Ed Patrick, Stefania Licari and Michael Akadiri. Photograph: Simon Webb/The Observer
So there was this case…” begins Dr Stefania Licari. For a moment you don’t know whether to expect her expert medical opinion or a punchline. A patient on the intensive care ward was in desperate need of a dialysis machine – without it, Licari thought, he would be unlikely to survive the night. She had spent almost an hour talking to him, empathising, trying to explain that this was life-saving treatment. But the man refused: he was exhausted and distressed, and wanted to go home.
“At a certain point, I realised I was losing him,” says Licari. So she tried something different – she cracked a joke. The man laughed, then was quiet. Licari accepted defeat. She told him that she respected his decision and went to leave. But the patient called after her. He’d changed his mind. He would stay and have the treatment.
“It was such a beautiful moment,” says Licari now, a few months later. “I’d prepared him with an hour of listening and empathy, but the turning point was the joke. In that moment he trusted me and that literally saved his life.”
As for the joke, Licari admits, she doesn’t remember it – “which is a shame, because I remember leaving the room thinking: ‘That was a good one, I should write it down.’”
After nearly 20 years as a doctor, working mostly locum shifts in intensive care, Licari started a new career – in standup comedy. At the Edinburgh Festival Fringe this August, she performed her debut hour-long show, Medico, inspired by her experiences of working in the NHS (and promoted as having “medically accurate knob gags”).
More surprisingly, Licari was not the only medic-turned-comic on the bill. There was also anaesthetist Ed Patrick with Catch Your Breath; psychiatrist Benji Waterstones’s You Don’t Have To Be Mad to Work Here; accident and emergency doctor Kwame Asante with Living in Sin, and intensive care doctor Michael Akadiri’s No Scrubs.
Meanwhile, Britain’s best known ex-doctor, Adam Kay – whose bestseller This is Going to Hurt has sold 2.5m copies – returned to the Fringe with a work-in-progress, This is Going to Hurt… More.
Licari recalls a group of them meeting up after their shows, still dressed in their performance get-up. “It felt a bit like we were in an on-call room – we were all in scrubs, walking down the streets of Edinburgh.”
Comedy might seem an unlikely side hustle for a doctor, given the demands of the day job. In fact, there is a long tradition, including writer Jonathan Miller, Monty Python’s Graham Chapman and the Goodies’ Graeme Garden. Harry Hill is even still registered with the General Medical Council (though not licensed) after 30-plus years in comedy.
“There’s obviously an element of performance in medicine and a strong history of revues,” says Dr Phil Hammond, Hill’s contemporary and one half of the medical-comedy duo Struck Off and Die. Hammond started writing with Tony Gardner while they were both junior doctors in the early 90s. Over the next decade, they enjoyed sell-out runs at the Edinburgh fringe and a sketch show on BBC Radio 4.
But while Gardner went on to focus on acting – appearing lately in Last Tango in Halifax and Gentleman Jack – Hammond has remained in practice as a GP for more than 30 years, while also writing and performing. “Most of the comedy I did was related to the NHS, so it really helped to work in it,” he says. “It gave you more authenticity – and obviously more material.” But Hammond says juggling the two is unusual: “Most doctors who get serious about comedy give up the day job.” Many, like Hill, don’t centre their past lives in their material at all.
This new cohort of doctor-comedians, by contrast, brings together the two identities, looking to their medical careers not just for jokes but for show concepts and stage personas. (In Medico, Licari, an Italian NHS intensive care doctor, performs as her comedic alter ego: an Italian NHS intensive care doctor.)
There is undeniably overlap. Both disciplines involve interacting with the public, and grappling with the stuff of life – much of it messy. There is the gruelling road to success, which many don’t make it to the end of; the late nights and long hours; the moments of acute pressure, followed by – hopefully – a payoff.
“There’s a truth-seeking there: you’re trying to get to the right diagnosis, out of complex things,” says Hammond. “A lot of medicine is about narrative and story – they do go well together.” They might even be mutually beneficial. Most doctors use humour as a coping mechanism, says Hammond. “For me, it’s a catharsis, and without sounding too trite, it did make me a better doctor.”
Akadiri, on the other hand, only realised he might have a talent for comedy while in foundation training as a doctor, in 2017. “I enjoyed making people laugh, but I’d never actually thought you could do it for a living… I’d thought: ‘I’m in medical school,’” he says. Called on one day to share his experiences of the job with a group of hospital colleagues, Akadiri told the story of the most stressful moment of his nascent career so far: when he had been summoned to the coroner’s court to give evidence over a patient’s death. (No negligence was found.)
“It wasn’t meant to be funny. It’s not a funny story. It’s actually quite harrowing,” says Akadiri. But his wry retelling, focusing on his mother’s outsized reaction (“‘melodramatic’ would probably be the word,” he says) found the humour in it nonetheless.
“The whole room of my peers was laughing, they really found it funny. That was when it clicked that there must be something here.” Within a month, Akadiri had done his first-ever set at an open-mic night. Five years later, he has performed standup on ITV2’s The Stand Up Sketch Show, as well as at comedy festivals and venues across the country. No Scrubs, his Edinburgh debut, made use of the same “harrowing” story that cracked up his colleagues. “I didn’t know it would lead to this,” Akadiri says. “I was doing it as a hobby, just trying to see if I was funny.” Now the question is whether he can make comedy his career.
