Up until rather recently, the history of gynecological health was written and recorded by men who seemed to have an inordinate degree of suspicion regarding vaginas. Aristotle, considered by some to be the founder of biology, believed that being born female was an innate sign of deficiency and a “departure” from nature. James Marion Sims, the inventor of the speculum who performed medical experiments on enslaved women, wrote in his unfinished autobiography, “If there was anything I hated, it was investigating the organs of the female pelvis.” Adam Kay, a former National Health Service doctor in obstetrics and gynecology (or “brats and twats,” as his medical-school peers referred to it), wrote in his 2017 best-selling memoir, This Is Going to Hurt, that his least favorite part of the job involved the urogynecology clinic: “a bunch of nans with pelvic floors like quicksand and their uteri stalagtite-ing into their thermals.”
I don’t mean to be unfair to Kay, whose deployment of dark humor seemed to be a coping mechanism to get through the crushing experience of being a junior doctor—90-plus-hour workweeks, disappearing resources, a revolving door of patients with physical and psychological needs far beyond what the cash-strapped NHS can attend to. His diaries, which he adapted for his book, capture a moment (roughly 2004 to 2010) when both writing and comedy were routinely meaner, less cognizant of what it means to punch down. Kay is a natural satirist—sharp, scathing, scarred—and women and their bodies provide him with boundless material. He details “warty vulval growths” that resemble cruciferous vegetables, a woman in labor who eats a blood clot because she thinks it’s her placenta, a sex worker whose makeshift “menstrual barrier device” is both rancid and “schnitzeled flat by her clients’ pummellings.” Kay believes that one patient who tells him that her breast pump is bugged is experiencing postpartum psychosis, but he’s ignored by his colleagues in psychiatry. When the woman has a breakdown, takes off all her clothes in the Starbucks below the hospital, and starts singing, “Holding Out for a Hero,” the scene is played not for emotional power but for semi-comic affirmation of our hero’s diagnosis.
In 2017, Kay’s vulval-warts-and-all accounting of life as a doctor was received as revelatory by British readers, which it was. Over the past few years, it’s drawn accusations of misogyny, which I’m not sure is entirely right. I don’t believe, after reading This Is Going to Hurt and watching all seven episodes of the new adaptation, also written by Kay, that he dislikes women. (The show was co-produced by the BBC and AMC and is now available to stream on AMC+ and Sundance Now.) Rather, he seems to disdain the elements of them that used to plague him in his former job, and the particular flavor of his judgment, today, feels informative. In his book, Kay is irritated at a patient for exceeding the weight capacity for the labor ward’s “obese” operating table; he’s amused by the audacity of a pregnant woman with a laminated, nine-page birth plan for thinking that she can choose the course of her labor; he’s angered by a patient who insists she’s experiencing agonizing pelvic pain despite her tests being normal, and who becomes so frustrated that she screams, “Why does no one take me seriously?!” She will, he writes at one point, go on to “waste this clinic’s resources for another year or more.” (Relatedly or not, the word endometriosis appears nowhere in Kay’s book.)
These parts have largely been pruned from the TV version of This Is Going to Hurt. Kay has also invented a new character, Shruti (played by Ambika Mod), another junior doctor working alongside the fictional version of Kay (played with lovable surliness by Ben Whishaw). The introduction of Shruti is a cynical move that’s annoyingly effective. By reorienting the show around her and what she endures during her training, This Is Going to Hurt becomes a bruising depiction of how catastrophically broken the British health-care system has been for decades, and how doctors and patients all suffer as a result. Kay’s personal gripes still periodically surface as comedy, but they’re muted by a much bleaker portrait of institutional failure.
This is not a show to watch if you’re pregnant, or postpartum, or still experiencing trauma from a difficult delivery. (I had to pause watching it several times, and my easy-breezy twin C-section was as routine as they come.) Nor is it a show that’s particularly interested in excavating why gynecological health care can be such an ordeal for women and people with uteri—the patients whom Adam and Shruti encounter still tend to be caricatures (the airhead who thinks her taste buds are a medical condition, the woman who names her triplets Milly, Billy, and Lilly). Rather, it’s a series with a devastating thesis about the health-care system and the doctors who manage to survive working in it. The qualities they share, This Is Going to Hurt suggests, aren’t ones like empathy, talent, or even care. The longer doctors stay in the world portrayed on the show, the harder and more detached they get, and the more skeptical that their patients have anything to say that’s worth listening to.
To watch this series and think about the plight of patients is to largely miss the point of what it’s trying to do. This Is Going to Hurt is set in 2006, a fact only occasionally alluded to by Adam’s archaic cellphone and the relatively antique condition of his car. In the 16 years since, the state of the NHS has only further deteriorated, with government ministers more willing to use it as a political football than to commit to funding its shortfall. The coronavirus pandemic placed unprecedented strain on a creaking behemoth that was already held together with thumbtacks, gum, and magical thinking. The point of the show is to expose viewers to the arduous and degrading experiences that doctors in the U.K. go through on their paths toward seniority. Whishaw is perfectly cast in the role of Adam: so slight that he appears not to have eaten in weeks, so exhausted that his whole face seems to have wilted, so awkward in his demeanor that his misanthropy is almost endearing.
Adam and Shruti both wonder whether they’re cut out to be doctors, and what the hazing of medical training is supposed to teach them. The sleep-deprived Adam makes a catastrophic mistake in the first episode that haunts him until the season finale. As much as he’s concerned about the patient he endangered, though, he’s enraged that a colleague reports him to the General Medical Council, the governing body that grants British doctors their license to practice medicine. “This is my career, not a playground for your personal vendettas,” he fumes. When she cites the offenses he’s committed, his dishonesty, and his arrogance, he reacts not with self-scrutiny but by blowing up at his fiancé. When someone suffers this much in service of others, his personal belief system seems to say, it’s churlish to criticize them for falling short.
Viewers will easily sympathize with Adam and Shruti, and lament the chronic underfunding and political myopia that make their jobs so much harder than they should be. And yet, watching the show, I found myself thinking about a recent report about maternity services at one NHS hospital trust that found that the lives of more than 200 babies and nine mothers could potentially have been saved if they’d received better care. There was, the report concluded, an institutional lack of compassion in how patients were treated, while women were routinely “blamed or held responsible for poor outcomes—even their own deaths.” In a separate survey of nearly 100,000 women in the U.K. released this spring, 84 percent reported having experienced, or having known another woman who’s experienced, not being listened to by health-care professionals. Three of the health conditions that women felt doctors had dismissed were endometriosis and heavy periods, pain related to menstruation or other gynecological conditions, and side effects related to the oral contraceptive pill. Care, or lack of it, has a profound impact in the immediate months after childbirth for parents and babies; in the first year after pregnancy, the leading direct cause of death for women is suicide. There are also profound disparities in women’s health care in the U.K., as in the U.S., with Black women more than four times as likely to die in pregnancy and childbirth than their white counterparts.
That the system is broken is undeniable. That doctors deserve much more than they get is equally so. But their patients deserve more too—to be listened to, to have a sense of agency over what happens to their body, to be seen as more than problem archetypes to avoid or walking conditions to diagnose and send home. This Is Going to Hurt is likely more accurate and more wrenching than most medical dramas that have aired on TV (“I knew so many Shrutis,” my doctor friend texted). But that doesn’t mean that it’s seeing the fullness of what’s wrong with women’s health care, or that it’s open to the things that might help fix it.