Information
Finished reading date: January 28th, 2023
My rating (out of 5): ⭐️ ⭐️ ⭐️ ⭐️
Genre(s): Nonfiction, medicine, humor, memoir
Summary
Another medical memoir for the books. John Lawrence accounts his days and misadventures in medical school in the first book of his three-part autobiographical series, all starting strong with two concussions and a dose of amnesia on the eve of his first day.
Analysis Rant
This was a hard read for me.
I mentioned this before, but memoirs are difficult for me to rate and deconstruct because it feels as if I am rating a life, and I don’t love that or even agree with that. Other people seem to enjoy the book, and that’s completely fine. However, I just didn’t connect.
I think one of my problems is that I read this after having completed This is Going to Hurt (link to my Writers Read analysis), another medical memoir. In some ways, that taught me how I like my medical memoirs. John Lawrence (this book’s author) and Adam Kay (This is Going to Hurt author) were similar in a lot of ways, actually. Both were not terribly enthused by the medical community but somehow ended up there and were able to get through it with their dark sense of humor. But the presentation was very different. Kay allowed the humor of medicine and human life to speak for itself, most of the time. The situation was funny. Commentary wasn’t needed. Lawrence seemed to try to make the story funny by adding his commentary and jabs. He tried to make it into a story rather than just telling the story. He told his stories with him as the center, where it often felt like Kay just walked into awkward situations and observed.
I think a lot of it had to do with structure and author intention. Lawrence’s intention seemed to be to tell his story. It’s his autobiography. He started at the beginning and he gave a full narrative account of his med school days. He was the center; it was about him, and the jokes he told were either at his expense or through his commentary of what he was feeling and seeing. Kay’s intention, on the other hand, seemed to be to tell funny stories that happened to him or around him during his time as a doctor. He wasn’t really the focus. The stories were. In between the stories, there were some moments of commentary on his life or even about the medical system to add context to the stories, but really, the stories moved the book along. I’m not saying that one style is better than the other. But, I did connect better with Kay’s.
And in some ways, Kay’s version allowed for him more anonymity and privacy. As it wasn’t 100% about him, but rather, using his story as a vehicle to share the stories of others and life in a hospital, we didn’t need all the details of who he was. So, he becomes less of a “character” in his own memoir, and therefore, there was less to cause us to like or dislike him. Lawrence’s version, however, was about him. It’s his story, and yet, the placement of contextualization (as well as his own small moments of social commentary) about his life would land in random places throughout the book, which just made it feel a bit messy and not very tight. Not to mention that there was quite a bit of redundancy within the book, with him often giving topic sentences about what he was going to talk about next that would befit an academic article, but for a book, felt very unnecessary. I’d rather you not tell me what you are going to write next. Just write it. Not to mention the chapter titles did more than enough for context. The book was only 200+ pages, but it took me several weeks to get through. I just couldn’t get into a rhythm with it.
Oh, and the titles. Some were very click-baity, if a chapter can be clickbait. It just added to the fact that his use of humor often missed the mark for me.
His humor, as well, felt inappropriate at times. Here is just one example. In the ER, he called a suicidal young girl “sexy” and then proceeded to talk about how something physical might happen with her. He does the right thing, and pulls away to another patient (who has a girlfriend to whom Kay is also attracted to) but then comes back to the first girl in order to see how she is doing and to potentially get some attention, only to find her confiding in and touching the leg of another doctor. He then proceeds to call her an “ER trollop” in his commentary. I understand that a lot of it was a joke and that most of his jokes are meant to hit as self-deprecating, but it just felt inappropriate. These are the types of jokes that can make someone who is frequently a patient feel uncomfortable reading. “After all, what if our doctors are thinking like this?”… and thus, in such a way, can encourage and stir up fear rather than assurance over our doctors’ capacities. Once again, it just wasn’t a book for me.
Something that I did appreciate about the book, though, was that he did try to humanize the medical profession by giving himself and his life over as a scapegoat. To some degree, it worked, and for sure, we recognized him as no medical god. Every doctor is human. Not every doctor might even want to be a doctor, and certainly, not everyone came into the medical profession from “pure” motives and passion. And I can’t really say anything about that. Maybe medicine is not a passion for everyone, and that’s fine, but oftentimes, I felt like he was extremely irreverent and even disrespectful of his very profession (especially his late-night casino runs the day before a hospital interview and missing his car pick-up), and that had me feeling all kinds of things. Then again, it is his profession, so if anyone is allowed to be irreverent of it, maybe it’s him. Yet, I feel like we live in a world where our lack of disrespect can also encourage others’ disrespect, and while I appreciate seeing his honest feelings, I wish we could somehow learn how to still be respectful of professions and people at the same time of balancing between recognizing their humanity and holding people accountable for their actions. I liked how Kay played the dichotomy by showing that as much as doctors are not gods, we need them to be good doctors that we can feel safe with. Knocking doctors off of a potential pedestal is different than then proceeding to step on them. But once again, this is Lawrence’s experience, and while I can’t judge someone’s own experience, I can say that I didn’t really appreciate the lack of balance or bias within the writing and book. But, no personal story is without bias. Likewise, while I’m still not entirely sure what his purpose behind telling his story is (outside of it just being a curious story), I’m not sure it was effective as a tool to present a case to become a doctor or even to share what it might be like for someone who might be interested.
