This is Going to Hurt Review

Review: This Is Going to Hurt

The most common question medical students have been asked ever since Adam Kaye’s best-selling non-fiction medical memoir was published back in 2017. What a treat to find out a screen adaptation of the book had been released as a seven-part comedy-drama on BBC1. The excitement to start it was overwhelming; a book that spurred on (or perhaps deterred?) a generation of unknowing teens to embark on a medical career, naturally I curled up on the sofa ready to watch the entire series in a day or two. Before I divulge any tantalising spoilers, binge watch it yourself or open the book to find out for yourself just how brilliant his story is. But for those still unaware and lacking the time to watch it themselves let me explain, the series charts the turbulent life of acting registrar Adam Kay in his job in Obstetrics and Gynaecology at an NHS hospital in London in 2006. During the series Adam is faced with innumerable challenges trying to juggle his personal and professional life in a chaotic system that is the current NHS. From broken computers and faulty emergency alarms to Adam struggling to get a psych review of a vulnerable 19-year-old patient who attempted to perform cosmetic surgery on her vulva, the series provides a startlingly accurate representation of the realities of life on an NHS labour ward. The direct juxtaposition between Shruti, one of Adam’s more junior colleagues, on her NHS shift, and Adam’s shift in private care where the staff get room service, an abundance of clean scrubs and each nurse only has one patient to care for further emphasises the underfunding of the NHS. The shock on the faces of my non-medic housemates, asking “is this really what it’s like?” or “surely this is just the stuff of fiction?” demonstrates just how desperately we need change. What was most impressive about This Is Going to Hurt is how it explores the struggles doctors face daily in such an honest, accessible way. For example, a central plot within the series follows the ramifications of Adam’s his first big mistake. In the first episode, he discharges a patient named Erika because he believes she is faking her symptoms. We later learn that Erika is displaying early-warning signs of pre-eclampsia, and Adam is forced to perform an emergency Caesarean to deliver her 25-week-old baby. As a junior doctor, Adam is ill-equipped to perform this surgery and consequently, Erika loses a lot of blood and Mr Lockhart, the consultant, is called in to take over. Adam is tormented by his mistake; throughout the series he sees flashbacks of the incident and eventually Erika lodges a complaint against him. However, in watching all that precedes Adam’s decision to discharge her, you naturally sympathise with him: the day Adam consults Erika, he wakes up in his car just before his shift, parked in the hospital, having fallen asleep from exhaustion the day before. The hospital is overrun with patients and Adam is the most senior doctor present. He is called back in for an extra shift that night, missing his best friend’s stag do. You

realise that these working conditions would force even the most experienced doctors to make mistakes. The public expects doctors to be more than human - not just NHS heroes, but superheroes. But mistakes will always be made when working in a fragile, unsupported organisation. This is most poignantly emphasised by Adam in the series’ final episode. In the previous episode, we learn that Shruti has taken her own life. At his tribunal, Adam honours Shruti’s life and draws upon the overwhelming stress she, himself and other healthcare professionals experience when forced to work in a broken system. He even points out that one medical professional, like Shruti, takes their own life every three weeks. The irony is that Shruti made very few mistakes in her job: she successfully assists delivering triplets; catches a ruptured ectopic pregnancy early; deals with Adam’s haemorrhaging patient swiftly; passes her incredibly difficult specialty exams first time; and deals with a domestic abuse case with unceasing compassion for her patient, even when she herself gets abused by her patient’s husband. It was this compassion that reduced me to tears; it showed the public just how much of the job goes further than medicine. I was upset, confused, and angry when she took her own life. The gradual deterioration in her mental health that was so tangible on screen felt unbelievably unfair. It was such a powerful, heart-rending demonstration of the ridiculously harsh realities NHS workers face daily. On a more positive note: the humour. Kay’s script for the series is just as laugh-outloud funny as his books. You laugh, mostly when you feel you weren’t meant to, and especially when Ben Wishaw breaks the fourth wall in a such a brilliantly comical, almost appalling way. The dark humour is a perfect means of introducing difficult issues in an entertaining, approachable manner. It is perhaps also what some doctors use to smile in the face of adversity. As Steven Fry said, ‘it is painfully funny, the pain and the funniness somehow add up to something entirely good, entirely noble and entirely loveable.’ This Is Going to Hurt really did hurt but was even more worth the watch because of it. One thing’s for sure, I won’t be going into Obs and Gynae.

