Adam Kay: "I was told to man up!" Coping with PTSD and mental health stigma

0:00Fearne Cotton: Before we start, this episode contains some chat you might find difficult to hear, so do check the show notes for more details. Hello, I'm Fearne Cotton and this is Happy Place, the show that looks at the moments that can change the course of a life. Today, I'm chatting to Adam Kay. If it wasn't PTSD, it would have been something very similar to that. And, you know, no mention of counselling, no mention of time off, no debrief afterwards. and so until I started talking about it and dealing with it just by saying it out loud I was you know waking up at three in the morning back in that operating theatre with my pulse going 200 beats a minute and like in an actual cold sweat.

0:44Fearne Cotton: Oh my good god there's only two weeks until the first Happy Place Festival of the summer. Ah I mean obviously I'm mega excited I love nothing more than being there with as many of you as humanly possible and just feeling joyful. But obviously I'm nervous. It feels like I'm throwing my own birthday party twice a year, every year. And, you know, you want everybody to have a good time. If you're throwing a party, which I think the happy place has that energy. Yes, there's like calm moments where you can go and meditate or go and do a sound bath and chill out. But it's got good vibe energy. It's like a big party.

1:24Fearne Cotton: and I am obviously incredibly nervous as you are when you're throwing a big party that everyone has a great time. I want every single person who walks through our entrance to feel the joy that we're trying to create and try something new, maybe learn something new about themselves or get some new perspective on life or a problem that you're going through. That's what it's there for. Certainly the talks tent, you know, that's where we've got all of these amazing helpful talks. I walk away each year going, oh my god, I didn't know that or that's changed my thought patterns on this. I want it to be as well as enjoyable, like really practical and helpful.

2:03Fearne Cotton: So if you haven't been before, do come along. If you've been before, there's even more good stuff this year. I've got so much going on. But let's get to today's chat because I've wanted to have Adam Kay on the podcast for ages, not only because I'm a big fan, but also my son Rex who's 13 is obsessed with his books my son will not read fiction he's not remotely interested he wants science anatomy books and Adam's kids books are so entertaining yet highly educational and interesting like Rex will read me parts from his books and I'm like I didn't know that I mean obviously left school a thousand years ago but it's just brilliant he's written loads of fiction and non-fiction for both kids and adults based on his former career as an NHS doctor.

2:50Fearne Cotton: His first book of course, This Is Going To Hurt, really opened a lot of eyes as to what life as a doctor is actually like and I mean that book is just phenomenal. I read it back when it first came out but I re-read it ahead of this chat and it's full of hilarious and heartbreaking anecdotes. He manages to make the book entertaining and funny but deeply sad at times too. He came into the Happy Place studios wearing, I mean, an outfit that I would have chosen for myself, quite frankly. I loved every item of clothing. He had a polka dot shirt but like giant polka dots. This kind of PVC crackled jacket and I'm going to call it like aubergine.

3:34Fearne Cotton: Great slacks and then burgundy loafers. Dream outfit. I couldn't be more in love with Adam if I tried. This message is brought to you by the Capital One Venture X card. Venture X offers the premium benefits you expect, like a$300 annual Capital One travel credit for less than you expect. Elevate your earn with unlimited double miles on every purchase, bringing you one step closer to your next dream destination. Plus, enjoy access to over 1 ,000 airport lounges worldwide. The Capital One Venture X card. What's in your wallet? Terms apply. Lounge access is subject to change. See CapitalOne.com for details.

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4:51Fearne Cotton: Right, let's do it. This is the show.

5:15Fearne Cotton: Adam K. First of all, I'm so obsessed with your outfit. I don't know what to do. Oh my God, I hadn't seen the socks. You've got polka dots. They're vaguely, vaguely matching. They're matching your shirt. I mean, this is an ideal chat for a podcast. I just, like, you're so on trend with the polka dots. I didn't see it coming today. And I want the jacket and the shirt. And I've got those shoes already, so. I mean, my admission about the shirt is I can't take full credit because my three-year-old chose, one of my three-year-olds chose it. They're quite good stylists, kids. Yeah, not bad. I was looking between a couple of them and she said, oh, go for that one.

5:51Fearne Cotton: Like that? Go for that one. Just a three-year-old comment. I love it. It feels like this has been a long time coming, us having this chat. Yes. When has it happened before? I don't know. I don't know. I mean, we've sort of communicated because you very kindly let me write a piece for your beautiful book where you collated people's memories, stories and poems about the NHS a while back. Over COVID, no, it was a really lovely piece. And I was so honoured to be asked to do it. So thank you, first of all. But I'm so glad that we are face to face today. IRL. IRL. Also, your kids' books are the most read books in our household.

6:29Fearne Cotton: Oh, no way. Yeah, my son will not read, he's not into fiction, so he's reading all of your factual books. Yeah. Kay's Anatomy, he loves. your book about medicine which is Kay's Marvelous Medicine we were reading that last night oh yeah and there's one about inventions if you like an invention we've got that one we've got all of them okay fine yeah we love doing True or Poo which is your true or false game yes we play that constantly excellent and also last I've got a whole book of True or Poo's I'll send you one of those oh well we need that that's like our favourite bit of the night but also like he'll come up with really great like as I said he's my daughter loves to read she'll read fiction for hours my son I have to like beg him pick up a book but your books he loves facts So it's so good because you're learning through this very entertaining medium of you telling these wild stories.

7:12Fearne Cotton: He was saying last night about how the Egyptians believed that we ate food and it was digested by our hearts. Yeah, it was a good guess, but they didn't quite nail it. I mean, it's so interesting. I'm really thrilled that this has been his sort of entry point into reading. I get so many messages from parents saying, I thought my kid was a reluctant reader. and it turns out they just needed a different type of book. And it's really cool because it's the national year of reading. And I think embracing all the different sorts of things that books can be is often like the way in for kids. So like my books, you know, I've written some fiction now for kids, but my nonfiction books, they're sort of their own sort of thing because they're funny, silly, disgusting and full of facts.

