TONTS. - Inside Our Broken Hospitals with Dr Neela Janakiramanan

Episode Date: July 15, 2022

My guest this week is the powerhouse that is Dr Neela Janakiramanan. In her own words Neela is a reconstructive plastic surgeon who spends most of her time playing with power tools to fix hands and wrists, while accidentally teaching, mentoring, writing, and fighting the patriarchy. She can also change a flat tyre and operate a barbecue. Neela was schooled in Melbourne and completed her medical degree at Monash University in 2003. She immediately commenced surgical training and was awarded Fellowship of the Royal Australasian College of Surgeons in Plastic and Reconstructive Surgery in 2014, having trained in major Melbourne hospitals including St. Vincent’s Hospital, The Alfred, Austin Health, Monash Health, Peninsula Health, Peter MacCallum Cancer Institute and the Victorian Plastic Surgery Unit. During this time, Neela combined the rigours of surgical training with completing a Masters of Public Health through Monash University, graduating from that degree in 2010. This gave Neela a grounding in research methodology as well as health programme development and implementation, particularly in poor settings. Neela’s CV is incredibly impressive the through line of which is a keen passion for justice and equality. Neela has been a fierce public advocate for change within the medical profession. She was instrumental in the Medevac Bill which was a law that was passed by the Australian Government providing critically sick refugees and people seeking asylum held in offshore detention a pathway to be transferred to Australia for urgent medical treatment. It was passed because of professionals like Neela who encouraged doctors from across Australia to write letters to their local MPs. Aside from her public work as a commentator (she has often been called on to speak about the issues facing the medical profession during the Covid19 pandemic) Neela has just written a brilliant unputdownable book called The Registrar which is out now. It is a fictional story about a new registrar called Emma Swann and as well as being a great read is also a deep look at our broken hospital system and the way it treats the people charged with our care. In this episode we discuss what it is like for women working within our hospital system that is often deeply patriarchal, sexist, racist and rife with bullying. For more from Neela you can find her on her website on instragram @drneelaj and to purchase a copy of The Registrar (which you should do immediately) you can head to any good book store or hereFor more from Claire you can head to www.clairetonti.com or @clairetonti on instagramYou can email the show at [e-mail] credits:Editing - RAW Collings and Claire TontiTheme music - Avocado Junkie Hosted on Acast. See acast.com/privacy for more information.

Just a warning before we start this week's episode, this conversation does include discussion of suicide and mental health. If this brings up anything for you at all, please talk to someone you trust or ring Lifeline on 13 11 14 for crisis support. Okay, here we go. I would like to acknowledge the traditional owners of the land on which I create, speak and write today, the Wurundjeri people of the Kulin which I create, speak and write today, the Wurundjeri people of the Kulin Nation, and pay my respect to their elders past,

present and emerging, acknowledging that the sovereignty of this land has never been ceded. Hello and welcome to Tons, a podcast of in-depth interviews about emotions and the way they shape our lives. I'm your host, Claire Tonti, and I'm really glad you're here. Each week, I speak to writers, activists, experts, thinkers, and deeply feeling humans about their stories. And my guest this week ticks every one of those boxes. Goodness me, she is incredible. In her own words, Dr. Neela Janakiramanan is a reconstructive plastic surgeon who spends most of her time playing with power tools to fix hands and wrists while accidentally teaching, mentoring, writing, and fighting the patriarchy. She can also change a flat tire, operate a barbecue, and is mum to three beautiful boys as well. Now, Nila's CV is incredible in and of itself, and the work she's doing as a surgeon is

wonderful. However, that is not all she does. Nila is also a fierce public advocate for change within the medical profession. For example, a few years ago, she was instrumental in the passing of the Medivac Bill, which was a law that allowed critically sick refugees and people seeking asylum held in offshore detention a pathway to be transferred to Australia for urgent medical treatment. It was passed because of Nila and other professionals like her who encouraged thousands of doctors from across Australia to write letters to their local MPs talking about the appalling

conditions for asylum seekers in detention and the urgent need for them to be treated properly on the mainland. This alone is also an incredible feat, but Nila's passion for social justice also became apparent during the years of COVID lockdowns. She became a public commentator on those issues, particularly for the medical profession and also providing up-to-date information as well for the community. Now, let's put that aside as well. Nila has just written a brilliant, unputdownable book called The Registrar, which will be out

in July. It's actually a fictional story. There's a few sex scenes in it. It's very pacey and reads like a psychological thriller, but it's also got a social justice bent to it. It's about a new registrar called Emma Swan, who is dedicated and ambitious. She's about to start a grueling year as a surgical registrar at the prestigious Mount Teaching Hospital, and she's excited to join her adored older brother, Andy, in pursuing the same

career as their father, an eminent surgeon who made his name at the Mount. But the pressure of living up to his distinguished reputation is nothing compared with the escalating stress Emma experiences as a registrar. Neela writes about the arduous, unremitting slog of 20-hour days, punishing schedules, life and death decisions, and very little assistance that is the reality for so many young doctors and older doctors in the system. She writes about the bullying, the humiliation, the misogyny, sexism, and racism. And it's just such a clever book because not only is it unputdownable, it also builds a huge amount of empathy and opens up the world of a surgeon in the making for people who've

never been involved in that side of the medical profession and paints a picture of a system that is at breaking point. As Dr. Norman Swan writes, it's compelling. You won't put it down. So here she is today, Dr. Neela. Before we get to her and our conversation, I'll tell you a few things more about her. Neela was schooled in Melbourne and completed her medical degree at Monash University in 2003. She immediately commenced surgical training and was awarded fellowship of the Royal Australasian

College of Surgeons in Plastic and Reconstructive Surgery in 2014. Having trained in major Melbourne hospitals including St Vincent's Hospital, The Alfred, Austin Health, Monash Health, Peninsula Health, Peter McCollum Cancer Institute and the Victorian Plastic Surgery Unit. During this time Nila combined the rigours of surgical training with completing a Master's of Public Health through Monash University, graduating from that degree in 2010. This gave Nila a grounding in research methodology as well as health programs and implementation,

particularly in poor settings. So there you have it. What an incredible person Nila is, professionally but also personally, she's super warm and very funny. And as we talk about today, was an awkward teenager, like so many of us. And it just goes to show you, doesn't it, that the people that we often admire the most and think are incredibly amazing and wonderful, and how can they ever do all the things that they do, are also human beings and also might have some of the fragilities that we have too.

Okay, here she is, Dr. Neela Janakiramanan. Well, thank you so much for joining me, Neela, today. I've been so looking forward to this conversation. Yeah, me too, Claire. Thanks for having me. Oh, you're welcome. Your book is wonderful. I read it in about, I don't know, two nights maybe. I couldn't put it down. Congratulations. Thank you. Oh, you're welcome. I want to talk about it. I have so many things, but before we do, I wanted to ask you a big juicy question that I know we've talked about a little bit on Instagram because I posted a photo of myself, my teenage self from school yeah more spying so I wanted to ask you what you were

like at school do you remember that girl back then oh I do remember that girl I was really shy I was complete nerd I really struggled to fit in I really struggled to find friends I was bullied a lot in primary school and it really wasn't until I got to late high school, university even, that I think I learned how to understand people. Yeah, what do you mean by that? That's a big statement. I think in an ideal world that we would take everyone as they are and people would just fit in seamlessly to various social, cultural mores and expectations. And I just didn't know how to do that naturally. And so I think, you know, given we don't live in an ideal world and given that we do place

this expectation on other people to fit in to the way that we expect them to. I think it took me a long time to learn how to fit into the world around me. And sometimes I still get angry. Sometimes I'm still like, but I want, but you know, this is me, you know, this is just take me as I am. But I don't think pragmatically that's how it works. And I think, you know, I mean, you're a parent as well. I mean, these are the lessons that we teach our kids, isn't it? And, you know, maybe some parents are better at teaching those lessons and maybe some kids are better at learning those lessons. But, you know, I came from a migrant background.

