She keeps you healthy and well, but who protects her?

‘I was sexually harassed or assaulted in 18 of those 21 [training] terms… we just accepted that as a cost we had to pay.’

While Dr Neela Janakiramanan’s debut novel may be fiction, the experiences it recounts are all borne of fact. The surgeon and author joined Future Women Live to discuss how her surgical training – and the burnout, pressure, and abject sexism that came with it – inspired her to write The Registrar, which follows Emma Swann through her surgical training.

Stories centred around the experiences of women are relatively scarce – one recent study by the University of Southern California found that men outnumber women four-to-one, despite other research noting that women read more.

According to Dr Janakiramanan, that same underrepresentation is true for literary work within the medical field.

‘What very little there is is all centred upon men: male patients, male clinicians,’ she said. ‘The ways in which women have often been portrayed are quite sexist, quite racist, quite derogatory.’

Dr Neela Janakiramanan penned her first novel, The Registrar, during Australia’s initial COVID-19 outbreak.

The industry is just as hostile for women off the page. She recalled how often she was told to avoid certain fields because they are ‘male-dominated’ and difficult to manage alongside family commitments. With years of experience under her belt, Dr Janakiramanan has realised it’s not just a warning for women – but anyone who dares to sit outside of the prevailing hyper-masculine stereotypes.

‘It’s not that it’s male-dominated, it’s that it’s dominated by a particular kind of man and a particular kind of alpha male culture,’ she said.

Dr Janakiramanan says it’s this culture that makes it difficult for women to exist in these fields, and impossible for them to feel truly welcome.

‘It’s very hard to concentrate on a case when a surgeon is playing footsies under the table with you. It’s very hard to find a mentor when the person you might identify as a mentor is asking you out on a date. It’s very hard to concentrate and learn when you’re spending your intellectual and emotional energy trying to work out how to make yourself safe in the workplace.’

It’s not just the behaviour of those individuals that make the situation so alarming – it’s a structural failure to hold them to account. Dr Janakeeramanan also told Future Women that the field of medicine has some of the same cultural issues as politics, which was the subject of a scathing review by Sex Discrimination Commissioner Kate Jenkins.

‘Say you are a trainee registrar. You have an employee, which is your hospital, your direct bosses who decide whether you’ll progress or not, you have an HR department that stands one step back from all of this. You also have a training college which assigns you different places to go but aren’t your direct employer,’ she said.

‘It creates this monstrosity where no one is actually taking responsibility for anyone.’

These degrees of separation mean it isn’t clear who you complain to, or if they would do anything about it. She adds that the personal cost of making a complaint is ‘so great that it serves as a barrier [too]’.

‘In any industry, if it doesn’t value its workers, then chaos is going to rule.’

When asked who was at greatest risk, Dr Janakiramanan was unequivocal.

‘Women of colour are on the bottom of the heap.’

She explained that she avoided making a woman of colour the protagonist in her novel because, as one herself, she understood the added difficulty it would require to represent accurately in the narrative.

In addressing all of these issues, Dr Janakiramanan thinks the best solutions will come from dialogue with those having negative experiences.

‘In any industry, if it doesn’t value its workers, then chaos is going to rule,’ she said.

‘The more that we band together, the better a culture, and the better a safety net we create.’