My husband and I have been together since before he started med school.  We have done the whole ‘move away from family for med school, start a new life, struggle with that new life, then make that new life work, only to relocate for residency, start a new life again, have a baby, and then struggle to make THAT new life work’ thing.

We have done the ‘I resent my husband for all the difficulties that his life choices have created in my life’ thing and the ‘I resent my wife for having expectations of me even though she’s the one with more free time’ thing.  We have done the ‘let’s compete over whose life is more difficult, stressful, time consuming, exhausting, etc.’ thing.

We have talked about all these things, and dealt with all these things, and worked through all these things multiple times.  We have each made changes, concessions, efforts, and adjustments.  We have reached a place where we know we really love each other, we know we don’t want to be without one another, we know that each of us has a great deal to take care of and manage, and we largely appreciate what each has to do on a daily basis.

And yet that doesn’t change the reality of our life.  Sure, it makes getting through it together a hundred billion times easier, but it doesn’t change the facts.  And if we’re being honest, the fact is that both of us end up having to operate at the intensity level that medicine requires.

You all know the drill… my husband does the long hours at the hospital, reads and completes research projects at home, and hopes that he gets enough sleep to keep up.  I do my part time job as a therapist, take care of our daughter, and keep the rest of our life functioning (everything from running errands, to household chores and maintenance, to managing finances, to thinking about, planning for, and making decisions regarding everything that needs to get considered on a daily basis).  We both operate with a certain intensity level that medicine has infused into our lives.  We each handle it differently, and it impacts each of us in different ways, but we both live it.

I don’t like this intensity level.  I don’t want to operate at this intensity level.  I don’t want to feel like I am constantly moving and doing and fixing and running.  I don’t want to feel like I have to always be ‘on’ and always take care of things myself.  This isn’t what I wanted for my life.  I did not choose medicine, and I did not choose this intensity level.

While I may not have chosen medicine, I did choose my husband.  And I have chosen to stay with my husband.  I have even chosen to start a family with my husband.  Because of this, I get a certain level of intensity in my life.  However, I find myself lately refusing to indulge it.  I find myself trying to lessen the intensity where I can.

I can’t make my husband magically come home early from a shift to feed my daughter dinner when I’m exhausted and feel like it takes too much energy to lift the spoon to her mouth, but I can say “I don’t care that the dishwasher isn’t full, I’m running it tonight anyway just because I don’t want to stand at the sink and wash today’s bottles by hand”.  I can’t stop paying the bills or going grocery shopping or doing laundry or showering (well, at least not completely), but I can determine when these things get done.  They don’t have to get done immediately all the time.

Recently, instead of using each of my daughter’s naps as a time to mad dash and get everything done, I have been trying to use at least three or four of her short ones over the course of the week to relax- whether that be watching a recorded TV show since I can’t stay up past 9pm to watch anything live, or reading a book that isn’t about how to get your baby to sleep, or just staring out the window and breathing.

I have found it helps.  The intensity level in my life IS higher than I would like for it to be, and unarguably it is because of the impact that medicine has on our life.  But this is my life.  And I refuse to live it in a way that makes me unhappy.

I have already decided that I want my husband in my life, and as a result of that, there are certain realities that I cannot change.  Will I always wish that he could be more involved, offer me more support, and take some of the burden off of me?  Probably.  Does he try to do those things when he has the time?  Sure.  But the remainder of the time, that falls to me to manage.

So through my recent reflections I have decided, now that the sleep deprived baby haze has lifted, that I will be treating myself more kindly, cutting myself some more slack, and living as much in the present moment as I can.  I am deciding to live less intensely where I have the power to do so.  Because this IS my life, and I don’t want to have lived it so intensely that I miss it.

Your choice: Feel sorry for yourself and wallow in your misery or take the opportunity to tell yourself that you deserve to celebrate yourself.

Here are a few suggestions for giving yourself the Valentine’s Day you deserve.

One of the first things that the commercials remind you about for Valentine’s Day is jewelry:  Diamonds, pearls, precious stones, gold, silver, platinum.  Sure you deserve a fabulous piece of jewelry or a new watch. The reality of the medical lifestyle says that it’s not likely to happen given the typical income of the medical student, resident or fellow though.

