A Book Review by Srianee Dias.
This is going to hurt by Adam Kay
The subheading on the title page says “Secret diaries of a
young doctor.”
The format was unusual, because it was based on his real
diary entries, and it is a series of anecdotes. Adam Kay records his life as he
progresses in OB/GYN from House Officer, multiple posts as Senior House
Officer, multiple posts as Registrar and
then finally Senior Registrar. At the beginnig of the chapters he explains the
responsibilities each post entails.
Most of the anecdotes end with a funny observation and I
found myself laughing out loud! Really
loud! He describes his relationships
with the consultants and his other colleagues.
We can all relate to his nights on call, and the last minute changes in
plans with family and friends. Because
he is Jewish, he had to work every Christmas holiday. He spent many hours in the hospitals which
strained his personal relationships. We
don’t hear too much about his personal life, because this, after all, is about
the life of a young doctor.
Some of the stories
are quite touching, and it is easy to see that Adam Kay is a sensitive young
doctor. He describes how he would visit the special care nursery on his way
home if any of the babies he delivered ended up there. He felt the need to
check on their progress.
Both his parents are physicians as well as many other
relatives. It is possible that he drifted into choosing medicine as a career
without too much thought. During his
stint as a Senior Registrar he finally realizes that he is not cut out to be a
doctor.
He is now a screen writer and author.
This book was quite engaging and entertaining. The author
uses a fair amount of slang (he attended medical school after all!) as well as
many British medical acronyms that were unfamiliar to me. I feel that this book would appeal mostly to
those in the medical field, although there were many appreciative reviews by
readers.
I hope that some of the readers of this blog will try to get
their hands on a copy of this book or download it. (It may be difficult to find in Sri Lanka.)
This is one of the many books in my purchased waiting list of books to be read! After reading this stimulating review by Srianee, it has jumped up several places and I shall embark on a promised rewarding literary journey very soon. Thanks, Srianee, and I hope many more will follow you and send me some more book reviews to post on our Blog.
ReplyDeleteMahen,
ReplyDeleteThanks for posting this review. I suspect that not too many people will actually read this book, but one of the reasons that I thought of reviewing this particular book for the blog, is because I thought it would be interesting to share some stories from our pre-retirement days. I don't have many stories from interesting encounters with patients, because as most of you know, I was a pathologist in the US, and by the time the patients ended up in my care, they were already dead! It was interesting, however, to finally get answers to the ailments that were troubling the patients, which their physicians may or may not have resolved while they were still alive. It was always a learning experience for everyone concerned.
I do remember from my long ago days as MO/OPD at the Karawanella Hospital, the women who showed up for treatment. When asked what was troubling them, they would say, "I came to the pola today and decided to stop at the hospital for some medicine too!" I listened to them, prescribed some vitamin B, and sent them on their way. They kept coming back on pola days!
Hi Srianee, Thank you for this review. On attempting to get the book on line from the local library (as I dont wish at this point in time to add to my current collection of books) , I found that it is also available as an audio book read by the author. I also came across another book/ audiobook by him - “Twas the Night Shift Before Christmas” -reviewed by the New York Times as “ A love letter to all those who spend their festive season on the front line, removing babies and baubles from the various places they get stuck at the most wonderful time of the year “
DeleteSounds interesting- I have started listening to this while awaitng the book you have recommended - 20 on waitlist !
Rohini, I found another book by him "Undoctored - The Story of a Doctor Who Ran Out of Patients". He thinks up some intriguing titles! I have downloaded it, but haven't read it yet. He is a funny writer. I should check out some of his children's books for my grand nieces and nephews.
DeleteThere are two episodes stuck in my memory because they relate to two of my bosses in Sri Lanka who had very high standards which I admired a lot. The first was while I was an intern with Dr Wickrema Wijenaike. He was doing a ward round and asked the ward sister why a certain patient was given a bed while so many more deserving patients were "floor" patients. The sister said something like this :-"Sir, he saw you privately and was referred by you for admission". Dr WW said "my seeing him privately has nothing to do with why he should be on a bed while so many more deserving patients are on the floor. Please give his bed to the floor patient". I was struck by his principles.
ReplyDeleteThe next story figures Dr Ranjith Munasinghe, who used to be Prof Rajasuriya's reg and was my Boss at Matale Base Hospital where I did my first post intern job. He was doing a ward round and was looking for a patient he had seen the previous day. Let's call him Somapala (fictitious). "Where is Somapala who was quite ill and needed a lot of observations and tests?". The Charge nurse said very proudly with almost a smirk "Sir, he discharged himself and left, and I made sure he signed the BHT that he was doing this of his own volition". Dr M, "What advice did you give him?". The Charge Nurse was surprised by the question and said "Sir, I did make sure that he signed that he was discharging himself against medical advice". Dr M was most upset. "Did you not give him a note and discharge medication with advice to come back if he changed his mind?". "No Sir, for such foolish men, we don't do that. We were really annoyed with him and made sure he signed!", Dr RM said, "In future, you will NEVER do that. If a patient wants to discharge himself, speak to him first and try to make him change his mind. If he refuses, call the on-call doctor if it is out of hours and if he also cannot make him change his mind, give him a note with our findings and recommendations and a prescription and tell him if he changes his mind, he is always welcome to return". The Charge nurse was flabbergasted. In his eyes, Somapala was an abosulute idiot who deserved no compassion.