For, throughout the book, he showed a very lackluster experience, with himself feeling different than others due to his rough start (with which I sympathize), but even at the end of his schooling, he throws out a line that we should go to med school. As there was pretty much zero background work to help his argument (as most of the book is spent in this space of chronic irony of someone with very little interest in medicine being in medicine), it felt empty and like the “right thing to say.”
Overall, outside of the things mentioned here, you do get a decent and honest image of what med school was like for Lawrence (although I do think it was a very singular case amidst some universals). I do think he is a much smarter guy than he tried to show himself as within the book, and it makes sense (based on what he wrote) that he was more into writing and theater than medicine. Likewise, there was a lot of crossover between what Lawrence said and what Kay said about sequencing and events, so there seems to be some validity between the two, even though they took place in two different countries. Kinda shows that much of the medical profession is universal in terms of experience. In reality, I started reading this book to research a book idea that I have, and for that purpose, it had its takeaways for me. In such a way, although it wasn’t a fav book for me, I did get something out of it.
As I said, this wasn’t for me, but it definitely seems that others have enjoyed it based on the reviews I have read. So, if you are curious about the med school experience and what it was specifically like for Lawrence, do not let my (over-)analysis stop you, and go ahead and try it out yourself.
As well, this is just part one in the series. It’s highly possible his tone will change as he gets older. I mean, I didn’t like myself in my 20s very much, and looking back, I am sure I would have to watch my tone of how I talked about myself at that time. Perhaps it’s a similar situation for him, and as he gets deeper into his career, his views and attitude may change. I’m not sure I will follow him that far, but I appreciate how hard it is to write three books and how much can change in all those years, so hats off to him for writing it all down.
Writer’s Takeaway
- Structure is important for memoirs. Be careful to find the balance between telling everything and not telling enough. Consider sequence. Consider purpose.
- If you want to write a memoir, read memoirs to generate ideas of what might be the most effective way of telling your story. Not every memoir needs to be in the same style.
- Some questions to think of for memoirs:
- Who is the focus?
- Whose story are you telling?
- What is the goal of telling your story?
- How do you want the audience to feel by the end of it? Did you lead them well throughout the book to arrive there, or did you just dump them there?
- Research for your own books. Use books you like and you don’t like.
- Every story is different and worth telling to someone. Don’t be afraid to write your story. There will always be critics.
Annotated Passages
“What do you call the person who graduates last in your medical school class?” Doctor.
→ So comforting… for medical students. Reminds me of how doctors and those who have gone to school with doctors often do not want their classmates as their own doctor… the role of doctor hits differently when you have personally witnessed their personal moments of idiocy.
But medical students are a ruthless bunch, as only the top of the class can apply for the most competitive residency programs.
→ Lawrence comments on the ruthlessness of med students and how they are out to get each other a lot, sabotaging each others’ chances, but I do wonder about this. I understand the competition to some degree, but with only his assumptions to go by without any evidence, I wonder how mean they can actually be.
I was quite aware that while I had been able to pass my exams, the head trauma had prevented me from learning the first year material as well as I wanted, an insecurity that, no matter how hard I worked or how well I did, stayed with me for my entire medical career.
→ I feel so strongly for him here… and as much as we can see evidence that we are doing okay (with him as well, as he passed all of his tests fairly well, it seems), our imposter syndrome burns that down as circumstantial evidence.
Should “modern” healthcare alter its focus from treating disease to also keeping people healthy in the first place? Good question, I agree wholeheartedly; the change is happening slowly, even in traditional medical schools, but for now I leave that topic to wellness bloggers.
→ These kinds of social commentary are so important but are so random within the book; the forced interjection of the question is one thing, but then to not even explain his viewpoint makes it feel “thrown in” as a bonus, and I don’t love that
One day you were a classroom geek wearing a T-shirt and flip-flops, the next you dressed like a working adult and stumbled right past the classroom into a den of zealous physicians, over-worked residents, and militant nurses. Those grizzled caretakers shouldered the burden of caring for patients in the hospital and now had the added chore of molding bewildered medical students into doctors worthy of sharing their hallways—and until then, making sure we didn’t kill anyone.