The Dawkter’s Wife plan to solve this one:

Appreciate the jewelry or watches that you already own. Take your favorite pieces and go to a reputable jeweler. Ask to have any precious metals and stones cleaned. Ask the jeweler to check any prongs that hold your stones. If you have pearls (or other pieces of jewelry that are strung) have your jeweler test the strand.   It’s well worth the cost to have any valuable or sentimental pieces restrung. Most pearls should be strung with individual knots between each pearl so that they don’t rub against each other. Have your watches cleaned and batteries replaced. This is the day to replace any watch bands and have metal watch bands sized. (Make sure you get the links back in case the band needs to be resized or you need damaged links replaced at a later time.)

If you haven’t yet done so, make an appointment to have your jewelry appraised and add the replacement value to a rider on your home-owner’s or renter’s insurance policies. Pat yourself on the back for taking care of yourself and your precious pieces.

The next thing the commercials and magazines throw at you incessantly:   Flowers.

If your honey remembers or is awake enough to remember that it’s Valentine’s Day, you’ll want to do what you can to prolong the life of your flowers. According to the flower experts (aka a woman I heard interviewed on the Diane Rehm show on NPR) the best way to keep your flowers looking fresh is to replace the water in the vase every day. When you have the flowers out of the vase, cut off about a half inch from each stem. This will do more to prolong the life of a flower arrangement than using sugar, salt, vinegar or preservatives in the water.

So, your honey didn’t remember to send you flowers? Well, you have a few choices to take care of yourself the Dawkter’s Wife way. Solution #1. Send yourself some flowers. Who better to celebrate your fabulousness than you? Order a dozen roses, an orchid, a cactus- doesn’t matter. Order a card with it. Sign it- “to me, YOU ROCK! Love, me.” Or if you know any other languages- sign it in a foreign language. Enjoy your little moment all day. Solution #2. Go to your local botanical garden. Appreciate the warmth and the beauty of the plants and flowers without actually having to attempt to take care of them. Mentally plot your dream garden when the training is DONE. (or if training is done, mentally plot the garden of your dreams when you have time/energy/money to do it!) Solution #3- have a plant or tree planted in your name. Lots of towns and cities have parks or forests that are for memorials or remembrances of loved ones. Why not have a tree planted for yourself? There are reforestation projects in the rainforests, in parts of the Middle East and in some of America’s parklands. I once donated trees planted in Israel for as a wedding gift for a couple that already had everything.

The next over-marketed Valentine’s Day gift? Lingerie. The Dawkter’s Wife way to celebrate the Valentine’s Day Lingerie Onslaught. If you’re a female medical spouse, swallow your pride and your nervousness and go to a real lingerie shop. If you have a Nordstrom nearby, they pride themselves on their lingerie departments; otherwise find a lingerie store habited by ladies of a certain age. Have yourself measured and try on as many bras and panties as you can. You will discover that you have been wearing the wrong sized bra. The Oprah Winfrey show did a show and 94% of her studio audience was wearing the wrong-sized bra. I went to a lingerie shop in Washington, DC and discovered that I was off by TWO cup sizes. Clothes fit much better and bras are much more comfortable when you’re wearing the correct size. I also learned that you really do need to take the time to try them on. My days of grabbing the ‘right size’ off the rack at the PX or Target are sadly over. I may buy them from those stores but I definitely try them on first.

If you’re a male Dawkter’s spouse- go buy yourself some new underwear. Really. Your medical spouse won’t notice but hey, you deserve it. Buy yourself something fun if you want. Throw in some new undershirts and live large ! Throw away the undershirts that are torn, holey or have stained pits. You’ll feel so much better. I’ll feel so much better knowing that you did. You wife will thank you.

