The Powerful Impact of Relationships
By Brad McEwen
Before I had the recent pleasure of sitting down and chatting with local Urologist Dr. Michael Monahan over a cup of coffee, I only knew what one might glean from a quick look at a Facebook page—that he was a handsome, single, 30-something doctor, with a sweet ride, a low handicap and a love of food, travel and his two precious pups.
But after spending some time with the talented surgeon, who has been with Albany Urology Clinic and Surgery Center since the summer of 2016, I learned there was much more to the native son than one could possibly gather from social media.
Just a few minutes into our Beyond the Bank interview I could clearly see why so many people I had spoken to were impressed with the Deerfield-Windsor grad and have been singing his praises in recent months.
From the jump Michael was very open and more than willing to talk with me about a variety of subjects, including his decision to go into medicine, dealing with the rigors of medical school, and why, despite the inherent difficulty of caring for people, he’s found fulfillment returning to Albany to practice medicine and build relationships in the community he loves.
“I really didn’t know what I wanted to do,” Michael said when I asked what prompted him to go into medicine. “My brother was two years ahead of me and went into dentistry and I was going to (the University of) Georgia doing the double Biology, Chemistry thing, but didn’t really know what I wanted to do.
“There’s not much you can do with a Biology or Chemistry degree. It’s either go to med school, dental school, or professional school. So I took the MCAT (Medical College Admission Test) and kind of made the decision to go to med school even though I never really had any preconceived notion of doing it.”
Of course with a history of medicine in his family—his grandmother was a nurse, his brother is a dentist and his father was a practicing dentist in Albany for roughly 30 years—it makes sense that Michael would be drawn to the profession. However, he said the decision had more to do with the way his brain works than with feeling the need to follow in anyone’s footsteps.
“I’m a very analytical person,” he said. “I’m a very non-emotional person. I’m a very science-based, matter-of-fact kind of person.
“So solving problems, making people’s problems better, fixing problems, that’s kind of what initially brought me into medicine. Of course, coming from a dental family background, my dad was always talking about the science base of things and why things happen, or why they don’t happen. It was always kind of interesting.”
Michael’s analytical nature no doubt also helped him navigate the rough waters of medical school, but so too did his overall drive and determination, which allowed him to stay focused on his studies despite the constant pressure that he said is part and parcel to being in medical school.
“Going to med school is just a different world,” he said. “In college I would wake up 45minutes before a test and read over some notes and that was it. In med school, I would have to study two weeks before a test, and continue to study for the next two weeks until the test. It’s just a different language. You’re basically learning a different language. I think one of the first classes you take, or the first thing you have to do before med school, is take a class called Medical Terminology.
“If you get accepted to med school, they send you a packet and they say you have to get X, Y and Z books. One of them is Medical Terminology and it says, ‘Read this and be prepared for testing.’ The second day you’re there it’s, ‘Oh, here’s the test for Medical Terminology.’ It’s a 20-page test with terms on there that four months ago you had no idea what they were. So, it’s literally a different language.”
Michael said that example really is indicative of the experience throughout medical school, which he added was so intense that it left very little time for anything other than studying.
“You lose a lot of people in your life,” he said. “Three weeks will go by and you’re like, ‘Oh, I haven’t called my mom or dad in three weeks or a month.’ You don’t realize what you miss. The time constraints are incredible. Any free time you have in med school, you’re studying.
“There really is no significant down time in med school. The first two years you get two months off in the summer, which is nice, but that’s time to reconnect with family. My mom would call me and be like, ‘Are you alive?’ It would be three, four weeks since I talked to her and my brother and sister the same thing. You talk to people that go to med school and that’s kind of across the board. It’s what happens. It’s kind of crazy.
“The people that went to med school with a significant other just astound me. It astounds me. I don’t know how you did it. Or how you had a kid while in med school. It’s crazy to me. I have a buddy who did it and he’s in the military, just insane. I mean you’re available for everything that comes along with a relationship for an hour a day, maybe. And that’s an hour in the day when you’re beat and you’re tired and you don’t want to do anything but sit there and watch TV, just mindless.”
