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It is going to hurt

2022/09/25 07:45:52瀏覽1266｜回應1｜推薦22

This Is Going To Hurt

Writer:

Adam Kay is a British comedy writer, author, comedian and former doctor. He is best known as author of the number-one bestselling book This Is Going to Hurt.

Kay was born in a Jewish household, with a sister Sophie. With his father being a doctor, he describes becoming a doctor as being a default decision. The Kay family was from Poland.

Kay attended Dulwich College, leaving in 1997, and Imperial College London, where he read medicine and graduated in 2004. During his time at medical school, Kay began performing in medical school shows in 1998. While at medical school, he founded the musical comedy group Amateur Transplants and wrote for BBC Radio 4.

Kay worked as a doctor between 2004 to 2010, leaving the profession after a patient suffered an undiagnosed placenta praevia; the expectant mother was subsequently taken to the intensive care unit, while the baby was delivered stillborn. Kay worked for a number of years as an obstetrics and gynaecology trainee, writing textbooks on the subject, before leaving medicine for a career in writing.

Adam Kay is a British comedy writer, author, comedian and former doctor. His television writing credits include Crims, Mrs. Browns Boys and Mitchell and Webb. He is best known as author of the number-one bestselling book This Is Going to Hurt.

Kays first book, This Is Going to Hurt, based on diaries from his former career as a doctor, was published by Picador in September 2017 and became an instant Sunday Times bestseller. The paperback edition was also an instant Sunday Times number one bestseller, a position it held for well over a year and selling over one million copies. It was the book of the year in the UKs 2018 National Book Awards.

Story:

Welcome to the life of a junior doctor: 97-hour weeks, life and death decisions, a constant tsunami of bodily fluids, and the hospital parking meter earns more than you.

Scribbled in secret after endless days, sleepless nights and missed weekends, Adam Kays This is Going to Hurt provides a no-holds-barred account of his time on the NHS front line. Hilarious, horrifying and heartbreaking, this diary is everything you wanted to know – and more than a few things you didnt – about life on and off the hospital ward.

Adam is an obstetrician and gynecologist practicing medicine in a public hospital. In a public hospital, both medical equipment and staffing are far worse than private hospitals. Here, Adam Not only have to face endless overtime, but also have to fight wits and courage with cunning and demanding patients, and have been under enormous pressure for a long time. But fortunately, in the hospital, Adam still made some friends, such as the fledgling intern Shudi (Ambika Mod ornaments). Adam has a boyfriend Harry (Rory Fleck Byrne) who has been in love for many years. Although the relationship between the two is stable, Adam has not disclosed his sexual orientation to his parents, let alone Introduce Harry to them. In an accident, Adams misdiagnosis led to the premature delivery of a baby, which became a rope that kept shrinking around his neck, causing him to suffocate.

House Officer:

Every doctor makes their career choice aged sixteen, two years before they’re legally allowed to text a photo of their own genitals. A doctor must be psychologically fit for the job-able to make decisions under a terrifying amount of pressure, able to break bad news to anguished relatives, able to deal with death on a daily basis. They must have something that cannot be memorized and graded: a great doctor must have a huge heart and a distended aorta through which pumps a vast lake of compassion and human kindness.

Senior House Officer-Post One:

Senior house officer is the point at which you decide what to specialize in. If you choose general practice, you remain in hospital for a couple of years, doing things like A&E, general medicine and paediatrics, before moving to the community and being awarded your elbow patches and permanently raise eyebrow.

I also liked the fact that it was a blend of medicine and surgery-my house officer jobs had proved I shouldn’t really be majoring in eithers. It would give me a chance to work in infertility clinics and labour wards- what could be a better, more rewarding use of my training than delivering babies and helping couples who couldn’t otherwise have them? Of course, the job would be difficulte emotionally when things went wrong- not every stork has a happy landing-but unfortunately the depth of the lows is the price you pay for the height of the highs.

