Med School Madness

 The Q and A. Part 2.

(Finally)

A long time ago, in what feels like a galaxy far away, before yet another move and other things on the way, I wrote a little blog post about the lives of several Student Dr. Wives.  It was great fun to ask the LDW girls a few questions and more fun still to read their well thought out responses.  If you are interested in reading that post, you can find it here (http://doctorwives.blogspot.com/2013/06/med-school-madness-theq-and-part-1.html).  That was part one; today I am finishing up that conversation.  In the first post, we talked about some of the shared realities of medical school and what it’s like to be the partner of those who attend medical schools all over the US.  We talked about adjusting to MS, finances, study time and such.  Today, I’d like to finish by posting about some of the emotional matters of being the partner of a medical student.  Again, I’d like to thank Jessie, Tabatha, Jennifer, Rachel, Amanda, Mia and Margaret whose answers made these posts much better than anything I could have done on my own.  I wish you could read all their responses. These ladies are far more gifted as story tellers and writers than I can ever be.  They should tell their own stories and I hope they can guest post  but until that time comes, thank you ladies for allowing me to share your answers.  Thank you!

Now then, let’s get started.

First question, I can’t be the only worrier.  What worries you now about your Student Dr?

Jessie- Getting through Step 1 and away rotations. His first rotation, starting July 1, will take him about 90 minutes away for three months. It’s going to be tough.

Tabatha- My hubby has already begun to worry about the dreaded "L" word. Lawsuit. He does not handle rejection or failure well. I worry about how he is already concerned about this in ways he shouldn't be (stressed out, losing sleep, etc)

Margaret- I’m definitely concerned about how residency will impact our fledgling marriage. Quality time is important to both of us and I think it will be hard to start our marriage in a new city at the same time DrH starts residency. I think we will both learn a lot about flexibility and generosity in these first few years!

Rachel- Time management and the hectic scheduling of fourth year. I feel like there's so many things he will be juggling at once, away rotations during applying for residency, traveling again for step 2, traveling for interviews. He is not a person who "stops" when there's something else he can do. He just keeps going and going until there is nothing left on his to-do list. That has worked thus far and got him a long ways during the lecture years, but now he is going to have to learn how to sleep when things are left undone until tomorrow.

As you look back, is there one thing you wish you had done differently? AND/OR what are some things you got right?

Tabatha- I know a lot of couples have kids before or during medical school but I am so glad we decided to wait to have kids. I feel like it took a huge stress off us. It was a hard decision to make (we both REALLY want kids) but I'm glad we decided to wait to start a family.

Margaret- Being flexible and making the most of the time we did have together, even when our schedules conflicted and limited that time.

Amanda- I have become a much more flexible person and learned a lot about myself.  I also made some of the best friends of my life with the Spouses Organization.  

Jessie- I am SO glad I went to law school. It is definitely possible to go back to school after kids are grown, but it seems like a much harder road than getting all the education you want and getting some experience under your belt before starting a family. I only wish both of us could have gone straight through; a year off between college and law school for me and three years off for my husband before medical school have delayed the possibility of starting a family.

Rachel- I wish we would have moved into a smaller place after we got married. I also think the sooner you can look at the true picture of finances in the many years to come, the better. I think waiting to start a family (was the right decision), even though that wasn't our original plan. It is a highly personal decision but going into a surgical specialty after medical school, we have eight years at a minimum until DrH will be out of training

As you look forward, what are some of your goals personally and as a couple who belong to the medical community?

Tabatha-My goals personally are to find a job that will allow me to be home more. As a couple we hope to just keep up what we're doing and make it through this crazy journey. Eventually, (after residency) we hope to end up back in Oregon where hubby can practice for a few years and then return to his school as faculty.

Margaret-We are hoping to start our family soon, so we will be striving to nurture our young marriage and cultivate a strong, loving home environment for our children while juggling the stresses of medical training.  As a couple, we feel very strongly that it is important to develop relationships within our community and to support doctors and medical couples who are younger in their training.  We hope to be a light to our community just as others have been lights to us.

