHS is in the safest hands – if it gets over the current bump in the road.

Would you agree you don’t necessarily need four A -grade or A* A-levels to be a good doctor?
Research scientist, name withheld

It is absolutely wrong that medics are recruited on the basis of having top grades, it should be about recruiting the people who would make the best doctors. The best doctors are the best communicators, people who understand what the job is and what it involves. Medical schools are full yet I wonder if we’re finding the right people. Certain schools make it easier for you to get four As or A stars at A-level than others. By insisting on top grades, work experience and extracurricular activities, you get doctors who do not represent the population they’ll be looking after.

Jonathan Ross

Jonathan Ross

Broadcaster and producer

Celebrated people often get asked who they’d like to play them if their story were filmed. You already struck lucky with Ben Whishaw so a) how disappointed are people when they meet you for the first time and you’re not him? And b) If Ben had not been agreeable to do it, who else might you have approached?
Ben did the most spectacular job, he’s a national treasure. He can dance between comedy and drama and brings huge warmth to a character who is deliberately written as not always behaving the best under the circumstances he is in. If you were casting yourself, why wouldn’t you choose someone as handsome as Ben Whishaw? But if it wasn’t Ben, I suspect the answer I’m supposed to give is … Jonathan Ross.

Despite being in the same profession, I was traumatised by your description of a young man whose penis was degloved after he slid down a lamp-post. Did you go too far? How do you manage to draw the line between comedy and tragedy in your work?
David, NHS director, London

Everyone’s mileage varies. It was a deeply traumatic situation, writing it as a funny story was my way of coping with it. But I know that a lot of doctors found the TV show a difficult watch because it dredged up complicated memories for them. I suspect that the reaction my material gets from doctors may be different from people watching as non-healthcare professionals.

David Baddiel

David Baddiel

How much of a doctor are you still? If I had a heart attack could you save me?
I’m a doctor if I want an upgrade on a flight (it never works). And I’m very much a doctor in the way I fail to get physical and mental help although I’d like to think I’m improving on that. I’d try to save you – I keep up to date with basic life support –because absolutely everyone should. And because, if you’re a doctor or former doctor, you’re a magnet for medical emergencies.

Would you agree you don’t necessarily need four A -grade or A* A-levels to be a good doctor?
Research scientist, name withheld

It is absolutely wrong that medics are recruited on the basis of having top grades, it should be about recruiting the people who would make the best doctors. The best doctors are the best communicators, people who understand what the job is and what it involves. Medical schools are full yet I wonder if we’re finding the right people. Certain schools make it easier for you to get four As or A stars at A-level than others. By insisting on top grades, work experience and extracurricular activities, you get doctors who do not represent the population they’ll be looking after.

Kit De Waal

Kit de Waal

Novelist

Your house is ablaze. You can leave with one item. No people or pets allowed.
I was going to say I’d take my dog or husband (I suppose that should be in the other order). Depending on how strong I’m feeling, I’m going to drag out my old grand piano. It’s my biggest extravagance – and one of the few things I have in my personal mental health toolkit. When I play the piano, it uses up 100% of my processing power and means I can step out of whatever is going on in the real world.

You have been criticised for misogyny, particularly in the descriptions of women’s bodies, at the vulnerable time that is pregnancy and childbirth. What are your thoughts on this?
Research scientist, Oxford

This is Going to Hurt, as much as anything, is an exploration of dark humour as a way of dealing with situations. Everyone is welcome to their opinions, and I’m aware of articles on this, but the overwhelming feedback I’ve had, from men and women, has been positive about the book and the TV show. I have the upmost respect for women and their bodies and their care. There needs to be a lot more done to make sure women get equal care in the NHS and around the world.

What did you do when you were nine years old?
Sibyl McLaren, aged nine, Ayr, Scotland

The main things in my life were my tortoise, Harry, my Lego and my saxophone practice.

Christie Watson

Christie Watson

Writer and former nurse

You specialised in obstetrics and gynaecology (or Brats and Twats as you call it). If you could go back would you pick a different specialism?
Yes – I was drawn by the obvious highs of the labour ward, never thinking about the lows that come alongside it. I loved the highs and couldn’t cope with the lows. Perhaps something more outpatient- or primary care-based. Most of my close relatives are GPs and although general practice has never been harder, my personality would have been better suited to it.

In This Is Going To Hurt you refer to obs & gynae as “brats and twats”. Isn’t that misogynistic and dismissive?
Name and address withheld

I can absolutely see why it might seem that way but, for me, it was part of an age-old tradition of humour in medicine. It was a term I heard on my first day on the ward. The TV show was directed by a woman, Lucy Forbes, produced by Holly Pullinger, and exec produced by Jane Featherstone and Naomi De Pear. We worked carefully on its tone and hope we achieved a portrayal of people acting as they do under extremely high stress. The character of Adam was an HR nightmare but we can see why he acted like that and see the consequences of his bad decisions and inappropriate behaviour.

David Lammy

David Lammy

Politician, shadow foreign secretary

With the NHS brought to its knees during the Covid pandemic, could we look to other health systems around the world for inspiration?
I’ve been lucky enough to visit huge numbers of countries with the book and I’ve spoken to doctors and managers in all of those health services. Not once have I thought there is a fairer system than the NHS. Every other system has two tiers and when there are two tiers, there are always people who fall between the gaps – usually the people with the quietest voices.