You know, my parents were still learning how to fit into Western cultures and workplaces and friendship groups so you know maybe they couldn't teach me the same lessons that I can teach my kids about what what fitting in looks like and what is expected of them I don't know yeah I resonate with that so much because I was so confused by people at school and I went to an all-girls school, so particularly by the way people aren't themselves in the world and you have to mitigate yourself and especially if you're a big nerd who's really excited by learning. Is that what you think people found difficult about you at school?

I truly don't know. There were other nerds that were better at fitting in. There were people who hid their nerdishness, I think. I think, you know, when year 12 results came out, I was a bit surprised by some of the people who got really good marks because they had just managed to hide that they were really smart. So I don't think it is just that nerdiness. I think it's probably more than that. I think it's how you dress, how you speak, how you carry yourself, how you engage with pop culture. I mean, we didn't listen to pop music at home or watch, you know,

the latest release movies. My parents listened to Indian music and watched Indian movies. And so those are the gaps in lunchtime snack break conversations that I found difficult to navigate, you know, those things that are a marker of fitting in, I guess. And I think lots of migrants probably have those kinds of stories. You know, I hear of Greek and Italian migrants who had, you know, pastrami sandwiches, for example. You know, I hear of, you know, Greek and Italian migrants who had, you know, pastrami sandwiches, for example, you know, cheese. And that was considered really not quite the done

thing. So, yeah, I think it's interesting. Yeah, I totally do. Right. Because as you go forward, so at high school and you're really smart and I'm assuming you did very well and got really good marks in Year 12. Would that be fair? I did, I did. Yes, correct. And so did you start straight away? Did you get into medicine? Is that where you landed?

Yeah. Did you find your tribe when you got to university? How did you feel once you landed there? University I think was a bit more forgiving. I had two social groups, which, you know, again, I look back on this and I'm surprised by it. One was the group of girls that I went through medical school with. And we were all a little bit different. You know, we had in our group, one of the girls who had gone to a state school and not a private school. And there were only maybe two people in our entire year of 160

kids that came from a state school. It says a lot about how we select doctors and how that's not necessarily representative of society and not necessarily a good thing. We had a lot of people who did come from migrant families in our little group. No one in our group was extraordinarily wealthy. No one had grown up in the leafy eastern suburbs of Melbourne. And it was interesting how we navigated together and found each other within the first week or two out of this swirling mass of 160 people who were all going on you know O-week camps and pub nights and whatnot you know we we managed to find each other so that that was interesting and I'm still friends with those gals and that's you know they're they're really important and even though I don't see them as much

as you know we all should see each other, you know, they're the women that I could call up at a moment's notice and say, something terrible has happened and I need help. And I know that every single one of them would drop what they were doing and come and help. And we'd all do that for each other. And then the second group that I spent a lot of time with, which is really interesting, was the debating club.

I did a lot of time with, which is really interesting, was the debating club. I did a lot of debating at university and debating tournaments and debating culture has been in the news a lot because of Christian Porter and the events that led to that woman dying of suicide in Adelaide a couple of years ago and what may or may not have happened at a debating tournament and that was a really fascinating culture because it was you know I did it because very naively I think now that I look back on it I just enjoyed you know the argument I just enjoyed talking whereas there were genuinely people there who saw it as a pathway to power and success and these are people who have become chiefs and success. And these are people who have become chiefs of staff for ministers. These are people who have become senior partners in law firms.

And I just didn't appreciate that it was a networking opportunity or a CV builder in the way that I've later come to realise that it was and was treated very explicitly as such by some of these people. But again, you know, some of my really good, ongoing, enduring friends come from that environment. And I think that that was actually a group where if we come full circle to the first question you asked me, I think that's where I learned to fit in. I think that's where I learned what, you know, you needed to do to not change yourself, just massage your personality into being able to fit in with a lot of people that I didn't intuitively feel that connection with. Yeah, which is so interesting, isn't it? A, that it goes back to what I was saying about

being at school and the strategies that I always walk around with my heart on my sleeve and it always surprises me still that there are people whose personality is strategic and what they're saying is strategic and the way they dress is strategic. And I just went through school totally oblivious that I should have T-bars and roll my skirt a certain way. I just totally missed that memo and I think that's a great thing but it is a scary thing when we're talking about power right

in politics yeah I think it's even though I've leaned into it it's not something that makes necessarily makes me comfortable and I think that as I get older I'm becoming more comfortable again with leaning back out of that and of being more confident in speaking my mind and presenting myself as the person that I really am and it is little things you know I've stopped wearing suits to work and heels just don't do it not interested and you know I walk into these groups of you know predominantly male surgeons who are all in their Hugo Boss and their shiny, you know, pointy shoes. And I'm just like, you know, I'm not going to be that person because I'm not that person. And like, let's be honest, suits are really uncomfortable. And I spent a lot of time crouching down looking at people's, you know, legs or, you know, trying to do procedures.

And I just don't want to do it in a suit. Yeah, gosh. And that's the joy of getting older, isn't it? And I guess having your own career and being respected in your field, you do now have this choice. You don't have to necessarily mould yourself. It's kind of freeing in a way maybe as you get older as well as a woman too. Yep. maybe as you get older as well as a woman too. What was it like being a woman in the medical

sort of university days, I guess? And then we'll talk later about when you become a surgeon. It's interesting. Women have been more than 50% of medical students for a really long time. We were at 50% when I was in medical school, and that was in the late 90s. And it had been probably at least five to 10 years since women hit 50%, maybe even longer. And yet, there just weren't that many women in positions of leadership. They weren't necessarily our lecturers, they weren't necessarily our clinical supervisors. They were not necessarily heads of unit. You know, it was a time when a lot of women were told you can't be a hospital specialist and have a family.

And so women were getting streamed into general practice. And that's not something that we got a lot of exposure to in medical school. You know, medical school was very hospital based medicine. And I think they're doing a little bit better now, but not that much. And so you have this devaluing of women and devaluing of primary care, which is such an important component of our health system. And so you go through the system, which is very patriarchal. It is very based in very traditional understandings of what power and leadership actually look like. And unless you can very deliberately mould yourself to that,

you're not given opportunities to succeed. And that was made very clear to me, even in medical school. I almost left medicine. When I say almost left, every single year. So I did six years of medical school. By the end of every single year, I was like, I'm not going back next year. I don't want to keep doing this. Oh, my gosh. And it was ultimately it was laziness and indecision kept me there because I couldn't think of something else that I would rather do.

So I'd spend the first half of the summer going, I don't want to go back. I hate this. And I'd be like, what else that I would rather do. So I'd spend the first half of the summer going, I don't want to go back, I hate this. And I'd be like, what else am I going to do? And then I'd be like, well, they're all as bad as each other anyway. So, oh, well, I've done a year, I may as well do one more. And then by, you know, eventually it was like, well, I've done six years, I may as well become a doctor. And then the whole thing repeated through specialist training as well.

Oh, I've done a year of it, I've done two years of it. Wow. What is it that you hated so much about it um I found it very lonely I found medical the first three so medical school we I did six years it's now four to five depending on sort of which medical school you go to but in our six- course, the first three years were spent on campus and it was all basic science. It was anatomy and physiology and dissecting cadavers and looking at specimens under a microscope and writing essays. And that was all great. I loved the first three years on the academic side. On the slightly more interpersonal side, there was always that sense of, do I really fit in to this group of people? And I managed to keep that at bay by having interests outside of medicine and doing other things. But then when it was really when I got to the clinical years,

that I found it very difficult because you're just thrown into the hospitals as a medical student. You're not given necessarily very clear direction in how you're supposed to learn. You're just supposed to go and see patients, you know, throw open someone's curtain barge and say, hello, I'm, you know, I'm a fourth year medical student. And someone's told me that you have a really interesting, you know, chest to examine. Can I listen to your heart? And patients are like, oh, okay, sure. What is interesting about my heart doctor? You're like, no, no, no, I'm not a doctor. I have no idea what's interesting about your heart.