Amanda-Our goals are to get a residency in our home state, with the full knowledge that we may end up a million miles away.  We’d like to have kids, a house and may be more cats. The future is exciting!

Rachel- To stay involved and be humble and stay anonymous. We want to give to the causes we choose and make an impact through volunteering, and then go on our merry way and enjoy the little time we have with our family together.

Jessie-I’d like for us to be more than just a doctor and his wife. That is, I don’t want my husband defined only by his job title, and I certainly don’t want to be defined as only an extension of him and his job title. That’ll be tough in our society, which is dragging its knuckles on the path to gender equality, and particularly in my religious community, where I am often asked first what my husband does, rather than what I do. If, at some point, I am a stay-at-home mom, I intend to wear that badge with honor, and I hope to contribute even the tiniest bit to an increase in society’s respect for the work mothers do. I can’t contribute that way if I allow myself to be defined as a “doctor’s wife.” I guess, essentially, I want both of us to preserve and proclaim our individual identities rather than being content to nestle into the boxes people will no doubt try to shove us into.   

Secondly, I hope we can hang onto our material perspective. I grew up in extreme poverty (extreme for the United States, that is), and my husband comes from simple means as well. I hear a lot of my colleagues and a lot of doctors’ families lament how little money they make and how hard it is to stretch their six-figure incomes (talking about after residency, clearly), and I fear falling into the same jaded mindset. No idea how we’ll instill the right perspective in offspring who, when asked, will have to answer that their parents are a doctor and a lawyer. Any advice there would be greatly appreciated.

Lastly, since our purpose at LDW is to support the medical spouse, I asked the girls share about a person who has encouraged them through the medical journey aside from their spouse. 

The unanimous response was that other medical wives get it.  They make a huge difference.  All those who answered stated that another MS girl has been just what the doctor ordered.  GO US! Jessie did bring up her puppy.  For her, her pup was a gift during the lonely times and Rachel had this to say:

“I have met many other significant others and spouses of medical students, but it wasn't until I found the right one who became a great friend almost instantly as soon as we started hanging out, that I found someone that could travel the road through medical training with me. Having someone to talk to who understand without judgment is HUGE. No one else will outside of this, nor should we expect them to. As we will never understand truly what someone else's spouse goes through in their field. It's great to have someone to call on those long days DrH is in surgery or on call, who is newly married with the time constraints our spouses have, who can share their insight on setting up housing for away rotations or finding the best deals for flights for interviews. If you meet someone who can truly go through this experience with you, it will be hard not to come out on the other side friends for life.”

Thank you all for reading and checking out our blog. I learned a ton from doing this post.  I was reminded how import support is during the medical school years and how fast the time truly goes by.  This journey is temporary, it’s best to remember whatever trouble you see today will soon pass away.  If you don’t have a medical friend yet, hang in there and come visit our FB group, many of us are getting the encouragement and the advice we need in there.  Until next time!

Anonymous stay-at-home-mom-by-choice of three, and wife of a resident story

Hi! I'm an anonymous stay-at-home-mom-by-choice of three, and wife of a resident. My husband was one of the few students in his medical school class married, with more than one child, the sole provider for the family, and with children approaching school age. This meant we had many more things to consider about residency than the standard applicant. I hope what we looked at will help some of you who may be approaching similar situations.

I am something of an expert in this topic because we've done this twice. Applied for residencies, I mean. You see, after what I had thought were a decent two years of one residency, he decided it wasn't the field for him after all and so we applied for one he felt had a better future and a better fit with his personality and we moved all over again. 

The first time we applied and moved, the kids were 0, 2, and 4. The second time they were 2, 4, and 6. We looked closely at the same types of things for both moves, though we had to make different choices of necessity. I'll show you what I mean. You may think all we did to prepare was overkill, and maybe it was, but peace of mind in both applying for residencies and creating rank lists was important to us. We'll do the same for fellowship programs if we decide to do one.