7:58But it means you don't need to follow a whole chapter through. You don't need to have to hold all that in your head. and I think I get a bunch of messages from parents of neurodiverse kids in particular saying the fact that it's in little chunks helps a lot. And hooray, because reading is non-fiction as well and it is graphic novels and it is putting an audiobook on the Tony or the Yota or whatever it is.

8:22Fearne Cotton: So it all counts, it all goes in. Yeah, we love our Tony as well. That goes on before bed every night. Oh yeah, yeah, that goes on holiday with us. It's genius, isn't it? So it's one of our crucial items. for like your survival oh yeah yeah yeah they are so good we are such big fans and it has been a real joy to see Rex actually wanting to pick up a book and get stuck into it and also really good for entry point sex education your K's Anatomy book loads of my friends have used that to have that initial moment with their children talking about sex and puberty it's been really helpful you're welcome uh yeah i'm sort of slightly aware when i was writing the book that because it started off i was just doing all the all my funny gross stuff and i'll teach you about the lungs and mucus and whatever and then i was like whilst i've got the kids trusting me because it because i'm being funny and they're their friend i can put in the more you know the slightly difficult stuff yeah and you know there is that sex head stuff and i can talk about smoking and i can talk about body image and I can talk about all sorts of different things there well hopefully if I'm not being too preachy you know take some of it in I mean not at all I think that's exactly why it works is that they're like along with the ride of the humor and and they kind of learn they're imbibing that educational stuff without even realizing it yeah and it's the it's the same way that you you know chop up the vegetables small isn't it you don't no one wants to think that you know that you know they're learning yeah exactly but it's all interesting stuff because I've always been obsessed with the body but I think it's because you have to learn about it at school as part of a lesson it never hits like the level of space or dinosaurs or something as a cool thing that people want to know about but some other facts are wild and I thought that's that's a that's good stuff for kids to you know dig into much so like you say you know that's part of our you know science lesson at school that we learn about the body but you didn't necessarily grow up thinking I'm going to be a doctor.

10:24Fearne Cotton: That's the route for me. It was something you kind of moved into over time. I think so. I don't know what I... It's slightly unfair asking people what they want to do. I think 18, when you have to choose to go to medical school, like, you know, no offence 18 years, but you're an idiot when you're... I definitely was. I was an absolute knobhead. And like, to say at the age of... Actually, 16, when you're choosing your A-levels, To say, oh, by the way, now you need to decide what you want to do until you retire. Mad. And so, you know, I'd feel guilty about leaving medicine for, you know, in all sorts of ways.

11:03But I think part of it is that I didn't know what I was like. If you go for a procedure or something, you sign the consent form. This is what's good. And this is what the risk is. And then you sign it. I don't think it was informed consent for any 18 year old saying, off you go. Yeah. You're going to be a doctor now.

11:20Fearne Cotton: it's wild I mean your book This Is Going To Her is now it's 11th year am I right? I think it's nine years because I only know that I don't have a great grip on on time and things like that but I had an email from the publisher saying we're going to do like a sort of a 10th anniversary what not yeah and do I want to you know write a new bit I just re-read it because I read it when it first came out you know it was everywhere you couldn't avoid it back nine years ago it was literally yeah sorry about that in a good way Everybody was talking about it. Everybody read it. And I could remember, obviously, it's all these incredibly moving and funny diary entries.

11:57Fearne Cotton: But I thought I really want to reread it because I loved it the first time around. But also to kind of go through your different stages of your career as a doctor and remember some of the unbelievable and sometimes stories that make you absolutely wince. But you were prolific in writing these diaries. Were you doing that even prior to your career? Was diary writing something you did as a kid? Not that I did as a kid, but I've thought a lot about why I started writing these diaries. And I suspect it was my brain trying to find a coping mechanism for the bad stuff. So I just, you know, well, life was not necessarily always good, but certainly very simple compared to a situation where you're at medical school cutting up a dead body or having to, you know, and the difficult situations you find yourself in when you're actually working as a doctor and the tough hours and tough everything.

12:53I found myself writing the funny, silly, disgusting stuff down. I don't know, to, I guess, look for the light in the dark, maybe?

13:01Fearne Cotton: Yeah, yeah. I think that's an amazing way to process your day when you've had a shit show of a day or just something that you're really struggling to mentally chew over. There is something about, I write everything with a pen. I'm, you know, not a book. I'll write that on my laptop. But if I'm writing notes for this or a little diarized thing. Or just admiring your notebook. Just looking at my post-notebook. But there's something about like pen to paper that does help you get that clarity or at least like you're saying, extracting the good bits from the more unsavory parts. Yeah, I think that's exactly it.

13:36And it's not the gold standard, you know, way of dealing with your emotions. but it's certainly a lot better than nothing. So like my coping mechanisms were writing stuff down and drinking white wine and they both work. But neither of them are what the medical professionals would say is the one you should reach for. But, you know, there's huge value in it. And it also exercised this creative bit of my brain, which I think I've always had, but was never, I don't know, was never presented to me as an option growing up.

14:10Fearne Cotton: No, well, it's not in school, is it, really? It's the arts and creative. An English lesson, which was, and I did, you know, I had a really inspirational English teacher, but then again, the lessons were mostly like talking about the religious themes of Brighton Rock or something, rather than like, you know, writing can be funny. It took me until university to read the first thing that made me laugh and think, oh, books are something. You know, coming back to talking about your kids and reading. It took me until I was much older than that to find that books are something I could enjoy rather than, I guess, enjoy or be examined on or something like that.

14:50But in my, you know, my dad was a doctor. Friends of theirs all had no one in their social circle had like a fun job. It was, you know, it was doctors and lawyers and accountants and servants and engineers and great. but there was no one, there was no one I could, did you have anyone in your life who was creative? I mean, I'm from a working class family.

