This Is Going to Hurt writer Adam Kay: 'It's vital for people to know that doctors are human'

Adam Kay was born in Brighton in June 1980. He seemed destined to follow in his doctor father’s footsteps and graduated from Imperial College London in 2004. During his training, Kay had performed in medical stage shows, forming the musical comedy group Amateur Transplants and writing for BBC Radio 4.

After six years as an obstetrics and gynaecology doctor, Kay left the profession after a patient’s caesarean section was complicated by an undiagnosed placenta praevi and the baby was delivered stillborn and the mother was rushed to the Intensive Care Unit. Kay suffered from symptoms common with post-traumatic stress disorder after the incident and, several months later, resigned.

In 2017, Kay’s first book – This Is Going To Hurt: Secret Diaries Of A Junior Doctor, based on Kay’s own diaries – was published and became an instant bestseller. The book was motivated by comments from Jeremy Hunt, then the health secretary, accusing junior doctors of being greedy after entering into contract disputes with the NHS. Kay’s witty and shocking account of the lives of junior doctors and the state of the NHS sold over 2.5 million copies, was translated into 28 languages, and was later adapted into a seven-part comedy drama for BBC One, broadcast in 2022.

His subsequent adult nonfiction books, Twas the Nightshift Before Christmas and Undoctored were also Sunday Times number one bestsellers. He edited Dear NHS: 100 Stories to Say Thank You, a collection of essays about the health service which raised over £400,000 for charity. Kay has sold out six runs at the Edinburgh Festival Fringe and sell-out nationwide UK tours. 

Kay’s non-fiction series for children started with Kay’s Anatomy which became the fastest selling kids’ non-fiction book of the decade. It was followed up by Kay’s Marvellous Medicine and Kay’s Brilliant Brains. The latest in the series, Kay’s Incredible Inventions, was published in November 2023.

Speaking to The Big Issue for his Letter to My Younger Self, Kay looks back on expectations of him as a child, using humour to cope and the reaction to his books.

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At 16, I was set out on a path to do medicine. Everything in my life was designed around this happening. I just remember an awful lot of homework. An awful lot of pressure. Obviously, I needed to get my GCSEs, my A levels. As well as that, the extracurricular stuff. For me, in the absence of any sport, it was music. My big quandary was that I wasn’t 100% convinced that medicine was what I actually wanted to do. 

I was slightly strongarmed into it. But for all the right reasons. My dad was a doctor and you want the best for your kids, and that meant a ‘sensible profession’. Of the four of us, the degrees were medicine, medicine, law, medicine. That period of my life would have been happier if I’d have chosen my own destiny more. Or if I’d known that it was possible. When I suggested to my mum the idea of maybe music as an alternative, that didn’t go down mega well. 

I was a class clown. You’re less likely to be bullied if you’re popular and if I couldn’t get popular through my God-given personality, I could by making the class laugh with some silly thing I’d said or done. That was a defence mechanism. At 16, for the most part, your worries are relatively small. When I was working as a doctor and seeing some genuinely grim, difficult stuff, the humour became a direct coping mechanism. Writing down the funny stuff was a way of processing. It was a way of looking for the light among the dark. 

I’ve never liked how I looked. But back then, clearly, I had a much better set of cards than I’ve ever had since. I had crippling anxiety, which was a huge barrier to putting myself in environments where I might meet people. I still don’t like myself, but I suspect I’d like my younger self an awful lot less. I was a definite smartass. I don’t think I did a good job of integrating into society. But then again, I went to an all-boys school and what a terrible way of becoming a normal member of society, being essentially banned from meeting half of the population until the age of 18.  

My upbringing was definitely not politically conservative, but it was in terms of life choices. Go for the safe car, the house you can easily afford, the job with a reliable income, the sensible pension. I’d tell myself about the other side of the coin. There’s also the version where you invest in yourself, you roll the dice and see what happens. 

The first real gamble I took was at age 30 when I left medicine. I’m now in a creatively lucky position, whereas for a long time, I was taking any piece of work so I could pay the gas bill. I’m innately a flibbertigibbet. As soon as I finish the project, I need to do something that’s different. In the last few years, I’m able to choose the projects I want to do but every time I say no, a part of my brain thinks, ‘That is the last thing you’ll ever be offered, are you sure you want to say no?’ I’m not a catastrophist, but life feels slightly too good to be true at times. 