That's why I'm here to have a listen. And then you go, you know, is that a funny murmur? Is that a patient's like, my normal doctor? Am I going to die? I'm like, I'm still not a doctor. I have no idea. And then, yeah, but then you still don't know the answer so you've got to go and find someone to present the case to someone who knows the

patient to go they went and saw you know Mrs Jones in bed seven and I thought she had this particular heart murmur what do you think and they're all busy they're all you know distracted with their own work you know I try make, I try really hard to make time for my medical students these days, but I'm one of those people who's like, oh, but we have seven patients on the operating list and four people in emergency and one of my registrars has COVID and, you know, the other one has her exam next week and it's all a catastrophe.

Hi, medical student. How about you stand over there? So I found that a bit challenging. I found by sheer chance the tutorial groups that I was put into were not people who were my friends or that I had a lot in common with. So I kind of, I didn't know what to study. I didn't know how to study. I didn't know how to seek help. As a consequence, I failed one subject and then passed it on a supplementary exam. And I just didn't do particularly well. And that came as a surprise as

well, because I had academically been quite a high achiever for a long time. So that was quite confrontational. And I just, again, I think we do some of those aspects of medical school better than we used to, but I found those three years very, very, very lonely. Yeah, and loneliness is so huge, isn't it, for humans in general. We're just designed to be in community with each other and in connection. Why did you end up specialising in hands and wrists? Because you do plastic surgery right yeah yeah hands and wrists and also skin cancer yeah work too yep so I do all the general reconstructive work you know a bulk of my work probably 80 90 percent of it is complex hand and

wrist and skin cancer and then I do other reconstruct general reconstructive things as well particularly in the public system you know know, if you have a chronic wound on your leg or I might help some of my colleagues with bigger cases where someone's had a mastectomy or a head and neck cancer that needs some sort of reconstruction. So basically I don't do any cosmetic surgery. All of what I do is reconstructive. The hand and wrist was it's very

hard to explain to people why you love the the weird things that you enjoy when I was in medical school I wanted to be a pediatrician that's that's how it all started out and then I was going to go to Ethiopia to do a in in your last or second last year of medical, you can go anywhere in the world and spend six to eight weeks doing whatever you want. And I was going to go to Ethiopia and work at a paediatric hospital. And at the time, you know, it's amazing what luck will do, Gulf Air stopped flying direct from Australia to Ethiopia. Oh, wow.

So I would have had to change flights. And basically what it meant was that the flight, which was supposed to be $1,800 became three and a half thousand dollars. Oh my God. Overnight. Yeah. And that, that was out of my budget. And so I was like, crap, I can't go to Ethiopia. And by this point, it was two or three months before we were set to depart. Anyway, some, my parents knew someone who knew someone who knew someone who

ran this not-for-profit hospital in Cambodia. And the flights to Cambodia were quite cheap. And so I was like, okay, fine, I'll go there. I had no idea what they did, but it was just, it was somewhere in the world that sounded interesting. And so that was a hospital that was run actually by an American orthopedic surgeon who was pretty close to, maybe he wasn't close to retirement, maybe he just seemed old because he was 21. He probably actually, now that I think back, was probably only in his 50s. That's so bad.

But I remember thinking 16 was old at a certain point. I was like, when I'm 16, I will have made it. So 50 would be like you're basically dead. Yeah, you had grey hair. Grey hair now. So anyway, he was an orthopedic surgeon who did a lot of reconstructive orthopedics. And I tell a little bit of this in my book. It's one of the few things in my book that's actually autobiographical. And so anyway, I was in Cambodia and we had all of these patients that couldn't walk, couldn't eat, couldn't see, couldn't hear, but they would have these little procedures and then they could. And I was just like, oh, okay, this is pretty amazing.

So I came back wanting to do orthopedics. But then as I was an intern and then I was a junior doctor in the hospitals, I did a lot of orthopedic terms and I realised that I didn't really enjoy hip or knee or spine or surgery, you know, the other big things that orthopedic surgeons do. Not for any reason I can put, you know, a finger on, I just didn't click, but I really enjoyed the hand and wrist surgery. And it so happens in Victoria that a majority of hand and wrist surgery is done by plastic surgeons rather than orthopaedic surgeons. Whereas if you go to Queensland, for example, most of it is done by orthopaedic surgeons, not plastic surgeons. So there are

these funny little geographic variations because it's a relatively new specialty in the scheme of things. It's really come along in leaps and bounds since the Second World War. And so it has just been, it's done by whoever in whatever city first started doing it. And the same is reproduced internationally as well. And in a few places in the world it is, like Switzerland, for example, it's its own specialty. So you don't do orthopaedics or plastics first. You just do hand surgery.

Wow. And this is restoring people's movement and dexterity. first, you just do hand surgery. Wow. And this is restoring people's movement and dexterity. Is that the main focus? Yeah. Yeah. So it's to restore function and function can look like lots of different things for different people. Usually function is some combination of having dexterity and also being pain-free. And you can't always, in fact, most of the time, you can't give people the hand they had before whatever injury or degenerative condition affected them. But you can normally find a balance between those two things that allow someone to function. So for example, stiffness is actually really well tolerated. People are ingenious and they learn

to work around the fact that their fingers don't move as well as they used to. But if someone has pain, that is a catastrophe. You can't live with pain. And so a primary aim often is to get rid of pain. But function is a more complex thing. And obviously function looks like different things to different people. So if you're 85 and you like pottering in the garden and maybe you have the odd hit of golf, your functional demands are very different to say a 40 year old musician who's at the peak of their career. So it's also about balancing up those considerations as well. I've heard you say in

an interview that the reason you love this work so much is that people will ask the same question of you when you come into the room. What is that question and what do they seem to say to you every time they come in? It's often not a question, it's a statement. People say, this is my problem and I need my hands because. And then at the end of that because there is something that gets to the heart of who they are as a person and it could be their work it could be a hobby it could be their caring responsibility you know whatever it is that's what they think is the most important thing in their life and that's what they want to be able to go back and do

and I just love that and I just love going, that's who you are. And there's so little opportunity in, you know, our busy packed worlds where, you know, as we were saying, we're all pretending to be slightly different people to who we are, the purposes of fitting in, that the people just go, this is me, this is who I am. Yeah, that must be such beautiful work to be able to do that and be restorative. Because I imagine when you think about doing medicine, that is the sort of work that you imagine before you get into a hospital setting and are stressed beyond belief and cramming chips from the, you know, vending machine in your mouth. I think in the book,

you call it the 3C diet. Yes. Yeah. Was it chips, chocolate and coke? Yeah. Coke, yeah, from the vending machines. Yeah. So that, what a beautiful thing to be able to work with people in that way. I wanted to ask you now about the registrar, your book, and you mentioned that other than the story about Cambodia, nothing is autobiographical. Where did the spark of this book come from? There is a very old book called The House of God, which was written in the 1970s, set in Boston, which is more autobiographical, I think, than mine, by a doctor who eventually became a psychiatrist. And it's considered sort of the Bible of medicine. It is full of black humour. There's all of these rules which sort of have

made their way into medical law. It's been called the catch-22 of medicine, but it's really, it's dated. It is racist. It is sexist. It's incredibly problematic for all sorts of reasons. So, you know, in medicine people have been muttering for a long time, you know, someone needs to write the new House of God. And I don't think that's what I've done. But that has always been sort of at the back of my mind, that there isn't a lot of modern writing about medicine and there certainly isn't much written from a female

perspective so even a lot of memoir like this is going to hurt which was written by adam k in the uk and turned into a tv series which is actually very good you know it is a very male perspective and so that was sort of always in the back of my mind that you know writing something about medicine might be interesting and fun to do and then there is a there's a day called crazy socks for docs and it was it was designed by a melbourne cardiologist named jeff toogood who has spoken very openly about his mental health issues and and he has co-opted the term crazy because that's what he has been called in the past and it's about wearing mismatched socks because poor self-care is often a hallmark of mental health problems and so this was started about five or six years ago

and it's kind of like a bit like IUAK Day for medicine but it's also meant to be a bit of a bit like IUAK Day for medicine, but it's also meant to be a bit of a reclamation from the medical community itself in terms of wearing crazy socks for doctors' mental health. And on the eve of Crazy Socks for Docs Day, I was talking to a few colleagues and one of my friends said to me, oh, you know, it was like when Josie died. And I was like, what? What happened? Josie was an anaesthetist that I'd worked with at a previous hospital that I no longer work at. And we worked really closely for about six months in a sort of a kind of that special relationship that surgeons and anaesthetists have because we're always in each other's pockets. And we spent hours and hours and hours together. And so in that time, you often talk about really, you know, personal things.

