Going Under

by Sonia Henry

  Max looks at me. I look at him. Then we laugh and laugh and laugh, and I feel better than I have in a very, very long time.

  Con the Greek comes over carrying two glasses of wine.

  ‘We didn’t order more wine,’ I say, trying to catch my breath as Max wipes tears from his eyes.

  Con shakes his head. ‘On the house.’

  ‘What? But you’re always saying the business is going broke!’

  Con glares at me. ‘It is.’

  ‘So we’ll pay,’ Max exclaims, pulling out his wallet. He nudges me. ‘I’ve got no money. Kitty, you pay.’

  ‘Fuck off! I always pay!’

  ‘No pay,’ Con says firmly. ‘This is the first time I’ve seen you two laughing together in a long fucking time. Doctors need more wine, and less work.’

  ‘And more money,’ Max says, gratefully accepting his glass.

  ‘You don’t need money in Kythira,’ Con says happily, sitting on the stool next to us. ‘In paradise, anything is possible.’

  ‘We’ve just been in hell,’ Max informs him.

  They say the road to hell is paved with good intentions, but to paradise it’s rocky and narrow and difficult.

  I don’t know where I’ll end up; my penchant for kissing married men then nearly killing them probably means I’ve got my own special seat reserved in hell, but I feel like I’ve been trudging up the narrow road for years.

  Maybe this time, I think, listening to Max and Con argue cheerfully about who’s more broke, my paradise is here, and now.

  Mum’s voice reverberates through my mind again: year ten English, Milton’s Paradise Lost.

  Long is the way and hard, that out of Hell leads up to light.

  fifty-nine

  Two weeks later, I sit anxiously on the ward staring at my phone. The Joker has called in sick at the last minute, which isn’t a surprise. Since the truth came out he’s been calling in sick nearly once a week. According to the rumours he’s either getting promoted or fired, so maybe he’s making the most of his sick leave just in case. Regardless, the theatre list is cancelled so I retreat to the safety of the ward.

  We’re all waiting for the outcome of the inquest into the death of the child from Wingabby. The preliminary findings will be released in the afternoon, and Estelle texts me to say that she’s expecting the worst.

  I’ll know by the end of the day. Stay tuned.

  Finally, at around 4 pm, my phone beeps with a message from her.

  Meet me in the utility room next to the men’s theatre change rooms. NOW.

  I stare at the words in disbelief. They could only mean one thing. Poor Estelle!

  My phone starts to ring.

  I answer it, preparing to say something sympathetic and supportive.

  ‘JOKING!’ Estelle shouts into the phone, sounding as if she’s just won the lottery. ‘Forget the utility room and get your arse down to the pub because we are celebrating, Dr Holliday! I’ve been cleared of any wrongdoing. I’m innocent!’

  For once I feel no guilt about leaving work at the appropriate time.

  I find Estelle at our usual table.

  Con points at us. ‘You have to pay today,’ he shouts. ‘I had to call in the plumber and you won’t believe what he’s quoted me. Fucking tradesmen.’

  ‘So apparently the poor kid had congenital cardiomyopathy,’ Estelle explains. ‘Even if I had intubated the trachea, it still wouldn’t have saved him. But it took ages to work out, because it’s such a rare condition they had to get some pathologist in America to come and consult on it.’

  We’re both silent for a moment.

  ‘Man, the inquest was stressful, though. I was shitting myself. It was horrible. The parents … Jesus.’ She looks grim as she reaches for her beer. I reach for my own. Beer: thank God it exists. ‘So, it’s all over,’ Estelle says, sighing. ‘We don’t have to start Hot Licks after all.’

  I laugh. ‘Man, it’s almost a pity. Now we have to think seriously about the future.’

  The Future. Just the thought of it makes me feel weird. After all of this, what’s next for us? For me, for Estelle, for Max, for the Godfather, Dr Prince—where next? At least we have a next, I realise soberly, thinking of the poor child from Wingabby—not to mention Rachel Copeland. Any kind of next is still better than cold hard dirt, a box, and my medical degree sitting silently behind a sheet of glass.