15:18Fearne Cotton: So my mum had about four jobs. She's like cleaner, delivering next packages and dental nursing, et cetera. But my dad was a sign writer for the whole of his career. So although it wasn't always his creative ideas that were being put down, initially back in the certainly 80s and some of the 90s, it was all hand done. So I'd go to the workshop and I'd see him and his kind of motley crew of people that would work with him. And they'd all be, you know, using the stick with the ball and doing this beautiful liquid handwriting with a paintbrush, which was mesmerizing. And then it all got changed, sadly, and all the acrylic machines came in.

15:53Fearne Cotton: So it became, oh, they just designed it on the computer and printed it out. So I definitely got to see like an arty side to something. It wasn't always like, I've painted this beautiful landscape because it was like, you need to make a sign for Wembley Stadium. Go. It was that kind of thing. So I sort of, I did to a degree, but I think it's quite rare, certainly in school, to look around, whether it's your parents, friends or whatever, and think, oh, I can see that that's possible. That I can be a creative writer or an actor or whatever it is, because it's more unusual. and I guess your route to creative writing was a windy one because of course it came off the back of you writing these diary entries there was never any intention when I was writing them that anyone would read them other than me and millions of people have now I mean can you ever get your head around that?

16:43no it's best not to it's like when you're watching one of these Brian Cox documentaries and it said you know the universe has got 42 squillions it becomes a bit upsetting if you try to process it But like, because, you know, obviously I'm very open and honest in my nonfiction writing. You know, the fact that so many people know all this sort of weird personal stuff about me, I don't want to process it. So let's just say it's only you who read it.

17:11Fearne Cotton: OK, it's just it's just me. Obviously, the end of the book is it was as heartbreaking to read the second time round as it was the first. And because it's been such a roller coaster of different emotions, but a lot of humor in there and you're extracting those light moments from the dark, the end is even more heartbreaking. And the book ends with you, well, not immediately, but you realizing that maybe this isn't the career for you. after you had the traumatic experience of being with a woman who well first of all you had to deliver a stillborn baby and then she was rushed off because she was losing an insane amount of blood you knew that this was something extremely traumatic to go through for yourself as the head doctor at that time in that operation but you knew also you'd probably go back to work the next day which you did.

18:06Fearne Cotton: And I guess that leaves you with a certain amount of undealt with business that you then have to look at down the line. Yeah. And I didn't examine it at the time. I wasn't given the opportunity to. The system isn't set up for looking after its own. So of all the people in this, I'm one of the people obviously affected the least, but I was still in the room and it was still tough you know for me as the as the as the doctor involved and it was a bit like i'd said i'd sprained my ankle or something oh that's awful you're all right but i mean obviously you can do antenatal clinic in the morning right because who else is going to do it in a system that's got no slack in it at all a system that says you're a bloody doctor you need bloody get on with it and um so you know no mention of you know counseling no mention of time off no debrief afterwards and that was just the the culture the time it's getting better a bit do you think it's getting better you know it's moving in the right direction but still it's a it's a tough gig and in a lot of ways I don't think I paint a particularly relaxing picture of being a junior doctor in that book or resident doctor as they now are but those are basically the good old days now that's before everyone moved to Australia that's before you know we're now a hundred thousand members of staff short in the NHS and you know a tough gig's become an almost impossible gig well that's what you say and you know and you you demonstrate that perfectly with a lot of the stories you're telling especially the end of the book being expected just to pick yourself back up and and crack on with it and not have that time for reflection or examination And so I did go back, you know, I did do that the next day and the day after that and the week after that.

19:53But essentially, I realized that whilst, you know, that wasn't a fatal blow for me, I was going to be able to, you know, pick myself back up and get on with it. I couldn't face that kind of thing ever happening to me ever again. and friends who I didn't talk about what what had happened because doctors don't talk about that sort of thing unhelpfully um friends would want me to feel better about it and and the ones who knew what had happened would remind me trying to make me feel better trying to remind me it wasn't my fault that on labor boards all you want is a healthy mom and a healthy baby as your bare minimum sometimes you do have one of these big disasters where you see neither of those two things.

20:37And that's probably going to happen every five or six years. And it's not about how hard you trained or the qualifications you've got. It's just a horrible fact of the job. And so I'd be told that. And then I had this sort of, I guess, this sort of depressing epiphany that I just couldn't face it ever happening. And so the best thing for me was actually to step away. and I thought I'd step away for a few months and then find myself a different branch of medicine to go into. One which is, I don't know, there's no easy branch of medicine famously, but I mean, I was attracted to OBS and Gynae, the labour ward set up by the height of the highs, but that's always set off by the depth of the lows and I thought I probably needed to find somewhere where the highs weren't quite so high but the lows I could deal with and yeah 15 years later I'm still on my few months off.

21:39Fearne Cotton: Yeah I mean it's taken you off on an extraordinary tangent which we'll talk a lot about today but I guess you even though you went back the next day you weren't immediately able to continue operating as you had been. You sort of were left with a paranoia that you would double check, triple check everything, make sure that you were going above and beyond, which then I'm imagining exhausted you to a point of no return. It actually made me a worse doctor because when I was on labour ward, you're aware of the labour ward set up. You're plugged into the machine and it's recording babies, heart rates in labour for for a lot of mums during labour and you're sort of you know taking a view and it goes up a bit goes down a bit and you sort of oh pop back in 15 minutes anytime a baby's heart rate dropped a tiniest bit I was like cesarean section because I wanted to prevent this sort of thing ever happening again but even though I knew I couldn't and intervening too much is just as bad as intervening not enough and I knew in my heart I wasn't actually being a good doctor when I was being over cautious and intervening too much yeah but completely understandable yeah and I don't know it's the NHS as much discussed I love and I think is our greatest achievement as a civilized nation healthcare that's free at the point of service it's based on your clinical need never based on your bank balance I think that needs to be cherished and protected at all costs I think it's perfectly possible to believe that on one hand and also believe it's often I mean one of the worst employers in the world yeah don't think they look after their their staff well enough and you know I'm just one of a million people with a story of how they were you know slightly let down by their employer.

