This Won’t Hurt a Bit (and other white lies) (Grand Central Publishing, May 2011) is a memoir of Michelle Au’s medical school and residency years (pediatrics and then anesthesiology). I received my copy free from the publisher via Net Galley in exchange for writing this review. I’m considering adopting this book for my undergraduate bioethics course in the fall, which is comprised mostly of pre-med seniors. Au has gotten blurbs from some medical writers I admire, like Kevin Pho (Kevin MD) and Robert Coles, and nice advance praise from Kirkus (“An upbeat memoir ” written with “style and humor”) and Booklist (a “treasure of a medical memoir”), so I was looking forward to reading it. This review will be fairly critical, but it’s clear I am an outlier on this book, at least judging by early critical and audience reception.
Au, raised in New York City, is the daughter of two Chinese American physicians. She met her husband, Joe, a future oculoplastic surgeon, in medical school at Columbia, where she also did her residencies, first at Children’s Hospital of New York at Columbia and later anesthesiology at Millstein (NY Presbysterian — also Columbia).
Like Julie and Julia, this is a book based on years of Au’s blogging at The Underwear Drawer (named for the place she kept her journal). And it suffers the way so many of those books do. The immediacy, brevity, and audience connection of a blog post can make up for a lack of really strong writing, overarching themes, organization, or other literary type things you might hope for in a non-free book (this one is hardcover for $15.98 — list of $24.99– or digital for $11.99). Also, I think blog posts, because they are short and spaced apart in time, can be more artlessly and casually narcissistic than memoirs can be without grating on readers. Finally, I enjoy first person present tense in fiction, but in reading This Won’t Hurt a Bit, I found the present tense doesn’t work as well for a memoir. Unlike a fictional narrator, I know that Dr. Au exists in time and place, as an anesthesiologist in private practice, which contrasts jarringly with phrases like, “What is happening now is this: I am wearing a pair of too-large latex gloves” (the opening lines), or like “Being the medical neophyte I still am…”.
Au had a baby during residency (and was pregnant with a second when she graduated), and the book advertises itself as the rare medical memoir which addresses work/life balance. On the cover is a cute stuffed monkey in bandages, and the subtitle is “My Education in Medicine and Motherhood”. This attempt to market to working mothers explains in part the tendency of the blogging reviews to be from mommy book blogs (like Literary Mama (“a treat to read”), and also explains why Amazon notes that the customers who bought this book also bought Tina Fey’s Bossypants.
Marketing aside, I can’t imagine this book really appealing on a wide scale to working mothers. In fact, the book is focused much more heavily on the medical training than the subtitle suggests, and it’s a good thing, because Au’s writing on motherhood is not exactly groundbreaking. You would think that physicians are the only women who have demanding jobs which force them to make tough decisions about childbearing and childraising. She only gets six weeks maternity leave! She has to use her breastpump in the shower, because there are no lactation suites in her workplacel! She has to eat her Hot Pocket … cold! *eyeroll*
Reading the book, Au came across to me as a privileged woman who had no sense of this. That she is a very smart and capable person who was working tremendously hard, I have no doubt. But she was working hard at a profession she voluntarily chose, which would give her a career of tremendous social prestige and wealth, and which her privileged background helped her, in no small measure, to pursue.
For example, Au’s nanny, eschewing the incremental raise schedule she has apparently agreed on, decides to ask for a 50% raise without warning. The nanny digs in her heels, “despite being told that 50 percent of the net income of our household is already being diverted directly into her pocket (we actually show her our paystubs from the hospital)…”. Then she is fired. Now just consider this for a minute. The way the incident is described suggests that the amount of money the nanny deserves for this work, and the amount of money the nanny needs to live on, is completely and wholly determined by how much money her employers can part with. But maybe the nanny’s child or mother became ill. Maybe the nanny’s husband lost her job. We never know, because the nanny is a nonentity in this story, not identified even by race, age, or any other factor besides her gender. Au concludes, despite the fact that she is an employer who more than likely offers a low wage, no benefits and no job security, that “regardless of who is employing whom, any set of parents with full time inflexible jobs are essentially held hostage by those who are taking care of their children during the day.” Really? Only a person in a vacuum of privilege can possibly equate her own temporary inconvenience with the livelihood of a low wage worker.
