This Won't Hurt a Bit: (And Other White Lies): My Education in Medicine and Motherhood

by Michelle Au

If Atul Gawande were funny--or Jerome Groopman were a working mother--they might sound something like Michelle Au, M.D., author of this hilarious and poignant memoir of a medical residency.

Michelle Au started medical school armed only with a surfeit of idealism, a handful of old ER episodes for reference, and some vague notion about "helping people."

This Won't Hurt a Bit is the story of how she grew up and became a real doctor.

It's a no-holds-barred account of what a modern medical education feels like, from the grim to the ridiculous, from the heartwarming to the obscene. Unlike most medical memoirs, however, this one details the author's struggles to maintain a life outside of the hospital, in the small amount of free time she had to live it. And, after she and her husband have a baby early in both their medical residencies, Au explores the demands of being a parent with those of a physician, two all-consuming jobs in which the lives of others are very literally in her hands.

Au's stories range from hilarious to heartbreaking and hit every note in between, proving more than anything that the creation of a new doctor (and a new parent) is far messier, far more uncertain, and far more gratifying than one could ever expect.

Genres: Medicine, Medical, Nonfiction, Memoir, Biography, Humor, Science

336 pages, Hardcover

First published April 20, 2011

About the author

Michelle Au graduated from Wellesley College in 1999, received her M.D. from the Columbia University College of Physicians and Surgeons in 2003, and completed her residency in anesthesiology at the Columbia University Medical Center in Manhattan. She is married to Dr. Joseph Walrath, has two sons, and lives in Atlanta, where she is an anesthesiologist in a private practice."

Reviews

[Lisa · Rating 5 out of 5]

Even better than your favorite episodes of ER or Grey's Anatomy, THIS WON'T HURT A BIT packs in all the elements of a truly great read---I laughed, I cried, I cringed and cheered, I learned a lot, and when I finished, I was preoccupied with a sense of awe from the experience for days. In fact, I wish I knew Michelle Au personally so I could call her and say, Tell me more.―Lisa Genova, New York Times-bestselling author of Still Alice and Left Neglected

[Sara · Rating 3 out of 5]

I am a huge Michelle Au blog fan, have been reading her since she was in medical school, so I couldn't wait to grab her book.

The good: this is a very clear layout of medical training. Excellent for families of medical students who can't quite understand, no matter how many times it is explained, what exactly a resident is.

Also, Au is quite brave in talking about the truth of doctor motivation - that we are not machines, we also have other concerns in life, and that medicine is not everything. This is such a taboo statement in medicine - she is amazing for admitting this in print, going against the grain of a brutal medical culture.

The bad: Where are Michelle's cartoons? Part of how she got famous was by drawing very funny cartoons about the medical education experience. The publisher didn't even use them as chapter headings? Really?

This plays over into a deeper problem, which looks to me like over-editing in an attempt to make a clear, linear, coherent narrative. In this editing, a lot of Michelle got edited out. Her blog is so great because of the eclecticism of topics, her wry and biting humor, and her snippets of life/dialogue (with patients, bosses, her husband, her kids). None of that was present in the book. That doesn't make a it bad book, just a very different book than her usual writing. Her more spontaneous writing is much more lively, quirky, and fun. This book is rather expository. It's an excellent explanation of the doctor training process, but Michelle's voice is somewhat lost, and that's the best thing about her. Where'd she go?

I'd recommend the book, and wish Michelle all the success in the world, and may push it on family members so they can quit asking me what an intern/resident/fellow is, but to get a more idiosyncratic (rather than generic house officer tale), check out her blog. I think they over-polished her work, or made her do it, and I think a lot of her liveliness, sense of humor, and earthiness was unfortunately lost.

[Himali · Rating 3 out of 5]

I’ve been reading Michelle Au’s blog for the past several years---before she went into Anesthesia, before she had her first child. I remember first coming across her blog through her scutmonkey comics. I imagine this is the way most medical students start reading her blog. Her irreverent commentary about the absurdities of medical school clerkships made me laugh out in quiet libraries, where I was supposed to be memorizing pharmacology or something.

