This Is Going to Hurt: Secret Diaries of a Junior Doctor

Content Warning: This section of the guide includes discussion of death.

“The decision to work in medicine is basically a version of the email you get in early October asking you to choose your menu options for the work Christmas party. […] Ultimately, no one knows what they’ll fancy for dinner in sixty dinners’ time.”

Kay explains that like most doctors, he made his career choice at the age of 16, when he had to choose his A level subjects. The figurative comparison of choosing a Christmas meal months in advance conveys the haphazard nature of making this momentous decision at such a young age. Most teenagers have little idea of the career path that will suit them or the demands of the profession.

“The night-time SHO and registrar will be down in A&E reviewing and admitting patients while you’re up on the wards, sailing the ship alone. A ship that’s enormous, and on fire, and that no one has really taught you how to sail.”

Here, the author conveys the intimidating level of responsibility placed on junior doctors as soon as they graduate. Kay uses the metaphor of an inexperienced sailor captaining a ship to highlight the enormity of being tasked with sole responsibility for the night-time wards. The ship’s “enormous” size refers to the large number of patients in his care, while the “fire” references the numerous emergencies he must deal with.

“It was like a particularly avant-garde episode of Changing Rooms. The sound was the worst part. With every breath the poor man took you could hear the blood sucking down into his lungs, choking him.”

This passage illustrates Kay’s use of humor as a coping mechanism in the face of challenges and trauma. By figuratively comparing how the patient’s blood sprays the walls to a home makeover show, the author introduces a note of levity. However, the vivid description of the sound as the “poor man” chokes on his blood conveys Kay’s horror and empathy for the patient.