  We’re interrupted by a commotion at the bar. Max and the Godfather have arrived, and Max is trying to persuade Con to shout him another drink.

  ‘We’ll give you free medical care,’ he promises.

  Con laughs. ‘The only time I see you is drunk, mate. As if I’m going to make you my fucking doctor!’

  ‘Drunk doctors are the best kind,’ the Godfather says, pulling out his credit card. ‘It’s okay, Max. I’ll pay.’

  Max doesn’t even try to look remorseful. ‘You know, I always forget my wallet,’ he says, pleased with himself. ‘Plus all my drink-driving charges have cost me a lot of money.’

  ‘What?’ I stare at him. ‘What do you mean charges? I thought there was only one?’

  The Godfather coughs. ‘I’ll get you a cocktail, Kitty,’ he says quickly. ‘Anything you want.’

  I’m glaring at Max, the Godfather is paying for our drinks, Estelle is flirting with Con, and the paint is chipping off the wall next to us, the pub as old and seedy as ever.

  People say that doctors save lives, but, being a doctor, I know the truth.

  A routine operation can kill you, but friendship is forever.

  Ashes, dust and beer.

  sixty

  On my last day of work as an intern, the last day I will be the most junior doctor in the hospital system or the world, I get a phone call from Winnie as I’m walking home.

  ‘There’s something for you at the door,’ she says, sounding a bit confused. ‘Um, are you going to be home soon?’

  ‘It’s not a bloody bomb, is it?’ I ask, wondering if maybe the Joker has risen.

  ‘No … but it’s pretty explosive.’

  I sigh. No doubt it’s another parking fine. I make a mental note to have a go at Winnie as soon as I get in. Like, who calls someone up about a fine?

  Walking down North Avenue, with the hospital looming behind me, I wonder how I will feel when I wake up tomorrow morning as a medical resident, now only the second-most junior doctor in the hospital. Probably much the same, I realise, allowing myself a small grin. Still, one rung higher is one rung higher. Medicine is nothing if not an exercise in delayed gratification.

  As I near number 19, I notice there’s someone sitting on the front doorstep. Oh, God—they’ve actually sent a debt collector?! I turn through the front gate and stop abruptly, unable to believe what my eyes are telling me.

  He’s as tall as I remember. His dark hair is the same, flopping over his eyebrow. He’s tanned and looks like he’s stepped off an island paradise—which he probably has, I remind myself. He’s wearing a t-shirt with a picture of a cartoon dog on it, and he is holding a package. I stand gaping at him, speechless.

  ‘Hi, Doc,’ he says. ‘We’ve got to stop running into each other like this.’

  The violins which have started up in my head come to a screeching halt.

  ‘Nice line,’ I say. ‘What do you think this is? A movie?’ Then: ‘Well, you took your bloody time! Good to see you’re capable of actually making a flight!’

  ‘Do you always have to start an argument?’ he replies, looking irritated. ‘I’m trying to be romantic.’

  ‘Sorry, I’m a bit lacking in the romance department,’ I snap. ‘I’ve been working hard while you’ve been gallivanting around.’

  He grins. ‘Okay, angry pants.’

  I try extremely hard not to smile.

  ‘I got you a present,’ he says, unwrapping the parcel he’s holding. ‘It’s a leather purse—had it made by a tailor in Saigon in Vietnam. It has Dr KH inscribed on it, see … and I had it made with a blue zip, because I know blu
e is your favourite colour. Remember your blue ski pants? I carried it all over the world for you. Then I messaged Winnie and got your address so I could surprise you after work.’ He gently lifts my stethoscope from around my neck. ‘Wow,’ he says, grinning, ‘you are a real doctor.’

  ‘Don’t think you’ll be working as a surf instructor while I slave my arse off in the emergency department,’ I warn.

  ‘I know.’

  Then there’s no more talking, and as we move towards each other I feel my mind completely empty, for once, of all lingering thoughts.

  I am finally a real doctor, and Fabien has finally come home.

  epilogue

  One year later

  I walk onto the pebbles for the seventh consecutive morning and wave at the men building the bar on the beach at Èze. I flew into Nice eight days ago.