When she announced on her blog that she had written a book, I knew I would eventually read it---though I didn’t imagine myself running out to buy it. I did finally pick it up yesterday.

Essentially the book outlines her journey through medicine. Long time readers of her blog will find many of the stories in her book very familiar. To be honest, I was a little disappointed by the lack of new stories. It’s written in a somewhat choppy style, some parts vignettes of her clinical experience, others dialogue of something funny or silly. It’s very much in the style of her blog.

Though some of the new stories feel a bit like filler, others are engaging. Though she’s probably most known for her acerbic sense of humor, she’s also surprisingly good with sentiment. Stories that particularly stand out are her experiences during 9/11, and her summation of the journey of a tentative medical student to a confident attending.

A good book, though I wouldn’t call it a modern day “House of God”.

[William · Rating 4 out of 5]

I mostly enjoyed the book but could not give it a five. There were some things in the book that irked me on a personal and professional level. I will not elaborate but it goes back to the expectations of peoples roles in medicine. On the flip side, it was entertaining as it brought back memories of my medical training. Granted, Dr. Au went to a more "prestigious" school than I and attended a much busier residency than I, a lot of the experiences mirrored each other. The doubt of ones abilities, the fear, the naivety, are all the same. We (physicians) have all seen the patients she describes and felt elation or heartache at various outcomes. I enjoyed the book and would recommend it to anyone interested in medical training or anyone that has walked in those shoes.

[Ekmef · Rating 5 out of 5]

This book has been on my want-to-read list for ages. I’m happy I could finally get my hands on it - it’s an amazing book. It is very realistic about medical training, but it’s not realistic in a gallows humor kind of way like so many books tend to do. Dr Au just shows us what it’s like, the good and the bad, while being very respectful towards patients.
This book addresses the central question of everyone who is in the process of becoming a doctor - how do I ever get to the point of not being ‘afraid’ anymore, how do I grow to be a doctor in mindset.

A perfect read for everyone who is about to start residency!

[Rachel · Rating 5 out of 5]

A must read for every medical student.

[DW · Rating 4 out of 5]

Well, I learned a lot, some of which I wish I hadn't. It filled in some gaps. So that's what a residency is. So that's why medical students look slightly embarrassed to be in the room with me and the doctor (and that's why one fell asleep while I was giving my history). So that's why that injection was a 15-minute nightmare of the resident scraping the needle along my bone searching for my joint - it was July and the ink probably wasn't dry on her diploma. (I know you have to learn, but do you have to learn on *me*?) So that's how doctors get to the point where they can joke about other things while intubating a dying woman whose family is outside the room sobbing.

One thing I don't understand is why doctors-in-training are required to work such long hours, even while sick, making life and death decisions while chronically sleep deprived. Laws limit the number of consecutive hours truck drivers and pilots can work, because their sleep deprivation can kill people. Clearly, doctor's mistakes also have the opportunity to kill people. The only reason I've heard is that residents must work many hours in order to get adequate clinical experience. In this book, Michelle notes that what she learned in her pediatric residency was completely useless when she started anesthesiology. Okay, she switched specialties, but is it possible that we're over-educating doctors?

This book was very well-written, with the author expressing a lot of compassion for the patients (except the ones used as examples during "pimping" - Janine Shepherd wrote in her book that she hated feeling like a curiosity in a museum). Interesting points to think about were that nurses defer quicker to male doctors, jobs not requiring night call and weekends are derisively called "mommy" jobs, pediatricians do seem to be nicer than most doctors, she struggled with leaving her baby with a stranger in order to care for other people, harvesting organs can be very unsettling (they don't worry about healing or scarring because the patient is already brain dead), and parents come to the pediatric ER for trivial things (which she couldn't understand until she became a parent herself).

