I feel a bit nervous because this is my first real post but I am going to try. It will be a long-form post but I will put the conclusion first to save you time if you just want the verdict. Hope you enjoy ;)!
If you’re considering becoming a doctor (90% of you are) then you must read this. It is eye-opening and extremely entertaining – I found it hard to put down at times – and this is my second reading. It can be read in about 3.5 hours and it should be read by anyone who doubts the personal sacrifice doctors make for patients and the NHS. All students who wanna apply to medical school should have to read it so that they can understand the full extent of the misery they are signing themselves up for and make an informed decision. I give it 5/5 stethoscopes. The book is quite vulgar – there is a lot of swearing and impromptu sex toys.
Okay, now that the sufferers of ADHD are gone; let’s dissect this book properly. Dr. Kay was an OBGYN and he describes his medical journey up until his resignation; dividing the book into the various stages of his junior doctor training (House Officer, Senior House Officer, Registrar, Senior Registrar).
Below I am going to list some of my favorite dates and events in his dairy and explain what occurred; it is very extensive so feel free to skip back and forth to the parts you’re interested in.
New steth. Email mishap (email@example.com)
A patient from stoke-on-Trent has dementia exacerbated by UTI and is convinced they are a german (fake accent); follows Adam exclaiming “Genius!” and then craps on the floor.
Nonsense Symptoms – Itchy Teeth, improved hearing, arm pain during urination.
Terrorist attack. All docs to A&E. Discharge all non-A&E patients from surgery wards. A patient is discharged if they can say “malingerer” without a cough.
Continual bleep every 15 minutes. SHO and Registrar both in A&E. He needs to put out fires. 8 am – night sister calls him a “good little doctor”. That was his first compliment since qualifying.
Seniour House Officer
Midwife calls, post-delivery patient unwell. Liters of vaginal blood. Emergency buzzer. Senior Registrar runs in.
2 am bleep. Unconscious gynae patient is disoriented and hypoglycaemic.
Consent JW for open myomectomy. Refuses blood transfusions but wants cell salvage.
The patient is 25 years old and 30 weeks pregnant. Complains of painless spots on tongue. Tastebuds.
2 am- Labour ward not busy, goes to the on-call room to use facebook. Simon posts “Goodbye everyone, I’m done”. Sends DM. Simon calls, drunk.
Bleep at 5 am to the labor ward to write a discharge summary. Patient’s SHO failed to do it during the day, Adam isn’t required but does it so her discharge isn’t delayed. The patient has ovarian cancer. Wide metastases. Cries. She won’t see her Son’s graduation or daughter’s wedding. Adam hugs her – first time he hugged a patient. She was tearful but none of her concerns were for her own life just the effect she would have on others. Adam had a patient a couple of months ago who had breast cancer and was advised to deliver at 32 weeks to start treatment. She delayed until 37 weeks to give baby the best possible chance. Died 2 weeks post-delivery.
Registrar Post I
Black Wednesday. It starts at St. Agatha’s.
Reviews mother in the clinic, 6 weeks after a traumatic delivery. She is distressed, thinks the baby has a tumor. Adam explains that it is just the occipital protuberance. She laughs.
A doctor tells him that he gets the words “shoulder” and “elbow” mixed up.
A psychiatric patient transferred to the respiratory ward after contracting pneumonia, he drank sputum.
At a friend’s party, she asked me to look at her baby’s ultrasound. “She looks perfect”. They did not know her gender. Plates are plomped unceremoniously.
Porter pretends to be a doctor. Adam wonders if he could get away with pretending to be a porter.
Pulls out a condom and KY Jelly and patient screams.
Discharges patient following a laparoscopic sterilization. She can have sex as soon as she is ready but has to use alternative contraception until her next period. “That means he has to wear a condom” – he says pointing to who he thought was her husband but was actually her father.
A house officer appeared in A&E last night following a suicide attempt. Anti-depressant overdose. Doctors are numb. Huge responsibility, minimal supervision, and no pastoral support.
Registrar Post II
A patient who Adam describes as 50% Goji berry wants to eat her placenta. Eats blood clots.
7 missed calls from Simon. Pocket dial.
Labour ward not busy. On-call room; lie in bed. Use facebook.
Special occasions lead to special items inserted into vaginal and rectal holes. Christmas – stuck fairy. “Do you want it back?” “Yeah”.
