《This is Going to Hurt》是一本由Adam Kay著作，Picador出版的Hardcover图书，本书定价：GBP 16.99，页数：288，特精心从网络上整理的一些读者的读后感，希望对大家能有帮助。
●本以为是插科打诨的消遣读物，读到aftermath我竟哭完了今年的全部眼泪额度。全书在写NHS，又何尝不是中国公立医院工作环境的真实写照。我不知这道路通向何方。
●以英式幽默开头，以胎盘早剥结束。刚开始看以为是医院人类迷惑行为大赏，最后留下印象的却是医生的笑与泪，英国医生一定和中国医生有很多共同语言。Ps: 为了偷懒对照译文看的，好些医学用语译得不准确，可能除了我也没人会纠结了。
●i laugh, and i cry
●非常值得一看。最大收获是以后做手术，千万不能迷信consultant, 保命找Senior Registar最好。
●Audible。作者Adam Kay，Gay，犹太人，前产科医生，段子手。日记形式小故事讲的无比精彩，喷饭居多，催泪也有。拍成电视剧一定特别好看。书末敦促公众关怀医生，不要相信政府宣称“医生都是为钱从业的贪婪者“的言辞，很有社会责任感。
●开头几段，中英文对比的读了一下。中文丧失了许多英文中的笑点，可单读英文，里面过多的专业医用名词又令人费解。不过确实是令人又哭又笑的一本书。
●一个妇科男医生的从业，哦不，弃业笔记。搞笑时能把行业笑话讲得通俗易笑，还不是那种越界的下流段子(这点已极其不易)；描述为何弃医从文时也铿锵有力，“学医救不了英国！”……当真又哭又笑。 3AO
●Absolutely enjoyable. Can't put it down. may buy a copy from Watersone
●非常合格地好笑，素材和技巧50/50。有声版删了少量脚注。附加后记和额外日记。写新书巡讲时读者问“如何帮助改善现状”，竟然从给MP写信落脚回：给你们的医生友人/家属跟你vent的机会（basically, be their free therapy even tho practice medicine in such a sys as the NHS inevitably came w/ the occupational hazard of being a poor excuse for a partner/friend to their loved ones）自己因inadequate support转行、怒斥政客逼得好医生出走——但建议NHS家属和从业者一起圣母牺牲。何必。这段太多余
《This is Going to Hurt》读后感(一)：即世俗，又神性，这很伤人
一个学医六年，从医六年的住院医师，最终还是放弃了医生的工作，成为一个喜剧脱口秀演员，这真的很伤人，每个放弃救扶伤的医生工作的人，大约都有自己的苦衷，最大的问题，似乎就是忙，忙到绝望，忙到没有时间生病。然后小医生用幽默的笔触把自己的医院往事写出来，除了幽默之外，还有，就象书名写的：有些东西的确很伤人
《This is Going to Hurt》读后感(二)：诙谐的前产科医生工作日志
幽默诙谐的前从业医生日志。用碎片时间断续读完了英国犹太裔前产科医生Adam Kay（现为作家、喜剧演员）这部文笔晓畅的作品。有令人捧腹大笑的瞬间，也有悬念迭起的手术事件；有各式各样缺乏医药常识的患者造成的令人啼笑皆非的症状，也有各类病房或手术室当中旁观或亲身经历的糗事。印象最深刻的是Adam劝一位产妇最好不要轻易选择在家中分娩时说的双关语
“Home delivery is for pizzas” ，愣了一秒突然get到笑点，笑完又不禁佩服作者的机智可爱。
Adam光明正大地吐槽NHS（英国国家医疗服务体系）效率低下威胁人民的健康，但在危急时刻总是客观冷静，牺牲无数个人的休息时间，拼搏在救死扶伤的第一线。他数十年如一日，一步步从house officer、senior house officer, registrar做到senior registrar，最后因为一位产妇死于剖宫产中未预见的胎盘前置大出血而过度斥责自己，出现PTSD症状，6个月以后选择离开医疗系统，走上了写作与演艺的道路。
篇末致当时在任的英国卫生事务大臣的公开信也发人深省：一个国家没有任何理由不对涉及人民健康的最基本的保障体系大力投资。人手、医疗资源与软硬件基础设施的严重不足，是英国当局应直视的尖锐话题。
《This is Going to Hurt》读后感(三)：this is going to hurt
放荡思无涯，龌龊不足夸。 41,this year we're doing Christmas on my next day off,the sixth of January.元月六号始得休息。下次调休。 71,phone around and find someone who's on leave to cover you.找个人替。 74,no condoms fit him,why？ i establish he's pulling them right down over his balls.套套用在蛋蛋上。 102，精神病患因肺炎转呼吸病房，诊所全员如临大敌。this wasn't kind of "say hello if you see him"notice thing.他昨天已迅速进入状态，在病房四周扫荡开去，不放过病友床边的每一个痰盂，尽皆倾倒无余。
105，求不得，所求非所得。俱苦。进来的想出去，出去的想进来。porter冒充doctor，doctor复羡慕porter。
106，记得带套，善意的提醒，谁知认父为夫，引发尴尬。contraception:避孕措施。形容父女两人的表情如《夺宝奇兵》剧末的纳粹份子。Nazis at the end of "raiders of the lost ark".
