This is Going to Hurt, Unless You Tell Yourself It Won’t
I’m late to the party with This Is Going to Hurt, but as usual when late to parties, I didn’t regret it.
What a fantastic adaptation. Bold, sharp, magnificently acted, edited to the point where the jarring emotional juxtapositions feel somehow coherent, and funnier than anything I’ve seen on the BBC since The Thick of It. That might all sound a bit hyperbolic, but in fact, the only part where I’m stretching the truth here is when I describe it as an adaptation.
Because it’s only tangentially linked to the omnipresent bestselling book, which beams its electric blue and yellow into every Waterstones in the country 50 times over. For a start, it tones down the vivid blue to a considerably darker shade. The book is bleak at times and ends with the traumatic double-death of a mother and baby, but by and large, it’s a snigger-into-your-scarf collection of anecdotes with a political edge. The TV series is something else entirely: something much more harsh and cutting, more acerbic and offensive, much more cynical, and the oh-well-let’s-just-sort-of-get-on-with-it-then Britishness of the book is pretty much absent.
This is most obvious in the interrelationships between the staff: it’s been years since I read the book, but I’m pretty sure the vast majority of main characters are new inventions. Many are comic; the most important are tragic. In particular, Shruti, Adam’s trainee/understudy who emerges from quiescence to steal the show, is treated like shit by Adam. Reassuring Tracy, who we recognise as the standard tough-but-with-a-heart-of-gold matriarch, turns out to be far from the supportive mentor which audiences have been trained to expect when they meet such a character.
None of the characters are particularly likeable; none of this has a disneyfied edge. As one reviewer pointed out, Adam seethes at the detached neglect he receives from his superior, Mr Lockhart, before turning around and snapping at every inferior he can find, proving that in this food chain, lion cubs inevitably grow into lions. Adam is not just sassy to his colleagues (although sass is hardly in short supply), he is cruel to them, along with his boyfriend, his friends and his mother (all of whom are magnificently acted, by the way). It’s almost unique to have a show with so few redeemable characters; a show so uninterested in redemption. During the final episode, when Adam wriggles out of a complaint tribunal by telling the most heinous of lies, there is no question that we should have no empathy for him whatsoever, and yet we do. How could we not? People like him are heroes, and this is what heroism actually looks like.
Something has changed since Adam Kay published the book, back in the halcyon days of 2017. It’s likely one of two things. Either Kay was gently forced by his publisher to write a book with more bumbling anecdotes and less inhumanity, and he wanted to write something darker all along. Or, Kay has seen the way in which the NHS has suffered in the past five years and decided on a more confrontational approach. It’s likely a bit of both.
The reason everyone is so awful in This Is Going To Hurt, in a word, is trauma. Adam’s botched caesarean section in episode one ripples throughout every successive episode, usually just before he lashes out at someone. However, the issue of trauma itself is never directly confronted in Adam’s story; the most direct conversation about it is between Shruti and her own mentor, Miss Houghton. Over a glass of wine, she essentially says, “It’s not going to get any better. If you can’t hack it, get out.”
She’s right, of course, despite the horrible consequences of that moment. Yet how could anyone possibly hack it? Blood and shit and bile, and by the end of your career, “a busload of dead babies with your name on it.” Who could cope with that?
But then, trauma’s a funny thing.
There’s a moment that anyone who’s ever looked after a toddler will recognise. When said toddler falls over, there’s an instant where the shock of the fall registers, and they decide, literally decide, whether to burst into tears or not. Reacting fast, agile, the parents and carers surround the toddler with smiles and laughter, or desperate distractions — “Look, Tabatha, a leaf!” — and if they do a good enough job, the child stops crying. Just forgets all about it. A tantrum which could last for half an hour is gone with the wind.
Sometimes I think trauma is a little like that.
