So it came as quite the blow to discover that I'd spent a quarter of my life at medical school and it hadn't remotely prepared me for the Jekyll and Hyde existence of a house officer.
-- Adam Kay (chapter 1)

Importance: Kay's experience in the medical field is often surprising from two perspectives: his own and the general public. Much of the book is devoted to surprising the reader with not only humor, but also with the unfairness and difficulties of the medical system. In the opening pages of the book, Kay alerts the reader that not only their but his own understanding the healthcare system would be challenged throughout the pages of This is Going to Hurt. By beginning the book with such a description, Kay foreshadows the whirlwind of difficulties that will be presented to the audience throughout the book.

A strange realization that it's the first time I've actually saved a life...
-- Adam Kay (chapter 1)