Anyway, I worked with her for six months, and then I left that hospital and didn't go back. And I just assumed that she was, you know, off living her life, you know, being well. And that was the night that I learned that Josie had died of suicide, six months after I had worked with her. And I hadn't known, I hadn't seen any of the signs, I hadn't, you know, it was just very confronting. And I sat down and I wrote the first three chapters of the book that night.

Wow. Oh, my God. I'm so sorry. It's all right. It's, you know, we lose so many people in medicine. We've had two deaths in the last month of senior clinicians in medicine and, again, both due to suicide. And, you know, I don't think that as a profession we necessarily take

care of patients particularly well I think that that has been written about and discussed extensively and you know still needs a lot of work but likewise I don't think we take care of health care workers well either and not just doctors you know including nurses and allied health and pharmacists and you know the hospital cleaners you know everyone everyone in the system. And I think particularly the last few years in the pandemic, we've seen how little we care about some of these lives. We've sent aged care nurses into aged care homes with no PPE.

We've sent, you know, nurses into COVID wards with no PPE. We've overworked people. We've, you know, asked superhuman things of them without a whole lot of recognition of what impacts that has had on people's wellbeing, mental health, their lives. And so I think ultimately that's what I was trying to do with my book was look at the system more holistically. Obviously there are both healthcare worker and patient stories in it and kind of consider how we, the system as it is kind of failing everyone. Yeah, that comes through incredibly strongly. So is that the story of Andy? Because Andy

is Emma's brother, right? So the story is Emma is the main character, obviously, and is a new registrar in the Mount Hospital. So her brother Andy is the one that is struggling. I'm conscious there are some really beautiful phrases that I think encapsulate some of the reasons why this must be happening as a phenomenon. And I want to ask you about that. One of the ones that you wrote about, you said, the secret graveyard of the doctor's soul, where one of the doctors, Vikram, is talking about the death of a mother and baby in his care. Can you tell us about that? What's that phrasing? What does it mean?

So the original is French, and I shan't butcher the original French, but it was a French surgeon named René Lariche who talked about the graveyard of a doctor's soul, that from time to time we all go to sit and pray. And I think that what that encapsulates so beautifully is that there are patients we hold on to. I mean, I would treat thousands of patients a year and some come and go and have their episode of care and there's nothing extraordinary about it, there's nothing memorable about it. And it's not to say that when we're treating those patients, they aren't important to us, but, you know, they form the background. But then on top of that, there are the cases that you never really let go. Not all of them have poor outcomes,

although sometimes that predominates as a feature. Sometimes they have challenging social circumstances. Sometimes you just had a connection to them for no reason that you can particularly put a finger on and you think about them from time to time. So I think that concept of, you know, the graveyard of a doctor's soul is a nice one because we do revisit these stories as they become as the years go on. These are the stories we often share with other colleagues, either as examples of the beautiful moments of our careers or as a cautionary

tale. And you never know when someone is going to earn their permanent place in your heart it can be quite unexpected and when I think back you know the the last you know 10 patients that I that have been put into that special place there's no real commonality there's and I certainly wouldn't have expected it for some of them even at the time but for some reason there's something that has that enduring power of of resonance I think yeah are you able to share any stories in particular it's hard to share stories without breaching confidentiality broadly speaking there's there's a child I think about often who had a very common illness which was they became very sick from that so so the underlying illness is common but not very many children get very sick from it and this was a child who happened to get very sick from it and ended up needing an episode of intensive care and in that episode of intensive care, multiple other complications arose, none of which were, you know,

due to mismanagement or anything like that. But that child ultimately ended up losing a limb as a consequence of all of this and, you know, that is an example of, you know, this was a child I treated years and years ago. How old would they be now? They'd be almost an adult now. And so I, you know, sometimes I think I wonder what they're doing now. I wonder how that event has shaped their life.

I wonder if it's created barriers to their progress. What are they doing? What are they thinking? Yeah, it strikes me that you're a very empathetic person and a deeply thinking person. Do you feel, because it comes through in the book in the way that Emma is treated as a registrar, experiencing those kind of events and lots of different ones, there seems to be a lack of empathy in the system. Would you agree with that? What we know is that empathy makes for a good doctor from a patient point of view, but it is also a leading contributor to burnout.

And I think that empathy, like lots of traits and characteristics, can be a bit situational. And we all have periods of time when we are more kind and more empathetic to the people around us and periods of time when we are less. And I think that sometimes a lack of empathy can be an innate characteristic of a sociopath. And I think sometimes it can just be because someone is on the verge of their own demise and they're putting up protective barriers to preserve themselves that comes at the cost of the people around them what do you see as being one of the reasons why we're losing so many medical professionals to suicide um it's complex reasons um some of the reasons mirror the reasons that you would see in a

general population. So, you know, there are doctors who have underlying mental health issues, such as depression, bipolar disorder. The thing that makes completion of suicide a bit higher in the medical workforce is that we have access to specialist knowledge and things like drugs that can be used more effectively than a layperson. But in addition to those baseline characteristics that you might find in any population, you know, doctors do, and nurses for that matter, do address more traumatic sorts of scenarios. So vicarious trauma is very real, particularly if you are an empathetic person. The system is very hierarchical. There is a lot of bullying and harassment.

So additional challenges that clinicians have to deal with, all of which contribute. And so if you look at a population level, you know, it's something like two and a half to three times the rate of suicide in doctors as opposed to the general population. I did not realise that was so high. Oh my goodness. There's a line that you write on page 70, normal rounds, so the medical rounds where a group will go around of residents to patients, normal rounds are for the shaming of residents. Yes. What did you mean by that? It's all about teaching. So, you know, in medicine, traditionally teaching has occurred by embarrassment and shaming. There is this idea that what we do is so important that if you are not perfect at it, then that's a problem. And look,

at a baseline level, I don't entirely disagree. I mean, there are genuine quality and safety issues, but it is a profession that's failed to understand and appreciate that you don't teach people by making them feel guilty and bad and embarrassed about the things that they don't know. You teach them by teaching them well. And so, you know, these ward rounds have existed for at least 100 years, probably more. And so, you know, you'll go in and you'll see a patient and, you know, the big boss up the back will be like, you know, tell me all about this particular condition. And if you don't know it, then you are embarrassed in front of all of your colleagues. And that is supposed to somehow motivate you to go and read up on

things better next time so that you are not embarrassed in future. But all it does is it drives people out and it impacts on people's mental health. Completely. You mentioned too, and I think it's quite clear in the book, there's some big themes around patriarchy and sexism and racism as well. Is that from your own experience of working in hospitals oh absolutely it is i mean medicine is fundamentally founded in patriarchy you know nurses were weren't considered separate to clinicians and you know the first doctors particularly in the european school of medicine which is largely what we practice now were really crap at what they did. They, you know, stuck leeches on people and they didn't wash their hands. You know, there's a, in the 1800s, 17, 1800s, a lot of women died of what was called puerperal sepsis. So after childbirth, they became septic and died. And part of the reason this happened is because, it's just

disgusting, male obstetricians would go from the dissection room straight to the delivery suite and latex gloves weren't around then. So they would be, you know, operating on fresh cadavers full of whatever bacteria, you you know a dead body will accumulate very quickly which is normal straight to you know manually delivering babies and these women would get infections and die and it was a time when midwives had far better outcomes than the doctors did but the doctors refused to wash their hands because they literally said, gentlemen don't have dirty hands. And so this is the history of medicine.

