Adam Kay: ‘The NHS is definitely more of a war zone now'

Times

13 hours ago

W hen the lives of doctors reach the screen, the physicians are generally depicted halos and all. Twice Robin Williams played Hollywood versions of real-life medics: Patch Adams, who healed by laughter in the film that bore his name; and in Awakenings, a version of neurologist Oliver Sacks, who awoke Robert De Niro from catatonia (and Sacks himself, incidentally, from his own non-existent heterosexuality). And in Britain we have Adam Kay, as played three years ago by Ben Whishaw in the BBC's Bafta-winning This Is Going to Hurt, an adaptation, by Kay himself, of his hilariously depressing diaries of life as a junior doctor in gynaecology and obstetrics. But this television Adam Kay is no glow-up, no Dr Kildare or Finlay, no Dr Turner from Call the Midwife . He is an effed-up cynic disgusted by the conditions he works in, his colleagues and far too many of his patients.
I am having a mediocre lunch with the former doctor himself in a café in Oxford chosen because Kay's NHS days are 15 years behind him and he is now a 45-year-old full-time writer living in bucolic north Oxfordshire with his husband and two children. This modest, solicitous, considered Adam Kay is nothing like his screen translation, who against all tradition is not a nicer, more virtuous version of the real person, but someone much, much worse.
With his husband, James Farrell, in 2023
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'He's very problematic,' his creator agrees. 'There's a [hypothetical] version of the show where the character with my name is an amazing superhero and goes around solving everything, but that's been done enough. Also, we want to watch interesting characters and I wanted to show that he is an arsehole and an HR nightmare, but I also wanted to show the pressures, the systemic pressures that lead to someone behaving badly, making bad decisions and, you know, starting to fall apart.'
There were women who watched the show and its hero's cold-eyed cynicism towards his patients' obstetric distress and called the whole thing misogynistic. 'I wanted to show someone under enormous pressure, behaving badly,' Kay responds. 'At the end of the series, however, he gets his comeuppance because of his behaviour. So, to my mind, that isn't endorsing the behaviour. I suspect a lot of the comments were made by people who hadn't seen what ultimately happened.'
But if you thought the TV Kay was bad, wait till you meet Eitan Rose. Rose is a boozy, paranoid, bipolar, drug-using, sexually rampant consultant rheumatologist, and the comprehensively damaged hero of Kay's first novel for adults, A Particularly Nasty Case — a title that could apply either to the murders Rose thinks have been committed in his stuffy, hierarchical yet ludicrously inefficient hospital, or to Rose himself. The best even Kay can say of him is that as a doctor he is 'fine' and good with his patients.
So how much of Rose is Kay, I ask, apart from them both being male, gay, Jewish doctors who graduated from Imperial College London? A percentage will do.
'Well, I find him very easy to write,' he replies, ignoring my suggestion. 'We share a sense of humour and sarcasm, but I'd like to think that he's a lot messier than I am. And while lots of people do have bipolar, I don't.'
Ben Whishaw and Michele Austin in the TV drama This Is Going to Hurt
SISTER
So there are bipolar doctors working in the NHS?
'There are bipolar everyones. I know a bunch of doctors with the condition and I spoke to them at length. One of the people [Jess Morgan] I credited in my acknowledgements used to tweet as the Bipolar Doc. As I say, I don't have bipolar, but there's a bit where I sort of inhabit him, when I talk about the way there are now two types of mental illness.'
Oh yes, I say, the socially acceptable ones, anxiety and depression, that are talked about at dinner parties, and then all the others?
'So with the first you can compare your antidepressants and SSRIs [selective serotonin reuptake inhibitors], but as soon as it's a thought disorder or as soon as it's schizophrenia or bipolar, that's totally different.'
I ask if he was a drug user like Rose. He replies that at the end of medical school everyone was told that any discovered drug use would terminate their careers. 'And that was a very sobering thing to hear. I know there's a lot more support for addicts and it isn't a sort of absolute red line, but I certainly wasn't shoving cocaine into my inhalers like Eitan Rose.'