I also liked the fact that it was a blend of medicine and surgery. In the event, it took me months to actually make up my mind, commit and apply. I think the reason I hesitated was that I hadn’t made any significant life decisions since I chose which medical school to go to at the age of eighteen-and even that was mosly because I was impressed with the cruly fries in the student’s union. Age twenty-five was the first point I actually got to make an active decision in the Choose Your Own Adventure book of my life. I not only had to learn how to make a decision, but also ensure I made the right one.

Senior House Officer-Post Two:

Shaolin grandmasters train for a decade or moe in a remote temple, waking up at 5 a.m. and only stopping at midnight, submitting themselves to a ife of celibacy, devoid of material possessions. I couldn’t help but feel it didn’t sound that bad- at least they didn’t have to uproot their lives every year to a completely different temple.

NHS deaneries, who are responsible for postgraduate medical training, move doctors to different hospitals every six or twelve months to ensure they learn from a broad range of consultants. Which I guess makes sense. Unfortunately, each deanery cover a fairly large geographicl area, and you get randomly allocated to units throughout that region.

Senior House Officer-Post Three:

The money is utterly out of step with the level of responsibility you have-literally life and death decisions-plus there’s the fact you’ve been to medical school for six years, worked as a doctor for three and started to accure postgraduate qualificaiotns. Even if you think it’s appropriate that yo take home less money per week than a train driver, there’s still the fact that these working weeks can involve over a hundred hours of unremitting slog, meaning the parking meters outsie the hospital are on a better hourly rate.

Registrar-Post One:

As a house officer you think your registrar is unimpeachably correct and clever, like God maybe, or Google, and you try not to bother them under almost any circumstance. A an SHO, they’re your port of call whenever you get stuck and need an answer: the safety net of some wise words just a quick bleep away. And the, before you know it, the registrar is you.

your subconscious ends up making a decision on your behalf, Either you fail to tune out the bad stuff form work and become permanently distracted and haunted at home or you develop a hardened emotional exoskeleton, which apparently isnt considered an ideal quality in a partner.

Registrar-Post Two:

And then in the second year as registrar he started doing regular locum work, he’d rather overstretched himself on the mortgage and it felt like a sensible way of making his income do at least a reasonable impression of my outgoings

Registrar-Post Three:

Eventually there comes a point where yo have to decide what kind of doctor to be. Not the technical stuff, like whether you’re into urology or neurology, but the more important matter of your bedside manner. Your stage persona evolves throughout your training but you generally settle on a way of dealing with patients a couple ofyears in, and carry it through into your consultant career.

Registrar-Post Four:

There are two things keeping him there. Firstly, I’d worked long and hard to get as far as I had. Secondly-and I realize it might sound a bit worthy-it’s a privilege to be allowed to play such an important role in people’s lives.

By the time I was six years deep into medicine, the shine had definitely rubbed off the surface. On more than one occasion my finger had hovered over the metaphorical “Fuck it” button—days where things had gone wrong, patients had complained, schedules had changed at the last minute—and my resolve wavered. Not quite enough to start circling the jobs page of the paper, but certainly enough to wonder if I might have any long-lost millionaire aunts

Senior Registrar:

You’re practically a consultant that I was now in my thirties, still in a career I’d signed up for fourteen years earlier, based on the very flimsiest of reasons.

Having gone to medical school, you might as well finish and become a house officer, then you might as well become an SHO, then you might as well become a registrar, then you might as well become a senior registrar, and by then you’re practically a consultant. There almost certainly don’t need to be so many different grades; I strongly suspect it’s designed so that the next step is always just round the corner. It’s the fifty-pound note you chase down the street, swept up by another gust of wind the millisecond before your hand makes contact. And it definitely works. One day I realized—as if blinking awake after a serious accident—that I was now in my thirties and still in a career I’d signed up for fourteen years earlier based on the very flimsiest of reasons.