You know, this is what we are founded on. And so if I can go sideways for a moment, there's an article doing the rounds today, actually, which is asking the question, where has, you know, where has medicine gone wrong that nowadays so many patients will go to the internet, their neighbours, their friends, they do their own research, in inverted quotes, before they front up and see a clinician. And this almost antagonistic approach towards medicine is causing a lot of particularly primary care doctors to burn out because every single day they're fighting this social media misinformation. And I have an awful

lot of, you know, frustration and sympathy with that. But likewise, you know, and sympathy with that but likewise you know as a profession we've got to look at ourselves you know we come from a period where doctors killed women and midwives didn't and so if we're now a hundred years on saying you know there was there was a baby that died from an unattended birth in Perth last week you know if we're saying why did that woman choose a doula instead of a doctor, you know, a doctor would have saved her life. That's the history. And it's not entirely irrational for women to say maybe doctors and medicine are a problem and maybe this other alternative, which has existed for thousands of years and for a long period of time actually did a better job than medicine maybe this is the safer option and the fact is it no longer

really is and there really is no justification for a completely unattended birth now but we still have women who have birth trauma we still have women who come out of the whole pregnancy childbirth experience carrying a significant amount of pain and trauma. So we haven't got it right, but other people are getting it more wrong. And we're not really meeting in the middle because everyone's just angry at everyone. And I think that's really challenging. And I think that then becomes really challenging for a patient who is trying to navigate complex health issues in a system which is quite foreign to them and where they're not necessarily getting the answers that they want. Completely. There's a line in the book where you say we all need to not retreat into our own specialised corners and think about health more

broadly. And I guess that's what you mean, right? That it should be a partnership that, I mean, I had a friend who used a doula in a hospital setting. And from what I understand, the outcomes are you have a very trusted midwife or doula with you who can advocate for you within a hospital. So you have access to things if you need them if things go wrong and isn't that the best possible way to do it so the woman feels safe and advocated for with the medical profession and it shouldn't be this kind of we know best block out any other way of thinking and not seeing the patient as a whole and that comes out so strongly in the registrar Emma is often

seeing her patients like she has a patient called Jackie, who is a beautiful person and she forms that connection with while she's going through cancer treatment. And she sees her as a whole person. And often there are senior professors that only see her as the condition. Is that sarcoma? Is that correct? Yeah. Yeah. At the end of the book, is it Prof Bones just says to her, oh, how's the sarcoma? And she said, her name is Jackie. And is that kind of what you're getting at? To me, that was the message I got from the book, that we need to be looking at people in a holistic way.

And I don't know if now I'm being reverse sexist, but I do feel like it's quite patriarchal to just see people in terms of, yeah, diseases and outcomes and fixing things rather than seeing them as emotional social beings within that framework. No, it's not reverse sexist at all, because the evidence really supports the idea that women have a greater tendency to do that. You know, if you take research out of general practice, for example, a female GP is likely to address more discrete health problems in a single consultation than a male GP, and they are far more likely to address non-medical sort of

socioeconomic and psychological contributors to health than a male GP. They're also more likely to discuss and move forward with preventative strategies than a male GP. And that evidence has been, that research has been repeated multiple times over the last few decades and it continues to show that trend. And again, not all men. There are fantastic male doctors out there as well, but at a statistical level, that's certainly what we see.

Wow. I didn't realise that. That is so fascinating. I love the phrase you say, under the eaves, the ancient woman raises her hand in a wave. And because there's a character in the book who's a homeless woman who's kind of sitting outside of the hospital as Emma comes in at all hours of the night, she's just, I guess, at the crux of it, completely overworked. No one seems to be caring for the people that are caring for everybody. There's not enough nutrition, not enough sleep going on,

ridiculous expectations, dividing these people into tinier and tinier pieces and being spread more and more thin across the system. Can you talk a little bit about that phrasing, that ancient woman, that connection that Emma has with this homeless woman sitting outside the hospital? Yeah, that character arose very organically. Of all the things in the book, it was probably the least deliberate thing that I did. But she was important to me because hospitals are a refuge to so many. Many of our major, particularly inner city public hospitals, do have a resident itinerant

population that you get to know by face know, by face when you're walking in and out. And it's, you know, these hospitals do, you know, will sometimes provide a sandwich and will sometimes provide, you know, let them sit in the waiting room if it's not too busy. But they're right there, they're right under our noses. And yet most doctors, most nurses, most patients will walk straight by them and not see them and not engage with them and not interact with them at all. And yet, you know, just because they don't have a home doesn't mean that they don't have value and humanity. And in the end, you know, that character becomes quite important to Emma.

And I think her journey in her relationship to this woman from very passively just waving at her and expecting some kind of responses, if, you know, that is enough, to actually speaking to her, actually taking her food, actually incorporating her in her own life as the, you know, a person with, you know, desires and agency and capacity. That ended up becoming quite important. But she wasn't, yeah, that was an interesting character. I wasn't sure where that came from but I just went with it. I think it's funny. I thought that sure where that came from, but I just went with it.

I think it's funny. I thought that. And then the reason I wrote that ancient woman raised her hand phrase is because it reminded me of what you were talking about midwifery and about the idea that, you know, thousands of years ago, women were the ones who had so much knowledge and were healers in their communities. And the idea that patriarchy has kind of taken over this medical system and really we need both and we need to honour those women, right, who have that knowledge and older women who've been through childbirth

and been through these experiences. And I often think about older women in my life when things have gone wrong with the kids who will say, oh, we'll just give them some of that or here's this. You know, even now I'm seeing a naturopath and, you know, I come from a medical background family, so I'm, you know, not very woo-woo necessarily, but I've found so much benefit from combining, you know, her knowledge of plants and herbs and food and when to eat food with the Western medicine side of things. And, you know, I just think we have a lot to learn. I like that phrase, the idea of the ancient woman looking over being like,

include me in this hospital, include my knowledge somewhere. I'm reading too much into your book. No, no, no, I think it's beautiful. So much. Yeah. I also am really fascinated by the storyline of Emma's relationship. So at the beginning she comes back from her honeymoon with her husband, Shamsie. And as it becomes clear, she initially thought she would probably have children.

And then the hours that kind of rack up during the hospital, the time she's away from him, the amount of time she doesn't get to spend or cancels on him or they stop having their dinners, their relationship becomes really fraught. And then she meets this kind of handsome David who's, you know, do you want to talk us through who David is in the book and what his character is? Yeah, so David is brilliant, you know, that's his overarching characteristic. And yes, he's handsome. And yes, he's, you know, charming and all of that. But he's brilliant. And he operates really well. And Emma looks at him and thinks, you know, this is what I want to be as a surgeon. And that's something that I can really, I think most think most surgeons in fact can almost proceduralist

that's probably a better way to put it can really empathize with and I'm sure in the trades that happens as well where you're learning a craft and you meet someone who just does it brilliantly and you think oh I want to do it like that and so there is that that connection. And I think I say this in the book, you know, there are surgeons, you know, I was told this right from the start, there are surgeons that you will look at and think, gosh, if I ever operate like them, I'll be lucky. And then there'll be others that you look at and you think, oh, yeah, I'll definitely get there. And then there's a third group that you think oh I already operate better than them and so David's in that that first group and so he's brilliant he has a modern take on all of these you know

complex medical issues and he fixes them better than anyone else and so that is aspirational for Emma but he also understands whether implicitly or explicitly, that that is intoxicating for her. And as someone who perhaps, you know, five, ten years into his own career is battling that period of time in middle age where you've got young kids and, you know, your relationship with your spouse is a bit tricky because everyone's busy doing things and he is like he's, you know,

