Like all other British doctors, after qualifying he became a House Officer (the lowest rank in the medical hierarchy); a year later, as a Senior House Officer, he had to decide what direction his future career should take. He chose obstetrics and gynaecology, known as 'obs and twats' at his medical school, thereby ensuring four or five more years of sleeplessness (he should have chosen dermatology). All this is vividly described; the tone of the writing is racy and witty with lots of good jokes and well supplied with expletives (not deleted)—more MASH than Holby.
Eventually Adam reached the rank of Senior Registrar, meaning he was one step away from becoming a consultant. Then came disaster. He carried out a caesarian section which went wrong. The patient had an undiagnosed placenta praevia (the placenta blocking the exit from the womb). The baby was dead and the mother bled heavily and was saved only at the cost of a hysterectomy (this was her first pregnancy).
No one blamed Adam for what happened, but he was unable to come to terms with it and, a few months later, decided to quit—a victim of 'burn-out'. Particularly in the more stressful specialties such as obstetrics this isn't an unusual story, as he makes clear.
Throughout the book there is an underlying thread of barely restrained anger at the way the good will of the junior doctors is being exploited, and this culminates in an open letter to the Secretary of State for Health printed at the end of the book, in which this is made explicit. Everyone who holds this office, Adam suggests, should have to work some shifts alongside junior doctors.
Not the things you already do, when a chief executive shows you round a brand-new ward that's gleaming like a space station. No: palliate a cancer patient; watch a trauma patient have their leg amputated; deliver a dead baby. Because I defy any human being, even you, to know what the job really entails and question a single doctor's motivation.The book exemplifies Horace Walpole's epigram: life is a comedy to those that think, a tragedy to those that feel. Adam both thinks and feels, but the feeling won out in the end.