An interview with Hannah Royster, who trained as a doctor in Australia and has just released her book "In Turn" - a fictionalised memoir of her hospital internship.
Hannah battled deafness, epilepsy and brain cancer in childhood, missing substantial schooling, but went on to do a medical degree. She tells the story in this episode of her medical training, internship and burnout.
Audio/book: "In Turn" by Hannah Royster
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Hi everyone. My name is Dex Randall and this is the Burnout to Leadership Podcast, where I teach professional men to recover from burnout and get back to passion and reward at work. Hello my friends, Dex here and today on the Burnout to Leadership Podcast I am interviewing Hannah Royster, who has trained as a doctor in Australia and will shortly be releasing her book Intern, which is a fictionalised memoir of the hospital internship. And I'm busy reading it and the eyebrows are shooting up around my head, I'll tell you. Anyhow, as many regular listeners will know, I have a lot of clients from medicine and because they're some of my favourite humans, frankly, and the feedback I get from medical culture universally across many countries, it really does sound fairly challenging these days and I know it's heading in a direction that's not easy for many people. So I'll be very interested to hear what Hannah says. Hannah was raised in rural, far north Queensland in Australia, hooray, a local, and has overcome deafness, epilepsy and brain cancer only to throw herself into medical studies. And Hannah has also experienced burnout and lost, I understand, several peers to suicide in the medical training. So I think hers becomes a very important voice in the medical landscape, not just in Australia, but really in the world. So a very big welcome today to the Burnout to Leadership Podcast, Hannah Royster. Thanks so much for having me, Dex. It's a real honour. Delighted to have you here. How are you doing today? Yeah, wonderful. It's coming into Christmas time, so all the good vibes are out. Yeah, and I hear it's pretty hot up there. It is, but we got some rain, so thanks very much for that down South peeps. So Hannah's about 2000k North of me. I'm in Sydney and the weather here is just a tiny little bit ordinary, but the weather up north is hot and tropical and steamy. I was up there a few weeks ago. Anyhow, so let's begin at the beginning. What I'd really love you to give us a little bit of an insight into first is you mentioned that you've overcome a number of challenges earlier in your life. And I wonder if you could just tell us a tiny bit about those so we get a sense of what your life was before you got into medicine. So my parents actually met in India. My mom was at the end of a 8 year long lesbian relationship and decided to go on a 30 year old self discovery trip to India. And my father, who was also just turned 30, had done the same, decided to go back and trace his parents missionary roots to go on his own self discovery course. And they met in India in an ashram and they had a little summer romance and I was the result of that summer romance. And so because dad's family is quite traditional, there was a bit of pressure there to marry and do the nuclear family things. So dad moved back to Australia with mom. She was living in Sydney at that time, still with her ex girlfriend. And they all moved into their little three bedroom in Sydney and thus the family began. And then my mother's ex girlfriend's then girlfriend, next girlfriend, brought us all to Far North Queensland and my two sisters were born up here as well. And we moved to property in the tablelands when I was about 7 or 8 because of my health issues. So initially I went deaf and was deaf for some time before mom and dad really clued on what was going on for me. And then in the midst of that, I started to have seizures and at first they were just absence episodes. So I'd zone out, I guess. And my earliest memory of it is playing ball at school and catching a ball and then immediately being yelled at by all the other children who were in a state of confusion as to why I wasn't throwing the ball and to hurry up and throw the ball. And then I was like, "Oh, okay." So I threw the ball and then some of the other school kids mentioned this to the teacher or to my parents about how I'd checked out there for a minute. And then I guess this kept happening more and more often. And then I was taken to a GP who diagnosed me with epilepsy. And at the time, mom and dad were offered an MRI brain, but they didn't think it was necessary and I was put on anti epileptic medication. But then my seizures kept breaking through the medication threshold. And so they kept putting me up and up and up doses until I was on the highest dose of the anti epileptic. I couldn't possibly go on for my pediatric body weight. And I was still having multiple seizures a day. And because of that, I couldn't go to school. And so I was at home and I was very numbed out zombie child on these anti epileptic drugs. And yeah, getting into sticky situations like falling into fireplaces and downstairs and all those dramatic life events, my poor parents. And so then mom and dad went back to the doctor and pushed for that MRI brain or for some kind of intervention. And