Once upon a time that seems far past now, Husband went to medical school in an inner city. That was fine for our young family because there were so many things to do with small children there, and we'd be through with med school before the school years. Straight up we knew it would be difficult for us to afford to stay there for residency, because once we had an income we'd have more things to pay than we did living on loans: like state and federal taxes, loan payments (circumstances here can differ wildly depending on deferment, the Federal Loan Forgiveness Program, Income-based repayment, etc), different insurance costs, needing another vehicle no matter where we did residency, the growing costs for feeding and clothing a growing family, kids' activities as they get older, etc. 

In our case, this ruled out all expensive big cities. This did mean that any big-name programs we applied to were the relatively few in more rural settings. Using the city-data.com we were able to assess costs of living in many places and thus determine where we could afford to live on a resident's salary. Also helpful in this were websites about property values and rental prices for 3+ bedroom houses and apartments. For rural programs we checked out what kind of shopping options they had nearby. We looked at tax rates in different states. And insurance costs, if they were available online. Even if they weren't available to us before application, we got definite numbers before creating rank lists after interview season. Research!  If you fail to plan, you plan to fail is an appropriate adage here for the single-income resident family.

We also researched safety. That same city-data.com website also includes crime rates and kinds of crime for a period of several years. It includes sex offenders per capita. It includes more mundane things like weather and education and property values and employment too.  The National Sex Offender registry, familywatchdog.us,maps out where sex offenders live if you enter an address so we would double check areas we'd want to live and make sure they were both safe and affordable to us.

We researched schools using greatschools.org, knowing our eldest needs a good school with motivated peers to thrive academically and home schooling is not an option with this child because of that peer motivation. All kids are different, of course, but it mattered to us and still does. We researched the religious community too. We're members of The Church of Jesus Christ of Latter-day Saints, otherwise known as Mormons, so we would look into how far away our church in a specific area would be from the residency program. 

Now, for the differences in our two residency applications. 

The first time, Husband had relatively flexible time as a med student to interview and we had saved some dispersed loans to cover the costs. The second time, he had to take time off work in his first residency program, meaning we had less time (and money, since this was a last-minute decision) to work with. Of necessity then, the second time around we applied to programs mostly within driving distance and included every program close enough that he could interview with only one day of precious vacation time. We were fortunate that his first program allowed flexible vacation days at all. 

Also, housing. The first residency we bought a house in a suburb. We had been renting so long and felt that the better school were in neighborhoods where homes weren't rented, not knowing of course that we'd only be there two years. Hindsight is 20-20! What's done is done, however, and we did what felt right to us at the time throughout. Can't ask more out of life than that!  The second time we couldn't afford to buy in any case and we saw that all three-bedroom apartments near where we had matched (also where the good school are) were being snatched up, so Husband rushed out (with another vacation day) and got the last one in town close to the hospital. This time we definitely chose proximity over living space and even cost of rent, but that's a choice we all have to make. We don't regret it: his hours here are much worse and we'd see far less of him if he had a longer commute - especially with icy conditions for nearly half the year! And we absolutely love the community.

Lastly, the time we had to adjust. Both moves we had family helping us for about a week, which is an immeasurable help in and of itself with children around. The first move we had a solid month of no obligations so we were able to move, get unpacked and settled in, start making friends, help our kids feel adjusted, etc. for weeks before Husband started working. Not the second time. Between quitting one residency and starting the next one we had more like 10 days to pack up, load up, drive, unload, unpack, get licenses and registrations and food and all. Yikes! I would not recommend this if you have children. We had rough adjustments this time across the board - with all five of us! So if you can avoid this (which I know may not be possible, especially for those beginning fellowships in a new place) then do so for all your sakes. But, you do what you gotta do and things will work out eventually even if it's rough at first. 

My sincere sympathies to all going through intense adjustment right now. Hang in there!

And best wishes to the up-coming applicants of all kinds!