《This is Going to Hurt》读后感(四)：of the pain and joy of working so close to despair, disease and death
这本书的中文名叫《 绝对笑喷之弃业医生日志 》，在春节前后很多人推荐，便决定一探究竟。由于作者是个comedy编剧，原以为是喜剧、段子。全部看完后，想引用一个很恰当的书后推荐语：
“It’s laugh-out-loud funny, heartbreakingly sad and gives you the low-down on what it’s like to be holding it together while serving on the front line of our beloved but beleaguered NHS. It’s wonderful.”
“This made me laugh out loud and cry in equal measures. Adam’s book weaves in and out of his patients’ lives and in so doing he tells, in a better narrative than I have ever seen before, of the pain and joy of working so close to despair, disease and death.”
【以下剧透】
作者很是幽默、诙谐。在早晚高峰的地铁上得庆幸有口罩挡着我龇牙咧嘴的傻乐，回家还忍不住转述一番，却远无法达到作者文字的乐趣。我也是头一回知道，原来英国的医生居然和我们这么相似？Unbelieably less paid, with unbeliable workload. 惨烈的现状，让我不禁同情起这个异国他乡的前医生，老乡见老乡。看样子，医疗真是个无解的难题。
作者是个妇产科医生，所以有很多门诊病房的趣事，甚至一些内心的小九九也如实写出，让我不禁担心书出版后是否接了一波投诉。但胜在真诚，也让更多人了解到这个行业的工作是怎样的，实际医疗决策如何。作者也感叹，we are humanbeing。所以不可能完全不犯错。但是，犯错的代价，有时候会很大。
这是为什么我看到最后突然难过的原因。我能感受到压在作者身上的那种沉重的责任、无力，甚至，期待尽快能够麻木的感觉。深深质疑当前的一切，我做错了什么，我做对了什么。也很出乎意外，知道了他离开的原因，和我刚看书时的猜想并不一样。摘抄几段文末的话，很好的总结了我未成形的想法，在看这本书时，不断对比英国和国内的医疗系统，想我们有什么待遇，为什么会有这样的待遇，这个系统怎么了，还有多少人会进来、会留下。作者并没有深入剖析这个过程，他只是呈现了，他作为一名医生，经历的一切。
故事的最后戛然而止，只留下沉默。
It’s a system that barely has enough slack to allow for sick leave, let alone something as intangible as recovering from an awful day. And, in truth, doctors can’t acknowledge how devastating these moments really are. If you’re going to survive working in this profession, you have to convince yourself these horrors are just part of your job.
I couldn’t risk anything bad ever happening again. If a baby’s heart rate dropped by one beat per minute, I would perform a caesarean. And it would be me doing it, no SHOs or junior registrars. I knew women were having unnecessary caesareans and I knew colleagues were missing opportunities to improve their surgical skills, but if it meant everyone got out of there alive it was worth it. I’d mocked consultants for being over-cautious before, rolled my eyes the moment they turned their heads, but now I got it. They’d each had their own ‘might have’ moment, and this is how you dealt with it.
One brilliant consultant tells her trainees that by the time they retire there’ll be a bus full of dead kids and kids with cerebral palsy, and that bus is going to have their name on the side.
