As his new memoir comes out, the author of This is Going to Hurt opens up about marital secrets, lies, politics, and fending off the critics
Follow-up memoirs can be tricky. After a certain number of instalments the autobiographer, however successful and skilled, can run out of anecdotal road. This is not a problem for Adam Kay. While his new book, Undoctored, returns to many of the themes of his multi-million selling debut, This is Going to Hurt, and the subsequent Twas the Nightshift before Christmas, and sparkles with the same bawdy wit , it is even more personal than its predecessors.
“I’m absolutely terrified for this book, to be honest,” Kay tells me in a Zoom interview from Edinburgh, where he is performing. “Because I’m telling all this stuff to people I don’t know. It’s a very strange feeling but I know it’s the right thing to do. I’ve spent a lifetime bottling stuff up.”
A huge part of the appeal of Kay’s writing is his ability to oscillate quickly between comedy and tragedy. In Undoctored there are laughs in even the darkest moments. Injury, trauma and grief are mined for comedy. But there is one chapter in which what he calls “the armour” of his wit, for once, fails him.
It takes place in a period that was pivotal in his life. He was beginning the transition from medicine to comedy and was offered a gig in New Zealand. His then-wife pointed out it would be hardly worth the hassle. By the time the travel times were factored in the fee would work out as barely minimum wage, she pointed out. But Kay had another secret motivation. He had decided to cheat. He wanted to have sex with a man one more time before “moving on with my nice normal straight life”.
And so he took the plane to New Zealand and soon after arriving went to a gay sauna. He gave a fake name and wrapped himself in the little towel they had given him at reception. Inside he found half a dozen naked men, and, as he was wondering what the chat-up protocol was, one of them approached him, took him by the arm to a cubicle, and raped him. Kay repeatedly said no. He tried to scream but knew that nobody would hear him over the pounding music. Instead he counted his own pulse and focused on the certainty that this terrible assault would eventually end.
Afterwards he went back to his hotel and slept in his clothes. He knew he couldn’t report the crime as then he would be forced to stay in New Zealand and would have to explain to his wife. He somehow managed to put a brave face on and struggled through the gig. He flew home immediately afterward.
His emotions were “impossible to process”. He wondered if the attack had been some kind of divine punishment for his “dishonesty and depravity”. He now had to deal with the trauma and “a terrible secret I couldn’t share”.
Back home he underwent STI checks and had to rebuff his wife’s attempts at intimacy. “I don’t think I’d ever known the true meaning of loneliness until then,” he writes in the book. “Who could I trust to under-react, to hide their shock, or be sympathetic and non-judgmental.”
“It was just horrible,” he says now, of the period that followed. “It was like you know when you wake up in the morning and there’s something on your mind, whatever it is, whether it’s the tax bill or the vet’s visit or whatever? And it takes you a moment to remember what it is... And then it hits you.
"I just had that feeling for f**king ages. And I made things worse by not talking to the people in my life, not talking to professionals. I just felt hollowed out. Humour is something that’s important to me but there’s no making light of that [rape].”
Kay eventually “blew up” his marriage, divorced from his wife and lost almost all of their mutual friends after the split. Around the same time he also decided to call time on his medical career. This was a difficult and momentous decision for him – he tells me he “still struggles with the guilt”. As the son of a GP, and with two other siblings who are doctors, medicine was always his professional destiny.
Growing up, he was a “nerdy” and academic child who “worked hard and was always keen to please”. He attended the all-boys’ public school Dulwich College, graduating in 1997, and Imperial College London, where he read medicine and graduated in 2004.
During his student years he developed an eating disorder, after one of his conquests remarked that he was a “big boy”. Kay would chew food without swallowing it and throw it into the bin in his bedroom, hundreds of times a day. He became obsessive about his weight, and trapped in a cycle of “reassurance, shame, success, failure; another unwitting enabler making the mistake of telling me how well I was looking”.
One of the reasons he wrote the first book, as well as this one, is the reluctance of doctors to seek help when they are struggling with their mental health, but he says that in the years since he developed the eating disorder he has sought treatment for his mental health issues.
“All of the big stuff I talk about, that will be the first time I’ve talked to lots of important people in my life about it. But the difference now is, I’m speaking to people who are professionals at dealing with this. I mean, I’m still not a great patient. I’m still always looking for an excuse not to go to my sessions, but they do help.”
The long hours, relatively low pay and the culture of “teaching by humiliation, teaching by bullying” ground Kay down, but he ploughed on and eventually ended up on track to become a consultant in obstetrics and gynaecology.
He struggled with PTSD after a delivery he was in charge of went badly wrong because the mother had an undiagnosed placenta praevia – which is when the placenta attaches to the lower part of the mother’s womb. It resulted in the child being stillborn and the mother going into an intensive care unit
after losing 12 litres of blood.
