Adam Kay (2017) This is Going to Hurt: Secret Diaries of a Junior Doctor.

I loved this book. It should really be read in conjunction with Jed Mercurio’s debut novel Bodies. Yeh, that Jed Mercurio that writes scripts for the BBC, Bodies and Line of Duty. Adam Kay is following a similar trajectory, half way between the drama of Jed Mercurio and the upbeat chortleness of Harry Hill. You’re probably thinking why should the tax payer should spend all that money training junior doctors, indirectly subsidising the Australian and Canadian health services, which is bad enough, but now it’s a straightforward path –albeit a long medical apprenticeship—to write for the BBC.   The answer is going to hurt.

Simply, we are screwing the NHS into the ground and junior medics are on the front line. That’s always been the case, but the pressure is more intense. Aneurin Bevin talked about needing ‘to stuff the consultant’s mouths with gold’ in order to get a National Health Service. Consultants, then  were treated as a rung below God. Not much has changed. In a note he sent to a GP, 21^st October 2010,  Kay as  a Registrar in Obstetrics and Gynaecology wrote, ‘if  you have any questions whatsoever, please do not contact me.’ It was a typo, what he meant to say was don’t hesitate to contact me, but it worked. The GP didn’t contact him. Kay had this to say about Prof Carrow, theoretically ‘on call for the labour ward.’ But ‘as much use as having a cardboard cutout of Cher’. ‘You don’t see Professor Carrrow during the day, you don’t phone him at night.’ Like a mighty liner navigated by junior staff, which changes every six months, when they change secondment, they learn on the job by that old maxim, see one, do one, teach one. Kay started 14 years earlier as a fresh-faced student and was a veteran of muddling through. So when Prof  Carrow appeared during the day Kay wondered what the occasion was. No doubt when David Cameron’s children were being treated there would have been a consultant monitoring every NHS bed the Prime Minister passed as there was for an extremely wealthy Saudi family. Here it was quite simple. A documentary camera crew was following behind Prof Carrow as he did a ward round. On camera Prof Carrow tells Dr Kay, ‘Sounds like you’ve got it under control Adam. But if you’ve any problems at all during the night, just call me.’ When the camera crew stop recording he acts more like the typical consultant, telling Adam, ‘Obviously, don’t.’ 

Kay, ad-libs, that one of the problems he faces is that patients don’t really see doctors are being human. His points about low pay and overwork are valid. He looks to his cohort, people he went to school with making six-figure salaries, while the parking meter in the hospital grounds makes more money than him. He suffers burnout (post-traumatic stress) when one of his patients dies. He’s not god, only human and a doctor advises him by the time he’s finished there’ll be a bus full of patients, who have died on your watch. It’s the nature of the beast. He moans about having to take a sideways or backwards step and retrain in another speciality. It would mean a loss of income.

That’s where I’ve less sympathy with Kay. Life seems sharper and speedy when you’re younger and full of seismic spasms, but it recedes like male-pattern baldness no matter how you try. Both his parents are doctors and he tells us his sister has accepted a place in a medical school, but let’s not forget middle-class parents,   getting their kids into medical school, is a status thing and a mercenary operation that would make King Herod look like a lightweight.  Working class kids have more chance of playing for Barcelona than being a junior doctor. The moneyed middle-class expropriation of the means of education is a given without the need for banner waving, what Herbert Marcuse called repressive tolerance.

No meritocracy here. Kay jokes the ideal entry for medical school has A grades and plays rugby, people such as Harold Shipman.  I’ll not bother googling how much a senior registrar gets paid. Kay should look below him, try living on the split shifts and gig economy of the hospital cleaners. His joke about the public not thinking doctors are human applies equally to those that have nothing and can expect not much more. Grenfell Towers taught us that. The NHS is staffed by the low paid, so I’m not buying into that the parking meter in the car park makes more money, poor me, I’m skint argument.

His open letter to The Secretary of State for Health is a walk in my shoes argument, ‘you, or your successor should have to work alongside junior doctors’. He makes an analogy ‘If the President wanted to press the big red button and kill hundreds of thousands of innocent people, then first he’d have to take a butcher’s knife and dig it out of a volunteer’s chest himself; so that he realizes what death means first-hand, and understand the implications of his actions.’

Absolutely, but the moron’s moron in the White House isn’t really like that. He’s got flunkeys to do that kind of thing. Draft dodger Trump guilty of having a spurious bone spur on one of his feet and now with the biggest arsenal in human history a spurious President Tweeting policy on the hoof. A no-brainer, reality is no obstacle to his egotistical whims. A straight choice between blowing up thirty million Koreans and starting an apocalyptical nuclear winter or being seen as being a weak-fall guy that doesn’t get bogged down in too much (or any) detail, then it’s goodbye world.

Poor people don’t really exist for him and his ilk. The NHS is an aberration and abomination because it doesn’t work for them. Nicholas Timmins wonderful book The Five Giants: A Biography of the Welfare State sums it up, the Americans used to run to us and try and work out how through cooperation and not competition we could provide such an efficient and low-cost service, now we run to America and look at  model that doesn’t work, Cannot solve the problems they create and in the hunt for revenues calls for more of the same, more privatisation, more trickledown economics and taking money from the poorest in society and gifting it to the richest. State subsidies as opposed to handouts for the poor. Adam Kay has nailed it, privatisation is a sham. It costs around £15 000 to deliver a child in the private sector, but when something goes wrong they use public resources. Let’s call it public theft by private means that enrich the already wealthy. That makes me mad. I’m not laughing.