Dr Munasighe was a wonderful doctor and a great example of an ethical practitioner who taught me far more than how to diagnose and treat illnesses. He taught me that every patient was a "person" who had to be treated with respect and understanding.
My first comment was a response to Srianee's request/hope:- " it would be interesting to share some stories from our pre-retirement days".
ReplyDeleteHi Mahen ,
DeleteI did my internship in Galle where the wards were brimming, with patients on as well as under beds, and the ward rounds used to take forever.
A similar incident to your experience with Dr. Wijenaike had occurred with Ana prior to my doing my internship with him.
During his ward round, a patient’s relative had protested that they had privately ‘chanelled’ him and questioned why he was not given a bed. Ana had explained that beds are allocated according to the medical needs of the patients and had nothing to do with ‘chanelling’, and promptly pulled out money from his pocket and thrust it in the relatives hands . The houseman- Dr. Soysa if I remember right, a graduate from Peradeniya had been eye witness to this and the HOs quarters was agog with the story.
On the very first day of my internship with consultant Dr. S. Anandaraja ! when the two other new interns and I were briefed by him , one of the things I remember being told was that we would be in charge of the beds, to be allocated to patients according to medical need.
In another incident I remember being stalked down the hospital corridor , all the way to the HOs quarters by a respectable looking man in SL National dress , with a pouch of gem stones , which I refused to accept in spite of much persuasion, even saying that he has made such gifts to other doctors! On reaching the HOs quarters and relating the incident to a colleague I was assured that I did the right thing by not accepting the gems , as his next move would likely have been a request for a bed for a relative .
I later learned from the Charge Nurse in my ward that he was a wealthy gem merchant from Beruwala whose relative was already in the ward !
Thanks to the early guidance from my parents on staying on the straight and narrow , I saved myself !
Thanks, Rohini. Ana was clearly a principled man as was my impression even before I heard this story. Money is always an enticement and our principles guide us on how we tackle it ethically. The incentive could be multifactorial from sheer desperation for money (possibly for a worthy cause), to sheer greed on the other end of the spectrum. Both Dr WW and Ana I am sure were very aware that they were role models with a duty to impart high moral values. I hope the like of them are still to be found in Modern Sri Lanka.
DeleteAnother incident comes to mind; this time in Kandy where I was a Consultant Neurologist from Dec 1977 to April 1979. I found so many staff members producing "family and close friends" at my OP clinic that I decided to do a special OP for staff in Thursdays from 2 pm to 5.00 pm to prevent disruption of my normal clinic. I saw many and it gave me a lot of satisfaction as I thought I was providing a good service to my staff. After my return to the UK after resigning my post, I learnt that the Charge Nurse was charging my "clients" and of the charge of Rs 25 at that time, Rs 20 went to the "Loku mahathaya", i,e, me and a measly Rs 5 for him! At the time I was seeing my staff families and their close friends, they were under the impression that they were paying for the service! I was stunned when I heard about this but there was nothing I could do about it as I was in the UK by the time I learnt about it.
Mahen, thank you for sharing your stories with us. It is interesting how some incidents/people become "etched" in our memory.
ReplyDeleteOne patient I remember is a male in his sixties or so, who was in our ward when I was Dr. Balakumaran's House Officer in Ratnapura. My co-House Officer was Pathmani Goonewardene. Dr. B was a fantastic person and in addition to learning about medicine from him, we had some great discussions about philosophy and ethics. This patient had a diagnosis of aplastic anemia, and I believe that the diagnosis had been made prior to my joining the team as a House Officer. During my 6 months on Dr. Balakumaran's ward this very pleasant patient was admitted repeatedly with severe, symptomatic anemia. He had a very supportive family, with several adult children. In 1967, in Sri Lanka, there was not much we could offer him except blood transfusions. The blood bank at the Ratnapura hospital was always short of blood, but his family would round up various relatives to replenish the blood supply by donating blood. Because of their enthusiastic contributions the Medical Officer in charge of the Blood Bank would release a couple of units for our patient. As time went on, the intervals between his admissions became shorter, and his quality of life deteriorated. Dr. B discussed the options with Pathmani and me, and said it was time to explain to his children and the rest of the family that we could not cure their father of his illness, and that the transfusions were merely prolonging his suffering. I supported Dr. B's approach, but Pathmani did not, and as you can imagine there was a rather heated discussion! The family understood, and accepted Dr. B's decision, and I believe that the patient expired a few weeks after his last discharge.