  One morning I woke up and decided it was time to take six months off training to finally try to write my book. I found a tiny apartment on the French Riviera with an internet connection, and two weeks later I was gone. I packed only carry-on luggage, my laptop and the little pink book my mum bought me at the post office, its pages now filled with notes: it contains people, experiences, tears, pain, memories and love. My dreams, and my nightmares, encased in bright pink fake leather. The glittery cursive d has faded, and Follow your dreams looks more like Follow your reams. It’s tattered and old now, and stained with red wine from when Estelle knocked over a glass as I was reading her and Max an excerpt.

  ‘You have to write this book, Kitty,’ she had said, looking at me intensely.

  We were sitting on the floor of number 19, surrounded by wine bottles and words.

  ‘You have to tell this story. Not just for us, or for yourself, because you want to be a writer, but for all those poor fucking medical students and junior doctors like us, for the patients and for the general public who think that doctors are superhuman machines. For people like Rachel, who didn’t have mates or support like we do. Forget making a difference by being a surgeon or whatever—this is your difference, Kitty: this is what you were meant to do. You have to write it. If you don’t, you’ll regret it for the rest of your fucking life.’

  ‘And cheers to that,’ Max chimed in, laughing as we clinked our glasses together. ‘Cheers to Kitty’s book.’

  I take them seriously. The hospital isn’t going anywhere, and I have my whole life to work. I get off the train at freedom station; the looking-glass between Dr Katarina Holliday and Kitty Holliday the writer vanishes. I follow my reams.

  ‘Bonjour,’ says one of the builders.

  I wave in response and am about to keep walking but decide I should practise my French. I’m in France, after all, and the morning is warm with the day stretching out in front of me into a glorious eternity. For the first time in a long while, I have nothing to do except whatever I like.

  ‘Il fait très chaud aujourd’ hui!’ I say.

  The men all turn to look at me. ‘Parlez-vous français, Madame?’ one of them asks.

  I laugh, holding my thumb and index finger an inch apart. ‘Un peu.’

  He nods in understanding. ‘You are English?’

  I feign a look of horror. ‘Non! I’m Australian.’

  ‘It is a long way. Are you here for holiday?’

  I pause. ‘Sort of,’ I reply.

  ‘What do you do?’

  I look at him. The words I’m a doctor are on my lips, words I’ve waited so long to say. But I’m not in Èze to be a doctor. ‘I’m a writer,’ I tell him. I have a feeling Rachel would approve.

  He smiles. ‘Lots of writers come here. Nietzsche—he came to Èze. You must walk the Nietzsche trail; they say he walked it every day for inspiration.’

  Nietzsche, the great philosopher, who wrote something along the lines of: He who has a why to live can bear almost any how.

  Is this my why? This small French town that I have been led to by the echoes of a dead young woman, the place I have come to write down my story, her story, my friends’ stories—is this my why? Maybe, I think, as the builder goes on to name other writers who have lived in the village, I am meant to be here.

  I smile, say goodbye, and continue my walk along the beach.

  My phone pings in my pocket. I pull it out. A message from Fabien.

  Having fun?

  I allow myself a small laugh. For once, he’s stuck back at home working while I’m gallivanting around the world. I don’t know what will happen with me and Fabien, but I’ve decided to listen to him and, like when we ski, just wait and see where we end up. To learn how to enjoy the moment feels liberating and unusual. It makes me smile. I turn my phone off. How times have changed.

  I take my laptop from my shoulder bag and, with my little pink book beside me, I sit there on the pebbled shore, and start to type.

  Thirty-three years ago, Toby Henderson was working in the emergency department of a hospital on the outskirts of the city …

  author’s note

  In 1978 the satirical novel The House of God was published, written by Samuel Shem, a psychiatrist who detailed the intern year of a group of young doctors at a fictional hospital. The novel describes the dehumanising, brutalising experiences of interns training at Harvard Medical School’s Beth Israel Hospital in 1974. It was drawn from real life and, more than forty years later, is still part of medical folklore. It is now 2019, and this is a conversation that still hasn’t ended.