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I grew up in an environment that wasn’t famous for sharing emotions. It’s taken me a long time to realise the value of opening up, whether it’s speaking to friends and family or speaking to professionals. Any time I’m screwing into a knot of anxiety and worry, James, my husband, is very good at spotting it. I’ve had enormous help from counsellors and therapists over the years and I will continue to. 

I was never much of a rebel. I was keep your head down, obey the rules, be a good boy. Then medical school doubles down on that. The good doctors are the ones who don’t make a noise. You never rock the boat. I think it is a big problem. We saw only a few months ago with the awful Lucy Letby case, the people who tried to make their voices heard were the ones who were shut down. Not just shut down but threatened with their jobs. It’s an old-fashioned environment in the worst meaning of the term.  

It was prime indie time so Pulp were my obsession. No one writes lyrics like Jarvis Cocker. One thing that would have absolutely blown my 16-year-old mind would be the idea that I’d get to work with Jarvis and he’d have done the soundtrack to a TV show I wrote. I’ve seen Pulp more than I’ve seen any other band. On the This Is Hardcore tour I went to four or five separate dates. That came out when I was at uni, Different Class in my GCSE year. 

Medicine needs more individuals. People come to medicine from all corners of the country, all corners of the globe, and they end up beaten into a kind of homogenised beige doctor. The edges are knocked off their accents, which is the most obvious sign, but that’s a sign of what’s happened inside as well. Doctors need to represent their patients and their patients are a panoply of all sorts of different people from all sorts of walks of life. We need to embrace the idea that doctors should be different. 

Lots of junior doctors gave me great feedback after [his 2017 book] This is Going to Hurt came out. People saying, “Until I read that book, I thought I was the only person that ever cried in the toilet.” But I also got hate mail, particularly from an older breed of medical consultant, saying it’s inappropriate to talk about struggling as a doctor; your patients mustn’t know, basically, that you’re human, which is my whole thesis. It’s vital for people to know that you’re human. 

I’d be shocked to hear that I would become a rabblerouser, fighting the system, upsetting authority. Particularly around the mental health of medics, which for years people have tried to ignore. This topic of suicide among healthcare staff, the numbers are an outrage, and so little is being done to move the needle on it. That’s my obsession and what I’m working hard on in my spare time.  

Do I feel a responsibility? I feel that ultimately dates back to 16-year-old me and guilt for having left a profession when the country invested good money in training me up. Also, my parents invested all this time and energy. So it’s not a responsibility, it’s a response to guilt. 

My latest book, Undoctored, is dedicated to an amazing tutor I had at medical school called Mike Schachter. He was the first person, probably the only person in medical school, who took an interest in me as an individual. A person who noticed I was struggling and encouraged me to find what ended up being performing and writing. And it turns out there was no one looking after him, and his life ended on his 70th birthday. We’d kept in touch a bit, but when someone dies, it’s always not enough, and certainly not recently enough. I wish I’d had the chance to sit down with him over dinner and say what a huge influence he’d been, what a fulcrum point he was in my life. 

The day I’d want to live again is the day my daughter came out of neonatal intensive care. She was born a bit early, a bit small. Babies sometimes need a bit of help at that age, and you’re never quite sure which direction it’s going to go in. It was a week of stress. A little knowledge is a dangerous thing. But knowing that she was out of the worst of the woods put absolutely everything in my life in perspective. I realised what was important and what wasn’t. To be honest, very little in your life is important when you’re comparing it to that. I could look at my life: I’m married with this beautiful baby and everything felt… The future felt right. 

I’ve got two kids, Ruby and Ziggy. They were both born through surrogacy. We owe the most in the world to our two amazing surrogates, our brilliant friends who did that for us. This is the first Christmas with the four of us. Or five if you count the dog, which we probably shouldn’t. I’m looking forward to the Christmases ahead where they get it, and they can enjoy the magic of it, because Christmas is very much designed for kids. Even though I try and make it all about me.     

Adam Kay’s latest kids’ book, Kay’s Incredible Inventions, is out now (Puffin, £14.99), as is his memoir Undoctored in paperback (Trapeze, £9.99). You can buy them from The Big Issue shop on Bookshop.org, which helps to support The Big Issue and independent bookshops.

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