Finally, if you drink wine, pour yourself a glass of something that YOU like. Or make yourself a cup of herbal tea or a cup of hot chocolate. Light a candle or two. Take a bath- add in those bath salts that have been sitting on the counter for years. Take a steaming hot shower. Listen to the music that your beloved can’t stand. Or listen to the music that reminds you of your hard-working beloved. Read a book. Watch the TV shows that your honey can’t stand. Put clean sheets on your bed. Sleep in the middle of the bed. You are important. Sleep well iMSN friend.

This month’s Dawkter’s wife is Jennifer Hussey.  Jenn is a founding member of the international Medical Spouse Network.  In addition to managing the medical lifestyle, Jenn also is raising an adorable little boy Nikolai and her husband, Rick.

Obviously, our expectations were a little high. Because we also are poor managers of money, we haven’t saved a dime. If our retirement money wasn’t automatically deducted each month, we might be looking at a cardboard box in our future.  We are still living paycheck to paycheck despite the best of intentions. It seems that now our wants and *needs* have just become more expensive.

Each month we have set out with a new budget plan. ..and each month, we have failed ourselves. I, of course, blame him. (But I’m guessing that he is secretly blaming me!). We each sneak $20 here and there believing that neither of us will miss that small amount. With two people dipping into the family funds, it’s no wonder that at the end of the month we can’t figure out where the money has gone.

My New Year’s Resolution this year is to get this under control once and for all. I have decided that the only person I can control is me, and so between you and I…and the computer between us, I’ll let you in on my secret.

I opened up a secret savings account.

In 18 days, I have managed to save $107.45 by following a few easy steps:

Second-Hand Ka-Ching

I began sorting baby clothes and toys for sale at our local second hand shop. I deposited the even dollar amount and change ($20.45) into my new account and pocketed the remaining $4.00. If I had kept the money in my wallet, I would have spent it without even thinking twice. Now, it is tucked away earning a little interest.

Pay in Cash and Plan Ahead

One of the biggest fixed costs in our monthly budget is groceries. With a family of seven (and one still in diapers) it isn’t hard to imagine that our trips to Coborn’s can become very expensive. I went back through our checking account and determined how much money I was spending each week. By doing strict meal planning and heading to the store with cash (instead of the check card) and a detailed shopping list, I was able to shave $50 off of the bill each week. I deposited $40 each week into savings and kept the $20 to buy stocking stuffers at the Dollar Store.

Pay Yourself

Instead of withdrawing money every few days, I decided to give myself a $40/weekly allowance. From that money, I also automatically deposited $7 into savings. After the holidays are over, I plan on depositing 10% each week into the new account. I am amazed that I have been able to save over $100 in less than a month. I am motivated by imagining the look on my husband’s face next year when we begin to discuss the family vacation and I offer to pay for it. Hopefully, when he sees how much money I have been able to save by simply cutting back and putting the extra money into savings instead of spending it, he will be motivated to do the same.

Look out Disney, here we come!

If I have to hear that conversation one more time when meeting a residents’ wife that I don’t know I might just have to hurt someone. Neurosurgery gets such a bad rap. “The hours are horrid”, “The doctors are all full of themselves” or “They have terrible bedside manners”. The things I’ve heard which are negative about my husband’s chosen specialty could fill a book the size of the latest Harry Potter novel.

Neurosurgery isn’t the most family friendly specialty; I’ll be the first to admit it. However I don’t feel it is the worst. My husband is a resident at one of the top programs in the country based on completed surgical cases. They are exempt to 88 hours versus the regular 80. I feel the difference is that my husband’s program truly sticks to the 88 hour rule. In the last year my husband has averaged 71.4 hours in an ACGME four week period. He has worked a week of 101 hours, but he has also worked a week of 47 hours in a non-vacation week. They have been able to stick to the 88 hours because the program has aggressively implemented scheduling changes which do not sacrifice patient care and continuity.

The program has brought in two PA’s and is trying to hire a third to assist the Chiefs. The Chiefs have a Chief junior (PGY-2) on their team at all times. The Chief and his or her team handle all cases that come in through the ER. The 11, soon to be 12, attendings each have their own practice. Some of their interests overlap but for the most part they individually cover all of the neurosurgical specialties. Each attending gets a resident. That resident covers 1-2 attendings for the quarter. That resident rounds on their patients each morning and evening while operating with one attending per day. At the same time that resident is assigned to an OR. That OR is usually staffed by their attending but if their attending finishes early for the day another attending could take over the room. Therefore another resident’s load is lightened and all residents finish at similar times for the day. This ensures that, most of the time, one resident doesn’t work for three hours while another works for 12. Work hour violations are also reviewed monthly in a conference attended by all residents and attendings so that solutions can be found.