I was the highest-ranking person in the department after hours. Knowing that when my bleeper went off, it was a problem that both the SHO and the registrar had failed to resolve.

Aftermath:

It’s a problem that’s baked into the profession. You can’t wear a black armband every time something goes wrong, you can’t take a month’s compassionate leave- it happens too often.

I’d seen babies die before. I’d dealt with mothers on the brink of death before. But this was different. It was the first time I was the most senior person on the ward when something terrible happened, when I was the person everyone was relying on to sort it all out. It was on me, and I had failed.

Officially, I hadn’t been negligent and nobody suggested otherwise. Medical negligence will always be judged by asking the question “Would your peers have done anything differently in that situation?” All my peers would have done exactly the same things and had exactly the same outcome. But this wasn’t good enough for me. I knew that if I’d been better—super-diligent, super-observant, super-something—I might have gone into that room an hour earlier. I might have noticed some subtle changes on the CTG. I might have saved the baby’s life, saved the mother from permanent compromise. That “might have” was inescapable.

No matter how vigilant he was，another tragedy would have happened eventually.

So in 2016, when the government started waging war on doctors—forcing them to work harder than ever for less money than ever—I felt huge solidarity with them. And when our government repeatedly lied that doctors were simply being greedy, that they were in medicine for the money—for anything other than the best interests of the patient—I was livid. Because I knew it wasn’t true.

The junior doctors lost that particular battle, largely because the government’s booming, baleful voice drowned out their own reasonable, experienced quiet one. I realized that every health-care professional—every single doctor, nurse, midwife, pharmacist, physical therapist, and paramedic—needs to shout about the reality of their work so the next time the health secretary lies that doctors are in it for the money, the public will know just how ridiculous that is. Why would any sane person do that job for anything other than the right reasons? Because I wouldn’t wish it on anyone. I have so much respect for those who work on the front line because, when it came down to it, I certainly couldn’t.

Putting this book together, six years after quitting medicine, I met up with dozens of former colleagues. Their dispatches from the labor ward tell of an NHS on its knees. Every one of them spoke of an exodus from medicine. When I left, I was a glitch in the matrix,

Don’t just accept what the politicians feed you. Think about the toll the job takes on every medical professional, at home and at work. Remember that all of them do an absolutely impossible job to the very best of their abilities. Your time in the hospital may well hurt them a lot more than it hurts you.

Highlights vs self- reflection:

1.p.6: It’s sink or swim, and you have to learn how to swim because otherwise a ton of patients sink with you.

2. Not every stork has a happy landing-but unfortunately the depth of the lows is the price you pay for the height of the highs

3.p.262: But promise me this: next time the government asks its pickaxe to the NHS, don’t just accept what the politicians try to fee you. Think about the toll the job takes on every healthcare professional, at home and at work. Remember they do an absolutely impossible job, to the very best of their abilities. Your time in hospital may well hurt them a lot more than it hurts you.

Golden Sentence:

Conclusion:

1.Why a kind focused determent prodigy filled with kudos turn out quitting the job that everyone envy?

2.美國心理學家Albert Bandura曾提出「偶遇論」。他認為：人們在日常生活中遇到的事件有很多偶然的因素，在這種偶然的相遇（chance encounters）中，對改變人類生活的未來方向發揮重要作用。這本小說，以「偶遇論」來詮釋非常適當。Chance Encounters change our life, we don’t know where the wind blow at, but we need to keep going in the wind. We can’t stop the storm, but we learn how to walk in the rain.-Len Sherman

3.Doctor Chang: doctor can only cure 1/10, 9/10 is cured by the patients themselves.

During covid-19, all the patients will be postponed, even for the kids. God create miracle, doctors are the servant of the patients!

https://tw.appledaily.com/local/20220616/2102A13EACA179464F1E4F576E

Questions by Emma:

1.Why a kind、 focused 、determent prodigy filled with kudos turn out quitting the job that everyone envy?

