Adapted from Dr. Adam Kay‘s memoir of the same title, BBC One’s This is Going to Hurt (with a teleplay also written by Kay) is a sobering watch. The seven-part series documents the distressing plight of NHS doctors in the UK working for a broken healthcare system. While set in 2006, the series’ portrayal of doctors stretched thin by over-exhaustion is still chillingly relevant to this present, as seen in the staggering rates of PTSD and depression amongst NHS staff during the COVID-19 crisis and beyond.
Based on Kay’s past experiences as a junior doctor in an Obstetrics and Gynecology unit, This is Going to Hurt destroys the illusion of prestige and honor that accompanies the job. The opening scene features the arm of a bloodied fetus hanging out of a patient, followed by visuals of dead mothers, postpartum hemorrhages, and premature babies. But what is most harrowing about This is Going to Hurt is care’s ironic incompatibility with the profession that demands it.
In this narrative, success in the medical field comes at the cost of one’s humanity: the better doctors are at their jobs, the more likely they are to be complicit in perpetuating workplace abuse. Where there are profits to be raked in, compassion takes a backseat; the business of medicine is simply business. The show’s protagonist, also named Dr. Adam Kay (Ben Whishaw), is emotionally detached and sees his patients as administrative boxes to be ticked off. His fourth-wall breaks are rife with caustic jokes about them. As people who have been on the receiving end of poor medical etiquette, we may feel alienated from Adam. But this alienation is precisely what This is Going to Hurt wants us to feel. In order to succeed at being a doctor, Adam must harden himself to the horrors of the job. This apathy also affects Adam’s personal life, as he takes up extra shifts to avoid having an actual relationship with his boyfriend of two years. The workplace doesn’t need Adam to be a person – so that’s where he feels most at home.
While medical dramas like Grey’s Anatomy and Scrubs espouse a saccharine view of doctors as selfless martyrs, Dr. Kay is severely underpaid and pissed-off. But, unlike actual underpaid workers, he’s also a posh twat with a private education. Adam’s father is a doctor as well; unsurprisingly, he refuses to speak to his son. Adam’s similarly emotionally withdrawn mother, Veronique (played by Harriet Walter, who is really owning this genre of twisted moms) degrades his job as a public worker and refuses to accept his homosexuality. And the realm of the upper-classes is also really where the cruelty resides. Adam’s inability to care is intimately intertwined with his class, and This is Going to Hurt uses his character to draw an honest connection between class and successful doctors.
This is not the case for his new colleague, Dr. Shruti Acharya (Ambika Mod), a working-class Indian woman, who bears the brunt of Adam’s condescension. Adam may have been hardened by years of government ineptitude and the horrors of the medical profession, but his mistreatment of Shruti is also rooted in his class upbringing. He fails to understand why Shruti is falling apart only two months into her rotation. He tells her that she’s a rubbish doctor. He doesn’t blame the system for her distress because the system is designed by people exactly like him. This is Going to Hurt reminds us that a system designed by cruelty can only endorse cruelty as the primary means of achieving career success. In a piercing moment of regret after falling out with his partner, Adam tells his best friend, “I think I am designed to be on my own.” The world he was brought up in – the same one that runs countries and their broken hospitals – does not tolerate love.
Shruti is a character Kay created specifically for this adaptation, and her storyline condemns the medical profession’s racism and classism. Even more than in his memoir, Kay self-consciously transforms his on-screen persona into a reprehensible man to demonstrate that while doctors like Adam do suffer, they inflict greater suffering upon doctors like Shruti to maintain the hospital’s power hierarchy. Yes, Adam is traumatized by wrongly discharging a pregnant woman with pre-eclampsia due to staffing shortages. He is haunted by visions of her premature baby and his PTSD invites our empathy. But how much of Adam’s mistake can be chalked up to systemic error when he dismissed the woman’s concerns because he also saw her foremost as uneducated? Low funding leads to poor care, but the medical institution isn’t exactly invested in leveling the playing field for doctors either.
Unlike Adam, Shruti uses her rare off-work hours to check up on a patient who’s a victim of domestic abuse. She fights for her patient even when it’s apparent that the woman’s husband may retaliate against her. But Shruti’s love gradually withers away as exhaustion and overwork take their toll. The more efficient she is at her job, the less space there is for her to express genuine care.
Shruti’s luck seems to turn for the better in Episode 4, when a senior consultant, Dr. Houghton (Ashley McGuire), gives her the chance to deliver triplets. Shortly after, Shruti confesses to Houghton – who is also working-class – how lonely it is to be surrounded by privately educated doctors. She feels like a disappointment to her immigrant parents, who believe that Shruti is saving the world. Shruti needs them to believe that she is saving lives, but all she sees are patients who are left for dead as emergency lines pile up with no end in sight:
I’m lying to my parents, because they’re so proud of what they think I’ve achieved. No one tells you how upsetting it is. I feel like I’m the first doctor to have cried in the toilet…like patients almost bleed to death, and babies get sick, and a husband basically assaulted me. And everyone else is like, this is just the job. It’s not fine, is it? And where’s the support?
Shruti unburdens herself to Houghton because she expects her colleague to understand what it is like to be demeaned because of class. But Houghton’s reply is coldly dismissive: “Get over it or get out.” There is no class solidarity to be found within a system designed to erode compassion, one that demands doctors to do the same if they want to succeed in their careers. Mod’s debut performance in a dramatic role is astonishing and visceral – we watch in horror as the remnants of Shruti’s belief in the moral goodness of her work die alongside Houghton’s reply.
In Episode 6, Shruti takes Houghton’s advice to heart and treats hundreds of patients with immense skill. She is no longer the flustered and inexperienced doctor that we saw in Episode 1. But she matches her efficiency with a general apathy toward her job. Saving babies is no longer the magical moment it was when Shruti was delivering triplets; it’s simply another chore to get out of the way. She’s hacked the system. And she’s earned the respect of both Houghton and Adam, both of whom praise her for being a good doctor. But Mod imbues Shruti with an undercurrent of deep sadness that cuts through these supposedly feel-good scenes. She watches as a patient goes misunderstood because no one in the hospital speaks Hindi. When Shruti steps in, the patient looks at her with extreme gratitude: finally, someone understands him. Yet what Shruti sees is yet another instance of institutional failure, a reflection of her own loneliness as a working-class Indian woman employed by the NHS.
Shruti takes her own life on the same day she’s showered with such praise, because she sees herself turning into a Houghton or an Adam and refuses to perpetuate the cycle of abuse. Shruti’s suicide (which takes place off-screen) is a public accusation of institutional corruption, but that it eventually happened isn’t shocking. This is Going to Hurt tells viewers that a world created by Adams and Houghtons isn’t acceptable. Are we able to tell each other, though, that this shouldn’t hurt? The title of Kay’s memoir forewarns a cycle of suicidal fatalism that destroys workers like Shruti for demanding more. During her first and last fourth-wall breaks, Shruti tells us, “I’m sorry. I really did try.” It’s a cruel and heartbreaking shame doctors and nurses still utter the same words today.