'The suicide rate is one doctor every three weeks. For other NHS staff the rate is even higher'
TOM JACKSON. GROOMING: DESMOND GRUNDY USING BRISTOWS HAIRCARE AND MIE SKINCARE. SUIT, REISS. T-SHIRT, SIRPLUS. SHOES, RUSSELL & BROMLEY
Since leaving the NHS in 2010 Kay has made a living as a writer, wedding speeches and ad copy at first, and then TV shows including Teletubbies and Mrs Brown's Boys, before success arrived in 2017 in the form of This Is Going to Hurt, the book. He is now in the happy position of writing scripts only for his own projects, including a forthcoming TV series about a ten-year-old doctor called Dexter Procter based on his children's novel last year. But it is his adult non-fiction work that will provide historians with an incomparable overview of the NHS in its long, will-it-make-it slog up to its centenary.
The books are also of immediate value to us patients, for they explain the ways of doctors to man. We learn, for instance, how to decode the descriptions of us they share with their colleagues. 'A pleasant lady/gentleman' means we are 'normal'. If the 'pleasant' is missing, it means we are 'actively unpleasant'. 'Thank you for referring this chatty lady/gentleman,' is a warning: prepare for a double-length appointment.
Since I have him right in front of me, I ask what he thinks of GPs who google symptoms during a consultation. He thinks they are unprofessional. 'Just turn your screen so that the patient can't notice.' The preferred protocol is to ask patients to leave the room to provide a urine sample and google away while we are micturating.
The multimillion-selling This Is Going to Hurt charts his first (and last) six years working as a hospital doctor between 2004 and 2010. Kay is briefly the optimistic, even marginally idealistic new boy preordained by his family — his father, Stewart, was a GP, and two out of three of his siblings also studied medicine — to a career wearing stethoscopes. It ends with his decision to quit after, as the senior doctor on the ward, he presides over a caesarean section that, owing to an undiagnosed condition, went terribly wrong — the baby dying and the mother losing 12 litres of blood and having a hysterectomy. None of this was his fault, but the trauma haunted him. A consultant who bumped into him later spoke lightly of his 'nervous breakdown'. For Kay, it was an entirely rational decision to walk away from a job he was unsuited for before it did him any more damage.
The 'stocking filler' follow-up two years later, Twas the Nightshift before Christmas, further looted his diaries for the dark hilarity of six consecutive Christmases spent working. Its very premise is a synecdoche for how the NHS treats its recruits.
Set in the present day, A Particularly Nasty Case may be fiction, but it brings the NHS history lesson up to date, although mostly it reveals history not so much repeating itself, as history stuck. Certainly the squalor endures. Rose notes that an outpatients' area scores three in his personal 'decrepitude bingo': storage heaters, loose electricity fittings and black mould. A ward ceiling is 'a bulging piñata of God knows what'. And nothing works. Rose advises an outpatient to head for the parking ticket machine that offers a discount because it permanently thinks it is Sunday.
The novel periodically escalates into farce — sex farce — so it is sometimes hard to tell when Kay is exaggerating with comic intent. Did he, I wonder, ever come across a hospital pharmacist, as per the story, with a side hustle selling drugs to staff?
'I didn't, but I thought it was probably…' I think he is going to say 'likely' but he course-corrects. 'So I don't know anyone who had that inhaler, the sort of squirty nose thing or a pharmacist who was acting as a dealer.'
I am strangely unreassured by this answer.
Personally, I perhaps rate most highly his book for strong-stomached adults that immediately preceded A Particularly Nasty Case. His 2022 memoir, Undoctored: The Story of a Medic Who Ran Out of Patients, charts his life post-medicine, his baby steps into making a living as a freelance writer and moving in with James Farrell, a television executive with whom he would co-found a production company and who in 2018 married him. I quite literally wept with laughter reading it the night before we meet. Everybody asks when Kay knew he wanted to be a doctor. I want to know when he discovered he was funny.
'When someone at school told me. I wasn't entirely unbullied as a child. I wasn't sporty or naturally gregarious. So someone very, very nice, in a very well-meaning way — who was one of the sporty, rugby, deputy-head-boy types — said to me, 'By the way, you are funny. But every time you say something funny, you look down and look ashamed. Just own it, basically.' '
'Wes Streeting says doctors will regret striking.They won't regret it. They'll leave'
TOM JACKSON FOR THE TIMES MAGAZINE. SWEATER, SIRPLUS. TROUSERS, REISS. SHOES, RUSSELL & BROMLEY
He was 11 or 12. A year or so later, in a similar manner, he learnt at Dulwich College school that he was gay via the perceptive guess of a schoolboy porn dealer who printed out bespoke filth utilising his father's printer. Rather later, he unintentionally came out to his parents, who had come to a revue he was performing in while at medical school. His friend Mike Wozniak (former doctor, now a comedian/writer/actor) announced him as 'everyone's favourite gay Jew'.