(1)at the age of eighteen, they got to make a life-long career with default destiny of tradition.

(2) It takes almost 16 year-training. After graduating from the 5-year-Department of Medicine, you will enter the first year of clinical practice, which is called Foundation year 1, or F1 for short, and the second year is F2. Until the end of the Foundation year (this is equivalent to the graduation of the Taiwan Medical Department), will you apply for a specialist and enter the two-year Core Medical Training, and then will receive 4-6 years of specialist training. Two years of Core Medical Training is like major internal medicine or major surgery training, after completion, it will officially enter into sub-specialty training. In other words, 8 to 9 years after graduating from the medical department in the UK are all training stages.

(3) Doctors are not God, they are human-beings, we need show our kindness and gratitude to them

(4)NHS take care of the patients’ right, sometimes the doctors are overwhelmed., In USA, every 3 weeks, do one doctore commit suicide. One doctor commits suicide in the U.S. every day(2018)

(5)All alone fight against the broken system, poor function, competitive colleague, stressful duties, picky patients,if no one will stand up for them, it will lost their passion soor or later.

2.What were you expecting form the book to start with? Did the book meet your expectation? If not, what was different?

It broke my dream for being a doctor, I assume that they enjoy their high payment and life, even the hardship will take shift, not so overwhelmed. It seemed to me that they are like butchers with highest technics

3.How did the book make you feel about HHS workers? Do you feel any differently to how you did before you read the book?

(1)I think they will stand up for the doctors, and have a kind heart to listen to the doctors.

(2)p.61:NHS deaneries, who are responsible for postgraduate medical training, move doctors to different hospitals every six or twelve months to ensure they learn from a broad range of consultants. Which I guess makes sense. Unfortunately, each deanery cover a fairly large geographical area, and you get randomly allocated to units throughout that region.

(3)p. 137: We should see the skyscraper-high bills of America as the ghost of Christmas future when it comes to NHS privatization.

(4) GP surgeries are already privately owned. Its true that general practices are run as businesses. This is because, at the founding of the NHS, most GPs worked as individuals from their own homes, and it would have been very difficult to nationalise them.

(5) Consultant got lure of highly lucrative private work.

Opposition to the NHS

Bevan faced a big job. Not only was a huge proportion of the country’s hospital stock war damaged, but many doctors were still in army service. Of those who remained, a large proportion was still to be convinced. Many of them had established practices and were resistant to change.

Between 1945 and the launch of the NHS, Bevan engaged in furious battle with the British Medical Association (BMA), the doctors’ union, over the terms of service offered to doctors – specifically the issue of whether they should be directly employed on set salaries.

In 1947, the BMA threatened to boycott the new service and the row became increasingly public: one letter in the British Medical Journal described Bevan as “a complete and uncontrolled dictator” and cooperative doctors as “quislings” (after the head of the puppet government in Nazi-occupied Norway). For his part, Bevan accused the BMA of engaging in “a squalid political conspiracy” and “organising sabotage of an Act of Parliament”.

Finally a deal was brokered in which GPs would retain the power to run their practices as small businesses, and consultants could both work for the service and retain their private patients. As Bevan put it bluntly, he “stuffed their mouths with gold”.

4.Would you have liked to be a doctor? How does this book inform that opinion?

Doctor need to be more smart, healthy, and good at communication, problem soving.

(1) your subconscious ends up making a decision on your behalf, Either you fail to tune out the bad stuff form work and become permanently distracted and haunted at home or you develop a hardened emotional exoskeleton, which apparently isnt considered an ideal quality in a partner.

5.Was there a point in the book that touched you more than the rest of the book?

What did it mean to you?

(1)It gives us a way to learn the medical terms.

(2) The SHO asks if she can perform, the caesarean while I assist. in theatre, the SHO goes through the layers: skin, fat, muscles, peritoneum1, peritoneum 2, uterus. After the uterine incision, rather than amniotic fluid, blood comes out-lots of blood. There has been an abruption.

