Blood. You expect the blood. But they never tell you about the screaming. The moaning in agony, the anguished cries, the desperate pleas for mercy, death even. Thankfully, I managed to pick myself up after that first gig…
At first I didn’t feel there was much crossover between my former life as a junior doctor and that of a comedian. If I made a mess of a joke, or a gig, I could learn from it and just hope the audience from that night either developed collective amnesia or all moved away to a town with no internet connection. Make a mistake as a junior doctor and the stakes were considerably higher – and my reputation would be low on the long list of things I’d be mopping up.
The parallels soon declared themselves though, the terrible hours for one. As a doctor, I was more than once so tired after a nightmarish nightshift that I found myself being honked awake by other cars when I’d dozed off at traffic lights. This was replaced with coming off stage in Durham at midnight and driving back to London, wide-eyed and seeing mirages of my duvet.
Then there are the tough crowds: no amount of audience heckling could throw me off my stride after half a decade of relatives threatening to break my legs because there’s no hospital bed available yet, or patients screaming that I’m a c**t while I’m patiently trying to deliver their babies.
In the seven years since I left medicine, I’ve pivoted careers once again – this time swapping the stage for the comparatively civilised life of a TV comedy writer. But while I’ve closed the curtain on the hecklers (save for the Twitter army when any TV shows air), it encroaches as much on my personal life as performing comedy or medicine ever did. Or in truth, eradicates it entirely – as I sit hunched over my laptop while the rest of the world picnics in the park or has a birthday.
In both writing and medicine, friends tend to struggle to quite understand why you had to cancel on them – they don’t understand what either job really involves. The writer’s words effortlessly appear on the page. The doctor can always leave when they intend to. Thirty years of Casualty have given rise to the idea that, as long as you have the right incidental music, any medical emergency can be patched up before the News at Ten. The reality was often the choice between cancelling dinner or letting a patient die, which is of course no choice at all.
The main difference, obviously, is that a bad day at the office when you’re working on the labour ward is a disaster that will stay with you for years to come. As a comedian or a writer, however, it really doesn’t matter. The slate is wiped clean and you can start again – safe in the knowledge that this time, only your jokes have died, and they’ll one day rise again on another script or another stage. In Durham, doubtless. At midnight.
Adam Kay was a junior doctor from 2004 until 2010. He is now an author, an award-winning comedian and writer for TV and film. His book This is Going to Hurt: Secret Diaries of a Junior Doctor, published by Picador in hardback and ebook, is out now
See below for extracts from This Is Going To Hurt
October 17, 2004
To give myself a bit of credit, I didn’t panic when the patient I was reviewing on the ward unexpectedly started hosing enormous quantities of blood out of his mouth and onto my shirt. To give myself no credit what- soever, I didn’t know what else to do. I asked the nearest nurse to get Hugo, my registrar, who was on the next ward, and meantime I put in a Venflon* and ran some fluids. Hugo arrived before I could do anything else, which was handy as I was completely out of ideas by that point. Start looking for the patient’s stopcock? Shove loads of kitchen roll down his throat? Float some basil in it and declare it gazpacho?
Hugo diagnosed oesophageal varices,† which made sense as the patient was the colour of Homer Simpson – from the early series, when the contrast was much more extreme and everyone looked like a cave painting – and tried to control the bleeding with a Sengstacken tube. As the patient flailed around, resisting this awful thing going down his throat, the blood jetted every- where: on me, on Hugo, on the walls, curtains, ceiling. It was like a particularly avant-garde episode of Changing Rooms. The sound was the worst part. With every breath the poor man took you could hear the blood sucking down into his lungs, choking him.
By the time the tube was inserted, he’d stopped bleed- ing. Bleeding always stops eventually, and this was for the saddest reason. Hugo pronounced the patient’s death, wrote up the notes and asked the nurse to inform the family. I peeled off my blood-soaked clothes and we silently changed into scrubs for the rest of the shift. So there we go, the first death I’ve ever witnessed and every bit as horrific as it could possibly have been. Nothing romantic or beautiful about it. That sound. Hugo took me outside for a cigarette – we both desperately needed one after that. And I’d never smoked before.
July 7, 2005
Terrorist atrocities across London, major incident declared, all doctors told to report to A&E. My responsibility was to go round the surgical wards and discharge any patient whose life or limb wasn’t in immediate danger, to clear the decks for new arrivals from the bombings. I was like a snowplough with a stethoscope – booting out anyone who got to the third syllable of ‘malingerer’ without passing out or cough- ing up blood. Got rid of hundreds of the bed-blocking fuckers.
July 13, 2005
The hospital didn’t receive any casualties, and with no patients I’ve basically done no work for a week.
March 22, 2006
Three a.m. attendance at labour ward triage. Patient RO is twenty-five years old and thirty weeks into her first pregnancy. She complains of a large number of painless spots on her tongue. Diagnosis: taste buds.