I don’t miss the doctor’s version of a bad day, but I do miss the good days. I miss my colleagues and I miss helping people. I miss that feeling on the drive home that you’ve done something worthwhile. And I feel guilty the country spent so much money training me up for me just to walk away.
o 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 the government repeatedly lied that doctors were simply being greedy, that they do medicine for the money – for anything other than the best interests of the patient – I was livid. Because I knew it wasn’t true.
I realized that every healthcare professional – every single doctor, nurse, midwife, pharmacist, physio 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 of the NHS because, when it came down to it, I certainly couldn’t.
Every one of them spoke of an exodus from medicine. When I left, I was a glitch in the matrix, an aberration. Now every rota bears the scars of doctors who’ve activated their Plan B – working in Canada or Australia, in pharmaceutical companies or in the City. Most of my old colleagues were themselves desperately groping for a ripcord to parachute out of the profession – brilliant, passionate doctors who’ve had their reasons to stay bullied out of them by politicians. Once upon a time, these people were rescheduling their own weddings for this job. The other recurrent theme, doctor after doctor, is how everyone remembers the sad stuff, the bad stuff, so vividly. Your brain presses record in HD.
A friend told me about a perimortem caesarean he performed: a mum dropped dead in front of him and he cut the baby out on the floor. It survived. ‘You saved the wrong one! You saved the wrong one!’ was all the dad could cry.
ut promise me this: next time the government takes its pickaxe to the NHS, don’t just accept what the politicians try to feed 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.
《This is Going to Hurt》读后感(五)：笑著哭，哭著笑
#書# 2017《This is Going to Hurt》7/10
作者：Adam Kay
出版社：Picador
副標題：Secret Diaries of a Junior Doctor
出版時間：2017-09-07
頁數：288
在醫院大院子長大，醫務生活不是一種想象，而是日常。小時候爸媽同時被排到夜班，我不在發小家裡睡，就是和哪個護士姐姐一起睡。實在耍起脾氣，爸媽沒辦法，只好偷偷帶到醫護休息室，讓我自己抱著小抱枕睡。半夜被急救吵醒，模糊明白大人們在做重要的事情，不敢哭喊，只會抽著鼻涕，淚眼汪汪，偷看門外的人來人去，如同做夢一般……
我曾經以為自己很討厭醫務生活，高中時理科成績更好，特意選擇文科外語類，斷了讀醫學院的可能性。但來到德國，卻“被動”地選擇了經濟學院和醫學院合辦的健康經濟學，也就是研究如何商品化“健康”同時產生最大的經濟效益。在醫學院上課時，教授們慣性因為手術延誤遲到，我就會看著窗外疾走甚至小跑的白大袍們發呆——童年的夢怎麼那麼長……
拿到碩士畢業證那刻，心裡意想不到的平靜。二十多年兜兜轉轉， 從厭惡、抵抗、逃避到面對，我總歸沒有做一個quitter，而是用行動完成了與自己的和解，終於從這個童年的夢中醒來，終於走出了心裡迷宮：醫務生活確實不是我想要的，因為我既無法在醫學角度面對和死神搶人的無力感，也無法在經濟角度決定犧牲哪些人群可以讓更多人受益。
所以閱讀《This is Going to Hurt》時，斗膽說一句是疼在心的感同身受——雖然作者Adam是實打實過了6年地獄般醫生生活，而我僅僅是耳濡目染和在深淵邊試探——經常笑著笑著眼淚就出來了：還好，沒有走上這條路。
不合理的排班表，讓地獄都遜色的夜班，永遠做不完的工作，處於責任心免費加班等等，在各國醫療系統都是老生常談，為什麼一定要這樣去剝削醫護人員，特別是處於食物鏈最低的年輕人呢？因為要嚇唬不適宜的人退出？還是慣性的轉移報復？
The night shifts, on the other hand, made Dante look like Disney – an unrelenting nightmare that made me regret ever thinking my education was being underutilized.
The system runs on skeleton staff and, on all but the quietest shifts, relies on the charity of doctors staying beyond their contracted hours to get things done. It would be against everything you stand for to knowingly compromise patient safety, so you don’t – which means you stay late after almost every shift.
During a diary card exercise, every doctor has to record their exact hours worked. But because the hospital can’t (or don’t want to) pay us for the time we actually work, they render the process completely meaningless. Either they lean on us to lie in the diary cards and just record our contracted hours or they throw dozens of consultants onto the wards to temporarily ease the burden on the juniors.