at that time there was some changes to Medicare. And so I no longer met the criteria for an MRI brain. And so they weren't able to give it to my parents. And so then mom and dad went down lots of different natural pathways as a strategy of desperation to do something. I was told to blow up balloons every day and eat eight dates and had to go off sugar and got special massages and drumming therapy and all sorts. And obviously that was doing no favors for my brain cancer that was growing in my head at the time that nobody knew about. And then it was my grandmother in America who had a friend who was a neurologist who was at a conference for neurological disorders in children in the States. And she happened to call this friend on the same weekend, there was a conference on and this friend said, "Oh, I've just met an Australian pediatrician here for the conference. I'll let them know." And so because of that conversation with the Australian pediatrician, that Australian pediatrician then rang the Royal Children's Hospital in Brisbane, a colleague there, who then that pediatrician rang my GP and said, "Get this child a bloody MRI now." So I had an MRI that same day, showed my brain cancer, got flown down to the Royal Children's Hospital that next week, had my surgery. They got clear margins first go. So I didn't need any chemo or radiotherapy. And then after that, there was just rehabilitation. And I walked pretty soon after the surgery again, and there was no issues with my neurology. And then I just needed six monthly MRI brain scans after that, up until I was about 16. But because I'd missed all of that school and I'd been really sort of taken out of the scenes and yeah, I was quite a, I guess, a fearful child after all of those experiences. Mom and dad put me into a Waldorf school, a Steiner school, which was very small and I guess a safe environment for me to rehab my way back into schooling. But that only covered primary school. So then in high school, that was really my first exposure to secular schooling since I was 8. And well, I failed every subject that first year of high school. And in that year, I told myself that it was because I had a part of my brain missing. And I remember having this thought and feeling really reassured and thinking, oh, I work really hard and I still don't do very well in school. And it's not my fault. It's just because I've got a chunk of my brain missing. And I accepted this thought and I moved on with life and I never mucked around in school. I worked hard and I did my studies and I did my homework and we have a very astute academic family. So there was a lot of emphasis put on academic achievements. So I worked and I studied and then eventually my grades got better. And I was 15 when I got my first A and it really blew up that perception I'd had of myself. And then because I broke that perception that I had, that I couldn't be smart, I really went for it. And it was all about my personal best and pushing to achieve that next better grade. And so everything else in life dropped away. And at the time my dad was really struggling with some mental illness issues of his own. And so I think disappearing into my academics was a bit of a saving grace for me being 16, 17 at the time. And so, yeah, I climbed my way back up the academic ladder until I was the top 3% of my year. And then I had a crush on a boy that lived next door to me. And his sister told me that if I said I wanted to be a doctor, that I'd really impressed this boy. So I put down on my transcript that I wanted to be a doctor when I grew up to impress this boy. And then I got into medicine and then my parents were so proud. And so yeah, I stuck to it and I went to med school all for this silly boy next door. That's the best reason I've ever heard for going to med school. But you've been through... That's an incredible triumph considering how much schooling you've missed and how much sickness you've been through and the traumatising effect of the brain cancer and all of that. That's a remarkable story all by itself before you even thought as far as medicine, isn't it? Yeah, it was a bit of a whopper, got to be honest. Did you... What year was it? Or how old were you when you just took up medicine? So I started medical school when I was 17. 17, okay. Turned 18 that year. Have you got any doctors in your family? I have an aunt, my mum's sister is also a doctor, but she lives in New Zealand, so we don't have a huge amount to do with that side of the family. Okay. Wow. That's quite a chunky background. So really, this is a Burnout Podcast. I'm going to ask you in a minute about burnout, but really coming into medicine, the incidence of burnout and indeed suicide is very, very prevalent. So I'm interested in your, particularly in your first impressions of medical training and hospital culture, because I've read about half of your book actually. I've just got it and I've just read half of it, but I haven't seen all of it. So what was your impression coming in? I think in high school, you don't really know what you're getting yourself into. And you just have these glorified perceptions of what being a doctor or an engineer or a lawyer is. And they're kind of the degrees that get posed to you by your school counsellors or your teachers as being the