Fortunately, Michael said, even though he found it difficult to find the time to stay connected to family and friends, there was an important sense of community among the other medical students which made things a little easier. In fact, he said that actually surprised him a little at first.
“Everybody’s kind of in the same boat you are and struggling like you are, so you create a little community with all the med students,” Michael explained. “It’s kind of like a second family, which is kind of an interesting dynamic that you never would have thought would happen going into med school or professional school. You always think everybody is out to get you, cut throat, ‘I want to be number one in the class’ kind of thing. But everybody goes through the same thing and they just want that camaraderie, that help.”
I didn’t pick up on it at first, but as our conversation wore on, it made sense that Michael would that a community developed among the medical students. It became clear as our chat shifted from medical school to practicing medicine, that the notions of community and relationships are quite important to Michael.
After all, it was the importance of community that drew Michael back to Albany, even though, like many high school and college students, he didn’t think he would necessarily return to his hometown after he finished school.
“I didn’t think I would come here, which is weird,” Michael said. “I don’t know why I never wanted to come back. I guess in college you get that, ‘I want to see things, want to do things; I don’t want to go back to where I know is comfortable.’ But I did do that.
“I went to Athens. I went to West Virginia [earning his Doctorate from the West Virginia School of Osteopathic Medicine]. I spent some time in Ohio training. I spent some time in North Carolina training. I spent some time in Michigan training. I’ve done that. People that go to college and don’t want to come back, I can understand. I wouldn’t want to come back here after college.
“But since I saw at least a little bit of what’s out there I also found out that I hate traffic which is a benefit here. I hate cold weather. I hate shoveling snow and driving on icy roads at four in the morning, going to work stressed out or getting called at 1 a.m. and it’s snowing. You can’t see anything. Or getting stuck in the hospital and you can’t go home because, ‘Sorry, the roads aren’t plowed.’ I mean I really don’t like cold and I don’t really like traffic, so it kind of limits where you’re going to be.”
But it wasn’t just the lack of traffic and the mild weather that drew Michael back to Albany.
“Familiarity is important to me,” he said. “I like to do new things, but having that familiarity is comforting. You meet some people that are like, ‘I have to go do things, new things. I have to go travel.’
“I love that too, but it’s not something I absolutely have to do. Coming back to Albany was comfortableness. When I was in Detroit training, it was great. I loved it. There were different things to do, different restaurants, different places to go, but you still feel like it’s not yours. You’re a little out of place. You come back here, you know people. I see people in the office that went to my dad for 25 years with their teeth and developed that relationship. They knew you when you couldn’t even talk yet. It’s relationships.”
Relationships also factored into Michael’s decisions about what type of medicine to practice. Early on Michael said he thought he wanted to go into orthopedics, not just because he loved sports and sports medicine, but because of the relationships he had built with Dixon Cotten and his father Bennett.
“I started following around Dr. Cotten, who was an orthopedic surgeon here for a long, long time, and Dixon Cotten, over at Southern Spine and Health,” Michael said. “The first year of med school you basically do the basic sciences—physiology, anatomy, chemistry, organ system, cardiovascular system, urinary system, whatever, just your basic systems. Your second year, you go out and shadow or follow different specialties. You may have gone through cardiology for a month (in year one), but then your second year you have a month of cardiology where you’re in the hospital, in the office, seeing different patients and doing things. You have these rotations among the different specialties. So at that point I was I was dead-set on being an orthopedic surgeon.
“I liked sports medicine. I like sports, and of course Dr. Cotten had an influence on me. He was an orthopedic surgeon, so I was like, ‘Oh let’s do this.’ “I wanted some type of surgery. I didn’t think I could sit in an office all day and just see patients and that’s it. I wanted to have a little break between office and surgery. I didn’t want to do general surgery either. I saw a few general surgeons and they seemed to have a lot of stress. Orthopedics seemed comfortable. They seemed happy.”
Of course, Michael didn’t end up going into orthopedics, and it was yet another relationship that factored into that decision.
“I never thought about urology,” he explained. “Then I came down here. I knew [Albany Urology Clinic and Surgery Center partner] Dr. Daugherty for a few years before I went to med school, just from playing golf with him at Doublegate. One day, it was in the fall, I had come down for something, a weekend, and I played golf with him.
