youp until quite recently, the history of gynecological health was written and recorded by men who seemed to have an inordinate degree of distrust of vaginas. Aristotle, considered by some to be the founder of biology, believed that being born female was an innate sign of deficiency and a “deviation” from nature. James Marion Sims, inventor of the speculum who performed medical experiments on enslaved women, written 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 physician in Obstetrics and Gynecology (or “kids and pussies,” as his medical school peers called him), wrote in his bestselling 2017 memoir, This will hurtthat her least favorite part of the job involved the urogynecology clinic: “a bunch of nans with pelvic floors like quicksand and their uterine stalagtitis in their thermals.”
I don’t want to be unfair to Kay, whose deployment of dark humor seemed like a coping mechanism to get through the overwhelming experience of being a young doctor – work weeks over 90 hours, resources that disappear, a revolving door of patients with physical and psychological needs far beyond what the cash-strapped NHS can meet. His diaries, which he adapted for his book, capture a time (circa 2004 to 2010) when writing and acting were consistently meaner, less aware of what hitting meant. Kay is a satirist by nature – sharp, biting, scarred – and women and their bodies provide him with unlimited material. It details ‘warty vulvar growths’ that look like cruciferous vegetables, a woman in labor who eats a blood clot because she thinks it’s her placenta, a sex worker whose improvised ‘menstrual barrier device’ is both rancid and “flattened by the punches of his customers”. .” Kay thinks a patient who tells her her breast pump is tapped is suffering from postpartum psychosis, but is ignored by her colleagues in psychiatry. When the woman breaks down, takes off all her clothes in the Starbucks under the hospital and begins to sing “Holding Out for a Hero”, the scene is not played for emotional power but for the semi-comic affirmation of the diagnosis of our hero.
In 2017, Kay’s tale of vulvar warts and all about life as a doctor was received as eye-opening by UK readers, and it was. In recent years, it has drawn accusations of misogyny, which I’m not sure is entirely accurate. I don’t believe, after reading This will hurt and watching all seven episodes of the new adaptation, also written by Kay, that he doesn’t like women. (The show was co-produced by the BBC and AMC and is now available to stream on AMC+ and Sundance Now.) On the contrary, he seems to disdain the elements that plagued him in his former work, and the particular flavor of his judgement, today feels instructive. In his book, Kay is angered at a patient for exceeding the weight capacity of the “obese” delivery room operating table; he is amused by the audacity of a pregnant woman with a laminated nine-page birth plan to think she can choose the course of her labor; he is irritated by a patient who insists that she has excruciating pelvic pain when her tests are normal, and who becomes so frustrated that she cries, “Why isn’t anyone taking me seriously?!” She will, he writes at one point, continue to “squander the resources of this clinic for another year or more.” (Relatedly or not, the word endometriosis does not appear anywhere in Kay’s book.)
These parts were largely removed from the TV version of This will hurt. Kay also came up with a new character, Shruti (played by Ambika Mod), another young doctor working alongside the fictionalized version of Kay (played adorably by Ben Whishaw). The introduction of Shruti is a cynical gesture of annoying effectiveness. By reorienting the show around her and what she endures during her training, This will hurt becomes a murderous depiction of the decades-long catastrophic destruction of Britain’s healthcare system and how doctors and patients alike are suffering as a result. Kay’s personal reproaches still appear periodically in comedic form, but they are toned down by a much darker portrayal of institutional failure.
It’s not a show to watch if you’re pregnant, or postpartum, or if you’re still going through trauma from a difficult birth. (I had to pause to watch it several times, and my twin C-section was as routine as it comes.) This is also not a show that is particularly interested in explaining why gynecological health care can to be such an ordeal for women and people with wombs – the patients Adam and Shruti encounter always tend to be caricatures (the beachhead 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 healthcare system and the doctors who manage to survive working in it. The qualities they share This will hurt suggests, aren’t they like empathy, talent, or even caring. The longer doctors stay in the world depicted on the show, the tougher and more detached they become, and the more skeptical they are that their patients have something to say worth listening to.
Jo watch this series and thinking about the fate of patients is largely missing what he is trying to do. This will hurt is set in 2006, a fact to which Adam’s archaic cell phone and the relatively old condition of his car only occasionally hint. In the 16 years since, the state of the NHS has only deteriorated further, with government ministers more willing to use it as a political football than to undertake to finance its shortfall. The coronavirus pandemic placed unprecedented strain about a squeaky monster that was already held down with thumbtacks, gum, and magical thinking. The aim of the show is to expose viewers to the harrowing and degrading experiences doctors in the UK go through on their way to seniority. Whishaw is perfectly cast as Adam: so light that he looks like he hasn’t eaten in weeks, so exhausted that his whole face seems to have withered, so clumsy in his attitude that his misanthropy is almost endearing.
Adam and Shruti both wonder if they’re cut out to be doctors and what the hazing of medical training is supposed to teach them. Sleep-deprived Adam makes a catastrophic mistake in the first episode that haunts him until the season finale. Although he is concerned about the patient he has put at risk, he is furious that a colleague has reported him to the General Medical Council, the governing body that licenses UK doctors to practice medicine. “It’s my career, not a playground for your personal vendettas,” he fumes. When she cites the crimes he has committed, his dishonesty and his arrogance, he reacts not with soul searching but by exploding on her fiancé. When someone suffers so much in the service of others, their personal belief system seems to say it’s rude to criticize them for not measuring up.
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 need to be. And yet, while watching the show, I found myself thinking of a recent report about maternity wards at an NHS hospital that found the lives of more than 200 babies and nine mothers could have been saved if they had received better care. There was, the report concludes, an institutional lack of compassion in the way patients were treated, while women were routinely “blamed or held accountable for poor outcomes, even their own deaths.” In a separate investigation of nearly 100,000 women in the UK published this spring, 84% said they had suffered, or had known another woman who had, not been listened to by medical professionals. Three of the health problems that the women felt doctors dismissed were endometriosis and heavy periods, pain related to menstruation or other gynecological problems, and side effects from the oral contraceptive pill. Care, or lack thereof, has a profound impact in the months immediately following childbirth for parents and babies; In the first year after pregnancy, the leading direct cause of death among women is suicide. There are also deep disparities in women’s health care in the UK, as in the US, with black women being more than four times more likely to die during pregnancy and childbirth than their white counterparts.
That the system is broken is undeniable. Equally important is that physicians deserve far more than they receive. But their patients also deserve more: to be listened to, to have a sense of agency over what happens to their bodies, to be viewed as more than archetypes of problems to be avoided or walking conditions to be diagnosed and sent home. This will hurt is probably more focused and heartbreaking than most medical dramas on TV (“I Knew so much Shrutis,” my doctor friend texted). But that doesn’t mean he sees all of what’s wrong with women’s health care, or that he’s open to things that might help fix it.