每個人都只有24小時，因為責任心照顧病人，就必然要犧牲自己的個人時間！對不起朋友，對不起孩子，對不起伴侶，對不起自己！難道英雄就不可以有自己的生活嗎？“自己”也是一個生命，也需要認真平等對待的啊！
We’re constantly reminded by the GMC not to be doctor to friends or family, but I’ve always just ignored that and provided them an on-call private service. Because my job makes me such a useless friend in so many ways, I guess I feel like I have to offer something to justify my name on their Christmas card list.
Ron tried to dump me as a friend today – a proper, sombre, grown-up discussion. He doesn’t know why he bothers trying to keep in touch with me when it’s clear our lives have drifted apart massively since school. I should at least vary up the excuses I give him. Do I really expect him to believe I couldn’t come to his engagement party or his stag do because of work？ That I couldn’t make the wedding ceremony because of work, and almost missed the reception as well？ That I missed his dad’s funeral and his daughter’s christening because of work？ He knows my job’s full-on, but how hard can it be to swap shifts if it’s something you really want to do？ I put my hand on my heart and swear to Ron that I love him, he’s one of my best friends and I wouldn’t lie to him. I know I’ve been useless, but I’ve seen a lot more of him than almost anyone else I know – the job is just unimaginably busy. Non-medics can never appreciate quite how tough it is to be a doctor and the impact it has on real life.
A friend who worked in general surgery once couldn’t go along to his own son’s emergency surgery because he was performing non-emergency surgery on someone else’s son and no one could cover for him.
ut it’s more than just the hours; you’re generally no fun to be around when you get home. You’re exhausted, you’re snappy from a stressful day and you even manage to deny your partner their normal post-work chat of bitching about their colleagues.
Your subconscious ends up making a decision on your behalf. Either you fail to tune out the bad stuff from work and become permanently distracted and haunted at home or you develop a hardened emotional exoskeleton, which apparently isn’t considered an ideal quality in a partner.
First Valentine’s Day spent with H in four years. I suggest that, Valentine-wise, going out with a doctor is like having your birthday on the 29th of February.
Me: ‘I haven’t been signed off to do them either.’ Midwife: ‘You don’t need to get signed off to do things – you’re a doctor.’ (Depressing but true.) Me: ‘Isn’t there another midwife who can do it？’ Midwife: ‘She’s on her break.’ Me: ‘I’m on my break.’ (Untrue.) Midwife: ‘You don’t get breaks.’ (Depressing but true.) Me: (pleading, in a tone of voice I’ve never managed before, like I’ve unlocked a secret level of my vocal cords) ‘But it’s my birthday.’ (Depressing but true.) Midwife: ‘It’s labour ward – it’s always someone’s birthday.’
如此巨大的付出，時薪卻如此低下。所謂的前途和錢途都是望山跑死馬，和其他行業比起來，簡直就是虐心。
I was profoundly underpaid. 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 accrue postgraduate qualifications. Even if you think it’s appropriate that you 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 outside the hospital are on a better hourly rate.
Ron recently got through his postgraduate accountancy exams, so we compare notes. While his firm cut down his hours so he could revise, I had to squeeze in as much revision as my bloodshot eyes would allow after work. Ron had a full month of study leave before the exam; I applied for a week off, but rota gaps meant that it ended up getting cancelled at the last minute, without discussion. His firm paid for all exam fees and materials; I had to shell out for £300-worth of textbooks, a £500 course, £100 for online learning resources and £400 on the exam itself, a grand total of £1,300 – a mere two-thirds of my monthly take-home pay. My carefully considered answers don’t even get seen by a human – it’s a multiple-choice paper and you fill in the answers in pencil on a grid, which then gets scanned and marked by a computer. I show Ron the RCOG pencil I pinched. He immediately gets a promotion and pay rise for passing his exam; all mine means is that I’m now eligible to enter the Part Two exam. ‘No. All it means,’ says Ron sympathetically, ‘is that you spent £1,300 on a pencil.’