“He said, ‘How’s it going?’ Well he’s a DO [Osteopathic Doctor, like Michael], and so is Dr. Wendland [another partner at Albany Urology]. The DO community, the osteopathic community, it’s a smaller community of doctors. There’s a whole lot less DOs out there than MDs, so if you have somebody that’s a DO you can kind of nurture them. I don’t know. It’s just a different mindset, a different brotherhood for osteopathic medicine.
“But anyway, Dr. Daugherty was talking to me and he’s like, ‘Do you want to talk about urology?’ I said, ‘No.’ But he said, ‘Why don’t you come chat with me for a week while you’re down for Christmas or whatever and see if you like it?’ And I said, ‘Okay.’ I had never thought about it. I hung out with him and I really enjoyed the field.”
A lot of that appeal, Michael said, came from the fact that urology provided a good mix of treating different patients for a variety of different conditions in a variety of different ways.
“We get a good mix of seeing patients for varying kinds of conditions,” he said. “I treat a lot of cancer. I treat acute pain with kidney stones. I treat a wide range of conditions that patients come in with.
“A bulk of our surgery is kidney stones, whether it’s treating stones in the kidney or treating stones in the ureter that drains the kidney. That bulk of our stuff is that. We’ll also remove bladder tumors. We’ll take kidneys out. We’ll take bladders out. We’ll take testicles out for testicular cancer. We’ll take prostates out for prostate cancer. Treat prostate disease. Somebody who has slow stream or weak stream, going to the bathroom all the time, we’ll reset their prostate or shave it down a little bit. We treat a lot of overactive bladder in females where we do injection therapy or neural therapy. Generally anything with the urinary system.
“In the OR (operating room) today there was a patient that Dr. Hines, who was an urologist here that left to go to Tampa, treated. He had bladder cancer. I ended up taking his bladder and prostate out and created a new bladder out of his bowels, his intestines, to hold the urine so that it comes out. That’s one of the big surgeries that we do. But this patient had a recurrence of his bladder cancer in his urethra, that tube that we urinate out of. So today I had to take out his entire urethra.
“So we do stuff like that you don’t think of. But somebody’s got to do it.”
While the variety of ways in which he gets to treat people as a urologist is appealing to him, Michael said the other thing he truly loves about the field is the fact that he generally gets to treat patients over a longer period of time, which in turn allows him the opportunity to build relationships with patients and their families.
“You get to follow these patients for a long time,” he said. “Sometimes with general surgery or orthopedics, you don’t get that. Somebody may have an appendix and get it removed and you’ll never see that patient again. Or somebody has a fractured patella. You see that patient for three weeks and that’s it, done.
“For urology, there’s maybe one percent or less, probably less than one percent, like half a percent or something, of patients that you actually don’t see again. So you develop that patient connection. It’s why a lot of people go into medicine. They want that relationship to take care of people. You tend to get that in urology when you follow these patients over a long, long time.”
Of course, building relationships with patients over a long period of time also means Michael gets attached to them, which can often be a two-edged sword, as some of those patients succumb to their illnesses, despite Michael’s best efforts.
We talked at length about how he deals with those circumstances, and he once again talked about his analytical nature and how that factors into dealing with patients.
“Maybe it’s just me, but in med school and in residency you almost get immune to it,” Michael said of dealing with the painful side of practicing medicine. “Not immune, but… Some people break down when they get a certain diagnosis or they’re very emotional with a certain diagnosis, but I guess it goes back to my matter-of-fact, science background way of thinking. I’m just like, ‘Well, this is what it is. This is what we have to do. This is how we take care of it.’
“But of course you have to have a large amount of empathy dealing with these patients because they’re going through probably one of the toughest parts of their lives. You’re there and you have answers for them, but you’re also there providing that support. They need to trust that you’ve been there before and you’ve seen this before. And that these patients that you’ve treated have done well. And you kind of have to reiterate that to them when you see them. It’s a ‘You’re not alone in this,’ kind of thing.