  In January 2017 an anonymous article was published on the physician blog Kevin MD called ‘There is something rotten inside the medical profession’. It was shared thousands of times. It detailed the dire state of training for junior doctors, and a recent spate of suicides of young medics working in Australia. I had particular interest in the overwhelming response to this article as I was the doctor who wrote it.

  I remember vividly sitting inside the emergency department as a friend told me that a colleague of ours had just killed herself. I remember the whispers and seeing people crying around the hospital. I also remember that, aside from among my close friends, I couldn’t discuss it with anyone and I had to put on a brave face and finish my shift that night. It was the second suicide of a doctor I knew within twelve months. A few weeks later, another doctor killed himself. All of these people were under the age of thirty-five, and all based in Sydney.

  I walked home and poured my anger onto the notes function of my iPhone, which ended up being published as the aforementioned article. The sense of disillusionment was overwhelming. There is something wrong when young people with a qualification as difficult as a medical degree, who have the skills and intellect to contribute to society in an enormously meaningful way, are pushed into a mental space where they think their only option is to take their own life. Every year in America four hundred physicians kill themselves. That’s an entire medical school. I refuse to believe the apologists who infer there are other reasons for such drastic actions. There is a common denominator in all of these deaths: the job, and the system in which we train.

  Being a doctor is all about control. Certainly, the expectations placed on doctors by themselves, their superiors, and the general public are enormous. Behind closed doors and with the knowledge you are going to be on call every night for one year (as is what happened to a surgical trainee I know well), between working sometimes sixteen-hour days, relatively paltry remuneration and extremely costly exams, is it any surprise that people then lose control? Be that with infidelities, abuse of drugs and alcohol, significant mental distress and, the worst case, suicide. I felt physically ill when the same surgical trainee told me on more than one occasion during this time period he had gone close to the roof of the hospital, with calm and clear intention to throw himself off.

  The impact of superiors showing their juniors kindness and care cannot be overstated. I know this from first-hand experience. I was very fortunate to have some consultants who I trained under be extremely kind and supportive, and this, between having a close-knit group of friends I could be ve
ry honest with, made the difference between me finishing my training and going under, for want of a better term. It may come as a surprise to senior consultants or hospital administration how vividly their juniors recall a kind word, a signed overtime sheet, or just a sense that they have someone they can speak to who actually has the power to meaningfully assist them when they are feeling lost or isolated.

  There is a kind of omerta that exists around the walls of a teaching hospital. Every now and again someone will break the silence and there will be shock and awe at the sudden window the general public is given into the mystical world of medical training, but the people who speak out know the cost at which their truth comes. The system promises change but the statistics surrounding junior doctor suicide and mental health remain dire. The flurry of responses to whistle blowers, if you want to call them that, dies down, and the cycle continues to perpetuate. This book I hope will contribute to breaking that cycle, and push towards meaningful and practical change. We are making steps, albeit small ones, to attempt to stamp out a culture of bullying, intimidation and unsafe working hours. Some hospital departments have had their training accreditations stripped from them until they improve the conditions their trainees work under, and I largely applaud this, despite the impact it undeniably has on doctors trying to finish their specialisation.

  In the words of a good friend of mine, being a junior doctor is a tough gig. No one is denying the need to have highly skilled medics caring for the sick, nor that we need rigorous standards to adhere to. No doctor I know would argue with that, nor do we want to. You know on your first day of medical school you aren’t signing up for an easy time, and we all accept the nature of the beast in that regard. However, there is a difference between a hard job, and a job that is made much harder by bullies, petty bureaucracies, colleges who refuse to open training positions, and an ingrained culture of abuse and brutality.

  To quote the article I wrote after that long shift in the emergency department over two years ago: ‘The only people dying inside a teaching hospital should be the sick patients for which doctors can find no answers.’ I, like my friends and colleagues, have worked very hard to be part of an ancient profession whose oath is Do No Harm. Now is the time to stop harming ourselves, and each other.