Residency Roundup: Duty Hours

I have noticed several reoccurring questions on our LDW facebook group about residency!  LDWblog is a perfect platform to provide answers that will be helpful to current and future resident wives. 

This week there was some questions/concerns about residency work hours and restrictions.  While I'm sure there are differences between how each specialty applies the rules, I wanted to post and dissect the real ACGME 2011 regulations for your guidance and information.
http://www.acgme.org/acgmeweb/Portals/0/PDFs/dh-ComparisonTable2003v2011.pdf

Here are my 'favorites':

-Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities and all moonlighting.   http://www.acgme.org/acgmeweb/Portals/0/PDFs/dh-faqs2011.pdf  for more information in their FAQs.  You get desensitized to the 80 hour weeks!  Its the weeks that push that four week average up that are brutal.  I overheard someone who works for the state department, joyously talking about how much overtime pay they received for working only 52 hours...wouldn't that be something!  The second link to the FAQs has some great followup examples and explanations.  I personally did not expect all the Journal Club, Dissection Lab, Tumor Board type meetings that keep DrH away from home that is not added into the '80-hour work week'. 

-A Review committee may grant exceptions for up to 10% or a maximum of 88 hours to individual programs based on a sound educational rationale. So what programs cannot justify the 88 hours? Although they are suppose to get permission first;)  I know of a program (not ours, I promise) that keeps to the 80 hr average but has 'volunteer shifts' that put the intern hours way above regulations.  

-Residents must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks).  At-home call cannot be assigned on these free days.  Four a month.  Are weekends really two days long??

- Duty periods of PGY1 residents must not exceed 16 hours in duration.  Seemed like a good idea.  But it makes the other PGY years make up for the hours.  PGY2 was not awesome.

-Duty periods of PGY2 residents and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital.  Programs must encourage residents to use alertness management strategies in the context of patient care responsibilities.  Strategic napping, especially after 16 hours of continuous duty and between the hours of 10:00pm and 8:00 am in strongly suggested.  I find this standard a tad humorous... strategic napping...where and when does that fit in? At the computer? On an extra gurney? Haha...who likes to nap when your ridiculously loud pager can and will go off at any minute? 

- It is essential for patient safety and resident education that effective transitions in care occur.  Residents may be allowed to remain on-site in order to accomplish these tasks; however, this period of time must be no longer than an additional four hours.  This is a huge one!  Although, it covers practically any variable that could keep DrH at the hospital, it defines what their real job is: patient care and learning.  They cannot leave after stitching up half an ear, or ditch the last clinic appointment because time is up!


Hopefully, as this year moves along we can focus on the time together and less on time apart!  

Cheers!

Cami

Don't Despair...You Are Not Alone

By Anonymous

During the process of your husband’s pursuit of his dream, becoming a doctor, did you ever have a moment where you seriously considered he may not be able to push through and make it to the end?  Being a part of the LDWs facebook page has made me realize that a lot of medical students have these moments.  Moments where they question the decision they have made, question if they are strong enough to make it through whatever barrier stands in front of them, moments that shake the core of their relationships, with their spouse, siblings, and parents because this process has the ability to make them feel completely alone; how could any one not in medical school really understand?

This is the story of our moment:

My husband was a high honors student during his undergraduate training.  He was Phi Beta Kappa upon graduation, did well above average on his MCAT, and got accepted to his choice medical school.  MS1 and MS2 were okay for him.  He struggled in some subjects, not because he was not smart enough to learn it but simply because of the rapid pace to which learning was expected.  He did poorly on his first exams in medical school and quickly determined what he was doing wrong in studying and adjusted it and brought his grades up.  Many of his grades were average to high average, which was disappointing to him being used to being an honors student but I was proud he was keeping his head above water.  I watched him study all day into the night and he would still be studying when I was getting up for work at 5:00 am the next morning.  He conquered things that would have broken me.  He never failed a class. He never failed a standardized exam. The opposite was true in fact, he exceeded many of his peers on his MCAT, USMLEs, and eventually his Board Exam.