物質獎勵已經如此惡劣，精神獎勵卻比它更差！年輕醫護剛剛放下書本，就要立即持槍上陣，不懂也要硬著頭皮上，而一個細微的錯誤就可能傷害一個生命——這種心理壓力之大，常人無法想象，但過來人應該很明白。上級的一個眼神肯定和口頭表揚，會給年輕醫護極大的信心。難道是害怕年輕醫護驕傲？自滿？挫折教育可以讓他們更好面對敗給死神的那刻？
one of my consultants had ever taken me aside to say I was doing a good job. Or that I’d made a smart management decision, saved a life, cleverly thought on my feet or stayed at work late for the thirtieth consecutive shift without complaining. Nobody joins the NHS looking for plaudits or expecting a gold star or a biscuit every time they do a good job, but you’d think it might be basic psychology (and common sense) to occasionally acknowledge, if not reward, good behaviour to get the most out of your staff.
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.
It’s sink or swim, and you have to learn how to swim because otherwise a ton of patients sink with you.
How much confidence would you have in someone staring into your genitals with a scalpel in one hand and a manual in the other？ I rapidly learned to maintain an air of absolute confidence, no matter how frantically my legs were paddling under the water. In summary, never play poker with me.
但即使隨著經驗增長，醫術逐漸嫻熟，醫生們還是會“客觀地”迷信，因為生命實在太脆弱了，他們的無力感太強了。
I’m not superstitious – I’ll happily limbo under ladders or live in a flat full of open umbrellas – but it’s something I was taught years ago and have passed on to juniors ever since. Science may trump the supernatural, but once someone tells you an operative technique is bad luck, it’s probably better to be safe than sorry.
Waited about a minute before making the uterine incision at caesarean until Heart FM had moved on to the next song. As appropriate as Cutting Crew may be for a surgeon, I refuse to deliver a baby to the refrain of ‘I just died in your arms tonight’.
和死神搶人那種無形的壓力，那種如履薄冰的窒息感，文字只能表達出萬分之一，但也讀得人喘不過氣來！
The device goes off, I say ‘Oh my God’ and reflexively jump to my feet. It’s not that I’m particularly excited about my Fiorentina – it’s just that the fucking thing has the exact same pitch and timbre as my hospital bleep. H takes my pulse: it’s 95. Work has pretty much given me PTSD.
I sat in clinic and explained to patients that I needed to start them on antihypertensive medication, despite the device strapped to my arm proudly displaying that my blood pressure was significantly higher than theirs.
ow I was the highest-ranking person in the department out-of-hours. Knowing that when my bleep went off it was a problem that both the SHO and the registrar had failed to resolve. Knowing that if I couldn’t deal with it, a mother or a baby might die. Having a consultant at home ‘on call’ is just a formality: most emergencies will be over in a matter of minutes, before they can even change out of their dressing gown. I would now need to accept ultimate responsibility for the fails and fuck-ups of an SHO and registrar I may have never met before.
當回天乏術的時候，醫生自己也會崩潰。Aftermath我讀了三遍，哭了三遍：我一直認為醫護就是西西弗斯——無論醫術如何高明，如何細心呵護，成功救治了多少病人，但總會失去某一個病人——巨石在臨近山頂又會滾下山。而並不是每一個人都能夠振作起來，再次把巨石推上山頂！
One brilliant consultant tells her trainees that by the time they retire there’ll be a bus full of dead kids and kids with cerebral palsy, and that bus is going to have their name on the side. A huge number of ‘adverse outcomes’, as they say in hospitalese, will occur on their watch. She tells them if they can’t deal with that, they’re in the wrong profession.
And, in truth, doctors can’t acknowledge how devastating these moments really are. If you’re going to survive working in this profession, you have to convince yourself these horrors are just part of your job. You can’t pay any attention to the man behind the curtain – your own sanity relies on it.
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.
That ‘might have’ was inescapable.
I wasn’t really dealing with it, I was just getting on with it. I went six months without laughing, every smile was just an impression of one – I felt bereaved. I should have had counselling – in fact, my hospital should have arranged it. But there’s a mutual code of silence that keeps help from those who need it most. No matter how vigilant I was, another tragedy would have happened eventually. It has to – you can’t prevent the unpreventable.
