The Makings of a Nurse

At long last, I give you my review of Michelle Au’s This Won’t Hurt a Bit. I’m sure you’ve all been waiting with bated breath…

I’ll start with what didn’t surprise me. I was delighted by the author’s self-deprecating and honest sense of humor. Her writing was accessible and relatable and I found myself wishing that the story would go on (hint, hint – sequel, anyone?). None of this surprised me because I have loved reading her blog over the years – I had every expectation that her book would be equally enjoyable. It did not disappoint.

Now, for what I found unexpectedly remarkable: the innumerable parallels between her experience as a medical student/new doctor and mine as a nursing student/new nurse. I guess I always pictured med school as this unknowable phenomenon that I would never experience or even try to comprehend. But perhaps because the storytelling was so relatable (see comment above about Au’s accessibility), I found myself thinking and sometimes even saying aloud, “This feels so familiar!” The multiple crises of confidence, the sense of being completely consumed by her educational experience, the terror/frustration/admiration with which she regarded more senior physicians, the ethical struggles she identified – I could identify with it all.

Which I think is why I was a little disheartened by the lack of nursing’s presence in the story. Obviously this is her story to tell and obviously it is a memoir about the experience of a doctor-in-training. But aside from lending context to a few specific experiences, nurses were conspicuously absent from the overall narrative. Aside from serving as the “jaded” cast of characters, nurses rarely entered the storyline as the vital members of the team that we all know them to be. It made me wonder, are we doing our future doctors and nurses a disservice by separating their experiences during their formative years? Were our educational systems modeled differently, might there have been a different story to tell?

But again, this was not my story. No sense getting my feathers ruffled by my obvious bias. Because what I really appreciated was her honest account of the delicate balancing act between career, marriage, and family. The experience of barely seeing her husband during their early residency years. The knowledge that to continue to do the work she loved, they would have to hire a nanny to care for their child. The raw emotional struggle that ensued from such knowledge. It was refreshing that Au didn’t mince words. She was an anesthesiologist, and she was also a mother. She was good at her job and she loved what she did. Her patients counted on her, and so did her infant son. She didn’t romanticize either role, nor did she complain. She rightly points out that “the problem with combining medical training with parenthood is that neither deserves anything less than your full attention, and to attempt to do both simultaneously is to feel that you are doing neither well” (p. 232). As a female professional who intends to work if/when I have children, I identify 100% with this sentiment. And I also wonder why it feels this way. Another discussion for another day, I’m sure.

So in sum, this is the story of a doctor and a mother. Through the lens of a doctor and a mother. Fortunately for all of us, it is a relatable and humorous lens. And the fact that her experiences resonated with me despite our differences, makes me think that perhaps we have more in common than we realize. And perhaps that is the unplanned moral of the story.

Discussion Questions

1. If you are a nurse/nursing student, did you ever consider medicine instead? (Or if you are a physician, did you ever consider nursing?) What factors made you choose one path over the other?
2. On page 14, the author says “nobody goes into medicine to be a scutmonkey”. In a way, nurses never stop being “scutmonkeys” (we never stop doing the dirty, tedious work even with years of experience). Do you agree with the author? What does this say about medicine vs. nursing?
3. The author points out that “the only people who can understand what it’s really like to be a medical student are people who are in medical school themselves” (p. 32). Did you feel this way about your medical/nursing educational experience? How did it affect your relationships with family/friends/significant others?
4. Do you see/have you experienced any conflict between female physicians and nurses? Why do you think this happens? (See page 126 for an example).
5. How did you feel about the author’s resistance against “playing the baby card” after returning from maternity leave? What does it say about our culture that female professionals worry about the repercussions of seeking “special treatment”?
6. The description of codes includes the line  ”there is nothing like that feeling that today, someone was trying to die, but you wouldn’t let them” (p. 281). How do you feel about this sentence? Does the adrenaline rush of “coding a patient” cause us to overlook the sometimes ethical gray areas?  The author herself acknowledges this reality when she notes that “we save the patients from a merciful quick death so that they can die a horrific slow one” (p. 260). Have you ever participated in a code? What was the outcome? How did you feel about the process?
7. At the conclusion of the book, Au discusses fear, identifying it as “a form of respect – to the patient, to the practice of medicine, to the knowledge that despite best intentions, things don’t always go as planned” (p. 303). How do you handle fear in your practice? How do you balance fear of doing harm with the need to appear confident? What role does humility play in health care? How have the “oh shit” moments of your career helped you develop your skills? How have they held you back?