REVIEW

Sonia Henry has used her experience as a trainee doctor in Going Under, her debut novel

There's something quite poetic about surgery, when you think about it.

The idea of slicing into a person's heart, or removing their consciousness to cut through the skin - there's drama and poetry and even beauty to be had if you have the right kind of skewed vision.

Sonia Henry was already seeing the world like this by the time she began her training as a doctor.

Sonia Henry, who has written a novel based on her time as a junior doctor in a Sydney hospital. Picture: Supplied

Sonia Henry, who has written a novel based on her time as a junior doctor in a Sydney hospital. Picture: Supplied

"You recognise that it's not just about cutting things open or disease processes. There's this amazing human thing happening that I find difficult to describe. But I knew it was there," she says.

Sometimes, the dramatic implications were everywhere she looked, even while she slugged through her exhausting years as a junior trainee in a busy hospital.

"I see the heart obviously as an organ because I'm still a doctor, but also the metaphorical implications of taking a scalpel to someone's chest and putting a hand on their heart," she says.

"I was always thinking, 'Oh my god, but I can't think about it like that! I can't break into poetry in the middle of a valve replacement!'"

But most of the time, she was exhausted, stressed and overworked - par for the course for junior doctors everywhere. The stories you hear about the brutal conditions for young doctors as they fight their way up the ladder are legendary and mostly true - crazy hours, bullying, lack of both sleep and a social life. But so are their abnormally high levels of depression and the number of suicides in the profession.

Henry and her colleagues saw or heard of it constantly.

"Every single doctor knows someone or knows of someone, or knows of multiple people who have committed suicide," she says.

"I'm so sick of hearing these stories - we have doctor suicide fatigue. It doesn't surprise me whenever I hear them, and I think that is just wrong."

Three years ago, she had had enough; she penned an anonymous opinion piece that exposed what she described as "the profession's shameful and disgusting open secret".

"In the cutthroat, often brutalising culture of medical or surgical training, many doctors stay stoically mute in the face of daily, soul-destroying adversity; at the worst case, their loudest gesture is deafeningly silent - death by their own hand," she wrote.

The article made waves in the medical community, was shared more than 22,000 times and was republished around the world.

Despite the chatter, not much has changed. But Henry has, in the meantime, outed herself as the author, and written a debut novel about life as a trainee doctor.

With a female protagonist, a couple of villains, a lot of sex, drugs and drinking, and plenty of humour, Going Under is a pacy and illuminating read. But it also delves right into what's gone wrong in a profession where basic kindness is looked down on, and self-care of any kind is a barely present concept.

Henry says it's not surprising that depression and suicide are rife in an environment that places competition and tough love above basic human decency.

"It sounds a bit trite and a bit simple, and a lot of doctors may turn their noses up, but there's this idea that the worse or nastier you are the better clinician you're going to be," she says.

"People have an idea in medicine for some reason that if you're kind, it's at the expense of your clinical judgement or something.

"I don't think that's true, I think that we're all clinically very capable. Australian has excellent medical training; our hospitals, despite the bad things, train good doctors. So I don't think we need to tell each other that we need to be better, we need to study harder, we need to do more research, we all know that. There's not a clinical judgement deficit inside Australian hospitals, there's a kindness deficit."

And it's not just about kindness to patients, she says, which isn't usually lacking.

"It's this idea of actually, if we just practice carte-blanche kindness to ourselves, to each other, to our patients, what could possibly be the harm in that? It really struck me - we're so unkind. Doctors are kind to their patients, but they're so unkind to each other and to themselves, and I think when there's this idea that for some reason kindness is a sign of weakness.

"And where does that leave you? So alone, and when you feel alone, what do you do? You either drown yourself in 20 bottles of wine, or you are severely mentally unwell, or you commit suicide, which doctors do."

Going Under by Sonia Henry. Picture: Supplied

Going Under by Sonia Henry. Picture: Supplied

Taking time off to write a novel did Henry a world of good - she's now a general practitioner, well away from the world of hospitals, surgeons, the despair of night shifts and the bone-tired exhaustion of 16-hour shifts.

But she also had fun writing it.

"It was very therapeutic in many ways, as I'm sure you can imagine," she says. Her protagonist is flawed and human, but so too are her villains: the cracks are evident and understandable, even while the type of cruel behaviour and psychological abuse she depicts are only barely exaggerated.

"Obviously there are bits and pieces that are loosely based on true events or things that I saw or heard about, but it's been through an 18-month editing process, so it is a fictional novel in the end," she says.

"To create a narrative arc takes a lot of ducking and weaving and adjusting... but my colleagues, the ones who've spoken to me, have been incredibly supportive, which is a relief because you never quite know how something's going to turn out. But I think they liked the honesty, even though it was fiction - it's a contradiction in terms, or ironic, I guess. I think they liked that I wasn't trying to gloss over it."

Since the book came out, she's been accused of "exposing" the dark underbelly of the medical profession, but to that, she can only scoff.

"It's actually all in the public domain, it's just that no one's really packaged it up in a fictional book as of late in Australia, as I have done, and probably because I'm youngish and female, it's been more shocking," she says. "I think none of this is a surprise."

Henry had always loved writing, and even after she chose a career in medicine, she figured she could one day fit writing in as a side gig somewhere, stressful though it was.

"I started to realise that some of the things that were happening or that I was hearing about, as well as the fact that they were shocking, stressful, whatever, the writer in me was thinking, man, these are bloody great stories," she says.

"Sometimes I'd go home and write stuff down, because it was just so out of this world. You'd have access to a little planet where you'd see human emotion, the full spectrum, and that's a very powerful thing for someone who likes to write."

Now that she's a general practitioner, she relishes talking to her patients and listening to their stories - all of which is grist to the mill for a writer.

"I'm genuinely interested in the human condition, so for me the writing and medicine goes quite well," she says.

"Actually a consultant of mine asked me once, 'Do you see yourself as a writer or as a doctor?'. And in the end, as it turned out, I don't think I can completely separate the two now, in a way."

In setting out to write her novel, she even made a point of realising one of the biggest writing clichés there is - she flew to the south of France, where she rented a room on the Mediterranean.

Like many things in life, though - the dream of being a rich, successful, high-functioning doctor, for example - reality fell a bit short.

"To be honest, did much productive writing take place there? I drank a lot of French rosé and I ate a lot of cheese and said to myself, 'what if I don't get a publishing contract?', and it all felt very glamorous," she says.

"It was part of the process! But I actually remember sitting on the beach with my laptop thinking, 'God these pebbles on these Mediterranean beaches are really uncomfortable!' Do you know how hard that is?"

Still, the book has a satisfying - if not entirely happy - ending. The novelist in her has allowed for some creative license, even when telling hard truths.

  • Going Under by Sonia Henry is published by Allen & Unwin and available for $29.99.
This story Darkness, poetry and medicine first appeared on The Canberra Times.