During the pandemic, former doctor Adam Kay tried to return to medicine.
Now a writer and comedian — best known for his bestselling memoir This Is Going to Hurt — Kay quit his job as a junior doctor in the UK in 2010 and his name was taken off the medical register five years later.
In 2020, when the National Health Service (NHS) called out for retired and former doctors to join the fight against COVID-19, he tried to re-join the profession.
"They had this hotline, and I phoned them up, and I told them everything I'd done and when I last worked, and they said, 'Thanks very much. We'll be in touch.' And then they emailed me a couple of weeks later saying, 'No, we're fine, thanks,'" Kay recalls.
"It was very insulting. Why didn't they want a labour-ward doctor who's not worked for a decade?" he adds, with a laugh.
While Kay may have been rejected by the NHS, he's been embraced by readers and audiences around the world: He embarks on his first Australian tour this month, playing sold-out theatres across the country.
This Is Going to Hurt is the basis of his live show, and comes off the back of February's free-to-air premiere of the TV adaptation, written by Kay and starring Ben Whishaw (Skyfall; Paddington).
Published in 2017, This Is Going to Hurt is a collection of diary entries written between 2004 and 2010. They detail his experiences as a young doctor specialising in obstetrics and gynaecology (or "brats and twats"): from the first caesarean section he performed; to the strange things people insert in their vaginas; to the toll being an overworked, underpaid doctor had on his personal relationships; through to the birth complication that led him to leave medicine for good.
The memoir is a passionate defence of the NHS, which at the same time highlights the systematic issues it faces — especially in terms of the wellbeing of healthcare staff.
A memoir about a junior doctor
When Kay set out to publish his diaries, he was working as a writer on TV comedies, and had performed sections of them at the Edinburgh Fringe. He never expected the book would resonate the way it did.
"I've been blown away with its success," says Kay.
"I think people are fascinated at peeking behind the blue curtain, knowing what a doctor's life involves, and also there's clearly an innate love of disgusting stories," he says.
"That all colluded to mean that lots of people bought it."
The book has sold more than 2.5 million copies and been translated into 37 languages.
"I thought I was writing a very parochial, particular story; it was just my story," Kay says.
But he soon started to get messages from doctors, not only from similar countries like Australia, New Zealand and Canada, but from Venezuela, Chad and Belarus.
"All these people said, 'This could be set on my ward.' And I think that's when I thought, 'I think I'm onto something here,'" he says.
"Because I'd been so open, which is something that doctors traditionally don't do, I became a bit of an agony uncle for medics … I was glad that they felt they could speak to me."
Turning a memoir into a TV series
The TV adaptation of This Is Going to Hurt premiered on the BBC in the UK and on Binge in Australia in 2022. The series not only follows a junior doctor called Adam Kay — a fictionalised version of the author, played by Whishaw — but trainee doctor Shruti Acharya (Ambika Mod from One Day).
The series follows Adam as he battles professional complaints made against him — first by a patient and later by a colleague. Meanwhile Shruti struggles with her mental health and a lack of support from her colleagues and hospital administration.
"I wanted the TV show to have a point," he says.
"I wanted to focus it really firmly on the mental wellbeing of doctors. And I wanted it to be less gaggy and funny than the book, because I wanted people to lean in and take note.
"It's essentially a show about Shruti more than it is about Adam. And, sadly, Shruti is based on people who I knew."
In the UK, one doctor dies by suicide every three weeks, and a nurse takes their own life every three days.
"There can't now be many people who work in a clinical setting over here who don't know someone who's taken their own life," says Kay.
He wanted to make sure the message was not just "brushed under the carpet", as it usually is.
"I knew I'd reach a lot more people through a TV show — it got 10 million people watching that — and that's more than I'll reach in a lifetime of standing up on stage and writing books."
That means 10 million people also saw a version of Kay he cheerfully describes as an "arsehole": rude to patients and nurses, sarcastic, arrogant.
"I could have written the version where that character is a superhero, but that's very boring telly," says Kay.
"I wanted to show the pressures of the job and what that does not just to a relationship and family and friends, I wanted to see the destruction on the individual as well. It's impossible, really, to work a hundred hours a week and at the end of it be unscathed."
At the 2023 BAFTAs, the series earned Kay the award for writing for TV drama and Whishaw best leading actor. Kay dedicated his speech to junior doctors.
"I was paid 25 per cent more in real terms than junior doctors are paid today. And if the government don't sort that out, they've got the most enormous problem on their hands," he said.
Comedy during COVID
Instead of returning to the NHS during the pandemic, Kay continued to perform live comedy — or at least he tried to.
He tried Zoom gigs and even had a crack at performing at a COVID-safe event where the audience watched comedians from their cars, with their radios tuned to the right frequency.
"Instead of clapping or laughing, they would do the windscreen wipers or flash their lights. And that was so weird. It was like being a stand-up comedian car in the film Cars," he says.
"At that point, I sat it out until we were allowed into actual theatres again."
With live performances cancelled around the world, Kay says people started to realise how much they valued the arts in their lives — at the same time as casual workers in creative industries were shut off from receiving government support.
"I'm not pretending it's the same as saving a life on a labour ward. But what is life for when it's stripped of [the arts]?"
At the same time as people were watching live comedy in their lounge rooms, they were also gaining a greater appreciation for healthcare staff. In the UK, many people participated in Clap for Our Carers, where people would applaud essential workers from their doorsteps.
"COVID crystallised in everyone's mind quite how important those jobs are, and how reliant we are on these people. [Though] not enough for the government to pay them anymore," he says.
But while people may appreciate the essential work of medical professionals more, Kay points out that budgets are more stretched now than they were in 2010, and that many doctors — like him — have left the field.
"Things are a lot tougher on the wards [now]," he says.
But Kay does think the industry has improved in terms of staff wellbeing. In 2019, the government launched a dedicated 24-hour helpdesk for doctors working across the country.
"Medicine can no longer get away with totally ignoring the concept of the wellbeing of its staff. They're not doing it well enough. But at least there's like some effort being made," he says.
"It's probably a kinder place than when I was working there."
'Culturally a doctor'
It took Kay a long time before he was comfortable calling himself a "writer". Yet even though he has started to put "writer" as his occupation on forms, part of him still sees himself as who he was.
"I consider myself culturally a doctor," he says.
"A lot of my friends are doctors. I still miss working as a doctor. I've got a lot of guilt about leaving medicine. People still text me their rashes. But I'm not a doctor. The reason that I applied to medicine in the first place to help people hasn't gone away: I've still got that in me somewhere."
He loves to perform on stage, and describes his live shows as a mix of stand-up and storytelling. What he loves even more is sitting at a table after a show signing books and talking to people — something he'll be doing on his Australian tour.
Usually, audiences approach him and say things like "This book helped me through this patch", or "This book put my child off studying medicine."
But recently his audiences in the UK have started to tell him a new story.
"I've had people come up to me, saying, 'You're not going to remember this person, but you delivered them 17 years ago.' Which is quite wild," he says.
"But it's also quite a good business model, isn't it: delivering your own audience."
Adam Kay: This Is Going to Hurt is at Melbourne International Comedy Festival from April 16-21, before touring to Sydney Comedy Festival, Brisbane Comedy Festival and Perth Comedy Festival.