For years, Akadiri has effectively been working two jobs: full-time as a junior doctor, most recently in orthopaedics, and gigging at nights and weekends. “It was getting a bit much,” he says. He has now given himself a year to dedicate full-time to standup before seeking out another NHS contract, or starting the six-year training to become a consultant. “If I have to sheepishly go back to the NHS and say, ‘Hey, take me back,’ then so be it – I’d rather fail than not try.” (Besides, he jokes, “The last time I checked, they need people.”) He is not concerned about finding new material. In his first few years of standup, Akadiri did not mention his “second life” at all. But, he adds: “There’s a part of me that thinks there’s still years of medical school and work to lean on.”
Certainly, the mainstream appetite for stories from the NHS has never been higher – with one obvious success. First published in 2017, This is Going to Hurt spent a year at the top of the Sunday Times bestseller list to become the top-selling narrative nonfiction book of the 21st century. Adapted from diaries Kay kept as a junior doctor from 2004 to 2010, working mostly on maternity wards, it led to a new publishing genre of “professional confessionals” as well as, this year, an acclaimed BBC series starring Ben Whishaw.
Kay himself has written two follow-ups, most recently Undoctored: The Story of a Medic Who Ran Out of Patients. But perhaps This is Going to Hurt’s greatest impact was the spotlight it shone behind the scenes of a hospital – the punishing conditions, structural inefficiencies and costly mistakes. “I’ve had the odd comment from a sniffy parent telling me their offspring was put off medicine by reading my books,” Kay says. “I can’t say that worries me – medicine is a job it’s crucial to go into with both eyes wide open.”
But if Kay’s savagely funny account was confronting to lay readers, it struck a painful chord of recognition with those in the NHS, many of whom said it had only deteriorated since his departure. The past two years in particular have been brutal.
Like most anaesthetists, Ed Patrick was seconded to intensive care through the early peaks of the pandemic, and says humour was vital in relieving the stress of the situation – and recognising its frequent surrealness. Patrick’s own enduring memory is of a mass of protective visors, hung up in the staff changing room and labelled with names for easy reuse – “like some paintball memorial wall”, he says. “This was when things were really dire, as well.”
Patrick had started doing standup while in medical school, seeking stress relief. It was met with such disapproval by his tutors that he kept it secret for years, even concealing it from colleagues. “I’d do a gig, then a night shift and never talk about it. I was living a double life.”
It was only when venues were closed by lockdown that Patrick realised how much he’d come to rely on the release. “I’ve always done comedy and medicine; they’ve always balanced each other out for me. I hadn’t quite appreciated how much,” he says. Patrick likens it to other doctors’ dependance on cycling: “In medicine you always need something on the outside to decompress. My Lycra is comedy.” Seeking a creative outlet and a reminder of what had initially drawn him to medicine, he started expanding his notes from anaesthetist training into a book. Published last year, Catch Your Breath: The Secret Life of a Sleepless Anaesthetist follows in the model of This is Going to Hurt in the division between entertaining, if nerve-wracking, anecdotes and emphatic political points.
If the stories of long hours, short staffing, high stakes and enduring humanity (plus the odd bodily expulsion) are by now familiar, Patrick’s final chapters on working through the pandemic make clear the monumental challenge of providing care – not made easier by the government. Beneath the fish-out-of-water self-effacement of Catch Your Breath there runs a righteous anger. For all the noise made about key workers’ sacrifice and the need to “protect the NHS”, Patrick says, “we just see very little change”. In fact, he adds, some benefits that were introduced early in the pandemic (such as free parking for hospital staff) have now been revoked – many hospitals still lack proper rest facilities or catering for shift workers. “People say there isn’t money and you look at the billions that were spent on test and trace…” Patrick trails off with a sigh. “There’s lots of things to be improved, but a lot of it is simple and about making people feel valued.” And, he points out, we all stand to lose from this “constant eroding” of the NHS. Patrick’s forthcoming show, a work-in-progress, is about his recent experience of seeking a diagnosis for his mother. It was only by virtue of her son being a doctor, their family’s persistence and “a huge slice of luck” that there was a positive outcome.
It gave Patrick new insight into the patients’ experience. People can look on doctors as all-knowing, he says, even superhuman, “but they only know as much as they get told”. He hopes the show will help people to act as their own advocates. “Especially with resources stretched, you need someone in your court.”
For that reason, Patrick has no intention of giving up medicine. “I love comedy as an art form, it feels part of my fabric, but I want things to get better and I think doing it from inside the NHS is the way.”
But straddling the two worlds is by no means easy. Kay was six years out of the profession when he started writing This is Going to Hurt, giving him the freedom to be brutally honest. As he wrote in the epigraph: “They can’t threaten to strike me off any more.”