One aspect of my husband’s program that some people see as a drawback is that he carries his pager at all times. He is the first point of contact for the nurses if they have a question on one of his patients. If one of his attendings’ previous patients has a question they call the operator which calls my husband. Since this call is taken from home and is not excessive it does not violate the ACGME duty rules. Some spouses prefer that when their husband is home, they’re home – no pager, no intrusions. In my opinion that isn’t a reality in this profession regardless of where you are in the training program. There are nights when my husband gets paged once an hour but that is a rarity, not the norm. My husband is on night call, in the hospital, seven nights this quarter and on weekend day or night call, in the hospital, four weekends this quarter. As the residents become more senior their call nights and weekends decrease until Chief year when all bets are off.

So what is my point? My point is that there are programs in this profession that have taken the steps to ensure that their residents get the education they need while having a life.

How do you find them?

Ask questions!

When you’re interviewing for residency ask the program coordinator to put you in contact with an upper level spouse or a resident spouse. The programs that want their residents to have a life outside of the hospital will not have a problem giving you that information. Many programs even arrange for applicants to meet with other residents for an informational lunch.

Don’t be afraid to ask questions about the cost of living, local school districts, cultural activities and the residency program itself. It is perfectly acceptable to inquire about what other resident’s and their spouses like most and least about the program. In addition, find out about any spouse support group and how to contact them.

If one of the top neurosurgery programs, based on completed cases, can keep their residents under the 80 hour rules, every other specialty should be able to do the same.

There I was, sitting on a cramped plane holding my son, then two and a half months old. My husband and I were talking excitedly. We couldn’t wait to get there. What would it be like? How hot is it going to be? Will the locals embrace us? Are we going to survive the journey?

We had been up for 38 hours or more the day before. I lost track eventually. My mom picked all of us up, dog included at the hotel in Vermont. We drove for a few hours packed to the gills in our car. As soon as we got there I started crying. We were leaving all of our family behind to embark on a journey to a country we hardly knew anything about.