→ The dynamics of a hospital is so complex… the burden is too large for any one of them. For as much as it seems like the book is trying to show that doctors are human, too, I feel like this also needs to be argued to larger organizations that treat doctors as some kind of superhuman, capable of doing an impossible amount of work while still maintaining their own sanity. Not just patients need to understand this. And perhaps the people who are harder to convince are the doctors themselves who take on these loads as “just a part of the job”; creating a space of normalcy around these things may be one of the biggest deterrents to changing the field
We were taught a very precise method of communicating medical information using a specific vocabulary tailored to each patient’s medical issues. The problem was that the patients were not trained to answer in the same vernacular.
→ Facts. Not to mention that everyone tells their own story a little bit differently
And just as you began to feel mild competency on your assigned service, finally able to answer the appropriate questions, it would be time to rotate to a new specialty with a different vocabulary and different questions and you were right back to being a medical clown.
→ Oh, the anxiety…
I had heard about rales in my second year of medical school, but until I actually heard them, the information was useless. And hearing them after being humiliated in my first of many horrific rounding experiences was a good way of ensuring I never forgot what rales sounded like. Yes indeed, a bit of method to the madness of fear-based teaching.
→ And yet, might there be a better way?
Even though call nights were exhausting, they provided us with the best learning opportunities.
… then again, it was so much worse for the patients, lying in shoddy robes, stuck with needles, and pumped with medicines that would make any of us goofy. Then, to top it off, they were forced to answer personal bodily function questions from a medical student.
→ Right. It’s about the balance. Life is just hard.
As you went further into training, your mind warped and you believed that those months without regular sleep, without seeing sunlight or friends, was normal.
→ Danger.
The single most important medical learning credo is, “See one, do one, teach one.” It works.
→ This shows up in This Is Going to Hurt; it’s an interesting practice, although I would freak out in that kind of setting
I’ll use that emotional breakdown to remind all of you, when seeing your medical providers, that they are people too. Some days, events outside our control make it hard to be our absolute best, no matter how hard we try, and sometimes all you can muster is to survive the day. So, be kind.
→ I think healthcare providers have some of the most difficult jobs, mostly because the care that they provide for others is often not even provided for themselves.
Future medical people take this message to heart: Listen to your patients. They know themselves better than you ever will. And parents know their children better than you ever will. My own corollary to that rule is: pay close attention when a patient returns and says something is still not right or that the doctor they saw previously did not listen to them; I swear, nine times out of ten, it saved my ass and the patient’s health, to acknowledge and respond to the fact that they knew something had been missed.
→ This is a genuinely good piece of information that I want doctors to know.
To my school’s credit, we had been instructed that the number one reason people take legal action against a doctor is not because something went wrong, it’s that the patient did not feel the medical provider listened to them. Even if something went medically askew, if the patient felt the doctor had listened and acted appropriately, they were unlikely to pursue legal action.
→ Understandable. Oftentimes, humans can meet humans in mutual understanding when a wrong has been done and the offender admits it. But to not be listened to and for the doctors to not admit it or apologize, then it is difficult to not be hurt and strike out.
Talking with real doctors when they were your patients was horrible. As a medical student you felt that everything coming out of your mouth sounded stupid to a real doctor. I remembered all too vividly asking basic questions of patients in hospital beds, and when they informed me that they were a doctor, feeling as though everything I did or said was being graded. I started thinking I was listening to their lungs incorrectly and that the patient would tell on me—so I’d listen to their lungs longer than usual just to make sure they thought I was actually listening at all.
→ This is so understandable from a psych perspective.
I’m not sure if you’ve glimpsed a lot of medical students, as they mostly exist in dimly lit hallways; but “tackling skills” is not typically what comes to mind when you look us over.
→ This was a good line. Funny.
Those had been my favorite months of medicine by far and I decided to apply to Family Practice programs with the goal of returning to work in a mountain clinic part-time while making films or at least acting in a community theater group. It was an excellent decision that perfectly matched the lifestyle I desired and I questioned it every step of the way.
→ Not enough info about his interest in writing throughout the book; why he wanted to write, why he chose medicine instead; just gets thrown in periodically
→ It is nice to see him state something that he enjoyed; although, it seems that the enjoyment has more to do with how this space will allow him time to do “what he really wants to do” rather than the type of medicine he wants to do
→ But there is also some wisdom in having a safe job with enough income so that you can explore your passions freely
→ “It was an excellent decision… and I questioned it every step of the way”… if this is not my brain…
Ancient wisdom said there was good learning to be gained from time in the medical bed. Plato, in his book The Republic, stated that doctors should be made up of those individuals who had experienced illness and injury; therefore enjoying an intimate knowledge of the medicine they would practice.
→ There is something to doctors being able to understand what it feels like to be a patient
Book Recommendations
Good memoirs recently read:
- Born a Crime: Stories from a South African Childhood by Trevor Noah
- I’m Glad My Mom Died by Jennette McCurdy
Medical biographies and memoirs:
- This is Going to Hurt: Secret Diaries of a Young Doctor by Adam Kay
- The Immortal Life of Henrietta Lacks by Rebecca Skloot