Babies and Family

This probably sounds awful, but we are guaranteed visitors when we have babies. That's not exactly why we have them, but it is something to look forward to when we do. For each of our three children that will have be born during residency we have had the grandparents, both sets back to back, all to ourselves for 5-6 weeks at a time. That is heaven!

At the same time depending on the timing it makes for long periods in between visits. My husbands parents come out about every 6 months for 2 weeks. But because we were expecting their usual planned trip in the spring was postponed 3 months. But that's OK, they will be here!

We love getting to spend time with them. Our children miss being near their grandparents and aunts, uncles, cousins. It is hard when we know they are gathering for family or holiday events that we will never know. Somehow having them here with babies are born makes it all seem OK, if only for a little while. 

If we decide to have more children perhaps we'll need to plan the due date close to a major holiday like Christmas! That may be the only our children will know what a Christmas with family around is like.

So my mother flew in yesterday and since then I've been busy getting all the last minute things I need to do without bringing all the kids with me. It has been heaven, and it's only been two days.

Perks

One of the perks of being married to a doctor is that you get the inside scoop on who the best doctors are. From the moment we moved here we have made inquiries among other doctors families, nurses, and office staff. We have appreciated that insider knowledge immensely. Friday I go in for my scheduled c-section and I feel confident knowing that I have the best team and not some randomly assigned players.

When I went in for my last appointment today I asked my OB/GYN if an anesthesiologist had been assigned to my case and we talked for a moment about hospital politics, changes in the group that administers anesthesia, and such. She said she never knew who was going to be in the room until she gets there, but that I could call and request the doctor I wanted. So my doctor called the doctor and now we have the best anesthesiologist on the service, and the same one who took care of my last epidural needs.

Now if I could only select the nurses who will be assigned to me during recovery.

Making Ends Meet

It didn't take long to realize that being an intern/resident and getting a paycheck didn't mean that much. In fact, in some ways if felt worse than being a medical student! That wasn't supposed to happen, was it? I mean a paycheck was a symbol that you were moving up in the world, that you were making your own way, that you had arrived. Isn't that what everyone was waiting for?

We were 6 months into our internship year and each month we watched as our savings account edged closer and closer to zero. We were in crisis mode and didn't see a light anywhere. We had just had our second child and the bills were going to put us in the negative (see my previous post about insurance), the home we purchased was in need of major repairs (see my previous post about our big mistake), and we couldn't see a way to stay afloat. As it was we weren't spending any money, it was beyond tight and I worried constantly about what we would do.

One day in January I looked through the Community Newspaper that our local paper sends out as a courtesy once a week, and saw an add for a work at home position with a local mail-order company. It was an answer to prayers and literally bought us some time. I was certainly over-qualified, but my current circumstances, a mother of an almost 2 year old and a 4 month old, really limited my options if I was committed to staying at home and raising my own children - which I was. So I took the job. I didn't like the work. It was tedious, it cut into the time I was able to be with my husband when he was home because it was difficult to get to work when the kids were awake. I didn't get much sleep during that time, but it did meet our needs for that year and I am grateful for the timing. We paid our medical bills and put a new roof on the house.

As time went on, it was obvious that my job from home would not be a permanent answer to our financial difficulties. My life was taking care of our children, and working. Not an ideal situation for someone in a new community, with small children, who needed to make friends and get out of the house occasionally. There wasn't time for it, and honestly I didn't have the energy either.

So what were our options? Some residency programs allow their participants to moonlight at ER's or Urgent Care Centers, where they can make hundreds of dollars in just 1 shift. Our contract with the hospital specifically forbids moonlighting so that was off the table. Our next option was the military. Besides the different branches of the military they also have different degrees of activity. The first being he could sign up and they would pay us a stipend during residency, and after completion of residency he would owe them 1 year full-time active duty for each year they provided a stipend. They would assign him to a military installation and once our time was fulfilled he would find a job in the private system.

The other option was to join as a reservist. They also provide a monthly stipend in exchange for reserve time to be completed after your residency at a ratio of 2 years reserve time for each year of residency you receive a stipend. You get to join the practice of your choice in whatever state you choose and they assign you to a unit (if you are near a unit). Two weeks a year, one weekend every month, and the possibility of being deployed for 90 days at a time no more than once every two years (don't quote me on that, I may be wrong about the frequency).

After much consideration we decided that going the route of a reservist would serve our families needs the best. With children who would be school-age it was important to us that we not be moving every few years and could settle down somewhere. It was also important that we get to choose where we live rather than having the military decide for us. The trade-off being that we are indebted to the military for a longer period of time. In our case we joined in the second half of our PGY2 and our time commitment to the military is 9 years.

There are days when I feel guilty about "pawning" my husband to the military just so I have the luxury of staying home with my children. I feel like maybe I didn't do enough, maybe I wasn't as frugal as I could have been (I know that isn't true, but I still think it), maybe we could have made it somehow. But I marvel that we made it is long as we did without some sort of supplemental income. Sure we could have gone into debt, but I couldn't even see how that would have worked. We didn't have the money to make credit card payments! More importantly when we got married we committed to never use credit cards to pay for things we couldn't afford. That is a promise we have been able to keep and have never broken.

Another thing that was of great importance to me was being at home with my children. When my first child was born I left a great job with a great salary. My co-workers couldn't believe I was willing to walk away from it so I could stay at home with my newborn (I don't think anyone had ever not come back from maternity leave) and that my husband didn't have an income. It did sound crazy, and it was scary, but I couldn't imagine it any other way. It wasn't fun going from being able to buy and do whatever I wanted to doing and buying nothing! But I don't regret that decision for a moment.

It is hard enough being married to a resident without taking on the added pressure of working and being a mother. For me I wanted to be available when my husband was, and that was unpredictable.  Taking care of our home, my husband and our children is now my full-time job.