Thankfully, in 2025, patients with similar diagnoses have a far better prognosis.
Srianee, what a beautiful story covering medical treatments available at that time and the ethics of dealing with what essentially was a terminal illness.
DeleteLeaping to the present, I think AI has come to stay and will be used more and more both in diagnosis and and in managing illness. I have major reservations and fears about algorithmic bias as a result of using data (unknowingly including judging group characteristics such as colour, ethnicity, sex and sexual orientation, with a bias). AI can reflect historical or societal biases. My other fear is that I need to be yet convinced that a machine, however clever in sifting data and manage "Intelligent" huristic short cuts which appear justifiable, has any capacity to experience human like emotions. Such as empathy, love, sadness, and undertanding complex social and societal interactions. This may be a "Mind-Body" problem which Philosophers are so fond of!
When it comes to terminal care for example, the AI robot may come up with a "solution" which no seeing, feeling, loving human being might make, but is economically logical and cost-saving... but, this is another interesting topic to discuss on our Blog if there is enough interest.
Mahen, I really don't think that AI can completely replace human judgement, however flawed. The "End of Life Decisions" would be a very interesting topic to discuss if our friends are interested. Each individual's circumstances are different, so decisions will need to be based on those. I try to discuss these things with my family from time to time. By uprooting myself from the US and moving to Colombo, I think I am attempting to change the circumstances!
DeleteKumar G.
ReplyDeleteDear Srianee,
Thank you for bringing this superb book to our attention. The author is a worthy successor to Richard Gordon who wrote the hilarious ‘Doctor ‘ books precursor to the long running tv series.This will be in my required reading list.
Dear Rohini,
I too had interesting experiences in Galle. During my internship in OBS/Gyn with Dr Wilfred Perera a private patient refused to be examined by me. I felt that she was within her rights, but had to report this to the chief as we had to clerk all patients. WP asked her to go to another doctor.
WP was the best surgeon I ever encountered. He was meticulous but also very quick. The hapless interns were constantly in trepidation but were lucky to have a superb anaesthetist, the gentle Dr Wickremasinghe who helped us with setting up drips and calming WP.
Many of my chiefs impressed me more by their humanity than their undoubted skills. A deeply ingrained memory is the Senior physician at the Mater Hospital in Brisbane Dr Rob Simpson trying to dissuade a young female from a termination of pregnancy. He was of course a devout Roman Catholic and seated by her spent more than an hour. I also remain grateful to him for his reference for me stating that I was the best Registrar that he ever had.This kick started my cardiology career in Australia.
Another incident was our Heamatologist/ Oncologist Dr Trevor Olsen talking to the parents of a young boy diagnosed with leukaemia. That was a masterclass in communication in the pre YouTube era.
In Srilanka my best guru was Dr Nages Nagaratnam an excellent and caring physician. In Australia I found my best mentor ever the pioneering
Paediatric cardiologist and echocardiographer Dr Dorothy Redford.
They have inspired me to mould my career in their like.
Kumar
Kumar, more heartening stories on ethical doctors with high principles! I salute Dr WP. You said: "Many of my chiefs impressed me more by their humanity than their undoubted skills". This is so important and something I have strong feelings about. Apart from Dr WW and Dr Ranjit M, I had excellent role models like Dr EVP and many more. In the UK I worked under two wonderful Neurologists, Dr Mike Yealland and Dr Iain Wilkinson. They fit the bill as you described. Dr MY sadly passed away, but I still keep in touch with Iain -nearly 50 years! Your boss, Dr Simpson, had considerable insight and powers of judgement! To say "that I was the best Registrar that he ever had!". You mentioned PAN Chandraratne, who was a SHO when I was a student at the GHC. He was a great teacher, always willing to help. Very lovely and very clever, and it didn't surprise me in the least when I heard about his success.
DeleteKumar,
ReplyDeleteInexplicably, I omitted to mention Professor P.A.N.(Tony) Chandraratne , the most outstanding academic cardiologist of my acquaintance. I worked as his advanced research fellow in echocardiography at University of Southern California hospital in LosAngeles. He was a genuine friend in addition to being an excellent mentor. At Medical school he was three years senior to us. Kamali N’s husband Srian de Silva was in the same year. Tony was married to Roanne whose father Dr Frank Perera was the pioneer Rheumatologist at the General Hospital Colombo.