23:40Fearne Cotton: Yeah, I mean, we do have to cherish it. It's so unbelievably important and so many of us rely on it or have. And, you know, like the book that I contributed to that you beautifully put together, it's touched so many people in huge ways, you know, in life-saving ways, in terms of having that one doctor or nurse who gave your relative or you that extra bit of care that, you know, that kindness, that human connection. It's so important. It's like, so in the States, the Gallup people, the polling people do one of the questions they ask the population every year is what's your biggest concern in life?

24:20What's your biggest stress? And every single year, the number one concern in life for people living in the US is the availability and affordability of healthcare. hopefully no one in the uk has that anywhere near their their their top 10 worries and that is a that's a brilliant thing but the healthcare system isn't buildings and it isn't mri machines and it isn't bedpans and it isn't anything other than the people working there and those are the people who need to be looked after and that's what our overlords you know and senior management need to remember that that is what the NHS is. It's 1.1, 1.2 million people, you know, putting themselves second, fifth, a hundredth so that other people be looked after.

25:09Fearne Cotton: I mean, I experienced it so recently. My son had to go to A &E and he's luckily absolutely fine, but it was in the middle of the night. Obviously. Yeah, always. And, you know, sort of awake all night. And I was sat there really, because I'd had a stint in hospital a couple of years ago and I'm really I was sort of borderline obsessed with doctors and nurses that that you know they're up all night doing this gig day in day out under extraordinarily stressful circumstances a lot of the time and we're in the kids A &E and I was sat there just watching there were maybe um four or five nurses and then a couple of other nurses and doctors were coming in at this point it was 1am and I was kind of selfishly at the beginning thinking, oh God, I'm not going to get any sleep.

25:52Fearne Cotton: I've got work tomorrow. This is a fucking nightmare. And then I sat there and they were all joking around like Mickey taking one of the doctors. Then another doctor came in. They all had a little in joke and were laughing here. And then one of the nurses came in to see us and was being really funny with my son, basically. Like trying to lift his leg in the air to see if it would move. And she was like, you're not very fit and had the sort of energy somehow at 1am to be larking around with my 13 year old, having a giggle with him, going back, sitting with all of their teammates. And I just thought, oh, this is actually one of the jolliest things I've seen all year.

26:28Fearne Cotton: And it's 1am on the A &E kids unit. It was sort of a bit of a wake up call for me and extraordinary. And I'm just in awe. And also the gratitude is like off the scale. But that obviously isn't recognised within the system because people aren't looked after, as you say, or paid well enough to stay within the job. And it's underfunded. Like, you know, it's a serious issue we've got here. It is. And it's, yeah, and it's currently heading in the wrong direction. And I don't know what the answer is. No. Do you? I definitely don't. And no one's expecting you too, but you've got the storytelling and the experience that I think alerts us to the fact that it is in trouble.

27:16Fearne Cotton: We know that, but that we need to cherish it and something needs to change. And that's a systemic thing that's kind of. Yeah. And personally, I think we need to avoid the people saying the system doesn't work. It's broken. It needs to be totally replaced with. Oh, here's a good idea with them. We could have an insurance based system and this and that. And a lot of these people who say these things have skin in the game. They've been, you know, someone from that world's given them some cash and that hasn't, you know, necessarily been, I don't know. Anytime there's a two-tier system, people fall through the cracks.

27:56And the extreme version is the system in America. And I don't, you know, I really don't think we should be. No, no, no. We should be heading down that road.

28:07Fearne Cotton: No, that will leave so many people with zero access to any medical care, which is the worst nightmare for many people out there. It's not good. Like all my American mates, and I'm sure it's the same with you, one of the first questions about a new job is what's the healthcare situation? Yeah, yeah. It's like determines the job they take, the area they live, such crucial decisions are based on health. And like, even though the execution of it at the moment, sadly, isn't as good as it needs to be, because there aren't enough people and there isn't enough resource and there isn't enough cash in the system.

28:44It's not like that.

28:45Fearne Cotton: No, no, no, no. I know. We need to really, really cherish it.

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30:03Fearne Cotton: When you hit that point of thinking, I really can't do this anymore. I love this job, but I cannot put myself through it. I mean, you describe it as PTSD. You had PTSD from this experience. I think I did. There's the only, you know, slight wobble on that is I didn't see a doctor to get the diagnosis because doctors don't like going to see doctors, particularly not about their heads. Doctors make the very worst patients. It's sort of it's like a mechanic taking their car to a different mechanic. Why didn't you just sort it out yourself? You sort of got that in your head. And as soon as it's about your mental health and that's times a thousand, you sort of, you really don't want to discuss this.

30:47But I was, you know, pretty much until I started talking about this stuff, when the book came out, that was pretty much the first time, it was the first time my parents knew why I'd left the profession. They knew I had, they didn't know I had. It was the first time my then boyfriend, now husband, knew about why I'd left. And so until I started talking about it and dealing with it just by saying it out loud, I was waking up at three in the morning back in that operating theatre with my pulse going 200 beats a minute and in an actual cold sweat. And if it wasn't PTSD, it would have been something very similar to that.

31:29Fearne Cotton: So, God, that's a hell of a lot to carry internally. I mean, I totally understand the blocks that we feel when we don't believe we can say to our partner, to our parents, like, I'm struggling mentally. I don't feel well. It's a big hurdle to get over that many of us have had to eventually jump over. Yeah. But that's a big deal to go through the decision making in your head of I'm leaving. I'm not going to be a doctor anymore without actually saying to anyone you're, you know, in a circle. And this is why. And I obviously knew that that wasn't healthy, but it wasn't until the book came out that I realized it wasn't uncommon.

32:11yeah i started getting huge numbers of messages you know people who write into the publisher email the publisher or you know message in social media whatever from doctors saying all starting the same way i've never told anyone this but and they'll tell me this enormous awful tragedy and then they'll say and i never told my friends my colleagues my you know my my partner my anyone it's just i know it's this cultural thing yeah in uh in healthcare and it's a really really really big deal and people leaving isn't great obviously but that's not the you know the the real problem essentially is the healthcare system has a huge suicide problem and it's something no one wants to talk about and it's a huge problem.