looking for an outlet I suppose. He is in a position to exploit that admiration and infatuation that she has for him, which is primarily professional, whereas for him perhaps is not. Yeah, there's clearly a power imbalance. And I'm curious because there's a lot of spoilers in this episode, but at the end of the book, that doesn't really get resolved exactly either. And it's not clear whether, you know, Emma has agency as well in that moment, in that sort of affair that's starting to, you know, bud with him. But then you also think he's opening up her career so much and talking up of all the things that she

can achieve and giving her opportunities that potentially she wouldn't have had otherwise. And no one else, when she's overworked, incredibly exhausted, underfed, you know, lonely, super emotional and stressed, He's someone in her life that keeps kind of giving her things and being supportive. So it is that complex power imbalance there. And I'm curious if that's something that you've witnessed in the hospital. Absolutely. I have. I've witnessed it. I have heard about it. and it's not exclusive to medicine. If we look at some of the stories that came out of Canberra in the last couple of years and particularly that 60 Minutes episode of the Canberra Bubble which looked at multiple relationships that various staffers had had

with various politicians, you know, I was looking at that going, yes, yes, that's what happens. You know, women get almost sucked into these kinds of relationships and they sometimes end up places that they weren't intending to end up and don't necessarily know how to extract themselves because there is such a profound power imbalance. I think it is different to a social affair, which I've also witnessed in my life where, you know, people meet at a park or, you know, their kids are friends or whatever it is, where it is genuinely more about, you know the the human connection that has gone

into this affair I think in the professional workplace particularly when it is a senior man and a junior woman there's all of these other overlays that can make it very difficult make it very easy for men to exploit and make it very difficult for women to extract themselves in that situation. The reason I left it unresolved is because it was so new that I didn't think Emma realistically had the capacity to understand what was going on and in the context of everything else that was happening in her life to actually set aside the time to process it and make a decision and I'm guilty of wanting authors to know what happens after the book ends but the reality is I'm not sure I'm not sure if she will go back to him I'm not sure if it will become an intermittent thing I'm not sure if she will go back to him I'm not sure if it will become an intermittent thing

I'm not sure if she'll decide oh actually no that was all a terrible mistake I'm just walking away I'm now at a different hospital so he has less impact on my life I don't know and so I thought the most realistic you know solution to that problem at that point in the book where the book ends was that there was no resolution. Wow. And which I guess is like life, right? We don't necessarily always know and things aren't always clear cut in that way. I think it was such an important storyline to have included because there's so much grey in it, which I think is life. As you get older, you realise grey hair, more grey. Yes. In the way you see things all over.

Yep. Definitely. I wanted to talk about this line, a lot of us struggle and no one talks about it, that you write on page 252. And what do you think would change the culture now to be more supportive for doctors and other people within those hospitals? I think the problem is that there are no available solutions to why people struggle. We have an ageing population. We have more and more people demanding health services.

We have a rising expectation from the population that every health problem has a solution. I say this to my trainees and sometimes I even say it to my patients, you know, not all symptoms have a diagnosis, not all diagnoses have a treatment and not all treatments are a cure but when we live in a culture where not only do you have doctors who are promising all kinds of things but you also have this socio-cultural expectation of wellness and that everyone will be feeling perfect and optimal at all times and then you have all of these wellness influences also peddling that as a possibility.

We don't leave a lot of space actually maybe feeling a bit tired as normal or actually maybe your intermittent headaches are just a thing that you have to learn to put up with or you know your chronic pain you know is really shit but we can't make it go away so maybe what you actually need is psychological support to help you cope with this horrible thing that has happened to you because we're not going to be able to cure it. You know, these are difficult conversations, but in the absence of them, there is a very high expectation from the population that medicine can offer, perhaps more than what it can offer. And so clinicians are tired. We don't have the time or the energy to

give every patient what they need. The system is not funded to do that. So in general practice, for example, if you do two short consultations, you earn a lot more money than a single long consultation. And so at a time when business costs are rising and the Medicare rebate isn't, it becomes increasingly difficult to practice slow medicine. So I think one of the challenges is that we can create space for doctors to talk about their challenges. And I think that is something we have done, and particularly female doctors are very good at finding support networks and talking about the issues as they arise. But there isn't actually a solution. And so everyone sitting around and agreeing that this is really crap and we all need to seek support for each other is

better than what it used to be, which was don't eat, don't sleep, just suck it up, everything is fine. But likewise, I also think in some part that that don't eat, don't sleep, suck it up worked because this is very controversial. I don't think older clinicians worked as hard as we are now in the same kinds of circumstances. You know, I've worked on units where there are now four registrars and the bosses are like, well, I worked here as a registrar. There were only two of us. And so therefore, you know, what are you all complaining about? There's double the amount of you. But then if you look at the amount of work that the unit is doing, it's tripled or quadrupled.

So yes, you have double the number of doctors but you're actually doing four times the amount of work which means that everyone is actually working harder and that's something that the older clinicians don't necessarily recognise. You know, population growth has really increased in the last generation and the number of, you know, doctors and nurses that we have available hasn't so I think I think it's complicated yeah definitely yeah I think that

it's complicated it should be the title of your next book it's complicated it's complicated gosh it's huge so realistically is there capacity to have more doctors and nurses going to training or are there people also leaving in droves because it's so difficult? There's definitely capacity for more nurses without a shadow of a doubt. We have a massive nursing shortage in this country made worse by closed borders for a couple of years. Doctors are complicated. Again, back to the complicated word. Doctors are complicated because we probably have enough doctors in some areas and a massive shortage in other areas. Convincing doctors to go and work in those areas of shortage, whether that is general

practice, whether that is rural and regional medicine, whether that is particular specialties, they are unpopular for a reason. So you've got to fix the core reasons why those specialties they are unpopular for a reason so you've got to fix the core reasons why those specialties are less popular and it might be that we have to actually start from scratch and select different medical students like you know as i said at the start we had one or two medical students who came from a state school and that isn't necessary that isn't representative of the population and so they are going to have various social expectations of you know if they grew up in the eastern leafy suburbs of melbourne that's going to where they're going to want to

live and that's where they're going to want to practice and so that's not going selecting more of them is not going to get you more doctors in Broken Hill, for example. So the other thing is quality of training. So we do want to give medical students adequate exposure to clinical work while they're training. We want to make sure that registrars get a certain caseload exposure so that, you know, again, if you're a proceduralist, you need to have done X number of procedures to be competent at it. And X will look different to different trainees. You know, some people pick things up quickly and some people need more support. But overall, there is an amount of experience. You can't cheat time and experience and exposure.

So just increasing the number of doctors becomes tricky there are some countries that have had to deal with too many doctors so the Netherlands for example has the most interesting medical selection system they having quite profound egalitarian principles they have a principle where any student who has finished high school in a in an academic stream can do any course they want at university. So there is no marks-based selection that is applied. And so when that started in the 60s, there were a huge number of people who chose medicine. And what they realised is that they then met this backlog where medical students weren't getting the exposure they needed, training doctors weren't getting the training positions they needed. And so people were doing

medicine and then spending four, five, six, seven, eight years waiting to progress to the next point. So they ended up putting medicine as the only course in the country that has a quota, like as an upper limit. But then they still felt that selection on the basis of marks or socioeconomic privilege wasn't fair. So they instituted a lottery. So again, if you meet this minimum standard at high school, and it's actually relatively low from an academic point of view, you can go into the lottery to become a doctor. And you can apply in this lottery a set number of times. And so it's interesting, you meet doctors who did a year or two of architecture or a year or two of engineering

or a year or two of literature before they got in. And so that creates a medical profession that has this really diverse base. And then about a decade ago, maybe even a little bit longer, they thought, well, is this the best way to be selecting? So they gave special permission for a set number of medical schools to select on the basis of merit, in inverted quotes. So marks and an interview and the kinds of processes that we use. And what they found is that doctors produced from that selection process, that merit-based selection process, were actually not as good as the doctors produced from the lottery. Because humans bring all of our innate biases into the selection process, and we're actually really crap at picking who's going to be the best person for this job. And so they've now gone back to a lottery-based system throughout the country,