Kumar
Hello Srianee
ReplyDeleteThanks for the book review, beautifully written as always. Those thoughts do bring back many memories of happier times despite the uncertainties of what life held for me. I too have been immensely fortunate to work with wonderful people both as colleagues and bosses. My memories always return to my career journey in the UK and the many who supported me in so many ways. That journey of 50 years could fill a book.
In SL I was fortunate to work with many of my batchmates. HN, Priya Gunaratne, Sanath Tissera, Vedavanam, Lubber W, Razaque, Bernice De Silva. These are the names that come easily to mind.The closeness of that association was simply wonderful.
In the UK on my journey in Radiology I met Mahes Nadarajah who became a close friend.
These thoughts of long ago reminds me of the lyrics of a song made famous in 1996 by Oasis
Slip inside the eye of your mind
Don't you know you might find
A better place to play?
You said that you'd never been
But all the things that you've seen
Will slowly fade away
This also has a poignant ending:
"But don't look back in anger"
Nihal, good to see you joining the crowd that had such positive exposures to great teachers. The practice of Clinical Medicine has to incoporate the practice of Medical Humanities, fast becoming a subject througout the World, including Sri Lanka.
DeleteMahen, Rohini, Kumar and Nihal, thank you for sharing some of the recollections and stories of your respective professional trajectories. I was hoping that would happen! Thank you also for rekindling memories of some of our outstanding teachers who taught us so much about practicing ethical medicine. Of the people you have mentioned I had the privilege of encountering Dr. Wijenaike only on his ward rounds as a medical student. He definitely impressed me. Dr. Ernie Peiris was the one who taught me the finer points of taking a good medical history and examining the patients properly during our preclinical rotation with him. We did this during our break from lectures and we were in a 'vacation mode.' When Lakshman Jayasinghe tried to 'fudge' his way through an answer to a question that Dr. EVP asked, Dr. EVP said, "you know, you will be the kind of doctor where the patient will say 'I will get better if this doctor only gives me water!" I think although Dr. EVP was joking, he recognized that Lakshman was the kind of person who had the personality to make a patient feel better.
ReplyDeleteAs an intern in Ratnapura, I had the good fortune to work with Dr. Balakumaran (previously mentioned) and Dr. Leonard Kiriella. They were different personalities, but both great teachers.
In the US I was influenced greatly by Dr. Roy Barnett, the Chief of Pathology at Norwalk Hospital, where I trained in pathology, and later by Dr. Jack Hasson, Chief of Pathology at Mount Sinai Hospital, in Hartford, Connecticut. The latter was a true mentor and a father figure to me. Something he said sticks with me to this day. He said "When you have something negative to say to someone, don't do it in writing. Try to do it face to face. If the person receives the criticism or whatever, in writing, he/she will read it over and over again and the situation will worsen." On the other hand he said that thank you notes and compliments should be sent in writing for the recipient to savor, over and over again! I try to do that as much as possible.
Back to the funny stuff. Kumar. thank you for reminding me about Richard Gordon's doctor series. I remember the movies "Doctor in the House, Doctor at Sea" etc. starring Dirk Bogarde. (They are available on YouTube, I think). I found out that "This is Going to Hurt" is available on AMC and I will be able to stream it sometime soon. Of course, money is involved, but I will be able to watch it free for one week. I will let you know how I like it, in a few days.
ReplyDeleteAs we reminisce our professional journeys I am glad we have all kept to the final thought of my last comment "Dont look back in anger". We have spoken of the good times and the helpful people. We all must have had to work with difficult people and endure the psychological vandalism of a few. So glad we have all put those behind us.
ReplyDeleteMany of those who were responsible for those hard times are not with us anymore. We all respect the social norms with origins tracing back to ancient Greece. Somethings are best expressed in Latin. "De mortuis nil nisi bonum," meaning "Of the dead, say nothing but good".
Hi Srianee
ReplyDeleteIn the eighties a sex worker from Soho, London presented at the Haemotology Outpatients with a history of recent onset of nose bleeds.
Following investigations, the doctor diagnosed autoimmune thrombocytopenia and prescribed a course of steroids. The doctor scheduled a follow up visit for the following month. During the follow-up visit, the patient threw the steroid tablets at the doctor, moaning that due to these tablets all her bruises had cleared up. This she claimed meant that she could no longer charge compensation for bruising in the course of work.
Good to see you on the blog, Bora. The term sex worker always amused me. Is this a way of making it look like a profession (which I suppose it is)? Such as Social worker, Council worker, Doomsday workers (President of USA and PM of Israel)?
DeleteBora, thanks for sharing your sex worker story. See, this is what happens when doctors don't listen to their patients. All the patient wanted was for someone to help cure her nose bleeds! Aiyo!
DeleteMahen, about the doomsday workers, I wish they would challenge each other duels like in the old days. Then we won't be at the mercy of crazy old men. It is so distressing...