This is Going to Hurt — But Shouldn’t Have to: An interview with Dr Ally Jaffee
Trigger warning: This blog contains discussions of mental health struggles and suicidal thoughts.
I am a postdoctoral researcher on arts and health and a writer for Inspire the Mind. Last year, I interviewed Dr Simon Ruffell on Ayahuasca, magic mushrooms and psychiatry. I now bring you the voice of another inspiring junior doctor, Dr Ally Jaffee, to discuss the controversial BBC show, “This is Going to Hurt”. The show has been criticised for triggering childbirth scenes and misogyny, although the lead female actor has rejected this criticism; it has also been applauded for highlighting the portrayal of the dedication and burnout of NHS staff.
Dr Ally Jaffee (@drallyjaffee on all socials) is an NHS Junior doctor passionate about mental health and its intersecting fields — particularly the arts & nutrition. She is a mental health advocate and a champion for “You Okay Doc?”, the mental health and wellbeing charity for doctors. Ally is a Diana Award recipient (an award for 9–25-year-olds for social action or humanitarian work) and co-founder of Nutritank (a think tank and educational hub for nutrition).
In this interview, we discuss “This Is Going To Hurt’”, her experience as a junior doctor in the NHS and her mental health journey.
*Spoiler alert: this blog discloses details on the BBC show This Is Going to Hurt.*
You have spoken before on the media about “This is Going to Hurt”, the book and now show by Adam Kay. For the readers that may not have watched this show, essentially it portrays Shruti, a junior doctor in Obstetrics and Gynaecology, and Adam the senior registrar doctor who is supervising her. Alongside her training, Shruti is studying for the Royal College of Obstetricians and Gynaecologists membership exams, while being apart from her family and being very lonely.
Once you watch it, you can’t unsee certain things, and I’m not talking about the graphic obstetric scenes, I’m talking about the fluctuations in mental health in Adam and Shruti’s characters, like the flashbacks that Adam gets from the emergency C-section he performed on a young woman that he earlier had discharged home, or Shruti’s sleepless nights studying, alone, in hospital accommodation. Do you feel that that’s an accurate portrayal of what some junior doctors go through?
I most related to Shruti’s character because she’s a junior doctor and I’m a junior doctor. These events were around 2010 when Adam was a registrar and we’re now in 2022. Now, legally we aren’t allowed to work over a certain number of hours a week and back then there was no regulation on that. One of the moments I resonated with the most is when she is in the early pregnancy clinic and she had her exams to revise for and she’s got patients queuing round the corner. Because of the pressure she was under, the way she broke that bad news on a couple miscarrying was very brash, without any empathy, and that wasn’t her fault. You could understand from Shruti’s position that it’s a systemic failure rather than an individual failure because she shouldn’t have been in a position where she was running on empty for so long.
I also really sympathised with the scene where she was out for dinner with a senior female surgeon asking for advice and the surgeon says: “You just get on with it and maybe this isn’t a career for you, maybe you’re too sympathetic, too emotional”. I think that is one of the huge issues in Medicine. This kind of mask you have to wear. You just have to move on. You don’t have time to process grief, to reflect on what’s just happened. Move on to the next one. You’re constantly firefighting. That was apparent with all the flashbacks, consistent with post-traumatic stress disorder, that Adam experienced — it was just intrinsic to his everyday life.
Are there pockets of support for doctors like Shruti and Adam, are they easily accessible? Are they useful? Do doctors have the time to engage with them?
I think this system has got a bit better given the working hours aren’t as intense. When my registrar says, “Oh, you look a bit tired”, I’d be like, “Yeah, it’s, you know, it’s my fourth day on-call, I’m feeling it a bit, my back is feeling a bit”. Some senior doctors will say, “Well in my day we worked double this” and I find that very unhelpful. I do find it very unhelpful when your seniors essentially minimize your suffering and then you feel like you’re weak.
That is very well portrayed in the show when the initially incompetent Shruti becomes more experienced and gets her junior doctor trainee, she becomes like Adam — she passes down bad behaviours that she learnt from him; verging on bullying.
I am sure it’s still around, but I haven’t had any negative experiences like that. The way Shruti treated her junior, I haven’t had that. But it’s the minimisation of the challenges, the message that we should be resilient, that we should be able to carry on and carry on without complaining. Carry on without needing to take care of yourself. In aeroplanes, we know that you do need to put your oxygen mask on first before you help others, but this principle is not drilled into the kind of fabric of becoming a doctor and the socialisation process at Medical School.
I’m an ambassador for “You Okay Doc?”, so there are incredible initiatives that are out there to assist doctors, there are pockets of mental health support for doctors, but it is still pretty unhelpful. When I started my first year of training, the only training we had around well-being was a 2–3 hour online workshop that was quite tokenistic. Luckily for me, I come from a privileged point of view: I’ve had private support from my mental health, and I’ve got an incredible support network, but obviously, for someone like Shruti, she was living alone in hospital accommodation, away from her loved ones.
I’ve had one colleague saying that she disliked the fact that Shruti took her own life because it made the show leave a really bad taste in her mouth. My colleague was relating so strongly to Shruti being incompetent at the start, and then you see her increasing competency, but it was heart-breaking when Shruti takes her own life.
For me, I think that was the most powerful thing because it just shows how high functioning depression can be and how prevalent it is in high achieving individuals, and how hidden it is. Systems need to change so that we can keep these brilliant minds going. The show is dark, not like the glamorous “Grey’s Anatomy” type.
You are very vocal on social media about your journey with your mental health and junior doctors’ mental health. Can you tell me more?
Essentially, at the end of my gap year before medical school, I started to suffer from panic attacks. It was quite debilitating. I had a lot of anxiety, but I never could put my finger on exactly what was going on. I didn’t have the literacy or the education. I know now that all these things are so normal, and everyone goes through them for a while. I kind of hid it and I didn’t really want to face it.
When I did my intercalated year at Imperial College London, that was a huge, huge turning point in my mental health. I started to suffer from low mood, it wasn’t just anxiety anymore. It was just lack of motivation, suicidal ideation — the whole myriad of symptoms that come with clinical depression. A lot of self-doubts filled me at the time. Was I going to be able to care for patients, being so unwell? You know, doctors make terrible patients. It took a while for me to accept it to then seek help. I wasn’t sleeping, eating, so I finally went on medication. Over six weeks, I started to sleep better, to speak with a bit more lightness in my tone of voice, to have clearer thoughts.
I got myself back to medical school and as the academic year started to progress, I became very open with talking about my experience. I realized how powerful that was because then I had really lovely people who opened up to me about their mental health. I just realized how much it helped me and the community I wanted to serve, by being open and authentic about my experience of poor mental health.
I am doing, from a preventative point of view, a refresher course with iheart (Innate Health Education and Resilience Training), a not-for-profit organisation that offers resilience training, and that really helped me at the time. I needed structure for when I felt so unstructured and chaotic, and in each session you have you go through a different theme around the human condition.
A new generation of doctors, I hope there’s more like you out there.
Oh, it’s so lovely to chat with you. It was a really, really fun interview.
Thank you for your time Ally, our conversation was raw and honest. Speaking to Ally has given me so much hope for the next generation of doctors being more supported than previous generations perhaps were, and that help is out there for anyone that needs it.