which is a very long-winded way to say yes you can end up with too many doctors and the problem with too many doctors is doctors aren't actually good for much else because we're so narrowly trained whereas like a lawyer for example you can do a law degree and go and work you know 50 different yeah it is interesting actually you mentioned this before the importance of having diversity rather than let's say say it, straight white rich men doing at particularly high levels because they like highs like we know this. And then you also have this huge diverse pool from a background cultural language perspective in the patients, right? But you don't necessarily have that in the medical profession or the people that are caring for

them. And obviously that's so important to have that diversity. I want to ask you about your grandfather and what he did in India, where your family is from. Yeah. So my maternal grandfather was a rural GP. So he was a rural GP surgeon. He worked in a fairly small town. He started off his career doing pretty much everything. He gave up obstetrics about 10 years in because it just got too exhausting going to middle of the night deliveries all the time. And by then there were a couple of other doctors who had moved into the area who were happy to pick up that kind of work. But he also, so he was a general practitioner, but he also did minor surgery.

So he did vasectomies and took out tonsils and fixed hernias and drained abscesses, pulled the odd wisdom tooth, that sort of thing. So the, you know, very old-fashioned generalist. Yeah, wow, which is different from the GPs, I guess, that we have here. Well, it depends. In some very remote areas. So we do have a College of Rural and Remote Medicine

that there is a specialist qualification of doing stuff like this because not all patients can be transferred to city centres. Wow, so they do end up having to be everything to everyone within their community. Particularly in an emergency setting, absolutely. Yeah, wow. Reminds me, my uncle is a priest and he's like that. He goes to these vast areas of the outback and is kind of everything to everyone,

from a counsellor sometimes probably to a nurse as well. I wanted to ask you, because you have such a passion for social justice, and it's so clear, not just from the work that you do now, the book that you've written, but also your work with the Medivac legislation and your public advocacy during COVID. Where does that come from, that real drive for equality and justice? It's a good question. I think it's innate. My grandfather, who was the GP, once said to my mother when I was I would have been about two or three, and she tells the story often, that she should never let

me read one particular Indian philosopher who does take a very sort of socialist social justice slant, because I'd be lost forever. So I don't know what he saw in, you know, me as a toddler, but I think it's and, you know, maybe this is what got me in trouble in primary school when I couldn't fit in because I was just like, no, it's not fair. We can't do that. That's not right. And that tends to put people off.

So maybe I've just gotten better at, you know, limiting it to significant issues and not picking a fight, you know, everywhere I go. You can't take that person's pencil. That was theirs. Give it back. Yeah, include Susie in the game. Stop being mean.

Now you're just doing it on a broad national scale, just trying to fix the medical system and also bring asylum seekers back for medical treatment here, all those incredible things. I think that's amazing. I did hear that your family come from the same region as Kamala Harris in India. Yes, that is correct. We are the same caste.

It's not supposed to talk about caste in India anymore but but it's real and ever-present and still a point of discrimination so yes same state same caste our grandparents may have crossed paths in Chennai you know she's a bit older than I am she's she's 10 years older so and again so therefore her family would have been a bit older again. But, you know, post-independence was a really dynamic time in India. I think as a country, particularly people who had been part of the British public service, like so my paternal grandfather was part of the British public Service and then became part of the Indian Public Service. And a lot of my aunts and uncles on that side of the family have continued

and have risen to quite high positions in the Indian Public Service. I think there was a lot of hope and a lot of optimism of what India could become. But again, you know, and I wouldn't say this at a family dinner because everyone would get grumpy at me, but our family is very class privileged in India and it was very class privileged people who were having these conversations. And the thing that has really changed in India was what my family would call reverse discrimination,

what is actually probably just restorative justice, is ensuring quotas for people from the so-called disadvantaged or backward classes, in inverted quotes, so that India as a nation could progress. And, you know, there are people in my family who would argue that that drove the country backwards before it went forwards. But A, whether or not that's true is arguable, and B, I think that if you believe in equity, you believe in equity. That's just what you have to do to give everyone fair opportunity. Absolutely. It's a beautiful value to have and hold on to, I think, can serve you through a lot

of things, believing in equity and justice, even though it can also be incredibly infuriating and heartbreaking at the same time, just for so many reasons. I want to finish because I know I've taken up so much of your time and it's just been so joyful. I've really loved this conversation. Thank you. And I loved your book too. I want to ask you quickly about the unicorn that you married called Brad because that is a whole other thing in the book, right,

about juggling family life and motherhood with a career like yours in surgery tell us about Brad and why you write that he's a unicorn yeah that was actually the first piece I ever wrote I was having a coffee with Christina Zivica who's a journalist and she I was telling her the story about like I was sitting there and I actually got a text message from my GP um saying you know can you confirm this appointment tomorrow and I was telling her this story about, like I was sitting there and I actually got a text message from my GP saying, you know, can you confirm this appointment tomorrow? And I was like, oh, I cannot get them to change it. You know, they always call me because I'm the mum,

but I've never taken the kids to the GP. Like he's the person who always does that. And she's like, you should write about that. I'm like, really? She said, you should write about that. And so I did and she sent it off to her editor at Women's Gender and they published it. And so it kind of went everywhere. And I was like, oh, so I did and she sent it off to her editor at Women's Agenda they published it and so and it kind of went everywhere and I was like oh so I can write okay interesting

but I think in the modern world where where dual income families are quite normal and a lot of women are taking up professional roles someone's got to hold the can at home. And, you know, in our household I'd like to say that it was all planned and negotiated and it was all smooth sailing, but it wasn't. You know, we had a baby and I threw the baby at him and went back to work when that baby was five weeks old. Wow. And it was awful. It was an awful time.

I wouldn't do it again. But I was five weeks old. Wow. And it was awful. It was an awful time. I wouldn't do it again. But I was in particular naive. I was just like, oh, yeah, babies, they just sleep all day. Don't think you're doing a PhD. You can take care of a baby and do your PhD. Yeah. So it was, you know, it was a crash course in parenting. It was a crash course in negotiation negotiation it was he often tells the story

he doesn't enjoy cooking it's probably the one thing that has persisted he can he can cook and he often does but it's not something he enjoys so I will often you know cook for the week and put in in the freezer or whatever but I remember our eldest son was about eight months old and I got home one night and he said that's it I'm going to learn to cook properly and I said what happened and he had gone to get some gnocchi and some sort of sauce at some shop and he brought it home and he had you know mixed up this creamy sauce and it split a little bit so you know how the butter separates from the cream and anyway he's feeding this baby you know this kind of oily greasy gnocchi and he just looked at it and he went I can't do this I cannot feed my baby such

crappy food like I've just got to learn how to cook and and he did and I think that we you know as mums we have those moments where we think oh oh, okay, my life has to change, okay, I have to make these compromises, okay, this is something that I just have to get over. And I think men have those as well and sometimes they need to be given an opportunity to discover that, I guess. I guess, you know, I see a lot of my female friends try and save their husbands and children from those moments um and I'd like to say that mine was planned but it wasn't I just

I just wasn't there I was at work and so it just it just you just had to think you know it just played out as it did um and he didn't leave me so you know two thumbs up but but I think those unicorns are becoming more common now as more and more women are becoming professionals as I have a lot of hope for young men you know the the male registrars I see now absolutely have a different take on the world because their partners, their female partners, you know, have their own needs and desires and things are balanced. I'm seeing more young people take paternity leave. I'm seeing more young men say, I want to work part-time. I'm seeing more men say, I don't want this high-pressure career. You know, my wife has

made that choice. I'm going to go and do something that's a bit more low pressure. And I think that's great. I hope that that changes because I think it's good for men as well. We so often tell women, you can have it all just not at once. I hate that phrase because, I mean, it's true, but men don't get it all either. You know, we think they do. We think that they're getting career and family. But when they look back upon, you know, that time, they were always at work. They missed out on that family time. They missed out on the holidays.