33:06So every three weeks, a doctor in the NHS takes their own life. Every single week, a nurse in the NHS takes their own life. And that's just two of the huge jigsaw of professions that makes up a health service.

33:19Fearne Cotton: I'm so sorry that I was totally ignorant to those horrendous statistics. It's not ignorant in the slightest. It's a function of the fact it never gets talked about because of stigma and shame and taboo and tradition and whatever it is, every time swept under the rug. And so, yeah, the numbers seem unbelievably high and they're multiples higher in that profession than almost any other profession. And the numbers aren't particularly improving. And so something needs to be done because it isn't... And I'm sort of aware that I say, oh, I had this bad day at work and I couldn't hack it and I left. And it sounds a bit sort of, you know, poor old me.

34:06I don't think that at all. It's a really big problem. And I think we just need to remember and recognize that the people who do these jobs are human beings. Yeah. And you don't want to think of your doctors and nurses as human beings. So, you know, you're going in a hugely stressful situation with an unwell child at one in the morning to an A &E department and a doctor or nurse says you need to do this. And you want to think, correct. Yes, that's what I need to do. I trust you. You're right. You don't want to think you're a human being who makes mistakes, gets sick, gets sad, gets tired. You need to put that to the side.

34:46And then you kind of start to believe that your own myth that, you know, maybe, yeah, maybe I don't get, maybe I am just a bit different. And maybe I can just put these barriers up and not deal with these emotions. It's a tricky one.

35:07Fearne Cotton: It is because every single human being in that role is going to be feeling probably every emotion every day. But if you're learning to suppress it and just go, nope, not looking at that fear, that sadness or that frustration that something didn't go well, whatever it is, that on a human level is going to build up into something that is unmanageable. Like it's common sense. A hundred percent. A hundred percent. I mean, you can always put your feelings and your problems into a box. It does work, but eventually that box is going to open and you have no control about when that box is going to open.

35:40And so that is not the way to deal with it. So, you know, I can only talk of the healthcare professions about medicine because that's the training I had. But I dare say it's not hugely dissimilar in the other healthcare professions. So I went to medical school. I was there for six years. And then an afternoon a week for my course was spent doing communication skills. And hooray, and that didn't used to be the case. A generation of doctors beforehand who thought you'd just sort of, you know, march in and announce things. so we're taught communication skills we're taught all these sort of brilliant techniques that you rely on about how to break bad news and all sorts of things and the nurse who was being funny and silly and messing around with your son's leg that's all good communication skills that relaxes the person not one point in these six years of an afternoon a week did anyone say sometimes you're going to have a bad day and this is what you do about it

36:35Fearne Cotton: Sometimes someone will die on your watch and you've got to deal with that. That's something that is not anything a regular human in another job is going to have to deal with. It's just not. It's just not. Out with, you know, the emergency services, you know, the front end, you know, medics, no one is, frontline medics, no one is dealing with that. And you need to be taught how to, you need to be told the techniques. um like when i applied to medical school uh it was have you got loads of a levels yeah yeah yeah all in sciences yeah um do you have like other interests yeah i could play the piano a bit okay great uh okay you're in that that was it there was no that that's what it was it was recruiting people who were good at science who could you know play lacrosse yeah I don't think that's necessarily how you get the best people at a job that's basically a job about communicating yeah and a job where you have to be honest not every person can do every job no no I you know the thought of me becoming a firefighter is is laughable and hopefully at some point someone would you know in the interview process someone would check i was actually up to the there was there was no are you up to it in and it's interesting because a friend of mine good friend worked as a as a legal aid solicitor and essentially was was burning out and could see he was burning out and thought i need to try something else so he was like i'm gonna be a train driver.

38:16Love trains, quite like the idea of sitting in a cab on my own for a bit. And so he went through that and that's what he did. Quite early on in the process, he had to speak to a psychologist who asked the question, if the very, very worst happens and someone jumps out in front of your train, are you going to be able to deal with it? Let's work this through. Let's talk this through. So if you want to, you know, be a train driver, you want to be an astronaut, if you want to go on love island you'll speak to a psychologist at the start if you want to be a doctor now you'll probably be fine and i think that's a you know and and these are 18 year olds they must i don't know

38:52Fearne Cotton: i don't think we're doing it right no i completely agree with you if you're not looking after the people that are looking after everybody else that is a recipe for disaster and it is you are dealing like that is the thing that i get from this book like the second time reading it again Like you say, it's an impossible job that we're asking doctors and nurses to do. Yes. And it's that simple. And they're expected to do it day in, day out under awful hours that they're having to often wake up, long hours that they're having to work. There's a thing in the book. Actually, I haven't read the book cover to cover since I wrote it.

39:28So maybe this disappeared into the cutting room floor. But there was a moment where we had this sort of on-call room on the labour ward where on the rare occasions where there wasn't an emergency buzzer ringing for 20 minutes, you could lie in that and get 20 minutes sleep and then on with the shift. And the hospital, in their wisdom, decided that that was going to be shut down. That if you're at work, you should be at work. And that means awaken. And I just, I don't know, as soon as that happened, my first thought was, if, you know, senior manager person, you or your partner are going into labor and a doctor needs to be, you know, called as an emergency to do a cesarean section or a ventus extraction or forceps or whatever it is.

