Shame and Medicine Exeter
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Shame and ‘This Is Going to Hurt’

The opening scene of the BBC’s television series This Is Going To Hurt (2022) finds Adam Kay (Ben Whishaw), acting registrar in obstetrics and gynaecology, asleep in his car. A sound drags him to consciousness. Siren-like to begin with, it gradually clarifies into a mobile ringtone. His colleague, Shruti Acharya (Ambika Mod), is calling to remind him that he’s on rota. In the middle of formulating a feeble excuse about traffic, Adam realises that, exhausted from his previous shift, he slept in the hospital parking lot. Underslept and underpaid, Adam represents a healthcare workforce under pressure.

We are soon presented evidence that, despite his working conditions, Adam is good at his job. Pausing at the hospital’s entrance, he spots a pregnant woman in some distress. After identifying himself as a doctor, he volunteers to check the progress of her labour. Later, when he has bundled both the woman and himself into a revolving staff lift, the woman asks whether he is a real doctor. “Fair question”, he says to her before gazing at the camera and continuing, “though strangely one you’ve asked me after you showed me your vagina”. The joke is a crude one; it is an in-joke Adam shares with the audience at the expense of a vulnerable patient in distress. The audience is encouraged to forgive him, however, when he manages the birth successfully. This is a doctor who, despite being jaded and cynical, over-tired and overworked, cares about his patients and his job. A character type in the tradition of Claire Maitland from Jed Mercurio’s television series Cardiac Arrest (1995-1998) or Rob Lake from Mercurio’s Bodies (2004-2006), Adam, we are led to believe, is the competent doctor, who, despite being beleaguered by overwork and inefficient systems, can still manage a wry line about patients’ foibles. Like Claire or Rob before him, Adam (the character, not the writer) mocks his patients’ foolishness, while ensuring they get the best standard of care.

Still, as critics have noted, Adam’s callous, misogynistic treatment of a vulnerable person is troubling. It treads too close to equating distress with stupidity and loose morals, and perpetuates what Milli Hill calls the birth room power dynamic. This is only compounded by the intimacy that the direct address to the camera creates between Adam and his audience, which, in such instances, edges the viewer towards complicity. Jokes weathered through medical comedy dramas of the 1990s and the 2000s have aged badly, even if they present a fair approximation of humour as coping mechanism in the medical community. These criticisms take the intimate aside and, later, moments when Adam explicitly breaks the fourth wall (when the actor addresses their audience directly), as uncritical endorsements of his point of view. I want to suggest, however, that the series develops a far more ambivalent position on Adam, and the nature of cynical-but-efficient doctor’s medical authority. It does this by undercutting the wink-nudge proximity of Adam’s humour with an even more intimate portrait of his shame.

Adam is a character swimming, to use Creed et al.’s metaphor, in a sea of shame. He keeps key aspects of his life hidden from those around him. His parents and colleagues do not know he is gay. His partner does not know about the cases that most affect him. Secrecy is, of course, not synonymous with shame, but it often acts as a useful marker because shame is so strongly associated with feelings of wanting to hide or retreat. Adam keeps secrets because he fears that those he loves will find him unworthy: In a particularly poignant scene at his engagement party, Adam imagines confessing his problems at work to his partner, Harry (Rory Fleck Byrne), only for Harry to call him an embarrassment. Adam’s efforts to hide himself are brought to a head in the first episode when he fails to diagnose a case of preeclampsia, which results in the premature birth of the child and near-death of the mother. In the aftermath of the error, Adam presents signs of acute shame, including closed eyes, bowed head and involuntary gasps. Adam’s chronic shame is exacerbated, then, by the acute shame of medical failure, which rebounds on to his sense of self. The six subsequent episodes of the series trace the fallout of this error for Adam professionally and personally in the weeks and months that follow, as a linear, historical narrative frequently interrupted by visual flashbacks. These flashbacks, which take the form of a montage of upsetting image related to the error, demonstrate that Adam is living in the aftermath of what Will Bynum et al. have called a “sentinel emotional event”: the emotional response to significant life-or-death situations in medical practice. Such moments of trauma are not new to the medical drama: the first season of Bodies used the visual flashback to convey the long afterlife of sentinel emotional events in the minds of healthcare professionals. This Is Going to Hurt develops the technique by contrasting the troubling disruption of Adam’s later flashbacks with the cocky confidence of his earlier verbal asides. The aside, which intercedes with the audience by appealing to the camera, finds itself overwhelmed by unwanted, shame-related images that burst into the frame, disrupting narrative continuity and producing responses that include silence, turning away, bowing the head and expressions of profound emotional pain.

Despite its unlikeable protagonist, This Is Going To Hurt presents a largely sympathetic portrait of junior and mid-level healthcare professionals doing their best in a cruel and dehumanising system. In this, it continues the underlying activist impulse that inspired the memoir it was based on. This is Going To Hurt, the memoir, was, like Rachel Clarke’s Your Life in My Hands, written in response to the junior doctor’s dispute from 2015-2016, to inform the general public of their working conditions and so build solidarity with the striking doctors. But the television series goes further than the memoir in representing the protagonist’s feelings of chronic and acute shame, and relating those feelings to the pressures on the NHS and its workers. While this does not exonerate the series for using tired jokes about stupid patients, it does present these jokes as the consequence of an already-shame-ridden situation, where everyone is already hurting.

Arthur Rose – Engaged Research Fellow, University of Exeter



24th October 2022

Photo by Marty Garcia on Unsplash


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