They missed out on that connection. And I think men are starting to realise that that is the sacrifice their fathers and predecessors made and that they don't want to make those sacrifices. Completely. It's so interesting, isn't it? Because I think once men are at home more and they see, or whoever the, you know, both partners are, whether it's same-sex couple either, you see the daily things

and you start to understand how it works, right, and you understand more about what you're missing out on. And if you're just never there, you don't even know what you're missing until it's kind of too late, right? So, yeah, and I think Annabelle Crabb writes about this so beautifully. What does she say? Men need lives and women need wives. Yeah, something like that.

Like they need to be given that opportunity to have more flexibility and time with their kids. And women only, you know, can also have more opportunity when we have men who are more involved, but it's better overall. I've seen that my partner and I work together from home. So we share the parenting completely equally. And he will say that, and I forget often how rare that is still. I mean, it's changing, but it's still quite rare, but he will often take the kids to things and we'll split things up. And he just knows how to change a nappy and do all the things. And I'd have him bat an eyelid. And then we're at a dinner party a couple of weeks ago and someone said, oh yeah, my husband's never

changed a nappy. He doesn't know how to, and people were laughing. And I was furious. I know. He had three kids and had never changed a nappy and they were like three, five and six or something. And I just spent the whole drive home in the car yelling at James about how ridiculous that is, that he's never been made to. Because it's not that he can't, he's just never been made to and never had to because someone else steps in and you're absolutely right.

I think it's really inspiring. Yeah, and look, I want to be careful about, you know, making it women's problem for overdoing things and their male partners not stepping in because that's just another way we blame women for men's incompetence like they should just be proactively just darling I'll do this one you know but but there are I acknowledge there are structural barriers and you know nowadays I don't ask my female trainees you know whether they've thought about work-life balance, because they have, I don't need to ask

them. So I will, I'll say to them explicitly, I'm not going to ask you this as a question, but if you have any specific questions about what that might look like through your training, and once you've finished, you know, happy to chat about how I do it. But I ask all my male trainees, I'm like, have you thought about your work-life balance have you thought about maybe having children one day and how you're going to manage that and when I first started doing that maybe five or six years ago it was deer in headlights sort of response but what what what children what oh just oh I'm like it's okay we're allowed we're allowed to talk about you know things that you want outside of medicine and they're like oh but I had never thought about it um whereas now increasingly I'm getting you know slightly more thought through oh yes well my partner is you know blah blah blah and you know we're thinking

about kids at this particular point in time and you know I've thought about maybe going part-time for a year and I'm like okay okay good you know and I think we should be asking young men these questions just in part so that they have it flagged to them that this is something that they should think about but secondly also to create an expectation that this is something men do do and ought to do and it's not something you have to be embarrassed by and that the system you know and I was asking the sense of you know what can we as a system do to support you like that because ultimately that's the vibe it's not it's not trying to catch them out in a trick question it's to go look you know part-time training does exist and here are the male surgeons who have done that so I think I think can make things better. I hope it's better for

my three sons. I hope they get options that, you know, their grandfathers didn't get. Yeah. And opportunities to see things done differently. Because that's ultimately what it is, like the character of Andy, Emma's brother. That's part of what's so stressful for him. It's not just how stressful the hospital is. It's also what he's trying to balance with his home life and his twin babies and his wife that he can't be there for. And that's devastating if you're someone who wants to be there. And we want people caring for sick people who have empathy, who do want to also, you know, be good providers and parents and be involved and care about their partners. And yeah, I think that's

wonderful. Well, honestly, Nila, you are so inspiring. My brother is in the medical profession and I told him I was interviewing you and he went, oh gosh, she's so amazing. Just all the things you're doing, honestly, it's just so incredible. So thank you so much. I wanted to finish by asking what you do for self-care, which is I know a real buzzword, but what do you do to look after you because you do so much? Oh, I'm so crap at self-care. I'm so bad at it. Sleep.

Sleep is my number one non-negotiable need and that is the one thing my unicorn husband always gives me. You know, it's the weekend sleep in. it is just if I haven't had enough sleep I'm just I'm so traumatized from the registrar years of not enough sleep and I and I had two out of three kids during those years as well so it was just it was five years no sleep so so sleep is probably the most important thing that I do but other than that I think for me self-care is about intellectual stimulation rather than other things, which I've only come to realise more recently. I've got to be interested in the world. reading or writing or learning a new skill or you know whatever it is I think that that is important and the last thing is holidays you know I don't I'm happy to go go go go go for most of the year

but I need proper breaks and particularly the last few years I've ended up very burnt out because who took holidays during COVID? You couldn't go anywhere. You couldn't do anything or, you know, lockdown. It seemed that there seemed to be little point to having a break if all you had to do was going to, all you could do is stay at home. So, yeah, this year I've actually tried to schedule in periods of time off where we go away and do something. And that recharges you and gives you energy and drive to keep going. Yeah. Yeah. Well, thank you so much, Nila.

This has been such a joy. I totally relate to that as well. When you've got a busy brain, you need to give it things to do or it'll tear up all the furniture, like a labor door or something, right? Just got to constantly take it out for walks. Otherwise, who knows what will happen. Well, thank you for the gift of the work that you do for your patients, but also for our broader community.

And really appreciate this conversation for Tom. Yeah, thank you, Claire. Had a great time. You're welcome. Oh, me too. Oh, where can we buy your book? Booktopia? Is that the right spot?

You can buy it anywhere. It'll be in most bookstores i think fantastic oh i can't wait it's it's one and it's also a teal front cover everybody which with the last election was just perfect was that just a divine coincidence it was a coincidence but it's also it's a very medical teal which i love it's you know it's the color of scrubs it's the color of drapes it's the color of you know lots of things in medicine because blood shows up really nicely against it I think that's why they chose that color in medicine not for the book cover don't get that on the book cover I'll go test that out oh that's so fascinating, isn't it? Wow, I never knew that. All right.

Well, it's a fantastic book, The Registrar. Go and purchase it wherever you can. What date is it coming out? It's coming out on the 5th of July. So very soon. Very soon. All right. Thank you.

Thanks, Claire. You're welcome. You've been listening to a podcast with me, Claire Twente, and this week with the incredible Dr. Neela Janakiramanan. Now, for more from Dr. Neela, you can head to her book, The Registrar. Go and grab yourself a copy at all good bookshops and online. And if you want to read more of her writing, you can also find her at The Women's Agenda and on Twitter.

She also has a website, drneela.com.au, where you can find out more about the reconstructive surgery that she does. For more from me, you can head to claretonte.com. That's my website, or you can also go to my Instagram account at claretonte. That's where I like to tell stories on social media. All right. Thank you as always to Roar Collings for editing this week's episode and also to Maisie for running our socials at Tom's Pod. And if you liked this show, I have lots of other interviews that come out every Friday. Season one, I had interviews with the wonderful Jamila Rizvi

and Claire Bowditch with Dr. Eve Reese as well. And I can't wait to share more conversations just like this one. I also do another podcast, which just happens to be an award-winning show. We came third for Listener's Choice in the Australian Podcast Award. It's called Suggestible, where I recommend you things to watch, read and listen to. I do that with my husband, James Clement, and that comes out every Thursday. So if you need something to watch next up, head on over there. And that's it for me this week. You can contact the show at tonspod at gmail.com. And if you wouldn't mind, leave a rating and a review and subscribe on iTunes or Spotify, wherever you listen to your podcast. It really makes a massive difference.

And if you have someone in your life that you think would benefit from this conversation, please share it along. I always love getting recommendations from mates. It's a really great way to stay in touch. Send a meme or send a podcast episode. They tend to be my two favorite things to do. And I'm sending you a whole lot of love this week. Okay. Talk to you soon. Bye.