I stay calm and ask the SHO to deliver the baby-she says she cant, theres somehing in the way. I take over the operation-the placenta is in the way. The patient has an undiagnosed placenta praevia. This should have been noticed on scans, she should never have been allowed to go into labour. I deliver the placenta and then deliver the baby . The baby is clearly dead. Paediatricians attempt resuscitation but without success.

To be a great doctor need to be professional and some lucky!

Pls276: Life is one long fucking pub quiz and I am never on the right team.

6.How does it feel to hear these encounters from the perspective of the junior doctor?

(1)you need to be ready to fight alone and got some lucky.

(2) In England, as a general practitioner(GP), 5 years as medical student, 2 years for foundation training, 3 year for specialism

(3)In England, as a hospital specialty. 5year as medical student 2 year for foundation training, 7 year for specialism.

7.Which patient stood out the most for you?

(1)One of the patient wants to cheer her girlfriend, and put the candle on his penis. Almost kill him.

(2)p.160: Patient DT is twenty-five years old and her second smear test: she has uterus didelphys-two vaginas, two cervices, two uteri. The patient tells him she prefers having sex with her left vaginz, as it’s bigger. Adam Kay soothe her that it just like the metal pencil sharpeners at school with two sizes of hole

(3)p.215: If the patient had a dolphin tattoo on her right groin, would it be so bad if my skin incision was slightly wider than usual and I had no choice but to decapitate the dolphin?

(4)p.239:An eighty-five-year-old, long-stay gynae oncology patient broke our hearts on yestrday’s ward wound. She misses her late husband, her children have barely visited since she’s been in hospital and she can’t even have her usual whisky nightcap in here. He decided to play Boy scout, prescribed whishky on her drug chart and gave the house officer 20 pound to get a bottle from the supermarket to pass on to the nursing staff, so they can fulfill the prescription on their drug round.

(5) The patient needs a caesarean section for failure to progress in labour, but her husband doesn’t want him to perform it because he’s maile. They are orthodox Muslim and have apparently been told they can have all female doctors.

8.Which was the funniest anecdote for you?

(1)They use their body as playground, stick strenge things into their body.

(2)The patient indeed has no urine output, but that’s because the tubing from their catheter is trapped under the wheel of her bed and her bladder is the size of a space hopper. I stop feeling terrible.

(3) “Congratulations, you did amazingly well there,”says Lily” Thank you!”I reply, then realize she’s actually talking to the mum.

Doctors sometimes need support,too.

(4)Patient RD is a twenty-seven-year-old gentleman who attempted a new twist on an old classic to surprise his girlfriend on her birthday. He stripped naked, lay on his back on the kitchen table and smeared his body with chocolate sauce. He achieved an erection then inserted and lit a thin green birthday candle. Unfortunately, his girlfriend didn’t get a chance to see this ill-advised yet imaginative birthday tribute, as RD soon dissolved into the excruciating pain of wax dripping through his urethra and into his bladder. I presume as he blew out the candle he made a wish that the urology department would have a good plan as to how to remove the stick of wax melted deep into his cock.

Summery Report by Emma

Duck shared his depressed experience to deal with the nasopharyngeal carcinoma in Swissland. Tawian brings him the warm blessings to recover from the trauma.

To Adam Kay, he is not a blessed doctor who was from Poland in a Jewish household with a doctor sister and a doctor father. To him, to be a doctor is a default choice. Kay worked a as a doctor between 2004-2010 leaving the profession after a patient suffered an undiagnosed placenta praevia, her baby was delivered stillborn. All alone, he fight against the broken NHS system. Poor function, competitive colleague, stressful dties, picky patients. More than that, each deanery cover a fairly large geographical area, and he got randomly allocated to units throught that region. The skykscraper-high bills of England comes to NHS privatization which take care of the patients’ right,he was really overwhelmed. BMA & NHS comeprised in which GPs would retain the power to run their practices as small businesses, and consultants could both work for the service and retain their private patients. Highly lucrative private work make the NHS more helpless.