As far as the writing goes, I liked that she never stated the race of her patients, but that it could come across in the description of their families, their names, and how they talked. I noticed that she described a couple patients as "pleasant" and couldn't help wondering if she meant the word as most people use it, or as the boilerplate that is put in most patients' charts if they are not screaming obscenities.

My takeaway point: stay out of the hospital, especially in July.

[Sarah Ewald · Rating 5 out of 5]

I found this to be a thoroughly enjoyable read.
Dr. Au is brutally honest about her road to becoming a doctor. She doesn't mince words, telling you exactly how it was, but she does tell it in a humorous way. She gets you into her thoughts as she is going to class, med school, as an intern and beyond. I smiled a lot while I read her story, but also cringed when she related other things that I, as a patient, would not like to hear.

She relates how, on 9/11, she was in the operating room, when a nurse came in to tell of the plane collusions.
"Jesus Christ," Dr. Harris mutters. And then the room falls completely silent but for the steady beep of the anesthesia monitors, each of us absorbing the news.
Frantically, I think, I have to call my family. One of the nurses in the room is clearly thinking of the same thing and starts dialing from the phone in the room. The volume on the handset is turned up high, and we can all hear the tinny beep of the busy signal.
Somehow, we finish the case, the kid is bandaged and awakened and together the team wheels him to Recovery. After talking with the parents and making sure that our patient is comfortable, one of the resident takes me and Bob to the tenth floor; and we walk over to the sky bridge up there, a long tube of metal and glass that connects the old hospital building to the new. It is here that we can finally get a view of what's going on in Lower Manhattan, more than two hundred blocks away.
This is the last time I will ever see the Twin Towers."

She tells of a time when a patient presents in the ER with symptoms clearly indicating a stroke, but the order to get a CT scan is delayed because of a scheduled CT of another patient that the radiologist doesn't want to delay. (If tPA, a specific drug is administered within 4 hours, a stroke patient had a good chance of surviving. (my comment))

"Four and a half hours after her daughter calls the ambulance, Jeanne finally gets her head CT. The stroke is not hemorrhagic, but the time window has closed. She does not get transferred to Columbia and she does not get tPA.
Up on the Neurology floor late that night, I am finishing my admission exam, getting Jeanne settled into her room...tying up whatever loose ends I can manage before heading home for the night. Jeanne is sleepy, her voice slurred, the right side of her face sagging from the stroke. She asks me something indistinct, and, not understanding, I ask her to repeat the question.
'Am...I...going...to die?' she asks, looking straight at me. This is the first patient who has asked me this question. I have never had patient die before, and the very concept is utterly alien to me. Why would she die? She is 36 years old. She is in the hospital now. We are taking care of her.
'No', I tell her firmly, not a strategy of bedside manner or just a reassuring answer before leaving for the night. I tell her she is not going to die because, with all the force of my youthful optimism and inexperience pressing down on me, I literally cannot conceive of the alternative."

"We are entrusted with the lives of our patients every day. In anesthesia, we essentially take the entire being of the patient into our hands, shutting down their consciousness, taking over the function of their lungs, their hearts, the blood flow to their organs, the very delivery of oxygen that keeps each cell of their body alive. And every day, we tell our patients that at the end of it all, we will return their bodies to them, undamaged or in some cases every improved, and patients for the most part trust that we will do just that. This is the job that we do each day. And every mistake we make while caring for our patients, every tactical misstep or error in judgment, feels like a breach of trust. Fear? How can we not be afraid? The day you sit back and think that you're infallible is the day your clinical instincts are gone.
In other words, if you don't admit to being scared sometimes, you're an asshole."

Stories like this pepper this book, and they can break your heart, but also restore your optimism.

