Writing ‘Emotional Female’

G’day! It’s been a while.. I see that my last blog post was in October. At the time, I would’ve been madly trying to finish my memoir – Emotional Female – which is now out! Hoorah. It was published by Penguin Books a month ago, and what a month it’s been. For those new to my blog – hello and welcome. I started it in 2018 after I became mentally unwell from my job as a Plastic & Reconstructive Surgery registrar. I was blogging from my hospital bed in a psychiatric facility. The blog post that I wrote about my breakdown is here. I initially wrote it on Boxing Day 2018, but decided to post it to my socials a couple of months after that in early February 2019 just before the start of the clinical year for my medical colleagues.

It was after that that my story was read by a wider audience and I was lucky enough to get approached by some book publishers. I’ve had a number of doctors interested in publishing their stories too, so I thought I’d share some information that might help. If I may suggest an excellent podcast episode which describes the road to publication, it’s this one by Better Reading – an interview with my publisher Nikki Christer, who was the Group Publishing Director for Penguin Random House and now the Publisher At Large. The normal process is to submit a manuscript either to a literary agent or directly to a publishing house. You may wish to hire an editor to polish your manuscript before submitting it.

Emotional Female took me nearly two years to write. I started around May 2019, and it had many rounds of re-working. I had never written anything of this length before (it’s just over 80,000 words) and didn’t know how to structure it. My first draft was a hot mess, which I sent to Nikki at the end of 2019. I basically wrote down everything I could remember from my medical school and junior doctors days in one big incoherent heap. It was hard to know what to include, and what not to. The process of then choosing what goes in the book required some thinking as to what the main themes were going to be. It’s funny how you have to fit your life story into themes because life isn’t like that, but I had to remind myself that this had to be a piece of writing that people can consume in a neat little package.

So, the themes: bullying & harassment, sexism & misogyny, racism (including the model minority myth & bamboo ceiling), and mental health. Fun, right? It was certainly distressing at times to write aspects of the book. I did have to take some breaks – sometimes weeks at a time – because I just couldn’t deal with it. It was heavy and I was still unwell. Frankly, writing this book probably wasn’t the best thing for my mental health, even though I knew it was important. But ultimately, it’s something I’m so glad to have done. From the beginning, when I wrote the blog post, my aim was always to try and change the toxic culture of medicine, and surgery in particular. It’s a sick and dysfunctional system even today, three years after I quit my job. Having spoken to friends who are still working in the public hospital system, and seeing young surgeons around the world get driven out, I know we still have a lot of work to do. Just this weekend I read a heartbreaking thread on Twitter by @MissBethanEJohn, who experienced the toxic culture of Neurosurgery in England and chose to leave after six years of training in it. Here’s one of the tweets from Dr John’s thread:

I related to this so much, recalling the surgeon who told me, “If you can’t handle the hours, maybe this isn’t for you.” What I’ve realised more and more over the past few years is how much hospitals and senior doctors gaslight young doctors – that’s what it is; gaslighting. I remember that same surgeon mumbling about how none of the other registrars had complained before me. There was no acknowledgement that what I experienced was different. The two registrars before me had less experience in hand surgery, which meant there were operations they couldn’t do on their own (so they weren’t operating solo late at night for example). They also happened to have supportive co-registrars working with them, who would come in and help. But that’s beside the point. If a doctor is burning out, or asking for help, let’s not ignore them. It’s so easy to blame the individual and dismiss the systemic factors.

What I’ve realised since sharing my experiences two years ago is that my story is unfortunately very common. The only beneficial side effect of this has been that I’ve felt validated by the doctors (not just women) who have contacted me with similar accounts. The more people speak up, the more we can challenge the system, which is so broken. No, it’s not Person A or Person B who can’t hack it – the hospitals are driving doctors away and we need to examine why this is happening and change it. We need to talk to the people who have left. In this brilliant opinion piece by Greta McLachlan and Simon Fleming in the British Medical Journal, they talk about the survivorship bias in medicine: we don’t learn by talking to the people who have stayed. They have survived and therefore think the system is fine as it is, but it’s not. I don’t have all the answers, but what I do know is that we need adequate staffing. We need to regulate the amount of on-call that registrars are undertaking. We have good guidelines for shift work – maximum number of hours per shift, minimum number of hours in between shifts – but not for on-call. Safe working hours guidelines have existed on both the Australian Medical Association and Royal Australasian College of Surgeons (RACS) websites for several years. The AMA Code of Practice about working hours has existed since 1999 even. But there’s no point in having guidelines that aren’t followed. They need to be enforced.

The thing that most needs to change is culture, but this is much harder to measure. ‘Don’t be a dick’ is something that’s fairly easy to understand. We need better leadership. Recently, there was a sexual assault case in Oregon involving Dr Jason Campbell who is at the centre of the allegations. As well as sending dick pics, Dr Campbell allegedly pressed his erect penis into a woman employee’s backside. There was criticism of Dr Esther Choo, who was one of the thirteen people the plaintiff had supposedly reported to. Dr Choo is one of the founding members of Times Up HealthCare – a not-for-profit organisation formed to address sexual harassment in health care. There was a Twitter furore about this incident, condemning the incident and expressing concern for the plaintiff. However, there was one Australian surgeon who was quick to defend Choo – Dr Rhea Liang, (now former) chair of the #OperateWithRespect committee of RACS. Here are a couple of her tweets and their responses:

There are other problematic tweets in this thread, where Liang continues to double down. It was disturbing for me to see that the chair of an anti-bullying campaign should say that a ‘cup of coffee conversation’ would be an adequate response to a sexual assault. Other surgeons spoke up about how inappropriate this was. It bothers me that people at the top are minimising the experiences of sexual assault survivors. If a woman were to report sexual assault to her superiors, I’d like to think that they’d do the right thing and escalate it immediately. As they say – the fish rots from the head. Liang has since resigned from her position. We need leaders who practise what they preach. We need leaders who don’t bully people on Twitter (I’ve observed plenty of that), or fail to support survivors. We need leaders who respond appropriately to unacceptable behaviours and workplace conditions. Cultural change requires institutional leadership.

On that happy note, I hope you are having a good long weekend. I’ve certainly felt like I needed the extra couple of days to recover after what has been an intense month (don’t even get me started on the Australian Parliament!). Take care,

Yumiko xx