I asked if I could go part-time (‘not unless you’re pregnant’) and investigated switching to general practice. But first I’d have to drop right down to SHO grade for a couple of years to work in A&E, paediatrics and psychiatry. I didn’t want to take a long journey backwards in order to start moving forwards again, only to find I didn’t like that either. I paused my training with the deanery and did some half-hearted research and lazy locum shifts on private units, but after a few months I hung up my stethoscope. I was done. I didn’t tell anyone the reason why I left. Maybe I should have; maybe they’d have understood. My parents reacted like I’d told them I was being tried for arson. At first I couldn’t talk about it, then it became something I just didn’t talk about. When cornered, I would reach for my red nose and clown horn, and bring out my anecdotes about objects in anuses and patients ‘saying the funniest things’. Some of my closest friends will read this book and hear that story for the first time.
人無完人，如此高強度卻又缺乏足夠休息的工作，總是有可能犯錯。醫護們自責心就已經很可能摧毀他們。但卻還有人無理取鬧，誣告坑錢，這是連根拔起醫護的信心啊！2015年英國的調查報告，13%的醫生產生過自殺想法，這比例……
Among all the predictably ‘hilarious’ remarks the patients made to me, one said something surprisingly astute. ‘It’s funny – you don’t think of doctors getting ill.’ It’s true, and I think it’s part of something bigger: patients don’t actually think of doctors as being human. It’s why they’re so quick to complain if we make a mistake or if we get cross. It’s why they’ll bite our heads off when we finally call them into our over-running clinic room at 7 p.m., not thinking that we also have homes we’d rather be at. But it’s the flip side of not wanting your doctor to be fallible, capable of getting your diagnosis wrong. They don’t want to think of medicine as a subject that anyone on the planet can learn, a career choice their mouth-breathing cousin could have made.
The other recurrent theme, doctor after doctor, is how everyone remembers the sad stuff, the bad stuff, so vividly. Your brain presses record in HD.
Unfortunately, I wasn’t able to counter sue for the hours needlessly spent going through old medical records, taking meetings with lawyers and defence unions, or the damage inflicted on my relationship by eroding the precious little time we spent together, nor the cost of the Red Bulls that kept me awake on night shifts after sleepless days of report-writing. Or the suffering I felt – the anxiety and guilt mounted onto an already stressful working life, the unfairness of being accused of being terrible at my job, the fear that maybe I was terrible at my job. I always tried my absolute hardest for every patient I saw and it was like a dagger through my heart for anyone to suggest otherwise.
A 2015 study by the Medical Protection Society showed that 85 per cent of doctors have experienced mental health issues, and 13 per cent admitted to suicidal feelings. A 2009 paper in the British Journal of Psychiatry showed that young female doctors in the UK are two and a half times more likely than other women to kill themselves.
但是病人對醫生一句簡單的“Thank you！”，就可以給予他們重新出發的動力，讓他們知道推動這個巨石上山，並不是無效無望的虛無，而是一條條鮮活的生命，一個又一個家庭新的笑臉。
When one of them said thank you, you knew they meant it – even if it felt like it wasn’t for anything special, just one of the smaller horrors thrown at you that day. I’ve kept every single card a patient has given me. Birthday and Christmas cards from family and friends would always get thrown away, but these guys survived every house move, escaping even my cathartic clear-out of medical paperwork once it was all over. They were little fist-bumps that kept me going, rays of thoughtfulness from my patients that hit the spot.
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.
the hours are terrible, the pay is terrible, the conditions are terrible; you’re underappreciated, unsupported, disrespected and frequently physically endangered. But there’s no better job in the world.
The careers on the other tables had their obvious draws – the principal one being a shit-ton of cash every month – but there’s no feeling like knowing you’ve saved a life. Not even that, half the time; just knowing you’ve made a difference is enough. You go home – however tired, late and blood-splattered – with a spring in your step that’s hard to describe, feeling like you have a useful part to play in the world.
Adam的退出，我不認為是半途而廢。他是經過深思熟慮。從醫學院挑選學生開始，到剝削年輕醫護，取笑NHS IT系統的幫倒忙，最後抨擊不合理的醫療制度陋習，他作為受害人，證詞連標點符號有極大的說服力。
Every doctor makes their career choice aged sixteen, two years before they’re legally allowed to text a photo of their own genitals. When you sit down and pick your A levels, you’re set off on a trajectory that continues until you either retire or die.
holding anyone to their word at that age seems a bit unfair, on a par with declaring the ‘I want to be an astronaut’ painting you did aged five a legally binding document.