degrees you should go for because you take these subjects or you've got these grades and therefore those kinds of people who get those high achieving grades, they go for these kinds of careers and that's what you should do. And when you're a 16, 17 year old trying to choose your life path, what do you know? And especially if you're, a people pleasing type A personality like I was, then of course I went for the advice of the people who are posed as being more knowledgeable or insightful than I was. And so, yeah, I think as a teenager, as a high school student, I didn't really have a clue. And then in med school as like the rumors of like horror stories from the woods would kind of come trickling through, or you get exposed to small amounts of it by being a medical student. It was just kind of like, had your blinders on because you had studies to do, there are assignments, you've got to get through your exams, you've committed to this path. And it was so much just to get yourself through that semester, that then taking that step back and really looking at what medicine really is, is just too big a slice of pie when you're still a young person trying to get yourself through a semester of workload plus an exam. And I think even then you're quite protected because you've got the medical school and you get to leave. Like you go there for the ward rounds and you're the shadow and there's a whole component of not niceness being the pot plant on a medical team as the medical student and being ignored or them never bothering to learn your name or not being given a list or whatever version of disregard you happen to get that week or that rotation. But after ward rounds or after clinic or after that one surgery, you get to leave. You've got lectures that protect you or bump out your day and you go home and you do your study in your own private space. And I think you also have colleagues that are in there and doing it with you. But once you're an intern, once you're out there in the real world, you don't have that protection anymore. And for a lot of us who went straight from high school to medical school, it was the first job we'd ever worked.It was our first, I was about to say 9:00 to 5:
00, butreally it's like 6:00 to 9:
00. You share an awful lot of insights about your experiences in the hospital in the book. But one thing I would like to ask you before we go any more about the hospital culture is what would you like people to know about being female in your position in the hospital? I think for me, it was the first time that I'd ever noticed that my gender made a statement. I think I'm a white, straight, middle class Westerner and I'd never really felt anything of racism or being a minority. And for the first time as an intern, I really noticed that perspective from people, not just supervisors, but patients as well. There's an ingrained bias when a doctor walks into a room, everyone pictures a man, a white man in scrubs probably. And so I got nurse a lot and from patients and also my supervisors would speak directly to my male colleague who was my equivalent, but never directly to me. It was almost like he was the filter that would then filter jobs or tasks down to me. And it just naturally fell that way. And I would just accept that because that's also in my conditioning to just fall into that role and to step back for a moment and be like, hang on, what's going on here? And how did that affect you? I think it was incredibly frustrating. It is incredibly frustrating, A, because you don't get the respect you deserve having worked in the same industry or having the same experience. There's like an infinite amount of pressure on women in the medical workforce because we also navigate sexual attraction and components of like passive aggressive backlash from supervisors who might not know how to navigate their attraction to us or our placement in the workforce as someone who's a well spoken, well educated, confident woman. There is a lot of pushback on suppressing that. And so it's kind of like you've got to go into the workplace with your force fields up all the time. That is something fairly high on the scale of disappointment, isn't it? Well, as well, bringing you to this, you mentioned peer suicide, which is a very common theme amongst the people that I speak with, both in the coaching industry and the medical industry about the medical environment. That must have been profoundly shocking for you. It honestly was because I think because I stayed in Far North Queensland for my intern and residency years because you hear horror stories about Sydney and Brisbane and Melbourne and big hospitals and big centres that are busy and they do have a lot of horror stories. But I just imagine that I would be slightly protected being up here. And I think with the pressures of COVID, it really brought a lot of toxicity in the medical culture out of the woodwork and it put a lot more pressure on doctors as doctors, but also doctors as just human beings and individuals trying to do day to day life, the same kind of pressures that everybody else was carrying without having to carry the strain of the pandemic at the workplace. And I honestly didn't see it coming when my first peer suicided and I'd just spoken to them the week beforehand. And I brushed off