Adam Kay’s diaries

Adam Kay’s diaries preserve the working life he left behind: dated notes of routine absurdities, difficult encounters and events whose effects outlasted the shifts in which they occurred. Saved from a mass of discarded papers, they became both a record of junior-doctor work in the National Health Service and the means by which Adam Kay eventually told a story he had long avoided discussing.

Preservation and rediscovery

After leaving his job as a junior doctor in 2010, Adam Kay received a letter saying he would never work as a doctor again. The news was not a great surprise, since he had been away from hospitals for a long time, but it made the end of that part of his life feel real. While clearing his spare room, he went through box after box of papers and kept only his old diaries.

Reading them brought back the long hours and the scale of the job’s effect on his life. At the time, he had simply kept going; in retrospect, he was struck by how hard he had worked. The diaries thus served not only as a store of incidents but as a record that let him see the cumulative demands of the work from a later vantage point.

A record of clinical work

The entries range from everyday problems to encounters in which uncertainty and responsibility are harder to contain. In October 2004, a patient suffered a critical emergency and died despite the senior doctor’s intervention. Adam Kay’s concise account records the response around him and the immediate aftermath, including changing out of his wet clothes. The diary’s matter-of-fact sequence holds the practical details beside the fact of the death, without turning the entry into a retrospective clinical explanation.

A June 2006 entry begins with a frightening discovery in a labour-ward toilet after a woman had been induced because her baby was late. Adam Kay investigated possible causes; the baby appeared well, and the patient was not in pain. A scan and specialist advice eventually established that the alarming appearance was due to two large jars of beetroot she had eaten the previous night. The episode shows how the diaries preserve the movement from alarm and investigation to an unexpectedly ordinary explanation.

Other entries record the work of staying with people through circumstances that cannot be resolved by medical information alone. When a patient known as CR learned she had only months to live, she spoke about missing her son’s graduation, her daughter’s wedding and the possibility of meeting grandchildren. She also worried that her husband would not know how to manage the boiler. Adam Kay did not pretend that things would be all right; instead, they talked through practical concerns, and he recognized that being able to speak openly seemed to help her. The diary connects this encounter with his decision to call his mother on the way home and tell her he loved her.

Loss, uncertainty and the limits of training

The diaries also document a later meeting with a couple whose baby had died. Adam Kay had seen the doctor earlier, and when she returned to the labour ward to give birth, she and her husband were relieved to see a familiar face who already knew what had happened. He records his uncertainty about what to say: no one had taught him how to speak to parents who had lost a child, and he was unsure whether expressions of hope or sympathy, or offering a hug, might help or make matters worse. He chose to explain what would happen next, answer their questions as well as he could, and return regularly. When the evening passed eight, he stayed until the birth had happened.

Placed beside the intimate account of CR’s fears, this entry shows the diary’s attention to the work of listening and remaining present when a doctor cannot undo a loss. It also records a gap in professional preparation as Adam Kay experienced it: he knew the practical next steps, but had not been taught how to address the couple’s grief. The notes retain both the uncertainty and the concrete decision to stay.

Humour and its interruption

Comic observation recurs in the diaries, often beside the pressures of the ward. In February 2009, an emergency buzzer brought people rushing into a room, only for the commotion to be explained by a midwife pulling the cord hard enough to bring down much of the ceiling. Another entry turns a familiar question about bowel movements during labour into a blunt, wry answer, adding that the patient had eaten a large curry in an attempt to bring on labour. Such incidents make the comic voice part of the record of hospital work, not a separate account of life outside it.

That voice has a limit. After a catastrophic birth, Adam Kay identifies the following entry as the last diary entry he wrote and says that the book contains no more jokes after it. He describes crying for an hour, being sent home for the remainder of the shift, and then returning to work the next day amid the expectation that he would continue as usual. The diaries’ ending is therefore not merely the stopping point of a notebook: it marks the point at which humour, previously a recurring way of telling, disappears from the account.

From private notes to public testimony

When Adam Kay reread the diaries, junior doctors were being attacked in the news. He thought it was difficult for them to present their side while working so much, and decided to share his own story. The notes, he explained, would show what the wards were like, how the job changed his life and how, eventually, it became too much. Their movement from private record to public account gives the book its double perspective: events are told in dated entries, while the later framing makes visible the career and consequences that the diarist could not yet fully assess.

After leaving medicine, Adam Kay did not tell people why he had left. At first the experience was something he could not talk about; later, he simply changed the subject and offered funny stories about patients instead. He says that some close friends would encounter the sad story for the first time through the book. In this context, the diaries are not just a source of anecdotes. Sharing them breaks a silence that had persisted even among people close to him, and makes the abrupt end of the entries part of the testimony they preserve.