[Juliana Poh · Rating 4 out of 5]

I thoroughly enjoyed this and could identify with many parts of it! Painfully funny as she brought us through her medical school and residency days. Particularly loved the part where she described medical hierarchy as a caste system, where the students are distinguished by the colour of their scrubs (lol), and when she described hating kids and their parents (it's true, when you know Paeds is not your cup of tea). I totally understand what she went through as a mother doing specialisation training - medicine expects your full commitment, but should family take a back seat? This constant dilemma of a working mum was realistically fleshed out, such as when she had to leave her sick child to look after a stranger in hospital. She described co-sleeping and pumping anywhere she could - many of us have been there, done that.

It was hilarious, how she described being so hungry on night calls that she raided the pantry and contemplated drinking Jevity - I'm sure there are some of us who had thoughts of trying those milk feeds when we were desperate too. =) Her description of the organ transplant episode was touching - how the donor was left all alone after the harvesting, and how she wanted to spend time with him but couldn't, wasn't expected to. Her other experiences as a trainee in US were very similar to mine: how the patient you pronounce dead still has agonal breaths (oops) and u start doubting your assessment, how you respond to a code, the motions you are expected to go through, how you discuss options with patients and family to get them to choose what is preferred. Plus other "oh shit" stories. All these, and the people she met along the way, shaped her development as an anaesthetist.

One line from this book is true: "There are few things worth doing that don't require significant sacrifice along the way". I recommend this to all doctors - for reliving your own memories as a student doing scut work or as a trainee on night calls, or for some really good laughs.

[paige · Rating 4 out of 5]

“Diamonds are simple carbon molecules, created under high pressure. And medical residents are just ordinary people growing up and learning who they want to be under the most extraordinary of circumstances.”

I read this book because one of my old friends was reading it, she’s in med school and it looked interesting. This book really shows the struggles and hardships that aspiring doctors have to face, but also the rewards and triumphs of becoming a doctor. The toll it takes on you mentally, physically, and emotionally. How it’s hard to make ends meet in the beginning and how difficult it can be to manage a relationship, marriage, and child with the demands of med school and residency, but in the end it’s all worth it, the risk is worth the reward. This book gives me a new appreciation for medical students and doctors, they have so much to deal with behind the scenes that we rarely get to see and the negative/harder emotions that they rarely show us.

[Doris Dvonch · Rating 3 out of 5]

I'd been meaning to pick this up after being a fan of her blog, The Underwear Drawer, for years. If you're not used to her writing, you might think she's super pretentious and pedantic. Well, ok, she is. But, she's funny! Too bad this book is edited in such a way that makes her sound a lot less funny than she really is. I guess this is a good book for people interested in med school and want to have babies at some point (re: subtitle). Unfortunately, the book documents more of the med school/residency hell than the motherhood part. Maybe 25% is about being a mom. I recommend reading this and then combing through her blog which is a lot funnier and has more personal anecdotes about motherhood.

[Myersakrawiec · Rating 2 out of 5]

This did not live up to my expectations. I found it boring at times, It seemed like these were her best stories, like craziest case, saddest, etc. But they weren’t the craziest or the funniest, or whatever she was going for. I have way better stories from my medical training than she did. Maybe she just didn’t write them well enough? I also found the author pretty condescending especially when she was doing her Pediatrics residency and then planning to switch to Anesthesia, like all young female doctors think about Peds because they don’t want to be overpowered by their patients. That’s ridiculous! I am glad she found her way out of the specialty.

I will keep all of this in mind when I am ready to write my own residency/medical school memoir.

[Annette · Rating 5 out of 5]

I loved this book and it held my interest all the way through. You didn't have to be a doctor to understand all the ins and outs of the medical specialties Michelle Au described.

I so much admire Dr Michelle Au. She is a practical, power house woman who can keep many irons in the fire at once and still manage her job and her life well. The book had me saying yuk! at times and Oh, thank goodness at other times. It gave me plenty of laughs and sadness too.

I am glad I read this book and got a glimpse into the medical profession and the huge sacrifices they have to make in order to become doctors and the dilemmas all doctors have around ethics. It is a book well worth reading in my opinion.