But Undoctored, when not being very funny, is extremely sad. Just as Rose in the new novel suffers post-traumatic stress disorder from the death of his sister, Undoctored is interrupted by chapters printed in bold type, each a morbid flashback to an event that afflicted Kay's mental health.
One of the most awful memories has nothing to do with the NHS, except that the trauma occurred when Kay was in New Zealand on a flying visit to do a 20-minute stand-up set (comedy at that stage was still a hobby) at a medical conference. This was, he writes, in the 'death rattle' of his medical career, and, I infer, towards the end of his marriage to the woman he had wed not so much because he was in denial about his sexuality but because he loved her, if not with 100 per cent carnality.
In the spirit of getting 'it' out of his system before buckling down to spending the rest of his life with H (as he always refers to his ex-wife in print) he had planned to have sex with a man while safely on the other end of the world. The night before the gig he visited a gay sauna. There a fortysomething took him by his arm to a dimly lit cubicle and raped him. Kay told no one until one day, over a decade later, he consulted a GP about blisters on his hands. As he was about to leave, he blurted out that he had problems around food, thought he had PTSD from his old job and, also, that he had been sexually assaulted. He started crying and the GP told him he needed to talk this through with someone.
It is such a shocking story I wonder why he put himself through the ordeal of writing, let alone publishing, it.
'I wonder that as well. It came in and out of the book many, many times. And ultimately it was because, at a basic level, if one person reads that and it helps them, then it was worth it. It's cost me nothing to write it, to publish it. I don't read my books once they're written. Generally, I'm not every day having an interview where someone asks me about it. I don't have to actively relive it, which obviously I don't like doing. But the fact that it then got published, if that then helps one person, two people, then it was the right thing to do.'
Another flashback does not feature him as a doctor at all, but as his pregnant wife's partner at an ultrasound. Kay sat next to her providing a reassuring commentary until it became obvious their baby was no longer alive. Humiliatingly, he immediately fainted. The next weeks in his job delivering babies were obviously hard and eventually he asked his consultant whether he could take some time off. The answer was, 'Really?' and Kay returned to the rota. No counselling was offered, and he says that he would have said no had he been offered any, such was the prevailing ethos.
Kay with his best writer Bafta for This Is Going to Hurt, 2023
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'There's this thing called Med Twitter. I presume there's a sort of Journo Twitter where everyone follows each other. It's about unreasonable behaviour by HR, essentially. So it might be a doctor whose fiancé is on an ITU [in intensive care], but to get compassionate leave to visit them you have to be married or a first-degree relative. My feelings about the NHS are well recorded. I think it is our greatest institution. But at the same time, I also believe it's our worst employer. I don't know if it's missing kindness or empathy or it just doesn't treat people like adults.'
Occasionally he did get help, just not from the NHS. Shaken when a one-night stand referred to him as a 'big lad', he developed an eating disorder, a kind of variation of bulimia in which he chewed crisps, biscuits, nuts and chocolates, masticated to suck out their 'goodness', and then spat out the resulting cud into toilets or a bucket in his room. He became exhausted from lack of nutrition. His skin developed eczema. His eyes hollowed. Finally, a friend chanced on the undigested remains in an 80-litre plastic bin in his bedroom, confronted him and said he needed help. He did not seek it, but did stop, for a while. Today, I can report, Kay is perfectly right-sized. Over lunch he gets only halfway through his panini, but then I get no further with mine. They are disgusting.
• My secret eating disorder, by Adam Kay
I ask whether an NHS worker suffering from any other chronic illnesses would receive help or whether it has a special blind spot for mental health.
'I think that's magnified tenfold if it's mental illness and that's why I work a lot with a charity called Doctors in Distress.'
And he was in distress, wasn't he?
'I was in distress. Not all the time, but a lot of the time, and I was a lot more distressed after I left. And now I get help. And now I'm in a good place, which is good.'
At the National Book Awards, where This Is Going to Hurt won three prizes, 2018
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But it is paradoxical that he didn't get the help when he was actually working with doctors.
'I didn't get the help. I wasn't offered the help. But it's an organisation that doesn't like to offer help. It's an organisation that traditionally says, 'You're a bloody doctor. Bloody get on with it.' And if you have to refer to your boss by their surname, it's very difficult to open up to them.'
