Last winter the UK’s National Health Service faced a ‘humanitarian crisis’ with two patients dying on trolleys in hospital corridors and the British Red Cross having to be called in (Campbell, Morris & Marsh 2017). Two books published by junior doctors last year give an insider perspective on this crisis, which was not an isolated one, with 50,000 elective surgeries being cancelled this winter against repeated pressures.
Despite the ongoing nature of the crisis, claims by staff that working conditions are like ‘something out of a war zone’ are often dismissed by politicians as hyperbolic and as an insulting equivalence to actual victims of conflict (Marsh, 2018). Rachel Clarke, a former journalist turned junior doctor, opens her book by arguing that these equivalences are anything but false, suggesting that her first night alone on call in a hospital was much more frightening for her than being caught in crossfire when reporting on the Congolese Civil War.
Clarke’s Your Life in My Hands: A Junior Doctor’s Story (2017) offers a first-hand look at life working in a health service stretched to its limits that cuts through the political spin. The book follows Clarke through her medical training to her specialization in palliative care, occasionally drawing from her past in order to explain both her medical and political proclivity (her parents both worked in the NHS and she once staged an effective sit-in protest against unequal use of the swimming pool in school). Despite the autobiographical nature of the work however, it is the political that is the main driving force. Clarke’s background as a journalist certainly serves as an advantage here, as she is able to weave a story that is both engaging on an emotional level and considered and authoritative at the same time.
One of the main events that the book circles around is the dispute between Health Secretary Jeremy Hunt and junior doctors over the imposition of a new contract to help achieve his vision of a fully operational seven day NHS. This contract was rejected due to a lack of extra resources needed to implement it safely and efficiently and the risk this posed to patients, which seemed sensible, given that Hunt’s reasoning for this contract was to combat the so-called Weekend Effect.[1] This dispute led to the first all-out strike of junior doctors in forty years.
In Your Life in My Hands Clarke discusses her own political awakening and involvement with the strike, including her new found obsession with social media and hash tag campaigns[2], her appearances in the media, the overwhelming support of patients and the public, and even finding herself camping out in a tent outside the Department of Health building. Clarke also offers a unique perspective on proceedings by reflecting on the gender pay cap in the new contract in which a government assessment suggested that the ‘impact on women’s pay was a “proportionate” means to an end’ (Cooper, 2016). The new contract was seen to be particularly damaging to single mothers. Although not single herself, Clarke does detail the difficulties of balancing motherhood with her job, due to the mounting costs of child care meaning that she is financially better off not working, as well as the effect of the inflexibility and long hours. Amongst all the political acts of blaming that took place surrounding increased pressures on the NHS, one of the most absurd that Clarke comments upon is a councilor for the UK Impendence Party (UKIP) producing leaflets blaming the crisis on an influx of female doctors to the profession, who would then have children and only work part time.
Adam Kay’s This is Going to Hurt: Secret Diaries of a Junior Doctor (2017) takes a somewhat different approach to Clarke. The book consists of short pithy diary entries that instantly betray Kay’s new post-medical career as a TV comedy writer. They are often structured like jokes with a punch line that possibly takes an artistic approach to the truth. Kay’s overall tone and attitude is quite reminiscent of Samuel Shem’s semi-autobiographical novel The House of God, which dealt with the brutality and cruelty of training in American medicine. In Shem’s book patients were often referred to as ‘gomers’, seen as an inconvenience, neglected, or even treated cruelly, although this was later recognized as a critique of the dehumanizing effects of medicine on the doctor AND the patient, as well as the ideological and economic considerations of the American healthcare system.
Kay’s humor is often leveled at the follies, sense of entitlement, and strangeness of his patients, but neither are fellow staff members and the institution of medicine itself left unscathed. This humor works to show that even “the best job in the world” over time becomes just another job, with its annoyances, bureaucracies , and absurdities.
At the same time the book is peppered with moments of genuine affection and absolute horror. Kay is genuinely passionate about his patients, cherishing his thank you cards from them in a profession that rarely praises its workers, and staying after his shifts to check on patients. He also talks of the immense pressures he faced in grotesque, realistic, and emotionally wrought detail, with one particularly traumatic experience with the death of a patient causing him to eventually quit the profession for good.
In contrast to Clarke’s book however, Kay’s is not nearly as political, as it comes pre-junior doctors strike. It does however end with the scathing open letter to Jeremy Hunt that got picked up in the press and granted him a dissatisfying audience with the man himself. Although both books offer a uniquely human perspective of medicine, allowing space for anger, fear, mistakes, and flaws, it is Your Life in My Hands that serves as essential reading to understand the current state of the NHS. Against an ideological backdrop of chronic underfunding, creeping privatization, and spin, Clarke’s book is a call to arms that understands that medicine must be refigured as both human and political practice. If you have someone, a family member, a friend, who does not believe what is happening to the NHS and why, Clarke’s book is a good as place as any to start.
[1] The increased risk of patients dying on weekends due to lack of staff, which has been disputed on a number of occasions.
[2] #ImAtWorkJeremy being a particular favorite that was used to highlight the fact that a large number of junior doctors already worked weekends
References and further reading
Campbell, Denis, Morris, Steven & Marsh, Sarah. “NHS faces ‘humanitarian crisis’ as demand rises, British Red Cross warns”. The Guardian. 6 Jan 2017. https://www.theguardian.com/society/2017/jan/06/nhs-faces-humanitarian-crisis-rising-demand-british-red-cross
Clarke, Rachel. Your Life in My Hands: A Junior Doctor’s Story. 2017. Metro Publishing. London.
Cooper, Charlie. “Junior doctors outraged over new contract that ‘discriminates against single women'”. The Independent. 1 April 2016. http://www.independent.co.uk/news/uk/politics/junior-doctors-outraged-over-new-contract-that-discriminates-against-single-women-a6963356.html
Marsh, Sarah. “NHS winter crisis: hospital ‘felt like something out of a war zone'”. The Guardian. 11 Jan 2018. https://www.theguardian.com/society/2018/jan/11/nhs-winter-crisis-hospital-felt-like-something-out-of-a-war-zone
Kay, Adam. This is Going to Hurt: Secret Diaries of a Junior Doctor. 2017. Picador. London.
Shem, Samuel. The House of God. 1998. Black Swan. London.