So that is our formula for making ends meet on a resident salary. The math doesn't work without extra income from some source (job, family, more debt), especially if you have children and want to stay home. If you are able to make it work completely on a resident salary - I applaud you.

Happy Father's Day

When it comes right down to it, I married an amazing man.  There probably isn't anything he can't do and more importantly can't do well. One of those, is being a father.

Perhaps the idea of resident and father don't seem like compatible titles for the same man, but I assure you they are. Regardless of how many hours he works he some how finds the time to be a father. And not just the type that provides a paycheck and some DNA.

We have a picture from medical school when our first son was born that I love. The doctor is studying for his board exams, text book and highlighter in hand with our 3 or 4 month old sleeping on his chest. I remember the nights that he would willingly sit up with me when one of our children were nursing or crying. He has always made the effort to be a father from the very beginning.

Even now, 6 years since our first child was born and on the brink of having our fourth, he still will sacrifice whatever is necessary to be a father. Numerous times when he has had projects, papers, presentations, chapters to write, etc he will come home to see the kids before bed and then head back out to finish his work. When he is home, he is usually ours.

The kids get so excited when they hear the garage door open because they know that daddy is home. Some kids have time cues, ours is a sound. They know it so well that regardless of what room in the house they are, they will run to meet him at the door. Not once have I heard him ask them to get off of him, or to give him a minute. He is always ready.

Doctor, father, husband: it is possible, he is living proof. Happy Father's Day!

Date Night

In theory weekly date nights sound like a great idea. Everyone needs time away with their spouse, away from the hospital, away from the kids. But realistically trying to do one every week is nigh unto impossible. Have you seen what a residents schedule is like?

I often joke that we would need to have a "on-call" babysitter so just in case he comes home we can go out. But who is going to sign up for that job? Who is going to turn down another babysitting job so they can be available just in case the doctor gets home in time to do something. And really how often does he get home in enough time? This is one of those situations when having family near would be great. Because they would gladly do something like this on short notice, and would understand that when you have a few hours, unexpectedly, you need to take advantage of it, because you don't know when it will happen again. (And typically they don't expect payment).

Besides only getting a date outside of the house about once every other month, there is the dilemma of money yet again. We usually only have enough in our budget to pay the babysitter, or go get dinner - but not both. That makes for some interesting nights out. We have tried to swap babysitting nights with another couple and have had some success, but they moved today, and in all honestly it didn't always work out as planned because of the above mentioned schedule. We will still try.

This happens to be on my mind because tonight we are going out! The last time we went out was in March for our anniversary. It is sad, but true. Not because we don't want to, not because we don't need to, but because timing is everything.

So we are paying a babysitter tonight and we may go out to dinner! Big spenders we are :-) And who knows with this baby coming it may be a while before we get to do it again.

Health Insurance for Residents - Great Until You Need It!

One week from today we'll be in the hospital having our baby! I should thank the nice lady from hospital pre-registration for calling me and reminding me.... I would not have forgotten.

What should be a time filled with hope, excitement, and possibilities is intertwined with the nagging knowledge that in about six weeks after delivery the medical bills will start rolling in. The part that isn't included in our deductible and the portion our insurance deems our responsibility. So after paying our monthly premiums, a deductible of $1,200 plus 10% of all charges (and that's the discounted rate), it's not pretty. But what is even worse is that the plan changed in January and by my calculations it is going to be more expensive this time around. I believe their intent was to make "health care" more affordable by lowering the premiums a little bit, but charging more when services were required. That doesn't really help unless you never need healthcare. And they only time we do is when we have babies - and it happens to be expensive.

I made a few naive assumptions about my husbands role in medicine and what that would mean for our own health care. See in my mind those individuals involved directly in providing the services would have the best benefits, right? Not necessarily.

My points of reference for maternity care and insurance were relatively narrow.  My three sisters have all had children. One of them was under military insurance and didn't pay for her health care, which would make sense. I know our troops get excellent care, and I am glad they do. But considering their salaries I would expect no less. My other two sisters work as medical transcriptionists for a local hospital in their state affiliated with a state university and their out of pocket expenses were less than $50 for each delivery.

What further added to my confusion was that when our first son was born,  between my husbands MS3 and MS4 he was doing research with a state university, and we were covered under their plan. We had the same insurance that state employees had - in summary it was awesome! We paid our premiums every month, had no deductible, and the full amount of my c-section delivery was covered. Not a single bill was ever passed to us.

My friends, living in town working for that large national employer I mentioned in another post, all receive 100% covered maternity care.

So using what little knowledge I had of maternity care and insurance, based on examples in my family and friends, I really believed that hospital workers, but especially residents and their families, would have at least the same degree of coverage. Boy was I wrong! We were already expecting when we started residency and didn't know the plans coverage and limits. You can imagine our surprise when the bills started rolling in! When it was all said and done the portion we were responsible for was $2,500.

My husbands residency is at a private hospital without connections to a state government. Maybe that is the difference. Regardless, I think who ever was in charge of selecting the plan they would offer their employees should be fired. Or maybe that is just another way to discourage residents from having children during residency.

So while I am excited about the arrival of our new baby I am also worrying about the $2,500 that will be due in about 7 weeks. We have it saved, because after having two children under this insurance we knew what to expect and planned accordingly. But in 7 weeks our bank balance will be zero yet again.

There are some things I will never understand about the business of having babies. If I could have them naturally I would, but my anatomy doesn't seem to know how to do it and therefore, I have c-sections. I realize c-sections are surgery and surgery is never an inexpensive endeavor, and more expensive than a regular delivery. But what really gets me sometimes is that I could probably have "aborted" for free (I never would under any circumstance). Some government entity would have fully funded that choice. But to have a baby that is wanted, will be loved, whose presence will contribute to the economy for years (have you seen the stats on how much it takes to raise a child to age 18), and will eventually become a tax payer - it doesn't make sense.