“Being that anchor for patients I think is important from a physician’s standpoint,” Michael continued. “If I went to a doctor and they were all emotional and couldn’t handle it, I’d get freaked out. You want to have that physician, or that rock, that’s going to take care of you, who is going to say, ‘Hey, this is what we’re going to do. We’re going to fight it this way, or treat it this way. We’re going to make it.’ That’s kind of what you have to put forward. You have to table whatever emotions you have.
“Sure there are patients that I see that I’ve either known for a long time, for the past year and half, two years that I’ve been down here, and I’ve developed that relationship with them. If something happens to them, of course I’m going to be emotional, but it’s not something that you show them. It’s something you deal with when you get back home. You subsidize or compartmentalize it. ‘This is going in the back now and I’m going to do what I have to do. I’ll come back to it later.’”
To illustrate the difficulty in balancing being the strong, positive influence in a patient’s life with the emotion of having to deal with loss, Michael shared a story about a patient of his who ultimately succumbed to cancer.
“There’s a super, super nice guy that’s like family, incredibly awesome,” Michael shared. “He was one of my first patients. He was telling me there was blood in his urine and I’m scoping him. He had had bladder cancer, cancer all over the bladder. When that happens, you have to get imaging and his imaging showed the bladder cancer had gone outside the bladder and was in his bones and other organs, just terrible.
“So telling patients that diagnosis is tough, number one. Two, following up with them every time and seeing them and checking how they’re doing and seeing their decline is tough. He passed away two or three months ago, which is pretty good for somebody with metastatic bladder cancer the last almost two years. But it’s just tough. The family comes in and they’re all appreciative and you’re just like, ‘I wish I could do more. I don’t know what you’re appreciating me for.’
“But it’s that empathy. It’s that he comes in, he trusts me to tell him what we’re going to do next and make decisions. It’s in the back of your mind. You’re thinking, ‘This is not going to be good.’ But you can’t tell people that. If you’re around medicine a while you start to realize that there’s certain things that aren’t going to be good and there’s certain things that ARE going to be good. But you can’t tell patients that.”
Fortunately for Michael and other physicians, the relationships he’s built with other doctors over the years help to ease those difficult times and help to provide alternative suggestions for treating certain things, when the treatments Michael has tried don’t seem to be working.
“That’s tough,” he said of those times when a treatment that should work isn’t. “You just have to look at the situation again from a different standpoint or from a different angle or talk to the people that trained me, or talk to my coworkers, see if they’ve ever had this. Ask around. Get other people’s ideas and views of a situation. Because if something that you were trained and taught to do to fix a certain problem doesn’t work, where do you go? Go to the people that taught you. Say, ‘Hey, I know this is what you’re supposed to do, but what if it doesn’t work?’ ‘Well, this has happened to me before, X, Y and Z.’ There are a lot of complicated patients like that.”
It also helps that Michael is not only required to take continuing education, but also really enjoys learning new things about medicine.
“Every year, tons of hours,” he said of continuing his education. “You have to go to conferences, do online modules, complete paperwork for extended learning and continued learning, all the time. Some people think of it as a burden. It’s a not a burden to me. I would think that if you’re in a field of taking care of and treating patients you would want to know everything possible that can be done.
“We need to stay up with new therapies and treatments because everything’s changing all the time. I don’t know why you wouldn’t want to have that new knowledge. To me, going into medicine, it’s a field that always has continued learning. In residency my trainers used to say, ‘You’re practicing medicine.’ You’re never going to be 100 percent done. It’s practicing. It’s getting better and better every year.
“You’re going to make mistakes and you’re going to struggle. You’re going to have those bad outcomes. You’re going to learn from those. Nothing in med school or even residency can prepare you for being out in the real world, being out there practicing and having those patients. They’re yours.
“It’s me now. These are my patients. They trust me.”
After spending some time talking with Michael and hearing a little bit about the drive and determination he has to build lasting relationships and care for his Albany neighbors, I have no doubt he’s able to quickly earn that trust.
While I hope I never have cause to become one of his patients, I truly believe that if I did, I would be honored to be in the care of someone like Dr. Michael Monahan.
As a resident of this community, and someone who also cherishes relationships and the wonderful people and things that make the Albany area great, I’m also proud that one of our own would make the decision to return home and take care of this community.
Connect with Brad – 229.405.7212 - firstname.lastname@example.org - @BradGMcEwen