another friend who said, "Oh, I'm a bit worried about this person." And I was like,"Oh, they'll be fine." But they really weren't. No, and I think that's often the way we find out because of the way that the medical training goes about never giving up, right? Never pulling back. Yeah. And I think we're really good at masks as being doctors because that's part of our training. We're told to leave it at home. We're told to compartmentalise and not to carry the burden, not to carry all the things and to, I guess, give that blank slate to the next patient. But then we also give it to each other. And I think we're all carrying our own traumas and triggers from being junior doctors that we then are quite close to being there for other people's experiences. Because to help someone with their experiences, you then have to be open and confess to yourself how un okay your experiences were. And I lost my train of thought. Well, it's really... I think it's so unfortunate that anybody in that system might feel that they've contributed in any way. Because I think most people can see that the problem is systemic, but I can appreciate it must be a tremendously difficult experience to have had. And on top of that, was that at the same time as COVID was in? Because that's not exactly a trivial experience either. No. Were you in a hospital at that time? No. My first peer suicide was in 2021. And there had been some suicides at that hospital the year before I started there. And then in 2021, there were three doctors in that town that suicided. Yeah. I can't even fathom how impossible to get through those experiences. And particularly during that phase, that was still when COVID was rampant, '21, wasn't it, really? Yeah. And that alone, I mean, the COVID experience alone must have been fairly charging. Yeah, absolutely. The uncertainty and the turmoil and, you know. And the being encased in plastic. And the stress and the pressure, all compounded. So I think what I've understood is you're redirecting your efforts from here on in. Is that right? Well, I'm starting GP training next year. Is that what you mean? Yeah. Where are you doing that? I'm doing it in the Tablelands up here in the far north again. After COVID, I decided that I was quite content to stay the small town girl that never leaves her small town and just be a bit comfortable in my little small corner of the world before I go and move in anywhere else in Australia. But I've got another two years to go now in my medical training, final two years. Woo hoo. Well, congratulations on all of the story until so far. Until this point, you've really overcome so many hurdles. I'm kind of mind boggled about the whole thing. Oh, really? I'm exceptionally well. And I can only imagine the value you then bring to the service of the GP. But tell me then a little bit, like which of these pieces for you of this jigsaw then fed into your experience of burnout? So I think for me, because I'd started medicine, having worked quite hard to get there, being like an average student two years prior, blowing up my perception of myself, working my ass off, studying all the time to get a high, a grade, get into medical school, and then arrive at medical school and be lumped together with the top achieving 17 plus year olds of Australia and then realise I was smack bang to average again. And I think I had to reconstruct my identity a lot during those years, which every teenager/young 21 to three year old does. Anyway, but I feel like I carried quite a lot of an extra load walking into that, or maybe not necessarily. But I finished sixth year medical school looking around and thinking, is this really what I want to do with the rest of my life? But I just invested six years of my life to get there. And I hadn't really tried it out. And it was in that final year of medical school that I did start to really look around and take notice of the culture and actually enquire from interns, regs and residents, 'cause I'd really started to notice that there was a lot of humour around how awful it really is. And as students, we used to say, like, oh, when we're doctors, or it gets better and stuff like this to keep charging us along. And I started to challenge those pep talk statements that we've made. And I asked various interns residents,"Does it get better?" And they were all like, "Oh, no, it really doesn't." And they would laugh about it, but so often this statement was reoccurring. And so I started to really observe what I was working into. And I really didn't like what I was looking at. So I finished my medical degree, and then I was like, do I really want to do this? But I decided I'd give it a term. So I did my first term of internship, got through that, I was like, okay, I'll give it one more. And I kept going term by term thinking, oh, can I make it? And then I was more than halfway through the year. So then I thought, well, I'll just finish the year. And so I slugged through it. And then I finished internship at the end of 2019. And I was going to go do some locum work and travel and have a break, but then COVID hit. And so there was no crossing borders. There was no nothing. So I thought, well, this is a terrible time to do that. I'll go back to work. And so I did some casual residency work, but then I got a job as a psych