Antenatal clinic. Midwife calls for a routine checkup. A premip low-risk patient; could not hear heart with sonicaid. Port. US machine grabbed, fetal death.
Rota flings him around hospital seemingly at random. Antenatal clinic to gynae theatre to infertility clinic to labour ward to colposcopy scanning. A GP with intrauterine death induces labour. Training doesn’t teach about how to talk to grieving couples and there is no suger-coating the situation because both the husband and wife are physicians. But they seem happy to see him – a familiar face in a dark day.”Do I say how sad I feel for them?” “How about a hug?” “Too much?” “Not enough?”. He stays past 8 am – his contract. Stays on labour ward until she delivered. Blood tests and talks through all possible tests to find cause of stillbirth. Has to collect samples from baby.
Stopped by police in Holland Park. “Did you know you just ran a red light?”. He just performed 5 caesarians.
Review Mrs Buckstar.
Skin closure; staples as good as sutures. SHO accidently staples Adam’s finger.
Patient says her breast pump is bugged. Puerperal Psychosis.
Patient presents to urogyane clinic for lost ring pessary.
Crash call to Labour ward. Husband played with birthing ball and cracked skull.
Called to early pregnancy unit but SHO to confirm miscarriage. Didn’t do ultasound properly. Twins.
Going for 2 weeks to Mauritius to celebrate 5 years with H. Relationship conducted over hurried breakfasts and apologetic texts. Email says he has to work in middle weekend. Colleagues had to cut honeymoons and miss funerals. Hospital refuses locum.
Registrar Post III
He navigates through a moral maze. He is called by midwife to see a patient with a worrying trace. Heart rate dropped. No time to wait for consultant. Consultant says he’s a minute away. Prepares tools but realises he can’t risk baby’s health. He delivers and the cord gases confirm he was right not to wait. Consultant apologises but he wishes it could have been in a big pile of cash.
Books holiday to France with H. Can barely afford mortgage. 52 patients in clinic, he is the only doctor.
French teacher refunds term’s fee because he missed a lot of lessons.
Ron calls for medical advice. His dad is losing weight and having difficulty swallowing. Cancer.
Registrar Post IV
Elective section for a patient who had 3 previous. Abdomen hard with adhesions.
Helps friends (Euan and Milly) with fertility issue.
Husband and wife are both in tears. Husband wants to be first to touch baby. Adam says that they will all wear gloves when delivering so he will be the first to touch the baby.
Swabs and spoons get lost in patient.
Crazy patient says she is delivering but isn’t.
Hangs out with old medical friends.
Miss Burbage is on 2 weeks compassionate leave.
Examines a student’s penis. Is bruised and he has trouble urinating.
First cervical cerclage.
Patient names baby Adam.
“Would you like to watch me sex a baby?”
“If you have any questions whatsoever please do not contact me”
Tested for HIV.
Recognises husband of wife whose baby he delivered at a halloween party.
Accidently cuts babies cheek.
Husband of infertility clinic couple might have UTI.
Patient failes to progress in labour. Husband doesn’t want him to perform surgery because he is a man.
Meant to come home at 7 pm but was back at 9:30 pm
Patient waiting in A&E for minor abdominal pain keeps getting pushed further and further down the list of priorities. Labour ward has become busier and busier. Adam is stabilising a patient with severe preeclampsia and is bleeped by a furious A&E Registrar. “If you don’t come to A&E the patient will miss the four hour target” “If I do come to A&E the current patient will die”, mic drop.
Has to deal with an angry son. “How many of these have you done?” “Is this not a case that your consultant should do?”
Sunday afternoon on Labour ward. A caesarian is needed for fetal distress. The couple is lovely, recently married, first child. Cuts through skin, fat, muscles, peritoneum 1 and peritoneum 2. Uterus is sliced and amniotic fluid flows. No blood. Abruption. The baby is dead. The patient dies shortly after.
So I loved this book because it showed the struggles from so many perspectives. His personal relationships suffered: he missed his best friend’s bachelor party for work, he had to conduct a romantic relationship over a few hours a day, he wasn’t able to easily catch a holiday. He was paid in peanuts for the lifesaving work he did. Adam was still struggling to afford rent while his non-medic friends were buying their second homes. His boyfriend was extremely patient and understanding. A lot of surgeons are on their second marriage (caused by lack of emotional availability and time leading to deterioration in romance). This book shows the highest peaks in a doctor’s career as well as the lowest valleys. Adam describes medicine as the best job in the world.