We were to leave the airport in Boston at 7am. The plane had mechanical problems, so
we left a few hours late. We arrived in Puerto Rico as our connecting flight left – without
us. We were exhausted…and dressed in our winter clothes with a new baby, an 80- lb
Golden Retriever and ridiculous amounts of luggage.
Stranded.
The airline put us up at the Marriot Hotel, but they didn’t accept pets. After much
arguing, a car was sent and we were taken to the most beautiful, expensive hotel I have
ever seen. I couldn’t imagine that they took pets. I think someone must have bribed them.
I have never slept so well. For the first time, our son slept through the night. It was
wonderful!
The next morning, we finally boarded our flight. All three of us, the dog in the cargo, 6
large suitcases, 3 carry-on’s and a laptop. The flight was short to the island. We were
flying so low; the other islands and an occasional volcano were visible.
The airplane swooped through the trees, weaving in and out. We could almost touch the
tree tops because they were so close. Before I knew it, we were ready to land. There
were houses made of plywood cinderblocks and sheet metal, banana trees everywhere,
mountains, and the most beautiful lush rainforest I have ever seen. We had arrived on the
island of Dominica, the West Indies. Our closest mainland was now Venezuela. “Wow!”
was my only thought. “We’re finally here.” Finally, we are living my husband’s dream
of going to medical school.
As we got off the plane, my thoughts changed from “Wow!” to ”Wow! It is so hot
here!” How am I going to survive this heat?” “When we left Vermont, it was 28 degrees
Fahrenheit. Now, here I stood in a pair of brand new shorts, a tank top, and flip-flops
(with the whitest legs ever) and I was ready to pass out from the heat.
We went through customs at the airport. This proved a little difficult. It was difficult to
understand the local dialect, but we managed to do okay with lots of “What? I’m sorry, I
didn’t understand the question”. The airport was not your average airport. It was very,
very small and lacking in so much that we consider normal. It was hot, all luggage was
moved by hand and the only business was one little stand that sold things to eat and
bottled water. Later, when we left the island, I found out they don’t even scan your
checked luggage. They just ask you what is in it. It took about two minutes to get from
customs to the exit. In that short walk, many of the locals tried to hustle us. Thankfully,
my husband has no problem telling people to back off. If it had been only me, I would
have had nothing left at the door. We picked up our luggage and were asked some
standard questions about what we were bringing in to the country. Since we were
students and had a child, they were quick to let us pass.
Outside, we found a driver that we came to know as Alexis. He was a nice guy – one of
the most reliable, honest people we met while we lived there. He had a fleet of transport
vehicles. He had many drivers that would pick up locals and students. Because he was a
hard worker -and trustworthy -he also had a contract with the university. Driving through
the winding roads and mountains almost made me sick. Thankfully, we sat with parents
from India coming to visit their daughter. They were veterans of visiting the island.
Talking with them kept me from getting car sick. After an hour-long, horn-beeping,
brake-slamming insanely fast weaving ride, we made it to our new home.
Because of our dog, we had to pre-rent a house. We had never even seen pictures. We
just knew it had two bedrooms and a yard. We pulled up to a small white house with
shutters, a small porch and a fenced-in yard. We found out that it did have hot water…in
the shower…when you flipped a switch. My first thought was laundry, believe it or not. I
ended up doing it by hand for months…. king sized sheets and bath towels included.
You can imagine my complete joy when an American woman walked out of the
neighboring house to greet us. We shared a yard and she had a German shepherd. We
were so excited! Our dog was happy to have a friend, too. Our landlord came to greet us
and give us the keys. She was a very kind woman and every now and then she would
bring us the most delicious pineapple.
The woman next door was in her 50′s, a lay mid-wife, mom of 6 and a mother figure to
me. Me, with a new baby, thousands of miles from home and any one I could count on.
She was going back to school to get her MD.
Many people refer to Dominica as a third world country. They don’t have a lot there, but
it is far from third world. They have phones, cable, internet, banks, and even a pizza
place! The university seems to be what keeps the island running. The country is very
poor. They used to be ruled by England, but gained their independence. We heard that
once that happened, combined with a catastrophic hurricane, the island was never the
same.
Dominica has the most delicious bananas, pineapple and mango I have ever tasted. The
fruits and vegetables will never compare anywhere else. They are rated in the top five in
the world for scuba diving. They have the most beautiful rain forest, waterfalls, boiling
lake, Emerald pool, and colorful birds and parrots. There are iguanas hanging around the
campus, coconuts, mangos and guava always falling to the ground. With a baby, I really
did not get to do too much on the island. But, if you don’t have children (or if they are
older) there are many things to do. You can island hop, snorkel, scuba dive, hike, day
trips to the capitol of Roseau, and – of course – hang out at the beach.
Although life on the island may have looked like a tropical fantasy, it often felt more like
a nightmare! We were there for 16 months. It was a long 16 months. There were
constant power outages. And then there was the heat, the lack of reliability from the local
community, goats, cows and bulls tied up on the side walks, stray dogs, starving children,
roosters crowing in your windows at all hours of the day and night, dirty drinking water
after the rains, mosquitoes that could carry you away, centipedes that can leave a nasty
welt, my favorite….”advice” from the locals on how to raise my son (and in the end, my
daughter too) and the constant wonder if we were going to make it out of there.
Looking back, I’m not sure if we would have done it all over again. The cost of travel,
the extra certification to do residency in the states, the stigma of being a foreign grad, and
being away from family, friends, and what I consider a comfortable lifestyle was hard. It
was an adventure, but going this route is not for the faint of heart. In the end, it did give
my husband the chance to become a doctor.
_________________
Sylvia Siegel is currently the very busy parent of three toddlers. She is married to a PGY-
1 resident in obstetric and gynecology.