But mostly I'm just irritated that the same hospital that has worked my husband for 80 hours per week, for what will be 6 years, cannot provide coverage to their employees and families that relieves them of some financial burden when it comes to providing for their own health. It seems the least they could do.

Advice: know your hospitals insurance plan, talk to residents wives who have delivered under the plan, and start saving your money. Unless of course your program has a generous insurance package, then go straight to the hospital and have a baby.

More Blessings More Miracles

When I take the time to sit down and really think about it we have been blessed above that which we deserve. Here is yet another miracle in our lives that further reminds me that our circumstances and trials are known by the One who is in charge of it all.

For the second half of my husbands PGY5 he has been doing a sub-fellowship in Complex Spine at an affiliate hospital in another city. You may remember me complaining about the timing with the soaring gas prices. But so many good things have come from that investment.

1. He started this sub-fellowship at exactly the same time he was applying for interviews for a post-residency fellowship. One of the attendings that he meet and worked with knew the director at the location of my husbands top pick for fellowships. Another attending at that same hospital gave him a fantastic letter of recommendation.
2. Because this wasn't a traditional fellowship, my doctor wasn't included in the call schedule. For the last six month I have not heard a pager ringer. I have not been awoken in the middle of the night. He has been able to attend church every Sunday. That isn't to say that he hasn't worked late, he has. But for his wife who would be completing her 2nd and 3rd trimester at this same time, it has been a blessing to know he would always be home, eventually.
3. This fellowship is much more flexible than his traditional residency, primarily because he isn't on their call schedule. The attendings asked him when his last day would be and he told them we were expecting next week. Their gift to him: the last week in June completely off. 

The timing of this sub-fellowship, couldn't have been better and has benefited us immensely. We are both confident that without the last six months he would not have landed the fellowship of his choice. That fellowship in turn should lead to a promising job in the sub-specialty he is most interested in. Promising job prospects + happy husband = happy wife.

Sallie Mae

To Sallie Mae,

Thank you so much for providing my husband with the funds necessary to pay his tuition, buy books, feed and house him during medical school, etc. It is our intention to repay you all that was borrowed plus a hefty amount of interest which you have been so gracious as to capitalize each year.

Since beginning residency we have spent hours upon hours each year explaining why we need to put these loans into forbearance/deferment. And without fail each year something on your side goes wrong. It doesn't seem to matter how early we start this process it is never as easy or quick as you suggest.

In fact, most of the time crucial pieces of information aren't given to us. Like this last year when you told us all of the loans would be deferred, only to start receiving harassing phone calls in January stating our loans were past due. I wish I would have kept a running total of the hours spent on the phone trying to get this resolved. Finally someone working in the USA was able to explain that some of the loans can only be deferred for a maximum of 4 years, and that they were now due. Everyone else was happy to send more forms to fill out that meant absolutely nothing and got no results.

Yes, he went to medical school. Yes, he is a doctor. And yes, now we are paying you but we aren't happy about it. Neither of us expected to have to start paying back these loans until he was finished and had the ability to repay. At the time the loans were taken out he doesn't recall any stipulation about some being deferrable for 4 years, and others for the entire length of residency/fellowship. For someone interested in a lengthy residency that information would have been useful, and remembered. Where was this disclosure?

If you are accepting suggestions might I offer one? I would appreciate speaking to someone who is familiar with medical school loans specifically when we call and have questions. Instead we get to talk to the same people who are dealing with smaller, straightforward loans, usually in another country. When you are dealing with balances that are quickly approaching $300,000 (thank you capitalized interest) you should have people who know the specifics of these loans inside and out. One phone call should be all that is needed. Let me remind you, your customer is a doctor! The odds are good that he won't be available to take your call during your business hours, or have hours to spend trying to figure out your mess. You need competent people who are available during hours the doctor is available.

I've been using the word "we" here rather loosely. I am his wife, and you won't talk to me directly about his loans. Instead you call and I take messages, when I am really the person you should be talking to.

Our annual (and sometimes more frequently than that) dealings with your company have firmly resolved us to pay you off as quickly as possible so that we never have to speak to your company again. It has not been pleasant doing business with you.

Sincerely,
A Doctors Wife

Day Dreaming

Is day dreaming about the future dangerous or healthy? My internal jury is still out on that one, and I've been waiting for the verdict for a long time.

I remember in the early part of our residency thinking often, either by myself of with my husband, about the things that would be different when we actually graduated from residency (and now fellowship), and paid off those student loans, and had some money to spend (at least that is the promised payoff for all this work, right?)

We live in a house that is 35+ years at the moment. My dream has always been to buy an old house and have Tom Silva and the crew from the PBS show This Old House restore it. My husband on the other hand doesn't want anything to do with old. He likes they way some old houses look, but he wants it to be new. I think he's tired of maintaining this old house! I assured him Tommy and the boys would do a great job. I think at this point we have settled on a new house that looks old.

One day while visiting the home improvement store, which is where you spend a lot of time when your house is older, my husband purchased a magazine for me. It was the October 2007 issue of HOME and in it was my dream home, complete with floor plans. I've been saving this magazine for the last 4 years!

On anther trip, this time to Sams Club, dear hubby picked up a vacation brochure with exotic locations. I think the advertising party was Pearl Resorts in Tahiti. We've picked out our big vacation already: Bora Bora. The beaches in the photos were stunning. One day maybe we'll actually go on that vacation. Our first vacation we've already decided would be a family celebration: Walt Disney World or Disney Land, depending on what side of the country we live on.