registrar. And I was only a second year doctor at this point. And lots of people told me that was a big step and it was a big step. So I stepped up into this reg position in the psych directory unit. And I did a six month posting in the community and then a six month posting in the acute ward. And I had some really amazing experiences, but also that was an incredibly taxing year full of thrown in the deep end, sink or swim responsibility and very confronting experiences. And I think by the end of that year, I was quite frazzled and I'd made the decision that I definitely didn't want to pursue psych as a career path. And that I would go into GP as like the last thing on my list that I could possibly imagine myself being as a doctor. And so then I came back to residency work and did more tick boxes and I can't stand tick boxes, tick backward rotations to fit the criteria to get onto GP training. And I was just holding myself afloat to get through that tick box time. And all through those three years since starting medicine, I'd been sitting on the decision of whether being a doctor was really for me and whether I really wanted to keep pursuing medicine as a career path. And I'd been going back and forth, back and forth. And my other passion has always been writing, but of course writing doesn't pay the bills. And I've certainly considered like putting my job as a doctor and going and working at Bunnings and writing in my spare time. But I've never quite been brave enough to do it because once you let go off medicine, it's very hard to get back on the horse again. And there's all scary opera sitting over your head and overseeing your experience, et cetera. So then I came to the end of'21 and I was extremely burnt out and my own mental health took a nosedive and I started experiencing quite severe anxiety and panic attacks at work. And it wasn't a pretty picture. And I had this book that I'd been working on since my internship and I'd been taking notes. And so the book was kind of like a permission slip for me to take some time off. And so I took this year off and finished the book or really wrote it because it was just notes on my phone at the beginning of the year. And yeah, so the book and my burnout worked hand in hand to give me this lovely time off. Speaks to serial high achiever who needs a note to take a bit of time off to write a book. Doctors, all doctors, they need notes. Okay, fair enough. Well, I'll let you tell us about the book. Tell us about it now. Tell us about it now, Intern, it's called. Tell us. Tell us more. So I had previously written a novel series just for myself as a teenager because it was my love and I had wanted to publish it, but it hadn't really ever gone anywhere. And it was very like dystopian fiction because I'd started as a teenager and everyone's worldview as a teenager is dystopian. But then I started my surgical rotation and I just couldn't believe the experiences I was having. And I thought this is more unbelievable than the things I'm conjuring in my mind as fiction. So I started to write down my experiences and I treated going to work like a paid writer's retreat or research. So when I'd have a really awful experience, it got me through because I was like, oh, this is really uncomfortable and I'm really hating this situation, but it's fine 'cause it's great content and I'm going to write about it later and it's going to get me through. So I had all these notes on my phone and like on scraps of paper and the back of blank referral forms and all this sort of stuff from my surgical term in internship onwards. And it partially made my day better and it helped me process my experiences because we know that writing helps with these things. And then it also... Yeah, just put a little bit more joy in the experience and gave me that observer seat. So it depersonalised a lot of my experiences, I think. But then, yeah, taking this time off because I was burnt out, A, for the writing because I've always wanted to be an author and publish my book and now I have go meet. Woohoo. Yes, congratulations. We'll come back to that because I'm going to put the link to the book in the podcast show notes. Reading the book, it was just one painful episode after another, after another, after another. And sure enough, the content is very compelling. I think I read the first 100 pages without putting it down at all. On the flip side of that, for me, it was kind of horrifying. I felt a little bit that this could easily be the very standard experience. They're the kinds of things that I've heard from other people as well before you. And I just think, wow, first, the system, I feel a little bit ashamed of it. I don't have anything to do with it either, but just in a patriarchal sense, particularly, it was a little bit on the nose. Well, it's definitely hard selecting what... It's all fictionalised to protect me and to protect the people that are in it. But it was very hard choosing which experiences to write about because, yeah, obviously the really awful ones are much easier to write about because they're the juicy ones and then finding that balance. But I think as a doctor, you just slog on and the first series of patient attachments that you make that then die on your ward in the most horrific way in front of your eyes and you have