In reality, medical schools don’t give the shiniest shit about any of that. They don’t even check you’re OK with the sight of blood. Instead, they fixate on extracurricular activities. Their ideal student is captain of two sports teams, the county swimming champion, leader of the youth orchestra and editor of the school newspaper.
Our computer system has been upgraded and, as happens eleven times out of ten when the hospital tries to make life easier, they’ve made everything much more complicated. It certainly looks much whizzier (and less like an MS-DOS program from school), but they’ve not actually fixed any of the massive clunking problems with the software, they’ve just slapped an interface on top of it. It’s the equivalent of treating skin cancer by putting make-up over the lesion. Actually, it’s worse than that. This glossy interface uses so much of the exhausted system’s resources that it’s now slowed to a nearly unusable crawl. It’s like treating skin cancer with some make-up that the patient has an extreme allergic reaction to.
In gynae clinic, I go online to look up some management guidelines for a patient. The trust’s IT department has blocked the Royal College of Obstetrics and Gynaecology website and classified it as ‘pornography’.
All junior doctors change hospitals on exactly the same day every six or twelve months, which is known as Black Wednesday. You might think it would be a terrible idea to exchange all your Scrabble tiles in one go and expect the hospital to run exactly as it did the day before, and you’d be quite right.
‘patient’. We should actually say ‘client’ – calling them patients is not only paternalistic and demeaning, but pregnancy is a normal and natural process rather than a pathological one. I just smile and remember the wise words taught to me by Mr Flitwick, one of my very first consultants, with regards to arguing with midwives – ‘Do not negotiate with terrorists.’
One would generally err on the side of caution and admit her until she can be scanned in the morning, wasting a night of the patient’s life rather than sacrificing my career if I’ve called it wrong. It also wastes the cost of a hospital bed, which is around the £400 mark. I suspect the cost of an ultrasonography shift would be considerably lower than this, and you’d save at least one such admission a night, but who am I to tell the hospital how to spend its money？ Particularly when they’ve just decided to get rid of the beds from our on-call rooms. (Perhaps they’ll save money on the bed linen they remember to change every week or two？ Perhaps they were worried morale was running a little too high？ That doctors would be too alert, too on it, if they got some sleep？)
ecause hospitals aren’t under quite enough pressure, the government has decided that all patients in A&E need to be admitted or discharged within four hours, whether they’ve had a stroke or stubbed their toe. If more than 5 per cent of these patients breach the target (unfortunately not the type of breech that interests me), the hospital gets fined and the management unleash a heap of hell on the A&E staff.
A flurry of people asking me ‘Are you OK？’, but also the definite expectation that I’d still come into work the next day, the reset button firmly pressed. That’s not to say they were heartless or unthinking – 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.
而Adam公開他的日記，一方面是為自己醫生生涯畫上一個句號，另外更是為了曾經的同僚們發聲，特別是年輕醫護們：政客們不要再無限制利用醫護們的善良和責任心，普羅大眾也不要再被政客們洗腦玩弄，否則失去新鮮血液補充，受損的是依賴公立醫療系統的大家啊！
junior doctors in the here and now were coming under fire from politicians. I couldn’t help but feel doctors were struggling to get their side of the story across (probably because they were at work the whole time) and it struck me that the public weren’t hearing the truth about what it actually means to be a doctor. Rather than shrugging my shoulders and shredding the evidence, I decided I had to do something to redress the balance.
ix years after quitting medicine, I met up with dozens of former colleagues. Their dispatches from labour 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, an aberration. Now every rota bears the scars of doctors who’ve activated their Plan B – working in Canada or Australia, in pharmaceutical companies or in the City. Most of my old colleagues were themselves desperately groping for a ripcord to parachute out of the profession – brilliant, passionate doctors who’ve had their reasons to stay bullied out of them by politicians. Once upon a time, these people were rescheduling their own weddings for this job.
alliate a cancer patient; watch a trauma victim have their leg amputated; deliver a dead baby. Because I defy any human being, even you, to know what the job really entails and question a single doctor’s motivation. If you knew, you would be applauding them, you’d be proud of them, you’d be humbled by them, and you’d be eternally grateful for everything they do.
It’s simply one doctor’s experiences, some degree of insight on an individual level into what the job really entails. But promise me this: next time the government takes its pickaxe to the NHS, don’t just accept what the politicians try to feed 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.