40:23would you rather that doctor has had 20 minutes sleep or you bolted the door so they can't and surely the answer is you and that's just a tiny example of not looking after people enough my um so many examples like a friend of mine who on the day of their own wedding had to do a morning clinic in full hair and makeup because they weren't allowed the full day off because the didn't allow it um you know someone who um whose fiance was sadly admitted to intensive care unit as a patient and they weren't allowed compassionate leave to visit their fiance because the hr rules say oh it's only if you're married or it's a first degree relative these are this isn't

41:08Fearne Cotton: looking after people and this needs to change it really it really really needs to change so massively. Otherwise they will just move to Australia. I love Australia. I've toured in Australia a few times and I'd say half of my audience there are British. Really? British doctors. I spoke to a friend of mine who's moved out. He's an A &E consultant out there. He reckons that 75, 80 % of his doctors in his department are Brits. What are they getting right over there? What are they getting right? They're paying them more. They are working them fewer hours. They recognise the work-life balance. And the thing that's hardest for us to achieve, it's much hotter.

41:56Right.

41:58Fearne Cotton: That one, we can't put any tax money towards that one, sadly. That's not going to change it. But ultimately, they're treating staff with respect and treating them as human beings. And it's like, you know, if you're a resident doctor, junior doctor, as was working in a hospital, once you get moved to a different hospital, which is fair enough, because, you know, work in big hospitals, some experts in this, some experts in that, make yourself the best version of yourself as a consultant. Great. But this other hospital that you have no say where you're sent is often 80 miles away. And so what does that mean?

42:35I mean, unless you exist in a vacuum, that means, you know, saying goodbye to friends, you know, trying to convince a partner to move 80 miles. They might say yes once. They're not going to say yes seven years in a row, are they?

42:50Fearne Cotton: No. I mean, you've had a fair amount of dealings with putting this message out there and writing open letters to government. Do you get feedback? Do you feel a shift in the right direction with positive change? So yes and no. I think now it's recognised that hospitals need to be doing more to look after their staff. But when you dig into it, sometimes it's, you know, 40 % off a mindfulness app and a Zumba class once a fortnight. And so better than nothing. But at the same time, not there yet. So it's, you know, I think it's really important to, you know, to keep banging that gong because it's a big thing.

43:54Fearne Cotton: So grab a bite, grab a seat, and earn unlimited 3 % cash back with the Saver Card. Capital One. What's in your wallet? Terms apply. See CapitalOne.com for details. Quick question. When was the last time a display ad changed your mind? Now think about the last time a friend told you about something they loved. Different feeling, right? That's how podcast advertising works. A host who's built real trust with their audience talks about your brand in their own words, in their own voice. It doesn't interrupt the experience. It's part of it. With Acast, you can access the world's largest podcast marketplace.

44:31Fearne Cotton: Choose the right shows, the right audiences, the right format. Then watch the data tell you it worked. You're not buying impressions. You're buying influence. Learn more by visiting acast.com slash advertise.

44:48Fearne Cotton: On a more personal note to you, when you decide to leave a profession like being a doctor, something you also known as with your friends and your family. And there's maybe not always the respect that you want at work, but there is a respect that you may be commanded. Your parents like, oh, my son's a doctor. You know, it's a badge that you wear. Losing that, did that make you feel lost? Like you were slightly untethered, not having the doctor bit in your world anymore? I think, I don't know how much kudos I took from it, but it was certainly a big part of my identity. Because I hadn't taken a breath since school.

45:29I didn't do a gap year. There wasn't a gap between finishing my degree in medicine and starting work. I was just, and I was on this treadmill, you're the house officer, senior house officer, registrar, senior. And sort of just moving forward, forward, forward. And then suddenly there's a power cut and the treadmill stops. And it's a bit, you know, that's not a good moment. And so it did take me a while to work out who I was if I wasn't a doctor because so much of my life was defined by it.

45:59Fearne Cotton: And what about the PTSD? Whether it was diagnosed or undiagnosed, you're waking up at 3 a.m. with a racing heart. You're dealing with panic. It's not a fun place to be. What helped you get through that? I mean, ultimately and long term, it was professional help. Yeah. Speaking to the people I should have been speaking to from the start. In the medium term, it was, you know, before it was a book, this was me standing up on stage at the Edinburgh Festival, reading out from my diaries. And I would read funny, silly, gross stuff. It would be 95 % just lols. and then I'd say this bit about what happened at the at the end not you know it's a confidence trick a bit like it's a confidence trick with my kids books they think they're getting just the funny silly stuff but they're being taught all of this hopefully useful stuff you know this is gonna hurt it's sold as a funny book but actually it's got this this message in it and the live show um which I probably should bring back for 10 years shouldn't I definitely do an encore victory lap You must.

47:09Okay, fine, deal, we'll do that. Do it. So I say this very, you know, it's a difficult story to hear. It's a difficult story to read out. But it was a very useful thing for me because that was the first time I started to process it.

47:27Fearne Cotton: Well, you have to confront it to deal with it. I think when we've got stuff that we're not able to even look at, and I've had this in my own life, like la la fingers and ears you can't heal from that because you're not looking at it so you have to do the worst bit ever which is and I think standing on stage quite a literal reading out of your story you're going to be processing that every time you get up on stage and do that to get your brain in the headspace to go right this is the reality of it now how do I move on from it Yeah, no, that's very well put. And it did help me. But ultimately, what should have happened is after this incident, there's even a term for this sort of thing.

48:17Healthcare professionals are described as second victims. Right. So it's like you learn at school that every action has an equal and opposite reaction. That's whoever that was. Newton? Someone like that. Anyway, let's say Newton. It's never equal what comes back, but there is always an opposite. And so this second victim term has... So the hospital should have been, right, now here's your debrief. Do you want to have any time off? And I'd probably said no, but just being asked that might be, Do you want to have counselling? I don't know if I'd have said yes or no. But again, knowing that the help is out there would have been a big thing.

48:59But I suspect the help wasn't out there. Even if I've asked for it, they'd have been like, nah.

49:04Fearne Cotton: But maybe even just the recognition that what you've been through was very difficult could have been the first step in that. Because if no one's saying to you, God, I mean, this must be full on for you to carry the weight of this after what's just happened. if you've not got that of course you're going to gaslight yourself and go no brush it under the carpet I'm moving on no one's telling me that like you kind of you need someone to mirror that back to you for you to go god this is something I need to look at here yeah and ultimately I did go and speak to my boss my consultant about this and and it went badly and I I could have predicted it would have gone badly in terms of it was brushed under the carpet for It was basically a version of man up, that worst possible phrase.