to stay controlled and composed because you're the decision maker. And then work is so busy and nobody else has a reaction to that situation because they're so detached because that's the way they cope that then you never give yourself space or permission to process that. And then it's just similar experiences on top of other experiences and throw in a bit of disregard or disrespect in there in the mix. And medicine is so fast paced and it's always driving and there's just really no space to breathe in it all that, yeah, I feel like actually we do live those experiences of quite harsh or negative or confronting experiences on top of each other. But because we're so conditioned as doctors to keep going with the slog that we just don't give ourselves permission to actually acknowledge them. No, I think that's one of the rules, isn't it? Yeah. As you say, park everything human at home. And even as a patient, I've got my share of stories about hospital experiences as well, some of which are not particularly glorious in various ways. And I can appreciate the pressure that staff are under is so visible, it's so palpable in every experience every day as a patient too. And that doesn't create a nice environment for you as a patient at all. Oh, I've had some completely wonderful doctors and nurses, I must say. But I can see the toll it's taking on me, I suppose. We've talked a little bit about it today. So in terms of your book, Intern, it's coming out shortly. Tell us about that. Tell us what you would like people to do, whether read it or review it or whatever. Where can they find it? What would you like people to do? Thanks so much for the plug. So it is available on Amazon in paperback and ebook as of the 1st of January. And please read it. Please enjoy it. Please wallow in my experiences 'cause they are my experiences. So I can only tell my own story. And this is a fictionalised version of my own story, my own experiences as a 23, 24 year old young woman facing the workplace for the first time as a junior doctor. And all the gore and glory that comes with that. But please also review it on Amazon or Goodreads. And you can follow me on Instagram at Hgroyster or on Facebook at Hannah Grace Royster. Terrific. I'm going to put all your social media links as well as the book links in the show notes. Thanks Dex. And I would just like to congratulate you on every single thing. It sounds like from the whole journey you've told me, it sounds like one epic challenge after another, after another. So congratulations on your medical achievements. Congratulations on the book. Thank you. That was a rips order. I can't wait to finish it. I'll leave you a review. Thank you. Anything I didn't ask you that you thought you might like to just add? I think it's very easy to criminalise the individual as a doctor, that supervisor or that one experience. But I think doctors are for the most part really good human beings trying to help people and they get into medicine to help people. But all of that gets lost along the way, along the pressure and the culture and the system is so unwell in itself that it's really hard to maintain the goodness or I guess the humanness within the system. It can be a challenge, but I do know a lot of people who are succeeding, which I find remarkable that any of them are. Bless those people. So perhaps we'll end on this then. What advice would you give somebody wanting to pursue a career in medicine? Read my book so you know what it's like. But genuinely I think that the general population does have this glorified perception of what being a doctor is like and it's full of money and fast cars and sexy girls and well sexy men as well 'cause we've got to put in the female doctor perspective. And this like cute little friendship culture like Scrubs or Grey's Anatomy and you all kind of do it together. But honestly it's not like that and it is gruelling and it's a long, long, long, long road and you think you've got there after medical school just to find out that you have so far to go. So yeah I guess for people who have committed take it a day at the time, for people who are thinking about it just make sure you know what you're getting into. Do their homework, get support. Yeah, absolutely, support is... I do think a lot of doctors are still completely wonderful and nurses and all of the ancillary staff in hospitals but I think it would be remarkable if anybody didn't know what being a doctor was like these days if they'd ever been to a hospital or a GP clinic. It's different when you're in the other side of the state. Yeah, it's pretty palpable as a casual visitor too I must say. But I would encourage people to understand the system whether they've engaged with it or not to be honest 'cause I think it's very revelatory about our culture in general. And it could do with a little bit of light reform. Can I get an amen? All right, well, congratulations on everything. Congratulations on the book and thank you so much for coming on the podcast today to talk about it. It's been great having you here. Thanks very much for having me. If you're in burnout and ready to recover, come and join my Burnout to Leadership Program. You can book in to talk with me at burnout.dexrandall.com. Just tell me what's bugging you and let's make a plan to fix it.