[Nate · Rating 3 out of 5]

A good book that covers the span of medical training from preclinical years to the end of her residency. I appreciated her talking about medicine as a job, not her life's passion. I appreciated her talking about how she had other interests and desires and about switching residency. This book felt overly expository at times, lacking some feeling or personality. That might be because these events happened in kind of a sleepless daze, so maybe not the most acute memories. I learned that the author became well-known for her comics, but they were not mentioned once in the book. If it's this relatively important thing why not talk about it?

[Rachel · Rating 4 out of 5]

This is the account of the author's journey from medical student through residency (during which she had a baby and kept working) and into being a full-fledged doctor. It's easy to read, and she describes how budding physicians have learn things by doing them even though they don't really know how yet. Her stories of patients, situations, and her own family are all nicely done.

[Rita Ciresi]

This "how I became a doctor" tale starts off breezy and comic, but halfway through--after the author becomes pregnant--it settles into an insightful look at how to balance medicine and motherhood. I enjoyed reading each of the short vignettes that focused on caring for extremely ill patients.

[Laura · Rating 5 out of 5]

The real world of medicine

This book shares the joys, trials, and tribulations of being in the medical field as a woman. I truly enjoyed this book even though a few anecdotes hit too close to home. A wonderful reminder of what and why I do what I do.

[Ben · Rating 5 out of 5]

An honest and thoroughly moving window into the medical education process. Incredibly well written, and the most enjoyable memoir I've read in recent memory. I'd recommend this to anyone, and especially to those considering a career in medicine.

[Jacinta Cooper · Rating 5 out of 5]

Definitely a must read for physicians and their families. Gives an insight into training and the toll it can take. I related to so many of the stories and was laughing out loud. Very therapeutic to read.

[Nicola Lew · Rating 3 out of 5]

A solid 3.5 stars. Some parts poignant and well-written, some parts a bit hackneyed.

[Teresa · Rating 3 out of 5]

It was fine. Cute stories. But I don't really care about how you become a medical professional and there wasn't an overarching plot driving me to read the end, so I quit at about page 120.

[Stephanie Benjamin · Rating 5 out of 5]

Entertaining, insightful, and captures the struggle of balancing work with family.

[Kadie Bennion · Rating 3 out of 5]

Some of the stories in here really rang true. Good read but didn't care for the author's use of profanity.

[C Bayne · Rating 4 out of 5]

Enjoyable and insightful

[Peni Lynn · Rating 5 out of 5]

From dermatome costumes to juggling a snack & fecal sample, nothing is off limits in this fun read. I loved the "scut monkey" cover and all the humanity inside.

[Nicole · Rating 4 out of 5]

Easy to read and provided great stories and insight into the medical world.

[Volny · Rating 5 out of 5]

A must read.
Haha if anesthesiology is like this then wtf is nsgy like 😀
Doctor Au is incredibly funny and I wish she wrote more books.

[Jillian G · Rating 5 out of 5]

Some great insight on residency, esp anesthesiology residency which is cool

[Kristen Cain · Rating 5 out of 5]

Accurate and funny memoir of a woman combining medicine and family. She takes the reader through medical school, marriage, residency, and parenting with honesty and hilarity. Loved it!

[SD · Rating 5 out of 5]

Many medical memoirs have not aged well with me and my career (or just with the passing decades)--this is another exception to that rule. As an anesthesiologist myself (who first read this book when I was a medical student), this memoir was especially poignant now that I'm in the same career Dr. Au is. I laughed and felt seen with so many of her vignettes of medical school and residency--even though she did both ~16 years before me, and medicine has certainly changed since then.

And like her, I switched my specialties mid residency (though I switched after intern year from general surgery and she switched after PGY2 from pediatrics). That part of the book too felt familiar and comforting.

Highly recommend this memoir, especially for women in medicine.