Adam make his default decision as a doctor and after 16 year’s fighting, he just likes the stork , but not a happy landing, the depth of the lows is the price and luck you pay for the hight of the hights. Finally, Adam Kay choose to be a British comedy author. Albert Bandura quotes that chance encounters change our life. We don’t know where the wind blow at, but we need to keep gling in the wind. We can’t stop the stro, , but we learn how to walk in the rain-Len Sherman.

Summery Report by Consultant Clive

Today was a great meeting with our outstanding leader Emma leading us through October’s hilarious book. This is Going To Hurt explains the pros and cons of being a doctor from delivering babies to breaking bad news. The author describes the rush he felt when saving a patient’s life for the first time on a night shift and how he subsequently gained confidence over the years. He also talks about the difficult work life balance of being a junior doctor. This led to almost no social life but, on the bright side, saved him money.

The struggle for a work life balance led to missed Christmases, parties and dates and ultimately led to the end of a long-term relationship. However, Kay also talks about the camaraderie between health workers and how they make the most of long working hours, especially at times such as Christmas. The book describes hilarious stories of misunderstandings and mistakes which lead to inevitable hospital admissions. The book depicts stories of strange things stuck in the wrong places and people caught in unusual predicaments. Patients can misinterpret or completely ignore instructions, the consequences of which only get caught later on, when they are forced to attend A&E.

It is hard to imagine how doctors are able to keep a straight face when they come across some situations portrayed in this book. These stories will continuously have you laughing out loud and wanting to tell your friends about the things you have read. We should also thank Ming Li who stays up to share and join in and our special guest today Duke who shared his own story of cancer treatment in Taiwan. Thank you to all our participants today and of course a huge happy birthday to Gloria.

2.questions: https://beckysbookblog.co.uk/2022/01/04/this-is-going-to-hurt-book-club-questions/

3.The Nightshift Before Christmas: https://thelastwordbookreview.com/2019/12/04/twas-the-nightshift-before-christmas-by-adam-kay/

4. this is going to hurt story: https://www.goodreads.com/book/show/35510008-this-is-going-to-hurt

5. Adam Kay:https://en.wikipedia.org/wiki/Adam_Kay_

6. Bevan: https://wellcomecollection.org/articles/WyjHUicAACvGnmJI

7. Doctor suicide; https://www.webmd.com/mental-health/news/20180508/doctors-suicide-rate-highest-of-any-profession

8.NHS(National Health Service)

https://zh.wikipedia.org/zh-tw/%E5%9B%BD%E6%B0%91%E4%BF%9D%E5%81%A5%E7%BD%B2_(%E8%8B%B1%E6%A0%BC%E5%85%B0)

9.doctor in England: https://www.onemovegroup.com/doctor-to-be-uk/

10.A rural doctor gave her all, then her heart broke: https://www.nytimes.com/2022/09/19/health/doctor-burnout-west-virginia.html?unlocked_article_code=AAAAAAAAAAAAAAAACEIPuonUktbfqYhkQVUaCibVUNEjsh3Bif_E3Lsmw3XjNi6SVCoH0OkOH82e-l3CZKxibp0zwzGfDpdnAYMYecZTnKVZLlA_DE6huIeFk5AIZChqotO-Vz07ms3DULx9rDXjNCzpdbwmgbbv5UnYaTK-XK2PgmYzZ1ow-esTflGq0XwCwKrDA7Q1joE4haF9c8g8ETQQZyCKvO3qAwF-ObiEbBLb6Ao3WoJJSG2Z3I7cu_9bLlIkWR-RR2h_4G089NteJNoRWa_-JBIhc8D96q4D5ehIMPuxHs64Oh9r7uXVww

11. This is going to hurt (TV series)

https://en.wikipedia.org/wiki/This_Is_Going_to_Hurt_(TV_series)