49:51But I could have predicted it because this was someone I had to address by his surname. It was so sort of hierarchical and militaristic and old fashioned and whatever that, you know, these consultants insist on being called Professor this, Mr, that, miss or whoever. like that's you know if you're if you're at the top of that tree you should be taking your juniors out for a bowl of pasta without a cup of coffee or a glass of wine just to make sure that you know you know that every one of them if they're struggling can can actually sit down opposite and look hopefully i know the person in question is now is now long retired hopefully those dinosaurs are no longer walking the earth and you know and now most of the consultants are you know at my age and hopefully people who take it more seriously.

50:39Fearne Cotton: I think I've done a fair few talks probably since COVID actually in varying workplaces could be a bank or an insurance company, whatever. And the one thing that I see again and again in places that do take people's mental health seriously is when someone at the top, the CEO or a line manager, someone who's got influence shows vulnerability to their team. That seems to be a big game changer. Exactly that. And there was a big thing on social media a few years ago where doctors were taking photos of their antidepressants and their psychiatric medicines. And that was hugely, hugely powerful. Exactly.

51:18I would say there are now, I think there are now two types of mental illness. And this is something I'm stealing these words from a character in a book, in a novel I wrote called The Particularly Nasty Case, which is about a doctor. it's a thriller and it's funny and it's all that but essentially at its heart it's about a doctor with bipolar disorder and one in 50-ish people have this condition which means probably one in 50-ish of the doctors in the world have this condition and so I announced I was you know writing this book and you know and the blurb goes out and I've got people with this condition in my life close to me.

52:04But other people got in touch when it was announced, including two people I'm sufficiently close to while I was at their weddings to say, I've never mentioned this to anyone before, but I've got bipolar, they said. And it's like, we're talking about stigma before. The amount of stigma, no one would say, would hide a condition affected any other organ of their body. No one would say, I would never normally say this, but I'm diabetic. or I've got asthma or I've got psoriasis or I've got anything. But these can do. So there's the two types of mental illness as I see it. There's anxiety, depression, OCD, all these things.

52:46And brilliant, I'm saying this is a good thing because it wasn't the case 15 years ago, but people will happily say, you know, I have this and this is what I take for it or here's what I'm seeing for it. And that can become like a dinner party, pub, whatever conversation. And then there's the other type of mental illness, the schizophrenia, bipolar, where people's instant reaction is often a bit to rear back and be a bit concerned, which comes out of, as all of these things obviously come out of ignorance, translating into fear and it doesn't get talked about. So I think there's still more of a journey.

53:27And this character in the book, Eitan, even though it's not high in the mix, but it's there. And all along, he's facing, basically, he reckons his boss has been murdered. No one else does. Police don't. Colleagues don't. Corinne doesn't. But he's really onto this. And the fact that he's got this diagnosis means that sort of everyone raises their eyebrow. that little bit higher. He's always being seen through the prism of his diagnosis.

53:59Fearne Cotton: This is why fiction can be equally as powerful as a nonfiction book because the messaging's in there, like you say, it doesn't have to be like the main theme of the book, but you've got a character who is impacted by that diagnosis and the judgment and the stigma around it. I think the more that we can have these conversations in a myriad of ways the better so that it's just normalised it yeah exactly I mean how you've got two children now who are three-ish three-ish three-ish um how do I mean obviously they're too young to have these chats yet but how do you think you'll approach that when it gets to later down the line whether it's talking about physical health or sex ed or mental health you know I am only now with my children talking about puberty and sex education and every time I'm like oh god I should I need and it feels like there's a discomfort whatever and mental health wise even though I spend my life talking about it at work I still sometimes stumble over like how do I articulate this you don't want to get it wrong and in trying to not get it wrong you sort of end up being stilted or say nothing and it's really tricky which is its own version of getting it wrong but look you don't You don't have to do everything perfectly.

55:14You just need to have good intentions. And I think the generation above us said absolutely nothing. And that's definitely wrong.

55:22Fearne Cotton: Yeah. And there's probably a version where you say too much. But, I mean, we've started to, you know, there are people, you know, friends and family in our kids' lives who are significantly unwell in that way. And it's not something we don't talk about. we just say you know person x is is ill yeah and we're visiting them in a in a hospital or in this place or that place and that's just what it is because you you create your own taboos by making it weird yeah and they have to be told that this is something to be to be scared of or to you know to not like yeah exactly just got to start those conversations early yeah so if you don't if you don't make it a bogeyman if you're if you can be obviously easier said than done frank and open about it and don't make it a bit oh we don't talk about that yeah exactly and in terms of your recovery and whether it's ptsd or not but your recovery from having panic and feeling that stress do you ever get little moments where it bites you in the ass again or are you yeah i do but less and less and less and i don't want to pretend i'm some sort of poster boy for really looking after my physical or mental health because I'm absolutely not.

56:42But I guess all I do do is treat my mental health like my physical health. And I guess make sure that I know what my first aid kit is at home. Like the basic stuff I can do, which is, you know, I can take the dog for a walk. I can stop what I'm doing at the moment. I can sit down and play the piano really badly. That's my thing I do that really, it takes me out of the world because I have to concentrate so hard. on getting the notes right that I can't think about anything else. So I've got my first aid kit. And then there's like, you know, the equivalent of, you know, phoning 111 or popping to the pharmacist.

57:19And then there's knowing when you need to see the GP or, you know, or rarely go to A &E. So just sort of just being able to spot the signs.

57:29Fearne Cotton: Yeah, yeah. And are you better at doing that now considering before you had a bit of a block with I'm struggling? Are you quite good at going, okay, actually, I need to have a second here to feel better, to feel well. Yeah. I mean, I'd say previously I was a one out of 10 and now I'm like seven out of 10. It's good. It's good. It's better. And I don't know if I'll ever get fully better than that, but that's where we are. Well, it's strange because I think culturally, we're not told to prioritise looking after ourselves. We're just not. It's like make sure everybody else is okay, especially when you're a parent.

