I FINALLY screwed my courage to the sticking place and settled down to watch an episode of This Is Going To Hurt, based on former doctor Adam Kay’s best-selling diaries which have been described as ‘brutally honest’. The BBC comedy, if that is the right word, stars Ben Whishaw, who seems to fit everyone’s idea of what a doctor should look like, and it is said to pull no punches regarding blood, guts and bodily organs.
The programme lived down to my expectations. It was dire and I stopped watching. I would like to explain why.
The reason given for the diaries and the programme is that medics use dark humour to survive the tragedies and traumas of their work. Such humour is an escape mechanism, we are told, allowing them to unwind and process horrific images, and help them to avoid more destructive behaviours. I have seen this idea espoused in a variety of articles discussing the show. But after 47 years at the medical coal face, I don’t buy it.
I was a medical student from 1967-73. We were exposed to the full realities of the human condition from our first few days, that is in the dissection room. I vividly remember the moment when, like virgins on their wedding night not too sure where to start, we entered the cavernous room at the very top of the college building to be confronted by ten tables, each bearing a shrouded figure.
In groups of eight per table we gingerly pulled back the sheet to reveal the naked cadaver which had been preserved by the injection of a mixture of glycerine and formaldehyde into the blood vessels. This procedure had been carried out by Bert, the mortician, who was never seen without a fag in the corner of his mouth (and who was to die from lung cancer).
No one fainted and we soon set to the job with scalpels and forceps to reveal the mysteries of the human body. None of us had seen a dead person before, but we quickly adjusted. Indeed we became quite blasé and laughed and joked while we learned, as any student would.
But the humour was respectful. These souls who had ‘donated their bodies to science’ had once been alive with families and friends, joys and woes, and when we had completed the anatomy course they would receive a proper funeral.
The second preparation for life and death, blood and guts took place once we had commenced our clinical work when we were encouraged to attend the daily midday post-mortem demonstration in the pathology department.
We gathered in an open theatre, and before us on a series of mortuary slabs were some of the hospital’s recently deceased, lit by powerful spotlights. In most the post-mortem had already been performed and the internal organs were fully on display, heart, lungs, intestines, liver etc. Under the bright lights the colours were vivid and startling. The pathologist would demonstrate the disease processes which had been the cause of death. It was a brilliant way to learn pathology. Afterwards we went to lunch.
The popularity of TV series such as Silent Witness show that many of the public have a morbid interest in what happens in a post-mortem department, though I suspect that if confronted by the real thing the reaction would be very different. But we became used to what would seem horrific and traumatic in other circumstances so that by the end of our training we were fairly resilient when we finally hit the reality of life on the wards.
In those early days after qualifying we often worked very long hours, but this was how we gained our experience. I remember walking back to my room in the hospital at 5am on a Monday, listening to the dawn chorus after a long weekend and a busy night, and realising that I was due back on the ward by 8.30am. However I loved the work and was doing what I had always wanted to do.
Like any doctor I had my share of triumphs but also tragedies. I think of the woman pulled out from beneath an underground train with both legs wrung-up like wet towels. Or the four-year-old who, clutching a cone, ran out behind the ice cream van and was hit by a car. I watched as the distraught parents were ushered into the room to say goodbye to their child.
While I was working in Luton a call came to attend a motorway crash. I was blue-lighted down the wrong way of the M1 and crawled into the back seat of what had been a Jaguar. I cradled the head of the driver and managed to get an airway in place and an IV, while the firemen spent the next 90 minutes winching the engine off his legs with much sparking and a strong stench of petrol. Yes, I was scared. He died before we got him to hospital. Junction 11 of the M1 still brings back memories.
My point is that we learned to live and deal with the tragedy of others. We processed our trauma in the normal ways – sport, culture, family, parties, drink etc. For me, my strong Christian faith was crucial.
Of course there was humour, but although it was medical in nature it was gentle. One of the annual events at the hospital was the students’ and housemen’s Christmas show, a miscellany of music, songs and sketches, and a surprising amount of talent.
Who could forget the pipes and drums of the Argyll Robertson Highlanders (a medical in-joke). Or the activities of East London’s Miss Wapping 1954 (North and South!) Or the exhibition by the greatest spitter in the world (a Welshman from Llanglottis). The memory of his ‘faster than sound’ spit remains with me.
There was always serious ribbing of the consultants. ‘We would like to welcome our new professor of infectious diseases who specialises in infections of the foot, and has also authored a successful West End pantomime, Pus in Boots’. Groan!
This is why I found the humour of This Is Going To Hurt so distressing and disturbing. The script dehumanised the patients and treated them as disgusting orifices, to be ridiculed, judged and laughed at. It was cruel and frankly misogynistic, sample: ‘brats and twats’.
Of course the current NHS is in a critical, possibly terminal, state and some doctors are unpleasant people. I do not know what sort of person Adam Kay is, but I understand that he did not really want to be a doctor, or at least not in the speciality he ended up in. But the character portrayed by Whishaw is really unpleasant. If that is medical ‘dark humour’, the BBC can keep it.
In later years as a consultant radiologist I used to tell the medical students how, late one Friday afternoon, I was asked to perform an image-guided procedure on a septicaemic lady thought to have a blocked kidney which had become infected. Wanting to get off for the weekend I complained but reluctantly agreed. After a long wait they wheeled in an enormously fat woman in a hospital bed which was broken and could not be raised above ground level. I complained a lot more; the patient herself was completely incoherent.
I ended up performing the procedure on my knees, and fortunately it went well as I guided a needle into her kidney and was rewarded by a gush of what the old physicians termed ‘laudable pus’ since it provided relief from the infection.
I met her again the following Tuesday when she was recovered, and discovered that she was not just a fat old lady (although it would have made no difference if she was) but a charming, highly erudite professor of history who was immensely grateful for my ministrations. So never judge a patient by appearances, I would tell the students.
And don’t believe the lie that doctors deal with tragedy by the sort of rubbish portrayed by the BBC.