A darkly funny and sexy novel that blows the lid off the medical profession and life inside a hospital by a young doctor whose anonymous article about the pressures of trainee doctors went viral around the world.
Dr Katarina 'Kitty' Holliday thought that once she finished medical school and found gainful employment at one of Sydney's best teaching hospitals that her dream was just beginning. The hard years, she thought, were finally over.
But Kitty is in for a rude shock. Between trying to survive on the ward, in the operating theatre and in the emergency department without killing any of her patients or going under herself, Kitty finds herself facing situations that rock her very understanding of the vocation to which she intends to devote her life.
Going Under is a rare insight into the world of a trainee female medic that takes an unflinching look at the reality of being a doctor. It explores the big themes - life, death, power and love - through the eyes of Dr Holliday as she loses her identity and nearly her mind in the pressure-cooker world of the hospital. But it is also there that Kitty might find her own redemption and finally know herself for the first time. Darkly funny, sexy, moving and shocking, Going Under will grip you from the opening page and never let you go.
Sonia Henry is in her early thirties and lives and works in Sydney as a doctor. When she's not being a medic she devotes her spare time to writing and has been published in Kevin MD (America's leading physician blog), the Sydney Morning Herald, the Australian Medical Students Journal, and has scientific publications in the ANZ Journal of Surgery.
Her most widely read article was an anonymous piece, 'There is something rotten inside the medical profession', which detailed the stress of medical training and was shared more than 22,000 times and re-published widely around the world. This article led to the start of a conversation that her novel Going Under seeks to continue. Dr Brad Frankum, head of the AMA NSW, penned an open letter in response to her piece, as did many other doctors who decided that it was time to speak out.
In her spare time, Sonia loves drinking wine with her friends, eating good food, and trying to save money to travel to new and fabulous places. She is a keen skier in the winter and likes Sydney for its beaches in the summer. She tried to join a gym but isn't a morning person so has replaced exercise with an extra hour of sleep.
She is passionate about the topics covered in her book and would love to be an advocate for change in the medical system.
Allen and Unwin
Author: Sonia Henry
Question: What originally inspired you to write Going Under?
Sonia Henry: Throughout medical school and then into my early junior doctor years I always had a sense that the experiences my colleagues and I were having, as well as being high stress, at times unpleasant, at other times quite amazing and hilarious, made for really good stories. Having always been interested in telling and sharing stories that was always in the back of my mind. Then as the idea took hold and a few other things started happening I also realised that there was more going on inside my mind rather than just crafting a story to write, and that there was a deeper message and issue that could be addressed through a vehicle of a fictional story. So as well as a pure creative – gee this would make a great entertaining book, there was also a very strong sense that things are happening inside our hospitals and to me and people I know that the general public has no idea about and maybe it's time to start a conversation. Medical fiction has always been a popular genre but I suppose the inspiration changed initially from 'wow I have some cool stories I could turn into a book' to – there's a problem inside our teaching hospitals, suicide is becoming something that doesn't surprise any of us when another junior doctor takes their own life, and a sense of urgency that now is the time to write this book and continue a conversation that really needs to be had (at the same time as hopefully entertaining readers who otherwise may not have known about the issues facing junior doctors.)
Question: How do you hope Going Under and your KevinMD article will change the discussion around the conditions of medical students and trainee doctors?
Sonia Henry: I guess the first way to make change is to inform. The article I wrote for Kevin MD garnered overwhelming support and responses that genuinely shocked me. That it was the sixth most shared article that year on the blog with over 22,000 shares really blew me away. I've seen it quoted across major news outlets and also mentioned as a source in commissions and research which was incredible. Having chosen to write it anonymously at the time meant that I could sit back and watch how it was received without it being prejudiced by being attributable to a particular person, so I felt that was powerful in itself. Sometimes to not be anyone you have the scope to speak for everyone, and the amount of interest and support that occurred after it reflected that back at me. I wanted people to focus on the issue rather than the author which at the time really worked and that mattered so much.
I guess I didn't really know what it would achieve when it was published but I think, to be totally honest, I'd just had enough and it was almost sheer desperation that led me to write it. I just thought, you know, I shouldn't be coming home after an 11-hour overnight shift hearing that a girl younger than me, more senior than me in the hospital, young, intelligent, with so much ahead of her, should be killing herself. And knowing this was far from an isolated story. I can rattle off at least 6 stories of junior doctor suicide in the last 1-2 years alone. Which is shocking, and frankly disgraceful. So my initial purpose was without any real goal in mind aside from to blow the lid off the system and say that this is happening and these are the realities. Certainly my book coming after this which has taken a lot longer to craft and edit and working with a publisher has made me have to consider what it is I hope to achieve beyond simply informing the general public and also saying to other doctors, you know, you're not alone. That was also a big impetus for writing it. I know it's a bit of a saucy book in parts and will challenge people's perceptions of doctors and the profession and I may well face some backlash. But in the end, I always have said to myself, if one medical student or doctor reads this book and thinks for a moment, just a moment, that they aren't alone, that other people feel this way, that they don't have to put on this façade of toughness, that maybe it is worth sitting back and looking at the job and the system through a healthier lens- then I will have achieved my goal. And that is probably the goal that means the most to me on a very personal level. Being a doctor can be incredibly isolating, and it's when we feel isolated that we lose our way and our desire to continue on. I hope my book helps to soften that sense of isolation.
Beyond that I would like to see change occurring on a major level. I would like mental health struggles in medicine to be properly acknowledged and completely de stigmatised. I want mandatory reporting of distressed or troubled doctors to be openly wiped, so doctors can seek help without fear of retribution. I would like the colleges to open training positions and stop charging so much money for exams. I would like there to be an overhaul of working hours. I would like all overtime to be paid. I would like bullying, sexism, and teaching by humiliation to be completely vanquished. I would like every medical student to be guaranteed an internship if they keep opening the medical student numbers- they need to match that in terms of job security. I would like the unaccredited registrar system to be carefully examined and competent doctors finding themselves in the position of being unaccredited for many years to be guaranteed some kind of job security. I would like there to be a massive cultural shift where doctors look after each other and support and kindness becomes par for the course.
Will any of this happen? Likely not in my lifetime, or maybe ever. But until I put the words on the page or seed the idea nothing will ever change. Hope is a powerful motivator, and to write this gives me hope.
Question: What is the main message you hope to spread to readers of Going Under?
Sonia Henry: The message after all that above is relatively simple. Doctors are human beings like any other human being. The expectations placed on doctors considering the conditions they work under are unrealistic and damaging. Junior doctors aren't rich or powerful or sitting in their ivory towers. They're working often 16 hour shifts, usually not being paid for overtime, and a third of their salaries are going on courses and exams which still will not guarantee they will be let onto a training program. I know four friends, all of whom have masters degrees on top of their medical degrees, who have found themselves in a position where they do not have a job next year. I was explaining this to one of my patients and he said, rightly, 'a doctor without a job? That seems ridiculous.'
Doctors care so much about their patients, and doing the right thing. The problem is that no one really cares for the doctors, including themselves. We know this, the system lets it perpetuate, and that's why our mental health statistics are so dire and why our suicide rates are so high. I have resigned myself to whenever I hear that a colleague has died 'unexpectedly' that they have killed themselves. I desperately don't want the doctors of the future to share this same resignation.
Interview by Brooke Hunter
Allen and Unwin
Author: Sonia Henry