Written by Tiga Hombrey

Divorce’s Grey Area

Once a week, I look after an elderly lady, Pat, whilst her husband goes to the local bridge club. Pat has Parkinson’s and whilst she remains mentally agile, her body is beginning to let her down, to her increasing frustration. For a while, I worried she was depressed and so I was pleased to hear her friend Sue was coming to stay indefinitely. When I first met Sue, Pat’s grandchildren remarked loudly with the kind of unawareness that only children can get away with, that Sue “was homeless so she had to stay with Granny”. Upon my admonishing, Sue replied that she had left her husband of 50 years last month and so in fact the children were correct; “at the age of 68, I am homeless”. She later recounts to me that she met her husband aged 20, he was 35, and his controlling behaviour had weighed her down for years. During the first coronavirus lockdown she was hospitalized for an extensive period due to endocarditis, during which she was, to her surprise, the happiest she had been in decades. It took her just over a year after that realisation to leave her husband. She attributes part of her courage to divorce him to her GP, who when Sue confided to her that she felt too old to leave her husband, simply replied that plenty of people do at her age. In our society we romanticize the last few years of marriage, in fact “growing old together’ is one of the most frequent phrases in wedding vows, and nearly always the ending of any romantic film or book. The idea of ending a relationship that late in life is at odds with the genial picture of a grey-haired couple gardening together and dying a few days apart as they simply cannot live without each other. Although this is a beautiful picture, it is unrealistic and increasingly outdated. In fact, Sue is not alone in her decision to walk away from nearly 50 years of marriage. In England and Wales, despite that fact that divorce across all ages is on the decline, the divorce rates for opposite sex couples aged 65 and over have gone up by 46% between 2004 and 2014. This dramatic change in the living arrangements and daily lives of a large number of over 65s has vast health consequences and it is impertinent that we aim to explore and understand this phenomenon. What is causing this increase and how does this impact the health and social networks of older age divorcees?

Why is Divorce in the Elderly on the Rise?

There are several factors cited as being responsible for this increase in divorce amongst older adults. One common theory is that due to the inherent gendered nature of heterosexual marriage, women having to take their husbands’ name etc, that as women have become more financially independent and socially liberated, they have begun to challenge the constraints of sometimes, decade long marriages, and this leads to eventual breakdown of the marriage. A study by Hochschild and Machung (1989) found that even couples which felt they had a gender equal marriage, still displayed traditional disparities between childcare and housework. In older marriages, children may have now left the home and the wife may feel she no longer is motivated to do the housework in order to appease her husband; a functional human being perfectly qualified at doing the work himself. Older women are more likely to be educated than previous generations and as such may have more financial autonomy and be less trapped in unhappy marriages. This theory is supported by research which shows that women are often the catalyst figure in the breakdown of heterosexual marriages. One study found that women in the US were responsible for 69% of marital ending. Another theory is the idea that women are more in romantic demand when they are younger and therefore older men are more likely to divorce their long-term wife in order to seek out a younger woman. However, this theory is unsupported and is at odds with the evidence above that women are often the ones asking for a divorce.

A much better theory is the idea of increased longevity. “Life expectancy has increased in the UK over the last 40 years” and therefore we have a much greater population of over 65s. The impact of such an increased life span on divorce was explored by a 1998 study which suggested that “increased longevity and health extending into later life may increase the availability of and responsiveness to spousal alternatives when childrearing nears the end in a marriage.”. The doubling of the rate of divorce among middle aged and older adults between 1990 and 2010 translates into a substantial increase in the number of people aged 50 and older who experience divorce.

What does this mean for the health of our elderly patients?

When couples divorce later in life; there can be vast consequences. The mental health impacts of divorce are extensive, and the loss of a long-term partner can be akin to grief in its ferocity. In addition, there may loss of a carer and individuals may have to rapidly learn new skills that they have had a partner completing for years’ such as cooking. As we begin to respect and view social medicine and anthropology with an increased interest amongst medical research, we must acknowledge this shift in lifestyle and living arrangements of a large proportion of our elderly. As doctors, we must respectfully refrain from stereotyping and allow older people to explore new relationships and take risks in leaving old ones. As for Sue, she is so extraordinarily happy it is hard to describe, she has bought a campervan and converted it to fit her needs. She stays with Pat and her daughter during the week, and then at the weekend she heads off around the country to explore. Of course, there will come a point where this is not physically possible; an 80-year-old living in a campervan is probably a living arrangement that many of us would judge and pity. However, the freedom she feels is similar to that of a teenager leaving home for the first time. She is discovering herself again and that is worth far more than the sanctity of a house with heating and a partner to die with. As out whole society is living longer, with more social and sexual freedom, we must try to encourage older individuals to make good choices that allow them to live out their life in a positive way and not shame them into unhealthy environments just because we fear dying alone.

Written by Molly van der Heiden