The conclusion of MS2 was celebrated.  MS3 and MS4 were supposed to be a great time. We never met anyone who dreaded his or her clinical rotations.  Everyone was excited to get into the hospital, experience all of the different rotations, and really feel out the process for what they want to be when they grow up.  His first rotations were Psychiatry and Neurology.  These rotations were fairly easy and although he had a tough resident that did not allow them to get away with not reading up on their patients, he got through and did well. 

His second rotation was Pediatrics.  His pediatric rotation was split into two 4-week sections.  The first month for him was outpatient pediatrics some of which was at a specialty hospital following up on pediatric oncology patients in the outpatient setting.  The second month was Inpatient Pediatrics. 

My husband came home from his first day on his Inpatient Pediatrics portion of his rotation obviously in a bad mood.  He began explaining to me the call schedule, expectations, ‘pimping’, and the pressure.  He was expected to be at work at 5:30am for pre-rounding 7:00am for lecture, round on patients for 6-8 hours, stay the night for his call shift, go to lecture at 7:00am, and round on his patients before leaving.  It was essentially a 24-hour call schedule flanked by two normal working days.  When he was explaining this to me my immediate reaction was this is something that everyone goes through and it will just take time to get used to it, just like it took time to work out the kinks in studying during MS1 and MS2. 

Within the next week, he began explaining to me how he hated being in the hospital and honestly did not like the actual job of being a doctor.  My husband loves science.  He is a scientist at his core.  He could have easily been a Physicist.  He was convinced he had made a huge mistake pursuing this career.  At this point I immediately went into damage control.  He had been working toward getting into medical school through six years of undergraduate and now was in the beginning of his third year of medical school and he was seriously talking about quitting.  We were sitting in the tiny living room of our one bedroom, 600 square foot apartment; me on a chair and him on the furthest end sofa from me.  He kept trying to explain to me that he could not do it any more.  He did not want to step another foot in that hospital.  He did not want to return for his shift the next day.  He had his knees pulled up against his chest with his face hidden in his knees.  In all of our time together I have never seen him cry like this.  I have never seen such desperation on his face or heard it in his voice like I did that day.  He was begging me for permission to quit. 

This initial conversation was short in hindsight.  I quickly called my husband’s father, who is a physician.  I demanded he discuss his feelings with his dad and that he get medication. He was showing clear signs of acute situational depression and I was heavily burdened by the idea of him feeling too ‘trapped’ in this career.  Two students at his school in other health science fields had committed suicide that year.  It was too common of a statistic. The debt burden, feeling of letting your loved one’s down, and feelings of failure do not mix well with the personalities that make it this far in this career.  I certainly never wanted him to feel like this was his only option.  After he called his dad and talked though things he made THE calls.  The first call was to his Dean followed by a call to his attending in his Inpatient Pediatrics rotation.  He explained that he was overwhelmed and wanted to quit medical school.  He explained to them that he was sorry and that felt this was a bad career choice for him. 

Our world was crumbling before my very eyes.  It is impossible to work up to this life for eight years and not have very solidified ideas of what life would be like.  All of our visions for the future were getting scrapped.  We were now in the situation where we had to figure out what he was going to do for a career to even begin to pay back his student loans.  His bachelors degrees were in Evolutionary Biology and Biochemistry, both of which are useless for actually making money.     

