Doctor-turned-comedian and writer, Adam Kay’s first book, This Is Going To Hurt, shed light on the stress, strain, and strange happenings during his time as a junior doctor. Now, he’s sharing the highs and lows of yuletides on hospital wards. But unlike Santa, the high pressure for NHS staff isn’t just for one day a year...

Adam Kay is currently doing the rounds – no longer on hospital wards as a doctor, but in theatres across the country – with a show based on his new book, Twas The Nightshift Before Christmas.

His first tour, earlier this year, drew on material from his original bestseller (1.5 million copies sold across 36 countries to date). Both books and tours are based on diaries he kept while working in the NHS from 2004 to 2010, and are as heartbreaking as they are hysterical.

“I love doing the tour,” Adam says. “The single most efficient way of getting my point across is by looking people in the eye and telling them about the NHS. Even though, technically, it’s a funny show, I’m doing it because I’ve got a message I want people to leave with.”

That message has many elements, including the importance of our healthcare system, the growing demands and reduced resources, the mental impact of trying to save lives, and dispelling myths about doctor’s workloads and motivations.

Adam Kay wearing a santa suit and hat

Photography | Charlie Clift

Spreading these messages has been a major part of Adam’s work in recent years. This Is Going To Hurt was published in 2017, following a period in which junior doctors were portrayed by the government, and some media outlets, as opportunistic for speaking out against proposed changes to working hours.

Adam’s first book was, in many ways, a ‘call to arms’ following this; a method of explaining to the widest audience possible the realities of working in the NHS, underpinned by real knowledge of doing so.

“I’ve now done the show to more than 150,000 people, and hopefully next time the junior doctors take a battering, that’s 150,000 people who might think about their healthcare staff a bit differently.”

Adam’s writing may have been intended to entertain as well as open eyes, but it’s also provided many who work in the NHS with reassurance that colleagues across the service struggle with the emotional and personal impact of the job – just as Adam did.

Pretending that we don’t need to talk about things can never be the right idea. People end up with coping mechanisms, and often they are not healthy coping mechanisms

During his time training and working as a doctor, Adam encountered sleep deprivation, a significant lack of resources in the hospital environment, and isolation from his partner, family and friends, due to the demands of the job.

However, it was ultimately the lack of acknowledgement and emotional support around traumatic incidents, and the toll this took on his mental health, that prompted Adam to leave his former career.

He didn’t share the mental strain he was under with anyone else at the time, something he regularly reflects upon. Keeping issues bottled up, he says, happens too often in frontline healthcare, and needs to stop.

“Pretending that we don’t need to talk about things can never be the right idea. People end up with coping mechanisms, and often they are not healthy coping mechanisms.”

He now regularly hears from other healthcare professionals, and the picture it paints is not a positive one. “Something that’s talked about extremely infrequently is the fact that every three weeks a doctor takes their own life. That’s beyond a tragedy, it’s a crisis.

“I had a message from a doctor about a year ago, who said two junior doctors in his hospital trust had taken their lives since he’d been working there, and he could see himself being the third if he didn’t get out or do something about it.”

There needs to be a change in how poor mental health is viewed, he insists. “Ultimately, the NHS, and every healthcare professional need to realise that you can’t look after your patients if you’re not looking after yourself. You can only look after yourself if there’s an openness about mental wellbeing.”

We need to admit we’re all human, we all make mistakes, we all get sick, and we all get sad

But it’s not just professionals that can make a difference. Adam suggests the public could show more compassion. One patient, he shares, saw him wearing a blood pressure cuff and commented: “It’s funny, you don’t think of doctors getting ill.”

“It’s crucial to think of everyone as human,” Adam laughs. “But you don’t want to think of your doctor as being too human, because humans make mistakes.

“When you’re being treated as ‘other’ by your patients, you act up to it. You play the role of ‘surgeon’ or whatever, and people can become alpha – and that’s not good because we need to admit we’re all human, we all make mistakes, we all get sick, and we all get sad.”

Adam is clear that there are systemic failings in the way that mental health is addressed – or rather not addressed – at the point of training. He’s recently spoken about the possibility of teaching students in the future, sharing the things he “would have wanted to hear” – and mental health would definitely be on his syllabus.

Adam's book 'Twas the nightshift before Christmas' book cover

Adam's book ‘Twas The Nightshift Before Christmas’ is available now

However, he’s also cautiously positive about moves being made to introduce the subject already. “There are green shoots showing,” Adam says. “They’re calling it ‘resilience training’, and I think that’s the right meaning but the wrong word, as it implies you have to be able to deal with anything.

“Maybe it’s psychological preparedness? We just need to be honest about what the job actually involves – about the bad days that accompany the good.”

As documented in Adam’s latest book, the good and bad days can happen any and every day in healthcare. Nothing trumps the demands on the NHS, and the never-ending requirement for staff to show up and help others.

This year more than 1.4 million people will be working in the NHS at Christmas time, and while we ready ourselves for the Gavin and Stacey special, they’ll be treating, operating on, and caring for patients in hospitals across the UK. And, according to Adam, there’s one simple thing we can all do to support them.

“It’s remembering that at Christmas there will be hundreds of thousands of people working in hospitals, and hopefully you’ll never have to see them, but they’re there if you need them.

“Just like giving a card to the postman, put the NHS on your list, because I found a thank you does make a real difference,” Adam says. “I still have every card patients ever gave me. I’ve thrown almost every other remnent of my time as a doctor, but I will never throw away those, because they made more of a difference to me than the people who sent them will probably ever know.”

‘Twas The Nightshift Before Christmas’ and ‘This is Going To Hurt’ (Picador) are both available now. For more information and tickets to ‘Twas The Night Before Christmas’ tour, visit