And then for my husband there are the cars. I already mentioned that he is a car guy. Whether or not he will purchase one when he has the opportunity and means is yet to be seen. But he does like to look at them, talk about them, pretend he is buying one online, etc. It must be in his blood. On his father's side, and to a lesser extent on his mothers, the men have all have been fascinated by beautiful, refined machinery. My husband likes to tell me that he'll buy me a certain vehicle and then I have to remind him that most of those cars don't fit a family of 6. Maybe it can be my weekend, run errands by myself car.

Most of my dreams are of a far lesser scale.

• hire a gardner/landscaper so husbands home time isn't consumed with yard maintenance.
• have a standing day/time/babysitter so we can go out together.
• drive cars that are new enough to not need the constant maintenance.
• be able to furnish and decorate our home with stuff we pick out instead of what we've been given, or what we've made do with(out).
• be able to treat ourselves to little things without fear of breaking our budget.
• give gifts to each other that aren't under $50.
• fly our parents out to visit us, and fly out to visit them more often.
• when something does break, or go wrong, have the ability to fix or replace it immediately.

It seems like we weren't the only people to get in on the act as I can recall my mother even sharing some suggestions! It was during a particularly rough patch when all I wanted was to be near my family so when I was having "one of those days" I could call and someone who would come to my rescue without me having to explain. I don't remember her exact words, but it was something to the tune of "one day you'll have the money to afford someone to come in a few times a week and give you a break".  That's a great suggestion, but what about today! While I don't remember the words exactly, I remember very clearly how I felt. My mother just told me to buy myself the help that she gives my sisters for free. The underlying message being that money would solve all of these insignificant problems I was experiencing now and would be for the next several years. How was the thought of being able to pay help in 7 years going to help me today when I actually need the help?  Since I was already feeling stressed and tired, I am sure I took her comments to be something other than they were meant to be. I got over it - you have to.

Which brings me to my final point about day-dreaming. I hope in the future our financial situation will be brighter. I hope that we'll be able to have the resources to enjoy many of the things we have sacrificed through this long journey. But those are still distant, albeit closer every year, dreams. Reality is we have to live our life now, not on promises of tomorrow. And the truth is you can't purchase a family, some things cannot be substituted or replaced.

Every now and again I slip back into the day-dreaming mode, but it isn't nearly as often as it used to be, and I don't hang out there as long. Some days it helps to lift my spirits and other days it doesn't work. Today is real. Tomorrow is still a dream.

Vacation Myths

Summer. A time filled with vacations, family outings, BBQ's, ball games, pool-side, you get the picture. It's Summer in the USA and everyone seems to have wonderful plans to look forward to.

But, alas, the life of a resident and his family. Maybe one day this will be a joyous time of year, but for the last 5 it hasn't been, and for the next 2 it probably won't be.

We live in an area of the country that is dominated by white-collar workers. The major employer in the area has one of the most generous benefits and flex-time policies that I've ever heard of. So much so, that I've even considered getting a job there! They also work 4-10 hour shifts. They get ample vacation time. They even get paid paternity leave. They have their own private "employees and their family" resort.

We also live in a university town, and several of our friends are professors - translation: summers off. I am beyond jealous. First,  that some of our friends get their husbands for most of the summer to themselves and their family. Second, that both of these groups of our friends get to take vacations. So at the moment, just about everyone we know is getting ready to go on vacation. I'm sad. We aren't going anywhere, again.

Can't we take a vacation you ask? Well, technically yes - realistically no. We haven't had a block of time off of any significance since we started residency. Yes, the hospital gives the residents vacation time - but no one uses it. (They also give sick days, but residents work sick-unless it is really bad. My husband has missed work because of illness once in 5 years). With the exception of the Intern year, he has yet to use even half of the vacation time they "give". The residents may take a day off here and there for various reasons, but a week or two? Never. We've even scheduled to have our baby on a Friday so my husband won't miss more work than necessary.

Residency programs aren't  staffed, or have the flexibility, to cover a residents absence more than a few days without the other residents (and their families) feeling the burden. "I don't want it happening to me, therefore, I won't do it to them" seems to be the prevailing thought, and I can appreciate that. Or "if I take a week or two off for vacation, I might seem like I am not a team player or dedicated to my job".  A residents job is to look good, they need good recommendation letters, they need as much time in the OR as possible, they need to be at work. They also need time-off. But, residency programs aren't known for their pioneering efforts in work/life balance.

There are some weeks when having one less resident wouldn't be felt, but those times can't be predicted ahead of time. And even if they could, they might not coincide with a time that is convenient to travel. Unless you are the type that can pick up and go at a moments notice, this strategy of "vacationing" doesn't work.

Until we are the master of our own schedule and case-load it doesn't look like we'll be vacationing. But I am telling you now, that first vacation we take is going to be awesome and longer than a 3-day weekend! Maybe that year we'll even take two!

Thankful for Technology

Every now and again I remind myself that things in the world of medicine/family were worse before we entered it, and I'm not just talking about the work hour restrictions. Before cel phones, text messaging, and instant messaging how did families keep in contact with their spouses at the hospital?

My phone is my life line to my husband. If it weren't for our mobile phones there would be days when we didn't get to talk to one another. Thankfully, because of this amazing technology it doesn't matter where I am, he can call for 45 seconds, or send me a text, letting me know what is going on in his day and even when he might be expected home. Or I can snap a picture of the kids and send it to him on his phone for the next time he has a moment to look at it. We are connected in a way that wasn't possible before. We are able to share information about our day as it happens instead of trying to recap at the end of a long day or long week.

I don't know how spouses survived the long hours and the unavailability. That must have been a whole different kind of hard that I hope to never know. So today I am thankful that this little device allows our family to stay connected.

Boys vs. Girls

Warning: I am feeling sorry for myself.

Ah, Saturday - and it happens to be a day off! But wait. There is always a but. That's right the doctor isn't in. In all fairness I could be with him, we could all be together. That also means we would all be miserable together.