I am a former NHS midwife. I gave up practising due to the negative impact on my mental health. What’s the most important factor in retaining obs & gynae doctors and midwives?
Belinda Memmott, nurse, Swindon

There is a point at which a workplace becomes impossible to work in. You can do two people’s work for a number of weeks covering parental leave, maternity leave, holiday, whatever. But at the moment, the chronic lack of staffing means it’s difficult for people because there’s no end in sight. We need to address this: we need enough staff so people can do their jobs safely and to the best of their ability.

Alan Johnson

Alan Johnson

Politician and writer, former Labour health secretary

The NHS is trying to persuade former clinicians to return to the profession. What would it take to persuade you to swap your pen for a stethoscope?
It took Covid: I offered and it turned out they didn’t want a gynaecologist who hadn’t worked for a decade. I will doubtless return when I reach my expiry date as an author, as all authors do. I suspect I’ve done my last shift on a labour ward but I think I potentially have something to give in education or policy within the service.

I played the man in the wheelchair in This is Going to Hurt – complete with oxygen tank on lap, smoking outside the hospital, and from whom Adam cadges a cigarette after an argument with a colleague. What’s your view of patients who shouldn’t smoke or drink when they have potentially life-threatening conditions but think “Ahhh, fuck it” and do it anyway?
Hamish, London

The main problem for that character’s health isn’t the long-term implications of the cigarette, it’s the short-term implications of an explosion from the oxygen tank! But more broadly, we need to do more to prevent people coming into hospital in the first place. We can do a lot better in terms of public health awareness and engagement, getting people to understand what being healthy means. Doctors shouldn’t tell patients to do anything, healthcare professionals should be in collaborative discussion with patients so that they are both on the same side. No one likes being told what to do – particularly if it’s giving up something they love.

Rosena Allin-Khan

Rosena Allin-Khan

Doctor and shadow cabinet member for mental health

You excellently highlighted the toll taken on the mental health of staff given the job pressures. What changes would you want to see that will have an impact on improving staff mental health and make them feel safe to report problems?
There is an emphasis on wellbeing in hospitals but when you dig into it, it often just amounts to a Zumba class. A recent report published by the GMC intended to improve support for the mental health of doctors but its recommendations were not taken on board by the government. People have a huge problem with seeking help. There is always the feeling that if you speak to someone, word will get out. There needs to be a culture, in medicine, that is less militaristic where people can talk openly. Juniors should be able to tell their bosses when they’re struggling, bosses should actively look out for their juniors. All staff should know where they can turn and trust they can get help that will not compromise their careers (at the moment, you are almost taught that doctors should not struggle).

I work cleaning on hospital wards and see doctors who are so young. Should they go later into the profession after doing different jobs? I feel they’re unapproachable because being a doctor is all they’ve done.
NHS cleaner, Essex, name withheld

Firstly, we don’t give enough thanks to the cleaning staff of hospitals. Often, patients’ only regular contact, as nursing teams and doctors change, is with cleaners. Second, we are sending people into battle very young. I’d be a big fan of a system that allowed people to come from different walks of life. There’s an underlying problem that people go into medicine as teenagers. As a teenager, how are you expected, when you choose your A-levels, to know how you’re going to cope with this sort of job and whether you’re going to be able to do it for 40 years?

Has a patient ever tried to kiss you before you delivered a baby or just afterwards?
Zaida Hilder-Franses, student, Brighton

Emotions certainly run high on labour wards … I must have an un-kissable face.

Stella Creasy

Stella Creasy

Labour MP

If offered, would you accept the position of secretary of state for health in the new prime minister’s cabinet?
I couldn’t work for a boss I didn’t believe had the best interests of the NHS at heart. Nothing I’ve heard makes me think she does. What is the point of a 2% pay raise for junior doctors when inflation is knocking on 20%? It’s all very well banging a pan and putting a rainbow in the window of Downing Street but put your money where your mouth is. If you support NHS staff, it needs more than just words.

Dolly Alderton

Dolly Alderton

Journalist and podcaster

Which do you prefer: people asking you for medical advice at parties, or people recognising you and asking you about Ben Whishaw?
It’s a major roll of the dice asking for medical advice, I’ve been out of the game a long time. All you would get are half-remembered semi-facts. And people are always disappointed when they ask about Ben Whishaw because he’s such a lovely man I can’t offer anything approaching a juicy anecdote.

What’s the worst food you can eat?
William Grimmer, aged 10, Norwich

Mushrooms. A running theme in my books for children is my relationship with mushrooms.

Are you working on more TV scripts? Or was This is Going to Hurt a one off?
Name withheld, Manchester

I wrote This is Going to Hurt with a beginning, middle and end. I wanted it to be about the mental health of healthcare staff. I did what I set out to do and made a taboo subject an unmissable conversation. I have no plans for a second series, I’d hate to do one for the sake of it. But I am in the early stages of a new project which will hopefully become something, and, if it does, will be very different but, hopefully, people will watch it.

  • Undoctored: The Story of a Medic who Ran Out of Patients by Adam Kay is published by Orion, £22.To support the Guardian and Observer, order your copy at guardianbookshop.com. Delivery charges may apply

  • Click here for details of Adam Kay’s UK tour This Is Going to Hurt… More

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