His Dean discussed his options.  They allowed him to get credit for his outpatient pediatrics rotation and take a month off from school.  We packed our bags and went home.  We left everything in our apartment and took some much needed time to really discuss what he wanted and where that would be taking us.  For most of that month I completely avoided discussing going back to medical school, even though it was constantly at the back of my mind.  I let him have the break he needed to not think about the hospital and bring the subject up when he felt okay discussing it.  That time came around a week before he was supposed to return to school. Small things during that month, like seeing a beautiful house or a fancy sports car, would remind him of the life that we had planned.  Going into medical school was never about the money but it was certainly hard to see how we would have anything nice trying to climb out of medical school debt with no usable degree for him. During that talk, we discussed possible specialties, the requirements of each, the interaction each had with patients, inpatient versus outpatient specialties, and the radiology and pathology options.  He decided to return to school.  He felt mentally prepared for it.  He never returned to that hospital or that city, until graduation.  He finished his Inpatient Pediatrics rotation and all of his following rotations successfully and went on to graduate on time and match to his number one residency program, where he works with patients daily. He conquered the 30-hour call shifts, the pimping, and the pressure.  He is a great doctor. Many of his peers had no clue what happened to him and we never discussed it.

The path to becoming a doctor is isolating.  Each and every flaw is self-analyzed during the process of just trying to get into medical school.  The medical school interviews criticize anything less than perfection, trying to ensure that they are picking only those students who they feel deserve it, from all their hard work during undergraduate, keeping those grades as high as humanly possible, doing the appropriate amount of volunteer work, research, letters of recommendation, being well rounded, and so on.  That’s the catch though.  We are all human.  We all need support. We all struggle.  The mentality of medicine is that perfection is the only quality that is acceptable.  Just know, perfection is impossible and if you have had one of these moments you are not alone and it is possible to come back from the brink and be okay, thriving actually. 

Signed,

Anonymous       

Stressed?

At a recent doctor's visit, my physician asked me how I was handling the stress of medical school. He is a great doctor and one of the many things that make him awesome in my book is his acknowledgment that being the spouse of guy in medicine can bring stress into a girl's life. He knows our family fairly well so we got to talking about how I am doing with it all. By the end of the visit I was reminded once more that stress is normal and as I left his office I started thinking of all the things I do that help reduce my stress levels and if I was doing any of them. I'm pretty certain we can all agree that moving constantly, acquiring tremendous amounts of debt, and the financial strain during medical school and residency are a great concoction for stress. With that in mind, I came up with my top favorite free and 'can do anywhere' stress reducing activities.

Reading-

I am a serious book worm so reading ranks pretty high on the list. Thank goodness for public libraries because being at SAHM does not pay well. If you like reading and especially if you have kids, I really recommend you get a library card and take advantage of such wonderful public service. Not only can you get books but also DVD's like Zumba and Downtown Abbey (both major stress reducers in my life). If you are lucky, your library may even have some really hip and cool folks who have awesome activities for your kids and you. Honestly, libraries rock!

Exercise-

Nothing clears my head like exercise. My hubby likes to run, however I experience severe discomfort when running so I am more of a walker and a hiker (you know what I mean, it sounds weird just now). Luckily, we live near many beautiful trails so I take advantage of them. My kiddo can strap his helmet on, get on his bike and off we go. Some days I am very lucky and my hubs will take said kid and play with him while I go on a trail and try to get lost. If the weather is awful and I can't get outside that's where Zumba comes in handy. Sure, I can't dance to save a life but hey...no one is watching! I really, really hope no one is watching.

Volunteering-

I can read and dance all the day long but sometimes what really helps me stay healthy is volunteering. I volunteer at my son's school because he still likes me and wants me there. I also help out at our church office whenever possible. Helping at these places makes me happy and they also help in keeping some job skills up to date. If I get fired as a SAHM, I may need another form of employment. Volunteering also forces me to speak to other adults and be part of a team of 'big people' not just a five year old and his bevy of imaginary friends. Plus, I like to think I am being helpful and that in itself is worth the effort of volunteering.

Faith-

Lastly, this is one is not for everyone but I have faith in something much greater than me so prayer is my saving grace most days.

I know time is not freely given to many of you and finances do not permit retail therapy or lunch with girlfriends every week so I hope this post reminds you of at least one thing you enjoy doing that is free and can be done anywhere. My sincere hope is that in the midst of the medical journey your family is enjoying the ride and not just waiting for a destination. I know...we hear that all the time!!! But, seriously enjoy your week and may be share with us what you do to relieve stress.

Judith