'This Is Going to Hurt': An honest look at how doctors suffer in a punishing system

The opening shot of the new series This Is Going to Hurt finds a man we will later learn is Adam, played by Ben Whishaw, asleep. His mouth hangs open. We are so close to him that it's hard to tell where he is. A distant sound wakes him enough that he tries to drag himself out of sleep, and the camera pulls back and rotates. It retreats and turns disorientingly, until we see that Adam is asleep in his car, behind the wheel, and his phone is vibrating. He never made it home to his partner the night before; he left work and went dead to the world for whatever hours of sleep he could scavenge. And now it's time to do it all over again.

Adam is a young doctor on the OB/GYN ward of a hospital. The series, made by AMC and the BBC and first shown in the U.K., is based on a memoir of the same name by Adam Kay, who spent several years as a doctor working for the National Health Service. Kay recounts in the book the weird anecdotes, yes, but also the harrowing stories. He talks about the toll that the lack of adequate funding takes on the system and on care. And he talks about the brutal consequences for medical professionals who go years without enough sleep, enough support, enough respite. The show's origins in memoir are reflected in the fact that it makes refreshingly spare use of fourth-wall-breaking, where Adam does turn to address the camera, but not often.

American viewers have seen plenty of medical dramas; for a time, you couldn't get away from them. In fact, the specifics of the patient whose story opens This Is Going to Hurt and then hangs over Adam for the whole season will be familiar to anyone who watched ER. But this is a very different series, in part because it's unrelenting in portraying the pace of Adam's days and those of a trainee named Shruti (Ambika Mod, also excellent here) for whom he's responsible. Shruti is trying to learn, but when the days are hard on Adam, he offloads his frustrations onto her – onto someone even less supported, even less cared for, even more vulnerable than he is.

It's key to the series' outlook that Adam is not consistently a pleasant person or a good doctor. He does things that you would not want your doctor to do; he does things that you would not want a friend to do. He is not an antihero; he is simply not a hero at all. He is one person being slowly and inexorably damaged by a job he loves, where he knows he is needed, where he knows he can help people.

Those scenes that are so common in American doctor shows, where everyone is having long talks about marriages or relationships, and especially where doctors are chatting idly with patients and getting to know them? You won't see them here. Adam is always looking at his phone, thinking about where he's supposed to be, thinking about which of the demands on his time should be met next. Each patient gets his attention only briefly. He cares about his patients, but it's an emotion he almost resents, and it's one he's encouraged to push away. His boss tells him at one point – you may spend time with them as you try to save their lives, but you don't go to their funerals. It's unprofessional.

This Is Going to Hurt is transfixing in part because it is prepared to portray, both in drama and in dark comedy, the toll this all takes on doctors personally but also on the care that they're able to give. It is an honest look at the limits of individualism in a system that is designed to be collective. There is no "Get me an amp of epi, STAT!"-style heroism that can compensate for lack of resources or lack of sleep. Tired people make more mistakes. Rushed people make more mistakes. People who spend years in abusive work environments pass down the same to those who follow them. Whishaw can play characters who are gentle and overwhelmed, but this is not that: Adam is unsettled partly because he can tell something in him is corroding; Shruti is unsettled partly because she has no desire to end up like Adam.

It's almost beside the point, but it's worth noting, that this is also a season of television that's uncommonly good at reveals and surprises, at telling stories that aren't going the way you think they're going. Everything in Adam's life, including his relationship with his supportive and loving boyfriend Harry (Rory Fleck Byrne), is complicated – disorienting, just like that opening camera shot. His mother (played by Harriet Walter, completing a trifecta of recent complicated TV moms in this, Succession and Ted Lasso) is not a source of support. The closest thing he has to a mentor is the head midwife, Tracy (a fabulous Michele Austin), who knows far more than he does, but whom he officially outranks. He is not OK, and his patients aren't, and his hospital isn't, and Shruti isn't. And the consequences reveal themselves in ways both shocking and inevitable.

It's funny; this isn't a COVID-era show, but it feels like a COVID-era show, in much the way paranoid thrillers can feel like a post-Watergate movement, even though many were too early for that to be literally true. This is a series that is not about COVID, but it is about the limits of the human beings we ask to step close to pain and death every day, day after day, with no relief in sight. It suggests a system that is always on the edge of disaster, where doctors and nurses are so busy trying not to drown that the personal satisfaction a lot of us may think saving lives would bring is something they are simply too overwhelmed to experience.

(A note: Americans who hate dealing with insurance companies may be surprised to see such a blistering critique of the state of the NHS, which at least does not have that mess to navigate. But adequate funding is still an enormous issue in Adam's world, and there's an episode dedicated to his experience in a private hospital that speaks cuttingly to what happens in so many situations where the for-profit systems available to the wealthy find ways to free-ride off public funding for private enrichment.)

Reinvigorating the medical drama is a tall order, but Kay's flair for gallows humor, which comes through in his memoir, and the stellar performances from Whishaw and Mod especially, make it work. This is a devastating, funny, sharp story about life and death and failure and success, and it's well worth seeking out the two streaming services now showing it – AMC+ and Sundance Now – so you can see it for yourself.

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