“To succeed in medicine, I was once told, you have to be quiet and mediocre,” says Kay now. “There’s no way to remain quiet if you’re writing books about the system.” He is not sure that he’d have been brave enough to write it, had he remained a doctor – “but if the job hadn’t broken me so much, I wouldn’t have found myself wanting to write.” Kay points out. (And if he was still working, he probably wouldn’t have had the time.)
In recent years, it has become harder for NHS workers to speak out about the frustrations and system failings, says Hammond – even at the remove of comedy. There were three series of Struck Off and Die, from 1993 to 2000; the first was so outrageous about the NHS, Hammond says, it generated a record number of complaints to the Broadcasting Standards Committee. He recently revisited the complete works of Struck Off and Die ahead of its release as an audiobook on Audible: “I laughed out loud at some of it and was hideously embarrassed by some of it.” (He has since made a preemptive mea culpa on Twitter.) But “that aggressive, hearty male humour” was the tenor not just of the med-school revues of the time, but of medicine itself, says Hammond. “Of course, you have to be accountable for the humour that you do, but we made fun of everyone… In those days, the BBC thought it was great: ‘It’s edgy, and it’s making a difference.’” The duo’s name was a joke that they had been sanctioned for by their professional body “for sharing medicine’s dirty secrets. Instead, Hammond says, somewhat wonderingly: “They never came for us.”
This was even as Hammond and Gardner talked on stage about how “every hospital had a Killer Keane, or a Chopper Chiltern” – dangerously incompetent or demoralised surgeons who were more concerned with preserving their pensions than their patients. Hammond blew the whistle on high mortality rates in babies at the Bristol Royal Infirmary in 1992, nearly 10 years before it was formally investigated – by joking about the “killing fields” on stage at the Edinburgh Fringe. “The BBC was recording, people roared with laughter – and that subsequently became the largest public inquiry in British history,” he says.
That experience of having to explain his “medical humour” in court, in front of grieving relatives, changed his perspective on comedy as a tool for change. “Dozens of babies had died unnecessarily and there we are, recorded a decade previously, making light of it. I decided to put on a straight face and tell the story seriously.”
Hammond switched to investigative journalism, predominantly as medical correspondent for Private Eye and a campaigner for patient rights and protections for NHS whistleblowers. “If you just do it as a joke at a comedy gig, people laugh and go home and do nothing.”
That said, Hammond adds, grimly, he has not seen results from advocacy either. In October, another damning report was published into often fatal failings in maternity care – the second this year. “I can honestly say nothing has changed – in 30-odd years, all I’ve done is make lots of people laugh.” Today’s doctor-comedians are further hamstrung by the contemporary climate of taking offence, Hammond suggests. “They will tell gentle stories about themselves and their own situations – some will make political points, but it’s not nearly as aggressive as it was in my day.”
In the 15 years since Kay’s diaries, medical comedy has become “slightly kinder, and more gentle”, says Hammond, and potentially an ineffectual instrument for change. It could even exacerbate staffing shortages, he says. “We don’t want too many doctors saying: ‘This is bloody awful, get out now.’ We have quite a high dropout rate as it is. I still tell the younger ones not to give up the day job. Medicine is an immensely rewarding career, and if you give it up it’s quite hard to get back in again.”
After all, Hammond adds, enthusiasm for true tales of NHS dysfunction may start to wane. “With 7m people on the waiting list, whether the public wants to hear jolly doctors’ stories is another question.”
But Kay says medics’ aspirations towards comedy are the tip of an iceberg of bigger issues with staff retention and morale, as the looming industrial action demonstrates. “It’s a workforce on their knees after two years of Covid and a decade of austerity, about to be followed by round two. I can’t think of the last time I spoke to a doctor who wasn’t discussing a potential Plan B – whether it’s going part-time, moving to another country, or moving to a different profession.” (And not always comedy, Kay adds.)
But rather than fleeing medicine for standup, Licari’s aim is to highlight how much they have in common – and perhaps bring them closer together. Some of her colleagues, she says, can “go through medicine in a very mechanical way”.
“Obviously there’s the long hours, the difficult training, the drama and trauma… but when you focus on the humanity of a situation, you can always find a way to metabolise it. It’s not necessarily humour, though that’s a huge part of it – it’s just those moments when we connect.” Now, Licari says, her standup experience has given her the confidence to make humour a more formal part of her medical practice. “It’s not just for personal relief any more, it’s also a tool to help people around me.” Even at the worst of the pandemic, when hospital staff were working 80-hour weeks, a minute of levity with a colleague could have an “extraordinary” impact on morale: “I’d think, ‘Wow, this is saving my day – and theirs.’”
And in the case of that patient who had been adamant that he wanted to take his chances with death, Licari is convinced her joke was instrumental in turning around his attitude to life. He even complimented her on her bedside manner, Licari remembers. “He said I had a very good sense of humour – for a doctor,” she says wryly. “I thought maybe I should tell him I have a show coming up.”
Grooming by Juliana Sergot; shot at Espero Studio.
Stefania Licari (stefanialicari.com) is at London’s Vault Festival next month. Michael Akadiri’s No Scrubs is touring nationally in February and March (twitter.com/MichaelAkadiri). Catch Your Breath by Ed Patrick and Undoctored by Adam Kay are both out now