Today he is in the big city with our son attending the PhD graduation of his brother-in-law. His step-mother who we haven't seen in a while is coming up, it should be a great reunion of sorts. Before the big party he and our son are going to spend some male bonding time (because this poor little boys doesn't get nearly enough of that in a house full of girls) at a museum. And when they get home it will be past bedtime. So on the doctors day off, I have seen him for about 60 minutes.

I'm trying not to feel to depressed about the arrangement, because I could be there, I realize it was my choice. But I am due in 13 days. The car ride is 2.75 hours each way. The baby's position makes it difficult to sit very long and I can't walk very far. I would be miserable, and everyone with me would be, too. So the boys have left and the girls are home.

We've tried to make the most of it. This morning I got them bathed and dressed up and we went out to lunch. Then we came home and took naps together. And for the evening I think we'll do a little window shopping and then come home and paint finger nails and toe nails. I think I may even let them attempt to do mine. That's right I still haven't gotten the professional pedicure I was talking about. Before the baby comes though!

But the point of this post is: there is always something that takes up the doctors time on his day off. Always. Days off are more of an illusion, a happy thought, than reality.  At least when the baby comes he will have a few days off. We'll see if those days turn out to be "off".

Add Personal Assistant to My Title

Not only am I the doctors wife, mother to his children, housekeeper, financial planner and chef, I can now add Personal Assistant to my resume.

The doctor found out yesterday that he needed to have logged all of his surgical cases into their database by the end of day.  He keeps barcoded printed stickers for each of his cases in a little black leather journal in his "office" at home. He called just after lunch to see if I would be able to scan some pages and email them to him so he could input them between clinical patients. So I scanned and emailed several pages.

Then when he came home he once again began working on these logs. They were slow going. So after putting the kids to bed he asked if I would help him by reading the information to him so he could input them into the database and make the deadline. We were done just before midnight, and he said that had I not helped he probably wouldn't have slept. Not a good thing considering he had cases to do today!

It is easy for me to lecture him on the importance of logging them once a month or even once a week to avoid having to cram a years worth of surgical cases into one evening. But, I also don't work 80 hours a week as it is. I can imagine that mundane task being the last thing he would want to do at the end of the day. Probably a lot like me and dishes. Chances are good we'll probably replay this event next year - hopefully for the last time!

(For the HIPA worriers, there were no names and I have no idea what the CPT codes meant, I was just reading numbers in the order he needed to enter them).

Resident Graduation

Last night my husband and I attended the annual resident graduation and dinner hosted by the hospital. The closest thing to a date we've had in months! These events are always lavish affairs and it is nice to get out and see the people that my husband spends most of his time with.

It was also sad. Many of these people we won't see again. They are headed off to jobs in different states, starting new lives, and many of them starting families too. And then I got really happy as it sank in that next year that will be us! Instead of watching people move on, for yet another year, it will be our turn to leave the "nest" and pursue the next chapter in our life.

We have one year left in residency. It's amazing how quickly the past 5 years have passed, but at the same time how long they have been. Can those two sentiments co-exist? Looking back they were fast, and I hope, looking forward, the next year will go quickly.

Anyhow, back to the party. We could have brought our children, but decided not to because we don't get nearly enough time alone. That and getting myself ready was work enough I didn't want to multiply that by 4! Next year we'll have our family of 6 celebrating a long awaited, hard-won, achievement. This will be the party of the year (for us).

My husband is wonderful. I can't go anywhere without someone who knows him telling me how great he is to work with, how nice he is, what a wonderful surgeon he is... they go on and on. I know it's true. Last year at this event he received the Resident of the Year award, and this year the program director couldn't help but gush over the fellowship he will be starting when we leave this program. Neurosurgeons are often known for their egos, but this man is humble. A quality I admire.

Drive Yourself Crazy

I often joke that as part of being married to medicine wives should be given a refillable prescription for the anti-depression/anxiety medication of their choice with no expiration date. Mine would be dispensed out of a gum ball style machine. There are so many things that happen along the way that can really throw ones balance off. Having said that, I jest about taking medication but have never taken them. It has been a temptation on more than one occasion, and it has probably been warranted more often than that! If you do, your mental state is probably a good deal better than mine, and I may be jealous. Once again, blogging is cheaper than medication!

One of the many things that can drive a person crazy is thinking of all the possibilities for the future. Where will we be for medical school, internship, residency, fellowship, jobs? Will they have good schools? Will housing be affordable? Will it be near family? Will I make friends? Will the weather be nice? The questions are endless and can consume ones mental energy for a long time if you allow it.

Trust me when I say I have driven myself crazy over each of these questions! By nature I am a planner. That is how I tend to cope with the unpredictable, I try to plan for it. If I had a crystal ball it would be well used. I dislike surprises and I am not spontaneous, but I like to think I am still fun - I just like that fun to be well-planned:-)

When my husband was applying for internships and residency I researched all of the possible locations. In the end I only needed to research one and I didn't need to start researching until after the match. There was still plenty of time, even for me. This time around, as he has interviewed for fellowships I have had to force myself to NOT go overboard with my planning and predicting. Let's face it, the fellowship won't start for another year and anything I find today could possibly change by then.

I thought I would be relived when we knew where we were going for fellowship, and I am. But apparently not enough. I still fret over where we might end up, because it will most likely be the place we call home for the rest of our life. It's a big deal! So when my husband tells me of where the current positions are available for his speciality I only listen with one ear. I won't allow myself to get all worked up this early in the game. When it comes time to apply and interview once again I may slip into the mode, but only long enough to narrow the list to my preferred locations. No wildly long spreadsheets, no sleepless nights trying to guess where we might go. No more driving myself crazy over something that I have very limited control over. Because if there is one thing I've learned on this journey it's that we don't really control our destiny - we go where we are accepted. Hard pill to swallow when you like to feel in control of your future.