但我不想用沉重來結束這個讀書筆記，畢竟老司機Adam開車，希望看到的是我們的笑臉啊。
othing can prepare you for sitting down a patient’s daughter to explain that something rather upsetting happened to her frail, elderly father overnight. I had to tell her that the patient in the bed next to her dad’s became extremely agitated and confused last night. That he thought her father was in fact his own wife. That unfortunately by the time the nurses heard the commotion and attended it was too late, and this patient was straddling her father and had ejaculated onto his face. ‘At least it didn’t . . . go any further than that,’ said the daughter, in a world-class demonstration of finding the positive in a situation.
This time it had soaked through further than usual and I found myself washing blood off my cock. I’m not sure which is worse: the realization I could have caught HIV or the knowledge that none of my friends would ever believe this is how I got it.
CBU (pronounced Scaboo) is the Special Care Baby Unit, NICU is Neonatal Intensive Care, PICU is Paediatric Intensive Care, PIKACHU is a type of Pokémon.
The nightmare in the toilet bowl I’d witnessed was in fact the rather damning evidence of the two large jars of pickled beetroot that ES had inexplicably taken it upon herself to eat the night before. Next time I want to refer him someone’s bowel movement, the consultant ‘respectfully’ asks that I taste it first.
ending a patient home from the day surgery unit following laparoscopic sterilization. I tell her she can have sex again as soon as she feels ready, but to use alternative contraception until her next period. I nod at her husband and say, ‘That means he has to wear a condom.’ I can’t quite work out why their faces are a picture of horror, melting like the Nazis at the end of Raiders of the Lost Ark. What have I said？ It’s perfectly good advice, right？ I look at them both again, and realize the man is actually her father.
atient JB decided to take advantage of tradition and propose to her boyfriend – going to the expense of buying an engagement ring, the trouble of putting it inside a Kinder Surprise egg and the imagination of inserting it vaginally. She would suggest some finger-work to her partner, he would discover it, retrieve it, and then she would go down on one knee (and, presumably, him). Equal parts unexpected, disgusting and, I suppose, romantic. Unfortunately, he was unable to retrieve it as planned – it had rotated itself lengthwise – and no amount of shoogling from either of them would get this particular goose to lay her golden egg. Remarkably, she was so keen to maintain the surprise she wouldn’t tell him what she’d done or why, but eventually decided this was a hospital matter, so we met in cubicle three. It was a very easy delivery with a pair of sponge-holding forceps. She hadn’t told me about the contents of the egg either at this point, so there was a moment of confusion for both me and the boyfriend when she asked him to open it. I gave him a pair of latex gloves, sandblasting the very last pico-trace of romance from the scenario. She popped the question and he said yes; presumably out of shock, or fear of what a woman who does that with a Kinder Surprise would do to him if spurned.
It seemed there were certain elements of the story he’d omitted; his cock looked like an aubergine that had been attacked by a tiger – swollen, purple, and with deep oozing gashes down its entire length. On further questioning, I learned he was boasting to his girlfriend last night about the strength of his erections and announced to her that its throbbing robustness could stop the rotary blades of a desk fan. His hypothesis was monumentally incorrect and the desk fan proved the clear winner.
Having a poo on labour ward when the emergency buzzer goes off, and within minutes I’ve delivered a baby at crash caesarean section. The second the buzzer sounded I crimped it off, but my wiping was cursory at best, which is why my arse is now unbearably itchy while I’m scrubbed into theatre. It’s acceptable to ask someone who’s not scrubbed – a midwife or ODP – to push your mask or glasses up if they’re falling off, or even to itch your nose. Would it be pushing it too far to ask them for a quick anal scratch？
還是讓我們多記住人生的美好，笑著哭，哭著笑吧。
書目錄
Table of Contents
Title page
Dedication page
A NOTE REGARDING FOOTNOTES
Epigraph page
Contents
Introduction
1. House Officer
2. Senior House Officer – Post One
3. Senior House Officer – Post Two
4. Senior House Officer – Post Three
5. Registrar – Post One
6. Registrar – Post Two
7. Registrar – Post Three
8. Registrar – Post Four
9. Senior Registrar
10. Aftermath
An Open Letter to the Secretary of State for Health
Acknowledgements
raise About the Author
Copyright page