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My name is Michelle Au, and I’m an anesthesiologist at Emory-St. Joseph’s Hospital in Atlanta, GA. Born and raised in New York City, I graduated from Wellesley College in 1999 with a degree in Psychobiology, and received my medical degree in 2003 from the Columbia University College of Physicians and Surgeons in New York.
During my third year of medical school, I started penning the “Scutmonkey” comics, a series of cartoon strips inspired by the absurdity of the medical education process. Some of the more best known of these comics include “The Twelve Types of Medical Students” and “The Twelve Medical Specialty Stereotypes.” In the years the years since, these comics have been published and presented in journals and at medical conferences around the world.
In 2008, I completed my medical residency in Anesthesiology at the New York-Presbyterian Hospital at Columbia University. During my final year of residency training, I wrote a medical memoir entitled This Won’t Hurt a Bit (And Other White Lies): My Education in Medicine and Motherhood, about the challenges of medical training and juggling the demands of residency with new parenthood. The book was published by Grand Central Publishing in 2011. I am currently working on a second book (tentatively entitled Knocked Out), a hybrid memoir about the history of anesthesiology juxtaposed with my own clinical experiences in a field of medicine that it sometimes feels like no one really understands.
At present, I’m also completing a Masters of Public Health at the Mailman School of Public Health at Columbia University, and have been selected to be in the Georgia Physicians Leadership Academy through the Medical Association of Georgia. My hope is to expand the scope of my medical service to help not just patients at the bedside, but to work on more population-based health policy initiatives. On the side, I live outside of Atlanta, GA with my husband, the oculoplastic surgeon Joseph Walrath, and our three children, whom I’m trying not to ruin.
This is a tough question, because the pace and demands of residency means that often, “success” is defined as just getting through the day. Particularly for those people who have significant outside of work obligations, residency can at times feel less like a phase of enrichment and growth than an exercise in pure survival.
However, I have a couple of thoughts on how to approach residency, and part of this is simply framing the experience in the correct mindset. Because in the end, medical training is intense, compact, and above all, temporary. In anesthesia, we’re given four years—five with a fellowship—to transform from well-intentioned but ultimately clueless medical school graduates into fully-formed, competent, seasoned clinicians able to handle anything the world throws at us. (In the operating room, at least.)
So how we should view those years is not simply as a grim, desperate survival gauntlet but as an opportunity few are afforded. This is your chance. This is your moment to gather your tools to become the best clinician you can be. What you get out of residency sets you up for the future. What are you going to do with that time?
I realize that I’m about a decade out from training, and time does have a way of softening memories into soft-focus retrospect, but: make the most of this moment you’re given. This time when you’re not supposed to know everything. This time when you’re surrounded by teachers ready to guide and elevate you. This time where the unstated goal of every day at work is to become better at what you’re doing.
So jump in. Try everything. Do as many big cases as you can. Relish the difficult experiences. Collect the stories. It’s hard, it’s tiring, you’re not going to get enough sleep, and you’re going to have far too many meals consisting of graham crackers and foil-topped cranberry juices. But realize you only have a brief time in residency, and really just one chance at making that time count. And at some point, soon, it’ll be over. Don’t throw away your shot.
Remember that, in many ways, residency is like parenthood. The days are long, but the years are short.
These days we’re all having more and more discussion about wellness in medicine, work-life balance, and physician burnout. I think that’s wonderful, because awareness around these types of professional hazards is likely one of the most important steps to combating their corrosive effects. We live stressful lives, but they don’t need to be lived in isolation.
I don’t think there’s necessarily one way to approach “wellness” in medicine, because each of us requires a different balance of things in order to feel well. But generally speaking, I’d say there are two important elements to maintaining wellness in medicine, and these elements apply throughout your career.
The first is that you should always find something else to love. A maxim often pushed as a trenchant truth in medicine is that no matter how much of your blood, sweat and tears you give to your work, the hospital will never love you back. And that’s true, of course. The hospital won’t love you back. But we shouldn’t do what we do in order to be loved back. We do it because we love the work itself. Because the work itself has meaning, and purpose, and a value that is not transactional.
But it’s important to also find something else you love just as much as you love medicine. It can be in family, friendships, creative endeavors, simple indulgences, spontaneous acts of fun. Love generously and widely. In residency, sometimes it seems like our little slice of life becomes the whole world to us, because medical training is so immersive and all-consuming. We come in before dawn and leave well after dark, and sometimes it seems that the outside world just ceases to exist. So it’s important to remind yourself that the world is a big place, and find something you love out in that world that grounds you there as well.
The second important thing, somewhat related to the first, is to always find meaning in the work you do. So much of physician burnout is tied to the fact that sometimes, the work we do becomes divorced from the satisfaction we derive from devoting our energy to a higher purpose. And it’s easy to understand how that can happen—it’s difficult to feel any gratification from fighting for hours a day with your EMR, and it’s hard to argue that these frustrating efforts have helped anyone, particularly the patients in our care.
But I think it’s important at the end of the day to take inventory on what you did that day that had purpose. And it doesn’t have to be a big thing each time. We’d all be burned out if we needed giant successes and miraculous intra-op saves to sustain us. The big things are great, of course, but much more often, it’s the little things that have more meaning. A small family interaction. A moment of connection with a colleague. A patient’s experience that was the better because of your involvement. Even the worst days have these small moments tucked inside them.
We tend to forget the little things, because we unfortunately work in a field where perfection is the default assumption. But remember what gives you purpose, and find the small ways you fulfilled that purpose at the end of each day.
I’m certainly not as good at staying up to date as many of my more brilliant colleagues (both during training and after), but one thing I’ve tried to do my entire career is always learn something based on my work each day. If I meet a patient with an unusual condition with which I’m not familiar, I’ll print out a review article and read that. If a patient asks me a question that I can’t answer readily, I’ll look up the latest practice guidelines and review those. If a surgeon come in with a novel technique that I’ve never heard of, I’ll look it up, and try to review the anesthetic implications of the approach.
Granted, this approach can be a little scattershot (and the ASA has more formal systematic review courses for larger topics at my disposal), but as a matter of bite-sized daily learning, I find connecting my reading with my day-to-day patient care incredibly effective, because it feels intimate, and immediate, and instantly useful. It’s not the only form of study I’d recommend to stay up to date, but as a matter of keeping yourself in check and not defaulting to assumptions and reflex, tying daily learning in with the patients right in front of you is a tremendous motivation.
Date of Publication: Spring 2019