And this is dangerous?
'It is. Correct. There is a reason that the suicide rates in the healthcare professions are higher than average. I don't know what the reason quite is, but it's undeniable that there is one. And even if no one is interested in finding out what the reason is, surely everyone should be trying to support everyone more to make that graph turn a corner.'
As well as Doctors in Distress, he works with the Laura Hyde Foundation, set up after the suicide of the nurse Laura Hyde in 2018. 'I was very low, but I never got to that place,' he says. 'But [the suicide rate] is one doctor every three weeks in the UK. I think one nurse or other healthcare professional every single week. Those numbers are unbearably high.'
And the BBC version of This Is Going to Hurt featured the suicide of a young doctor.
'That was the first scene I wrote. That was what the show was all about.'
Although he is 'not president of Matt Hancock's fan club', he does give the former Tory health secretary credit for one thing. He met him in his 'sex palace' a couple of times and pointed out there was no helpline for medical staff to call for support with their stress. A couple of months later, Hancock launched a helpdesk for doctors, expanding nationally what had been a London-only service for GPs.
'Matt Hancock is entirely responsible for that and I'm hugely grateful.'
He did not get on with Hancock's predecessor, Jeremy Hunt, and while he met the current health secretary Wes Streeting at an award ceremony and he seemed 'dead nice and smart', he finds himself edging towards the 'lazy criticism' that politicians are all the same. The NHS never heals.
• Adam Kay needles Jeremy Hunt over doctor memoir
'The NHS is definitely more of a war zone now. I wrote about the good old days, it turns out,' he says of Tony Blair's years of plenty.
He is, of course, backing the latest junior, now resident, doctors' strikes. 'Nice people are drawn to helping people and thank goodness for them. We should treasure them and we should pay them. We should give them a break room and we should let them have a fortnight off for their honeymoon and we should do all the other stuff.'
But, he adds, the doctors do not need his support, or for that matter the public's. They have a plan B, which is to work abroad, he says — and indeed the General Medical Council the day after we meet reports that one in five NHS doctors is considering either doing just that or leaving medicine completely.
'I don't know,' he says of the strikers' 29 per cent 'non-negotiable' pay claim. 'I just think it will prove good value for money to keep people alive. And there was some quite aggressive thing [Streeting] said about, you know, 'They're going to regret it if…' '
In fact he told them, 'If you go to war with us you'll lose.'
• Adam Kay's diary of a new dad: this is going to… scream!
'They're not going to regret it. They're going to leave. You're going to regret it, because they've left. And then you'll be saying, 'But I've doubled all the medical school places.' But it takes four, five, six years to be a doctor, whichever route you take. That doesn't help you with the A&E consultant who has just left, who's 15 years further on.'
In the end, the only cure for this particular physician who could not heal himself was not to emigrate but to leave the profession. It worked a treat. 'I've got a work-life balance. I don't have tragedy in my workplace. I have so much respect for the people who are still out there doing it.'
His work-life imbalance as a doctor has recently been replaced by another equation: balancing his needs and those of his children, a boy and a girl born in the United States to two separate friends of theirs, but sharing a common egg donor. He shows me on his phone a picture of Ruby and Ziggy, now both around two and a half. They are, of course, adorable, but Ruby arrived five weeks early and weighed just 4lb 6oz and Kay missed her birth (Farrell just made it).
'I sort of slightly thought I was done with labour wards… But no, she's great. They're both great. I'm dead lucky. It recalibrates life in lots of ways, doesn't it? There are these people who are right now 30 miles away, 40 miles away, whatever it is, who are more important to me than me, and are distracting me the whole time, who didn't exist three years ago. You realise how selfish you were. Although selfish isn't necessarily a bad word. It's important to look after yourself.'
And he did look after himself. By quitting, I mean.
'I did in the end, that's true. I wouldn't say I wouldn't change anything — I'd change absolutely loads. But I'm a very happy boy.'
So if there is ever a saccharine, revisionist Hollywood movie of this caustic former doctor's eventful life, we can be certain it won't be as good as the telly version of This Is Going to Hurt. At least, however, it will be entitled to deliver an unexpectedly sappy and upbeat ending. n
A Particularly Nasty Case by Adam Kay (Orion, £20) is published on August 28. To order a copy, go to timesbookshop.co.uk or call 020 3176 2935. Free standard UK P&P on online orders over £25. Special discount available for Times+ members