58:07Fearne Cotton: It's obviously a necessity, but we're never, I think, especially in British culture, it's like seen as indulgent to make sure that you're okay. Yeah, that's very well put. So you have to really go against the grain to go, I'm going to say no to that thing, or I'm going to choose to do this because I know it will make me feel better, rather than doing the 100 jobs that I'm meant to be doing over here. Oh, for sure. And I think, you know, medicine, working in that profession for a while, has, you know, changed me and my personality in all sorts of good ways. Like I sort of, you know, I'm very good at thinking, well, no one's died.

58:44You know, I can sort of, you know, I can put things in perspective. I'm very good in an emergency. You know, if this room catches fire, I'll be very calm. They teach you at medical school.

58:54Fearne Cotton: I want a lot of flammable stuff in here as well. I think my outfit isn't going to last long, is it? But it's like one of the things they teach you is the first pulse you check is your own in an emergency. That's one of the things you can't be an effective doctor when, you know, you need to get the baby out in two minutes. Yeah. Someone's heart stopped or whatever it is, if you're panicking. So you don't run to the emergency. You walk fast, but you're not. No. And so that has given me lots of it's given me lots of positives. But one negative is my work life balance. It's quite hard to shake that because in when I was working as a doctor, it was 100 to zero.

59:32Fearne Cotton: all work no like there wasn't space for no for life like even if you were meant to go out for dinner or drinks if the labor buzzer goes and there's some great big emergency and you're there for two hours there's no one to take over from you just you've just become the flaky friend and then by the time you've missed a couple of those drinks they stop inviting you and then sort of you end up with no life so you just do work so still like i don't know i'm now self-employed i should you know and i'm i'm i'm very lucky as a writer because for a long time i was you know I would take any job that was going to help me pay the gas bill.

1:00:03Now, you know, I can pick and choose a little bit, which is a wonderful situation to be in. I can be creative in the ways I want. Nonetheless, anytime something goes in, I said, no, I have to say this. I have to make this work because what if it's the last thing I'm ever offered? And I think that's just a bit of that sort of, you know. Wiring. Wiring. Yeah, exactly that. And, you know, I bring work on holiday.

1:00:24Fearne Cotton: Yeah, I get it. I get it. It's just it's ingrained in you. It's how you work. It's why you keep churning out so many books. But as I said, I'm a massive fan. I love what you're doing. I think this book, you know, although it's coming up to its decade, it's just so important for if anyone hasn't read this, I don't know who hasn't, but if anyone hasn't, it's such an important read and so entertaining to read. You know, it's a brilliantly entertaining book, but that also highlights all the changes that need to happen and a whole shift in respect and how we look at the work, the work at the NHS, the people who are involved, the humans, the humans behind it.

1:01:03Fearne Cotton: Exactly. That's the main word, isn't it? It really is. And thank you for writing your brilliant kids' books because they're bringing my kids a lot of joy and education on the sly, which we absolutely love. Before we wrap up, two questions. The first is we are creating a Happy Place playlist full of jolly music that makes us feel good. If you need to have that escapism, you need to go and walk the dog, What is that song that you're going to be listening to? So, I mean, it's not a traditionally happy song, but there is joy in it. It's Days, the Kirstie McColl version of the Kink song. I love Kirstie, wow, that voice.

1:01:39And it's just, it's the best voice plus the best song. And it's, hopefully my funeral isn't super happy, but I've told James, my partner, that that's the song to be played at my funeral because it is upbeat. And also, hopefully now I've said this, out loud on your podcast, he will remember it. Because occasionally he'll be like, what's the one, is it Daydream Believer? No, it's not Daydream Believer. Don't get the wrong one. So don't put Daydream Believer on.

1:02:10Fearne Cotton: No, no, no. Just days, please. Okay, that's going in. And lastly, Adam, what is your, or what or where or who is your happy place? Can I please have the Isles of Scilly? Oh, I've never been. You must go. I'd love to. But don't tell too many people to go. Actually, I shouldn't be saying this out loud, should I, because all these people are hearing. It's the most perfect, unspoiled, irritating to get to. It's so wonderful when you get there spot. And even though it's only half an hour from Penzance, it's somehow its own climate. Yeah. And it's like, I don't know, it's like being 100 years ago. And it's magical and peaceful and quiet.

1:02:55and all the things my life isn't with two toddlers.

1:02:58Fearne Cotton: Of course it's not. That's the absolute opposite. Well, thank you so much for being on the podcast. It's just been a joy and educational and important. So thank you so much. Thanks for having me. Oh, Adam, what a brilliant human you are. I hope I get to hang out with Adam again. That's the feeling I was left with after that chat. Like, well, I've got to do that again, preferably over a glass of wine. He's just a joy to be around and cares deeply about the work that he's doing, the messages that he's putting out there and for us all to really care for the NHS. So what a top guy. Absolutely bloody love him.

1:03:38Fearne Cotton: You can read Adam's novel, A Particularly Nasty Case, in paperback now. And obviously I urge you to read This Is Going To Hurt If You Haven't. I mean, most humans have, but if you haven't, it's a must read. A massive thanks again to Adam and to you. You are the greatest.

1:04:13Fearne Cotton: Happy Place is researched by me, Fern Cotton. The producer is Anushka Tate at Happy Place Studios with studio engineering by Basil Oxtoby. This message is brought to you by the Capital One Venture X card. Venture X offers the premium benefits you expect, like a$300 annual Capital One travel credit for less than you expect. Elevate your earn with unlimited double miles on every purchase, bringing you one step closer to your next dream destination. Plus, enjoy access to over 1 ,000 airport lounges worldwide. The Capital One Venture X card. What's in your wallet? Terms apply. Lounge access is subject to change.

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