When Au has a child, she describes herself as “turning into a hippie mom.” What this means, for her, is not anything interestingly thoughtful, but that her own son is “too perfect” for circumcision and that she is too tired from her job as a doctor to not co-sleep. Um, I don’t think “hippie mom” means what she think it means.
Au’s chapter on working in the pediatric emergency room is a diatribe against the people who dare to show up without a reason she personally deems legit. To her credit, Au admits that “the Emergency Room is turning me into kind of an asshole.”
For every patient who has been dragged in by his parents for sneezing twice and not being able to finish his Whopper Jr.,…
6:00pm-11:00pm One of the busiest stretches, and also a peak time for people to bring their children into the ER for seemingly no good reason whatsoever. “Hey kids, we’ve all had dinner, we’re all still awake, what you say we take a big family trip down to the Emergency Room and check out what’s playing on that little TV they have out in the waiting room?”
Au vilifies a parent who does not know what medicine she is giving her child, and a host of other patients, without once considering how they got to this place of ignorance or bad choices. She concludes, bitterly, that “parents are idiots.” But wait, when her doctor friend has a child, Au delightedly reports Ms. Female Physician’s ignorance of how to care for her newborn (“Should she just … pour water on him? Dunk him into the water like a teabag? What kind of soap should she use? Towel or blow-dryer? … Baby bathing was not covered on the Board Exam!”). I guess when you don’t know how to parent because you were too busy becoming a doctor, it’s ok.
In fairness, Au recognizes, after having her own child, that her attitude towards her ER patients was one of hubris, but never at any point in the book do I get the sense that she thinks about medicine as a social practice in a society stratified by a lot of things, many of them kind of unfair. Actually, there is one brief reference to feminism when Au gets a fellowship at Columbia in anesthesiology at the same time her husband gets one at Emory. What might be a prompt for some real reflection on gender and managing parenting in a demanding field is completely skirted when she says “really, in the end, there is never any question, and it amounts to not so much of a subversion of my own plans as a global plan for our family and what is best for all of us.” But it’s not obvious to this reader, anyway, why”there was never any question.”
When a colleague smirks that “all the jobs in medicine are daddy jobs”, she has a momentary flash of irritation, but then wonders, “really, why am I even offended? Isn’t it true?” And then she refers to herself as a bad employment bet: “I have to wonder, would anyone dare to offer me, a female physician in her childbearing years, a job at all.” I think exploring these issues might have made for a very interesting read, especially for women med (and pre-med) students.
This book might be useful reading for students looking for a first person account of medical school and beyond. Au is very forthright about her nervousness and sharp learning curve. Au has said in interviews that she hoped for an upbeat but not a naive portrait, and I think she has succeeded there.
If I were to assign this, I would absolutely have to fill in some blanks. For one thing, Au’s references to nurses come in two varieties: (1) mute helpmeets, or (2) bitches on wheels. To take one example, you would think Au was the only one on the code team, the way she describes the codes. But nurses are an integral part of responding to codes, as are other staff. In some scenes you would think there were two anesthesiologists and them alone taking care of a patient. She never mentions hospitalists, and barely mentions critical care doctors. And finally, I am quite sure every Columbia facility has, or has access to, a cracking good ethics consult service, but you would think from reading this book that there is no support for doctors, patients or families when it comes to difficult ethical issues that arise in practice.
For those not in the medical field, there are a handful of vignettes which are very worth reading: her account of being in a Manhattan hospital during the events of 9-11, her account of declaring a patient dead, and then having to de-declare, her account of having to go ahead with aggressive treatment when part of the family and the staff disagree, to name three examples. It’s a quick read, and not badly written. If medical memoirs are your thing, you might give it a try.
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There are so many interesting things about this book, but that alone would make it a wall-banger for me.
I think I read memoir not to find out what has happened to a person but what it has made of them and what they make of it. This sounds like nothing that would engage me in spending time in the life of this woman.
Wow. I have a good friend who is a plastic surgeon (hand specialization) and she went through so much more than this woman, in terms of med school & residency, career decisions, pregnancy, etc., and yet has so much more compassion and self-awareness. Or maybe because of what she’s gone through? No, she’s just a really decent person.
And, what Merrian said.