I’m venturing into armchair psychology here, I know that. But it’s time to fess up that I think about this all the time. Whenever I read history books, for example, I just can’t comprehend what a bloody awful, brutal spectacle the history of humanity has been. For the average Tom, Dick or Harry from the middle ages, who’s lost six of his brothers to dysentery, his father to bubonic plague, his first love because she got pregnant and died, and his aunt because she sneezed funny one time and was burned at the stake for witchcraft, how can he not be traumatised beyond belief? How can anyone have gone about their daily lives under the weight of such trauma?
The answer seems to be that it was normal. Or more specifically, it was sociologically accepted to be normal. Ultimately, our responses to events are down to how our brains interpret them, in both an immediate and a long-term sense, and a big part of how we interpret things is how we’re taught, by others and by society as a whole, to interpret them.
I think lots of us have some small degree of trauma from the pandemic. At the moment, looking through Instagram at the horrendous treatment of Shanghai residents and remembering the long April days of isolation, I feel a slight spasm of anxiety. Only slight — but it’s there. But if I wasn’t hearing traumatic stories of the pandemic from friends and family members left right and centre, and if I wasn’t reading about the worst of the pandemic on twitter, would I feel the same way?
To be clear, I’m not saying that trauma doesn’t stem from individual responses to stimuli; I’m just saying that our responses are hugely magnified, or diminished, based on the influences of those around us.
Staying on the pandemic theme: is the nation of the USA traumatised by coronavirus? I think it’s fair to say the answer is: a little bit, yes. Many loved ones lost, many shortages, the sight of morgue trucks stacked with bodies on the streets of New York City. But a far more traumatic event, 20 years before, will forever be associated with New York City. You know it without me even needing to write out those three numbers; you know it because it spectacularly traumatised the whole country. Now, this is justified, of course, as 3,000 died violent deaths that day. But almost a million Americans died of the virus — you probably heard the expression “one 9/11 every day” to describe the severity of the pandemic at its peak. Americans are much, much more likely to have known someone to die of Covid than on September 11th, yet it is 9/11 which undoubtedly holds the greater national trauma for Americans. Every American I edited at work that week came back with personal stories of their own individual recollection of that day’s events. Why? Because, for a variety of socioeconomic reasons, they were told to be traumatised by the politico-media complex. To emphasise: this does not mean the trauma is invalid, or wrong, or invented. It just means it has been magnified.
This system works in reverse, too — people and nations can be told not to be traumatised by something. The relationship between the United Kingdom and the Republic of Ireland, has been, let’s say, complex over the last century. And yet while every Irish child knows the history of the home rule debate, the potato famine, The Troubles and the IRA, most British kids don’t have a clue. Of course we don’t — we weren’t taught it, by our teachers or our media or our parents. When I went to uni and to China and came into contact with Irish people, I held no more pre-conceived notions than I would have if I’d met a French person. That is to say, a few stereotypical ideas, a vague notion of past battles, but nothing concrete; certainly nothing which would affect my behaviour towards them. For them, though, the situation was different. They weren’t traumatised as such, but they had an awareness of the national trauma that past events had caused, and that had an impact. It was news to me when, aged 21, I learned about the IRA bombing campaigns in my country, some of which lasted into my lifetime. My generation of British kids were simply not exposed to the any sort of trauma from these events — but you can bet that if it had been politically expedient, the British education system would’ve inculcated a suspicion of the Irish.
Bringing it back, slightly desperately, to where I began: doctors. How do doctors cope with the death and pain which surrounds them? They tell themselves, and I expect each other, that this is normal. But it’s not, and it’s certainly not in the horrific conditions of the modern NHS. So, a protective shield of community acceptance is erected over every hospital — an invisible bubble which separates the middle-ages mentality from the sheltered world of the rest of us. For a lot of medical staff, this is enough — they can see things on a daily basis which would traumatise us for decades and remain unaffected. But for others, it isn’t enough, and the culture of This is Fine, This is Normal fails. Some trauma slips through, or one specific event hits home, as with Adam Kay himself, and they have to leave medicine. And as the TV adaptation shows, they can quit in more ways than one.
We can never thank medical staff enough. And we never will.