To the horror of friends, his parents and colleagues (the rumour would later go around that he had suffered a nervous breakdown), he decided to walk away from this permanent and pensionable job and begin “fracking my only other discernible talent” – comedy. To begin with it was anything but a meteoric rise and the new book is remorseless in depicting the unglamorous drives, unreceptive audiences and motorway sandwiches, but there was an element of catharsis to it all.
“My PTSD, if that’s what it was, whether it was technically that or something like that, stopped when I started reading out my diaries on stage. I noticed over the months after that, there was a change and I was like a one-man experiment. And the idea that talking about stuff actually helped unlearn what was drummed into me.”
At Edinburgh Fringe, where he read the diaries out, a publisher was in the audience and offered him a deal to bring out the diaries as a book. This is Going to Hurt was published in September 2017 and instantly became a bestseller. Its success seemed to pre-empt the groundswell of appreciation for frontline staff that we saw during the pandemic.
“I got message after message from doctors all over the world saying, ‘I thought I was the only doctor who’d ever cried in the locker room or cried on the toilet,’” Kay says. “Because at the end of that book, I wrote something I was uncomfortable about writing, about being so open and honest about that case.
"And it resonated and people said they felt like they were failing less or felt less isolated in that position, because they realised they weren’t the only person.”
And yet there were some that took issue with Kay’s approach, particularly when the book was adapted for a BBC series of the same name.
The new book recounts the president of a medical college responding to a speech Kay gave with the words: ‘Thank you for this Adam. I think it’s important for me to add that this is, of course, not everyone’s experience. What I mean is... not everyone is cut out for the job.’ Meanwhile, British journalist Tanya Gold wrote: “The memoir is riven with self-hatred, and hatred for female bodies. It contributes to the already swollen canon of female shame. Its gaze is so masculine the TV show had to invent a leading female character out of nothing, for balance.”
Kay says he was surprised at some of the criticism, particularly since the show was made by a largely female team – both its director and producer were women.
“The idea of the show was a deliberately unlikeable protagonist dealing with an impossible job, through his sense of humour,” he says. “I suspect some people thought that I was glorifying or glamorising being a dickhead, a HR nightmare. Whereas I suspect that some people only watched the first episode and then didn’t see how every single bad action this person did exploded his life, and rightly so.”
Of the criticism that the series was not centred on patients, he adds, “This was a show deliberately written as about the healthcare professionals. Because there’s a thousand shows which are all about the patient story. I’m the wrong person to write about the experience of a patient on labour wards.”
And there was no doubt that Kay’s work had a huge cultural impact, to the point where successive British health secretaries, Jeremy Hunt and Matt Hancock, invited him to speak to them. Kay wasn’t especially impressed by either – Hancock seems to have tried to tame him, asking Kay to remove a tweet he’d written – but the author says that it’s systemic problems in the political system, rather than personalities, which are at the root of failure to bring about meaningful healthcare reform.
“The bigger problem is the fact that politicians are more concerned by their electoral cycle and their re-electability and what policy is going to wash the best with whoever’s going to be voting for them, than the actual department they’re looking after.
"I’ve no idea how it would work and I know I’m not the first person to think of this and it’s out of my intellectual league, but there has to be a way of taking something so fundamental as healthcare away from political decisions.”
After their terms are up, “politicians move on and get their well-paid job in some pharmaceutical company that they’ve previously helped. It just all stinks. Meeting politicians did nothing to endear me to politicians.”
In conversation there appears to be a bit of a disconnect between the wisecracking persona of the page and the rather vulnerable-seeming person whose answers come unadorned of jokes. The new book makes frequent references to his social awkwardness, something that’s hard to tally with his comedic confidence.
“I wish I wasn’t [so different in print and in real life] but I think the real me is more on the page,” he says. “I think I do less pretending on the page, I’ve always been able to be totally honest with my diarising. You learn to put on a show in real life. I mean, part of being a doctor is acting the part. I’ve always been happy to do a funny line at my own expense.”
Now 42, and remarried to James Farrell, a TV producer who worked on the adaptation of This is Going to Hurt, he seems in a better place than the rather tortured subject of his memoir. His parents have both told him they’re proud of him (“Although if I phoned my mum to say, ‘Oh while I’m up here, I’m going to do a locum shift as an obs and gynae registrar,’ she would squeal so loudly, you’d be able to hear it across Edinburgh”). And he has, belatedly, found contentment, even if replicating the “highs and lows” of medicine is hard.
“I’m the happiest that I’ve ever been. I can’t pretend that what I’m doing now is anything other than a thousand steps removed from delivering a baby on a labour ward. But I feel by luring people in with funny stories I can maybe also convince them that the most important thing is that they look after themselves.”
‘Undoctored: The Story of a Medic Who Ran Out of Patients’ by Adam Kay is published by Hachette and out now