This is Going to Hurt— BBC drama based on the book by Adam Kay. Currently available in the UK on the BBC iPlayer
The tone of This is going to hurt unfolds with its foreground, a close-up of young doctor Adam (Ben Whishaw) asleep in his car. The camera angle straightens as Adam wakes up uncomfortably in the front seat where he fell asleep in the hospital parking lot instead of driving home.
With its continuous background noise and camera movements, skipped cuts and unflinching details of medical procedures, This is going to hurt depicts the daily carnage and chaos of a National Health Service (NHS) obstetrics and gynecology ward, Obs and Gynae, or “kids and pussies,” as Adam puts it in one of many direct addresses to the camera.
The series is adapted from the bestseller, It’s Gonna Hurt: Diaries of a Young Doctorby Adam Kay, based on his own experience in the NHS between 2004 and 2010. Its gritty realism showing the relentless pressures on NHS staff has been well received by NHS workers and the public.
Kay’s book sold over a million copies after it was published by Picador in 2017 and it has remained on the Sunday time bestseller list for over eight months. It became a political event, with thousands attending kick-off meetings across the UK.
The television adaptation follows junior physician Adam, temporarily assigned as an assistant clerk in the Obstetrics and Gynecology Department. Adam goes out of his way to impress the consultant, Mr. Lockhart (Alex Jennings), who drives an expensive car and manages to get home on time.
Adam, on the other hand, who takes more shifts and “volunteering” to return to the hospital regularly, misses more social engagements than he actually does. This includes his best friend’s bachelor party, which he was supposed to have planned. This is the life of a young doctor.
Ben Whishaw delivers a sometimes heartbreaking performance as Adam. It’s sometimes easy to dislike him for his rudeness and flippancy to colleagues and patients. His apparent coldness and his sense of entitlement attract criticism, both professional and personal. But there’s clearly an element of self-defense involved in his “gallows humor” and it’s much easier to empathize with him – permanently exhausted, irritable and short on time to do anything, including sleep. We can feel his misery at the fate of an NHS system that keeps him working in dire and often dangerous circumstances.
Central to the storyline are the flashbacks Adam experiences after delivering a premature baby, failing to identify the mother’s condition. Obviously suffering from PTSD, Adam arranges to visit the baby and reveal his thoughts and feelings to him rather than to his long-suffering boyfriend Harry.
The child’s mother (Hannah Onslow), spurred on by her sister, sues Adam for his failure to properly diagnose her. This further increases Adam’s stress, leading to his frequent outbursts of tears, anger, and ultimately depression.
Some of the program’s comedic moments are particularly effective for their swiping at government bureaucratic stupidity and hypocrisy. Chief midwife Tracy (Michele Austin) and other staff are forced to take a ‘language in health care’ course of the type inaugurated by Tony Blair’s new Labor government (1997-2007) when even as he continued the assault on the NHS. Instructed that their patients are now to be referred to as ‘clients’, Tracy asks, ‘What does that make us? The prostitutes?”
Later, when asked about the preferred language for “birth defect”, Tracy replies, “We don’t have a working printer in our ward – we’ve had a ceiling leak for over four years and that’s what are they spending the money on?’ His remark summed up the frustrations of staff whose goodwill and humanity have supported the NHS for years.
The wild inequalities in healthcare delivery are illustrated in episode six when Adam lands a shift at an exclusive private hospital in London. Its elegant Georgian facade, opulent lobby, silver service menu and eerie calm form a stark contrast to the manic chaos of life on the NHS ward. But a medical emergency soon reveals the hospital’s shortcomings, reminding Adam of the supreme value of collective expertise and resources embodied by the public system.
Alongside Adam is another young doctor, Shruti (played by actor and comedian Ambika Mod), who is at the start of her career in Obs and Gynae. We see her constantly studying for exams, in addition to grueling shifts following Adam and trying to learn on the job. The pressure is constant, with Adam frequently telling her “Watch one, make one, teach one”.
Shruti, from a working-class family, turns to the larger-than-life Miss Houghton (Ashley McGuire), the only consultant from a similar background, to try to forge a mentor relationship. When Shruti asks what support is available to help her deal with stress at work, Miss Houghton, not with hostility but in an attempt at “tough love”, tells her that she can either accept the realities of work or exit.
Things end tragically. Ambika Mod’s moving performance as Shruti lives with the viewer long after.
In the last episode, Adam explains in monologue that “an NHS doctor commits suicide every three weeks”. In the first six months of 2020, the period that includes the start of the pandemic, 64 healthcare workers took their own lives, according to data from the Office for National Statistics. During the same period, 226 nurses, 79 paramedics and paramedics and 17 medical students attempted to end their lives, according to the Laura Hyde Foundation (LHF) named after a nurse who took her own life in 2016 .
Adam Kay resigned from the NHS in 2010, traumatized by the impending death of a patient after earlier diagnostic failures. He published his book in direct response to then-Health Secretary Jeremy Hunt’s claim during the junior doctors’ 2016 contract dispute that they were ‘greedy’.
From January 2016 young doctors, members of the British Medical Association (BMA), voted 98% to strike against the imposition of a new contract which reduced payments for unsocial hours and lifted safeguards against excessive hours, one of the issues addressed. so tragically in the series. It was the first time in more than 40 years that young doctors took industrial action over their pay and conditions.
As the WorldSocialistWebSite reported, throughout that year, that “junior doctors – all those without the rank of consultant – fought determinedly to oppose the contract, going on strike five times in the face of a media campaign right wing aimed at demonizing them for daring to oppose the destruction of their jobs, terms and conditions. Opposing a relentless battery of government-led propaganda, they launched the first all-out strike, without emergency cover, in the nearly 70-year history of the NHS.
Their courageous stand was betrayed by the BMA. With 15 days of strikes scheduled for October, November and December 2016, the BMA abruptly called off all action at the end of September, allowing the Conservative government to impose a vastly inferior contract with bitter repercussions.
This is going to hurt depicts NHS staff pushed to their limits during the years of the Labor government of Tony Blair and Gordon Brown. Things have only gotten worse since then.
Wage freezes, long and unsociable hours and chronic underfunding had taken their toll long before the pandemic. COVID-19 has turned hospitals into a war zone, with around 400 staff leaving the NHS every week in 2021, citing burnout, poor work-life balance and poverty pay.
The experiences described in This is going to hurt are a daily reality for millions of healthcare workers and patients, testimony to an irrational social order that puts profits ahead of lives. Adam Kay, program directors Lucy Forbes and Tom Kingsley, and his talented cast including Ben Wishaw and Ambika Mod, are to be commended for their heartfelt portrayal.
But for all its obvious fury at the conditions endured by staff and patients, the series ends on a note of obvious frustration in Adam Kay’s personal decision to leave the profession. When Adam asks if there will be an inquiry into the circumstances surrounding Shruti’s fate, Miss Houghton replies: “This hospital has about three doctors and a budget of £12.50. If you want to change that, become a government minister, because there’s bullshit – anything any of us can do here.
However, opposition to the intolerable situation in the NHS and health systems around the world is growing. The central problem facing healthcare workers is the suppression of such sentiment by healthcare unions and the Labor Party. The necessary response can only come in a direct fight against such false friends who are as committed to the defense of capitalism, profit and private health as the conservatives.