Relax. Breathe. See what life has in store for you. (Advice from myself to myself. I hope I take it.)

Medicine Is A Family Commitment

I realized long ago that in order for this to work we had to be a family devoted to Neurosurgery, we would all be in this together or it would be a disaster.

When we married, my husband was an MS3 and was in the process of deciding what he wanted to be when he grew up. We would talk it over, forward, and backwards. His other interests were Pediatric Cardiology and Orthopaedics, both of which were just as long as arduous as Neurosurgery. So I knew from the very beginning that regardless of which specialty he chose, I would be in for a long ride. What he wanted to be wasn't nearly as important to me as what he would be most happy doing. I couldn't think of anything worse than being married to someone who had regrets about what he chose to do with his life. A specialty is a commitment that is difficult to change midway through.

I think I've mentioned before that we've had two discussion during this residency about whether or not we (I) can survive. It is me who just can't seem to go on another day, and me who needs to express it. Both of those times he has said, and I believe him, that he will do something else if it means we will all be happy. And each time I gather enough strength to go on again. Most of the time going forward on your chosen path is easier than giving up and trying something new. Plus I am not a quitter, a whiner sometimes but I don't give up. That doesn't mean I don't have to remind myself that "we" chose this! What I also try to remember is that when we made the decision to specialize in Neurosurgery we both felt good about that decision and agreed to move forward having faith that it would be for our good (and probably good for his patients as well).

It is a long ride, but I don't have the luxury of being a passenger only. When you are married to a medical professional you are a part of what makes that man who he is. Hopefully as a spouse we can make it easier for them to go about doing their "jobs". Our work is often silent and most of the time not nearly as glamorous as I would like, but it's my part in making it work. I certainly wouldn't want my doctor worrying about things at home (cleaning, cooking, shopping, laundry, bills, etc.) when he should be concentrating on my tumor!

My husband often jokes that it is a good thing he doesn't handle our finances, and I agree! I know how much time it takes me, and he doesn't have the time to do it. The role of a medical spouse cannot be underestimated. While I don't always agree that a residents life is conducive to having a spouse or children, it is that same spouse and children that make a residents life complete and well balanced (and well-fed).

Behind every good man/doctor, is an amazing woman. I am meeting more and more of them each day. I just wish they lived closer!

Should Have Been A Dentist

There are days when I wish the path my husband had chosen would have been shorter.

Last week I called to make an appointment to see the dentist for a check up and cleaning. As I was talking with the receptionist, trying to schedule this appointment, she told me what their hours were: Monday-Wednesday 8-3, off Thursday, and 8-12 on Friday. No wonder I have a hard time getting in! With a schedule like that the dentist is always booked.

I have a friend who is married to a dentist. Whenever I see her around town she is without her three children. It doesn't matter what time of day or night, she is always on her own. When I ask "where are the kids?" she says, they are with their dad. In their defense he is a good 12 years older than we are so I suppose you can say that he's put in his time. Now he works just a few days a week. I can't begrudge that. But I do get a tad jealous when I think of all the time they have together (or alone).

I am not the only one that laments not going to dental school over medical school. Occasionally my husband will get in on it too! No residency. You graduate and can start your own practice. There are virtually no emergencies. Regular hours, no holidays, no weekends, no evenings. He did think about it. He has several extended family members who are in some aspect of dentistry, but it wasn't for him.

Some people have passions, some have jobs, some people have careers, some have callings. Those who choose the long road in medicine must be called, because who else would sacrifice so much? I try to remind myself that this is more than a job, more than a profession, this is part of his calling in life, and by extension my calling as well.

The Blessing Van

On our way home form church today I was thinking about what else but cars, money, and blessings. Since my last post was about a car, I thought today's post could be about the blessing van.

Three and a half years ago a friend of my in-laws was sick and his family was liquidating his assets in preparation for putting him into assisted living. They contacted us to see if we wanted to purchase a van and assured us it was in great condition and an excellent price. As much as we wanted to say "yes" we didn't have the money to buy a van, or anything else. We had just found out we were expecting again (common theme throughout our residency years) and were planning on putting three car seats in the back of our aging, paid for, sedan. We hadn't shared this information with anyone yet and we were planning on doing something "cute" to break the baby news at Christmas time.

My in-laws were scheduled to visit us the next month (November) and we were excited to have them. What we couldn't have known is that they weren't flying but driving 3 days cross-country in this van that they had purchased for us as a Christmas present. After a present like that, we couldn't help but break our news to them early. A van that would comfortably fit our growing family is exactly what we needed. They didn't know how great that need was, but they purchased this van anyway. Some things in life have a way of humbling a person. This was one of those experiences where I have felt that my Heavenly Father knew who I was and what my family and I needed, and he had prepared a way for those needs to be met by someone who also loves us.

Driving home in that same van today I was overwhelmed by what a blessing it has been. Not only was it given without condition, the van has required nothing of us. We put gas in it and we change the oil. It hasn't needed anything else. That is amazing! The van is 10 years old and will have 100,000 in a matter of months. More than amazing it is a miracle.

Need To Save Money, Buy a Car!

Some of the financial decisions residents arrive at may not make sense to most people. I remind myself most people aren't residents.  My example for today: buying a car.

I've been a tad irritated with my doctor husband for the last two weeks because he has spent nearly every moment of free time he has either doing online research, or at dealerships trying to work out a deal on a car. At first I thought he was just wasting time, because building luxury cars online is one of the ways he relaxes - or so it appears to me. Soon those luxury cars were looking more like used foreign cars and then the talk about maybe trading our car in, and then he was talking to salesmen and the bank. Maybe we don't need a new car maybe we do. It depends on which side of the checkbook you are standing. Oh, and by new I don't really mean new, I mean new to us.

