[This is one of the finalists in the 2026 book review contest, written by an ACX reader who will remain anonymous until after voting is done.
asserted
voting → write → reader
I’ll be posting about one of these a week for several months.
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I → post → months
When you’ve read them all, I’ll ask you to vote for a favorite, so remember which ones you liked
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you → read → ones
I’ve established that wine is her poison.
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wine → establish → ?
Me: ‘And how much wine do you drink per day, would you say?’
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you → drink → day
Patient: ‘On a bad day I only manage one.”
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I → manage → one
The first faces I ever saw in this world were three sweaty, anxious obstetricians, and one of them was holding the rest of me.
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one → see → me
He was assisted by my paternal grandfather, who is also a gynaecologist.
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who → assist → grandfather
My maternal grandmother, who is also a gynaecologist, was outside in the corridor doing crowd control, partly because of her people skills and mostly because the operating theatre had run out of space for elbows.
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theatre → do → elbows
I was extracted from the uterus, given the customary slap on the rump, performed the customary screaming, and resolved on the spot, somewhere below the level of conscious memory, to give the speciality a hard pass.
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I → extract → pass
I came to this through a sequence of choices that involved, at various points, an Indian medical internship, the discovery that I am fond of sleep and a predictable evening meal, and a gynaecology rotation that confirmed every prejudice the Caesarean had instilled.
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Caesarean → come → prejudice
I tell you this not to establish my credentials as such, but because Adam Kay’s This Is Going To Hurt is a book about obstetrics and gynaecology, alongside an unusually clearly documented decline in mental health, and reviewing it without naming where I’m reading it from would be a small dishonesty.
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I → tell → it
The system Kay is describing is the one I currently work inside.
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I → describe → ?
The condition he is describing in himself, although he doesn’t quite name it, is one I have seen up close in colleagues and, on at least one bad stretch, in myself.
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I → describe → myself
I will let my older, wiser, and possibly more handsome colleague take over:
uncertain
colleague → let → ?
B: That is one impressive set of credentials for reviewing this book.
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That → review → book
Thanks for the introduction, I suspect I am only one of those things.
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I → suspect → things
While my birth was not nearly as salubrious, and while I’ve never worked in the NHS, I’m a doctor who is more or less an exact contemporary of Kay (so I’m a senior doctor now), and winced along in recognition over a lot of what he says here (although, as we’ll get into, I have a dimmer view of him than you do).
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you → work → him
I think we need to set the scene for the book we’re talking about.
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we → think → book
The latter owes an obvious debt to Catch 22 with its mix of absurdity and bitterness, substituting hospital medicine for war (House of God is at its best when it can convince you that one is much like the other).
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one → owe → other
This is Going to Hurt slots nicely into this tradition: it’s ostensibly a set of diary entries rather than a novel, but it covers much of the same ground as those earlier works, has the same mix of medical anecdotes, cynicism and burnout.
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it → go → anecdotes
House of God ended with its protagonist going into psychiatry training; without spoiling too much, it’s safe to say that this wasn’t the outcome for Kay.
A: The book has been read in two dominant ways since it came out in 2017.
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it → end → 2017
The first is the heroic reading: a comedic exposé of NHS dysfunction, a love letter to overworked junior doctors, the kind of book you press into the hands of a relative who has just complained about waiting times.
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who → press → times
The second is the hostile reading, of which Tanya Gold’s essay probably counts as the ur-example: a self-indulgent memoir whose author offloads his exhaustion onto the bodies of female patients, dressed up in jokes that are funnier to him than to the women they reference.
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they → count → women
Both readings have things going for them.
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things → have → them
Both miss what I think the book actually does, and by a country mile.
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book → miss → mile
This Is Going To Hurt
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This → go → ?
is, read with a clinical eye, a textbook case study of moral injury and post-traumatic stress in a competent doctor, narrated by the patient himself, with the diagnosis hidden in plain sight.
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diagnosis → read → sight
The book is his presenting complaint.
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book → present → ?
The institution that produced him then declined to treat him, and the book is the receipt for that decline.
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book → produce → decline
Once you see the book this way, several things follow.
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things → see → book
Kay’s defenders are right about more than they realise; his critics are wrong about more than they think; and the system that broke him in 2010 is, in 2026, still producing more of him, faster.
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that → realise → him
I agree something went very wrong with Kay, and we’ll get into all the contributors to this process, culminating in the horrific event that ended his medical career.
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that → agree → career
But while I work in a similar system, I (and the readers) don’t have a good handle on the NHS so, if you would, a brief primer on the UK’s health service for the uninitiated?
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you → work → uninitiated
The National Health Service was founded in 1948 by a Welsh ex-miner turned Health Minister named Aneurin Bevan, who spent the previous decade campaigning for the proposition that nobody in a wealthy country should have to choose between treating their child’s pneumonia and paying the rent.
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nobody → found → rent
The system he built rests on three principles that have remained nominally intact for nearly eighty years: care is comprehensive, universal, and free at the point of delivery.
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care → build → delivery
You walk into a hospital.
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You → walk → hospital
They fix you.
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They → fix → you
Nobody asks for a credit card.
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Nobody → ask → card
For Americans and others only accustomed to for-profit care encountering this for the first time, the experience can feel vertiginous, like you’ve stepped into a film about the Soviet Union, except the doctors speak English and the building has running water.
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building → accustom → water
…and 546 more, not listed.
The Aporia