The car my husband drives we bought three years ago after we dumped our savings fixing his old car. We find ourselves again in a position where we have spent thousands of dollars fixing this car with no guarantee that something else won't go wrong. It has 115,000 miles and is 8 years old. My husband has put at least 45,000 miles on it in three years and the odds are that something else is going to go wrong in the next two years. Somethings can be predicted. Miles + years = repairs.

So we have discovered that we can save an extra $50/month by trading his car in now for one with half as many miles, better gas mileage, and 3 years newer. Chances are better that this combination of miles and years will not yield as many repairs over the next year or two. We cannot afford repairs of any size at this point in time. It is still risky, but we're going to give it a go.

To most people this decision might not be the right one. After all, the car he is trading in will be paid off in two years. In two years he would certainly need a new car, and in two years we will be able to afford one. Great! But in the meantime, today we need that extra $50/mo even if it means we'll have a car payment longer. It works for us.

I've talked about our finances before. They aren't looking pretty right now. We have to come up with a way to save every available dollar over the next year. So we are canceling our basic TV package, canceling our home phone, dropping extra activities (races for my husband, stamp club for me, ballet for my daughter, etc), and trying to save money on everything else. The only thing we agree we won't give up is our gym membership, it has been my outlet for the last 2 years and they have free babysitting. Its the only time I get to spend alone and is money well spent if it means mommy will be sane.  Again, cheaper than therapy.

So today we have a shiny, new to us, car sitting in the garage next to my van that is coming up on 100,000 miles. Hoping and praying that the van we don't have any payments on will continue to bless us with limited maintenance and safe travel for the next 2 years, at which time I am getting a new van! Probably just another new to us van.

Good Friends

Another sprinkling of thankful thoughts.

I've been fortunate to have good friends throughout our time here. They move in and they move out, but I've been blessed to have at least one of them here at all times.

The first was a sweet woman I met when we first started going to church here. For the first three years of our residency she lived here but has since moved to New York. She is the mother of 7 children, and we had pregnancies that overlapped, so some of her children were the same age or very close to mine. She was always so optimistic and faithful about the events in her life. She taught me that family was the most important thing. She is a terrific mother, and one I want to be like. Her husband is a corporate attorney and traveled frequently so she was familiar with our lifestyle. She was the kind of friend that even though you might only see each other on Sunday you knew you could count on her. She was always offering to help. I've missed having here. She was my beacon, my example of how to survive and do it gracefully.

The same month that this friend moved, a new friend entered our lives. A third year medical student, his wife and their daughter moved into our congregation. Naturally having the same professional interests we were destined to be friends. Their daughter was the same age as my middle child and they were expecting. It was almost like looking at us as we moved here with one child and were expecting. Our daughters played together, we swapped babysitting, shared dinners together, and saw each other at the gym often. They moved last month for their internship and they will be missed. She exemplified living a joyous life. I don't remember ever seeing her down. She has an adventurous spirit that I admire and find lacking in myself. She is thoughtful and generous. She will be missed.

About a year ago another dear friend came to my rescue, although I'm sure she didn't know it at the time. Our congregation had some boundary changes that brought new families into our ward. I quickly discovered that she and I were members of the same gym and attended the same classes but at different locations. We decided that we should be workout buddies and for the last year I have enjoyed seeing her a few times a week. Not only has it helped my discipline at the gym, but it has provided for some time to talk, without children under foot, that I usually don't get. After an hour long class, hanging out on the treadmill to talk is a treat. We also have children that are near the same age and she has such a dynamic personality. She pulls me out of my shell and has introduced me to many of her friends who have become my friends. She has taught me to loosen up a little bit and just have fun, stop being so serious all the time. When I think about moving next year, she is someone that I will miss the most. 

Last night she threw a baby shower dinner for me at a local restaurant. I told her that I didn't need a shower as I already had everything from my previous baby born during the same season of the same gender. She wouldn't hear of not celebrating this occasion. She is probably the most social person I know! So for the first time since I've lived here I went out to dinner with friends, many of them thanks to her introduction. As I looked around the table I realized that I have been missing out on so much of life. I've used my husbands job, our finances, our children, etc. as a way to shut myself off from people who I need in my life. 

There are so many people around me who have offered assistance of all kinds that I rarely take up on their offers. Why? I think most of the time I don't want to impose on their life. They have things to do, kids to take care of, houses to clean, etc. I know that most of them wouldn't expect to receive anything in return. I need to do a better job of letting people in. It is something that I have struggled with my entire life. But I am going to try harder.

The Big Mistake

Having the benefit of hindsight I can say the biggest mistake we made as we embarked on residency was purchasing a home. A BIG mistake! The home isn't big, the mistake was. You probably thought, it was all those kids we had:-).

In a way the two were related. We knew we were going to live in this location for 6 years, we knew during that time chances were good we would have more children. I mean we already had one and were expecting another, so the odds were that in 6 years we would have at least one more, if not two, or three. A family needs a place to call home, kids need a good education, we needed to feel safe. It seemed silly to rent and throw away money for 6 years. We justified ourselves all the way to the bank. Where the loan officer confirmed we could afford the house we selected and more. But what did they really know about us? On paper I'm sure it looked like we were crazy for not spending more.

We did look at really inexpensive homes. After we exhausted all our options in our initial price range, eliminating all the ones in so-so neighborhoods, with tiny bedrooms and one tiny bathroom our realtor suggested we move up a little bit in price. Of course, after looking at homes the size of a mobile home anything she would show us would look great. And it did.

We settled on a home that was about the same age as myself. To it's credit it backed up to a nice neighborhood park, and was in a good school district. We knew it was going to be tight financially, but after looking for days didn't see another option, or wouldn't consider another option. One being we could rent and keep looking. But I didn't want to have to move multiple times. How lazy!

So we bought this home. Which would have been fine, until it wasn't. See a home of about any age needs constant nourishment in the form of maintenance and upkeep. Before we knew it we needed a new roof, garage door, gutters, water heater, and air conditioner. Now it needs a new driveway, appliances, and flooring. It's not going to get something it wants or needs because we don't have anything to give it. It has drained all or our resources and isn't going to give anything back.

We knew it needed work when we bought it, but we were hoping the work it needed would be cosmetic. The fun stuff like paint, appliances, flooring and lighting.  Instead we've poured more money than I care to recount into the necessity of "keeping it up".

What would we have done differently? I wish we wouldn't have gotten hung up on owning a home. I think we felt some sense of entitlement after finishing medical school. That somehow we had earned the right to our own home. That the length of time almost mandated that we own something. Isn't that what most people in their 30's who have graduate degrees and children do?

Again, this problem of owning a home wasn't supposed to be an issue. When we bought the home the economy was in a much better place. Our area hasn't been hit as hard, but anyone would be hard-pressed to find an area completely unaffected. We weren't thinking about having to sell the house for a profit, we just wanted to break even, knowing that by the time we were ready to sell we would have a nice big check (thanks to our new "real" job) to help start us on our way. Now that the circumstances have changed we have the added worry of getting our home ready to sell on a budget that doesn't exist, in a depressed housing market, with the anxiety of needing to walk away from the closing table (assuming we can sell it) with enough money to pay our first/last month rent when we move.

Advice to medical students and residents: Don't buy a house. There will be plenty of time for owning a home later. Unless you have piles of money to throw at it, stay away from the bank and go directly to the rental office. Use the money you save by not having to maintain a home or yard to have fun and enjoy your family. Spend time together, and maybe take a vacation. Build up your savings account, because all sorts of non-home related things can go wrong (cars don't last forever). Instead we are a slave to this house. Don't be a slave!

Healing - What's Bothering Me?

I woke this morning with yet another revelation. I knew this blog would be good for me.

I have a family blog that I've maintained for the last 3 years. You know the ones dedicated to your kids and all the fun, happy things that happen in your life. Where all the pictures have happy children and only the best of the best are blog worthy. I stopped blogging in November and for the next 7 months. I just couldn't bring myself to do it. All of the things I wanted to say didn't seem appropriate for the format I had previously chosen (happy, cheerful, we love life, etc).

My departure from my family blog also happened to coincide with the fairly recent discovery that we were expecting again (planned), my husbands announcement that he would like to do a fellowship, and the discovery that part of his student loans were due and couldn't be deferred any longer. The combination of these events really did me in.

I am by nature a planner, forecaster, spreadsheet making fool. This proposed fellowship was the wrench in my plan. You see, resident surgeons in my husbands specialty usually secure jobs the spring of their 5th year or the beginning of their 6th year. That would be us right now. With that signed contract also comes a signing bonus, or financial retainer, that binds them to that decision and prevents them from looking around further. It is often equal to or greater than their resident annual salary. It is a big deal. Many of our previous plans and decisions over the last 5 years, and more recently, have hinged upon that timing.

I am grieving. It seems silly to be upset over something like money, or rather it seems shallow, when you have been blessed with so much. But the position we are in now is one that makes me worry significantly. For the last six months we haven't been able to save any money. In fact our savings rate has been negative. Meaning we have been using what had previously been saved. When we got married we vowed to never carry a balance on our credit card and we have managed to successfully do that for the last 7 years. It's not something we would consider breaking lightly. It's been tempting, but we've resisted. That we've been able to do it this long really is a miracle in itself.

Any one of the following would have been bad enough by itself, but they have all come at the same time:

• My husband has been doing an internal complex spine fellowship about 45 miles away at an affiliate hospital. He commutes 90+ miles a day, 5 days a week. The timing couldn't be worse as gas prices in our area have averaged above $3.90 for the entire 6 months. So any savings has been claimed by the gas station. 
• Starting in January many of the smaller student loans that were unsubsidized were called due. We thought for sure that all of his student loans would be deferred until after residency. That isn't the case. Apparently you have 4 years and 6 months from your date of medical school graduation for some types of loans. So in January we also started paying back student loans.... Sallie Mae received anything we could have saved. 
• In January the state that we live in also increased their state income tax from 3% to 5%. It is a flat rate on your taxable income which is a 66% increase in the amount of state taxes we pay. Taxes! More potential savings given away.
• Fellowship interviews. Fellowship interviews are a lot like interviews for residency in duration and intensity. Fortunately, we only had two interviews before we found out he was accepted to the one that we wanted and he could stop traveling. These interviews, again thankfully only two, were on our dime completely.
• We have a baby coming in June! The hospital/employer that our residency is attached to doesn't have a very generous insurance package for their employees. In our case we pay a deductible plus 10%. All of our children have been born via c-section. Our costs with each birth have been $2,500. 
• We own a home. That is probably all that needs to be said. The costs associated with getting it ready to sell wouldn't have been an issue if we were moving on to a job instead of a fellowship. We can't lose money on the sale of this home. There is no money to make up the difference.
• Moving expenses. If we were moving on to a job, moving expenses would be in our contract. A 1-year fellowship doesn't come with moving expenses. Yet another expense we will bear in addition to the expenses associated with finding a place to rent.

Bottom line: we are running out of money fast and the payday we were counting on has just been delayed by a year.  I am stressing! After we pay for the delivery of our baby, our savings account will be zero, nil, nada!

When you are pregnant the last thing you want to be is worried. Somehow everything feels worse, but I know this is bad even without being pregnant! Having said that, I am a believer in miracles. I know that some way, some how, this will all work out. I know we'll be able to keep our commitments and find a way to take care of the things we need. I just have no idea how that is going to happen. That drives me crazy! It will take a miracle, and I hope there is one more left for us. We could really use one about now.