Making Mistakes: Part 4

Just when I think I am nearly running out of mistakes I make new ones! But that is all part of the improvement phase of life which I am understanding to mean the improvement phase of your entire life.  I really only have a few left in this series.

This one isn't necessarily the most painful mistake, but it was costly. Most mistakes cost something in terms of money, relationships, emotions, physical harm - if there wasn't some visceral consequence of making a decision how would we knew we could have made a better choice?

Sadly, not all decisions are logical ones - sometimes they are purely emotional ones that you can't argue with even though you know what the consequence will be.

Mistake #4: Taking an entire month off before starting the real job

This is one of those mistakes where I knew it wasn't a good idea, but how do you tell the man/woman who has spent the better part of two decades being told where to go and what to do that they need to start work sooner than later. They have an entire career of work ahead of them. It seems like an eternity and this is the last rest stop on the road.

I think everyone I know looks forward to taking a month off between the end of training and the start of a new job. It is almost expected and is one of the "prizes" we think we all earn. When will there ever be another time that you can take 4-6 weeks off and just do what you want before embarking on a career of long hours, stress, and life saving work?

So when he signed the contract and I looked at the start date I knew it wouldn't be rainbows and flowers. I knew because as part of my homework two years ago, so I would not make a tragic mistake, I ran across this article  appropriately titled Two Big Mistakes Graduating Medical Residents Make. For a time I even had this link on my sidebar so I saw it often. Didn't matter! I forgot all about it in the euphoria that is signing a contract!

Sure, that month off was nice to spend with my husband and children. Yes, it was nice to sleep in and not listen to a pager go off in the middle of the night for an entire month. Absolutely, we had a great time!  We took a couple of weekend trips, visited family, and just relaxed. We did everything we felt we couldn't do during training.

Here is a warning, given in love, from someone who was very recently there:

That time off has a fixed cost. In fact when you look at it from a financial perspective that month off may have been the most expensive month of our entire lives. Think of how much that month off will cost you in terms of dollars. I don't always think about money, but money is important and learning how to tame it is a survival skill.

The larger your salary the greater the opportunity cost of taking time off will be. Let's say your salary will be $400,000/year. If you divide that amount by 12 you are looking at a gross income opportunity loss of $33,333 for that one month that you will never get back or make up. Of course the net amount will be vastly different (love taxes), but even then the net loss would be somewhere in the neighborhood of $20,000. What could $20,000 do for you?

Can you afford to miss out on $33,333 in earnings and approximately $20,000 in cash? Is taking a month off worth that much money to you? If the answer yes, then maybe taking a block of time off is the right decision for you. If the answer is no, maybe starting work sooner than later and then taking a vacation after you have worked for a few months is the right decision. You know doctors get vacation time, right:-)

Suggestion:

Spend some time as a family deciding how much time off is needed or appropriate for your situation and financial goals. Have the conversation and consider the financial implications. Are you buying a house, want new furniture, must have a vacation now, just want do do nothing? Once you can identify what your priorities are, you can determine what portion of your income you are willing to miss out on to have it. Maybe all you really need is a week, not a month.

For me, I wish we had started work earlier. In our case, it would have been well worth it for me to move our family in and unpack all by myself. I would have gladly done it alone, in the pouring rain, barefoot, in exchange for the amount that we missed out on.

Now, almost 3 months after starting work, we finally feel like we are catching up from that 1 month we took off. Was it worth it? It was nice, but it wasn't worth missing out on $xx,xxx. One week or two would have been sufficient, a month was too long.

Decide what is right for you and your situation. Decide.

Here is one mistake you don't want to make - Medical Monday's is coming on this next week. Monday November 4th. Yes, the bad news is that it is November and the good news is that you can start the week off right by joining with us!

Making Mistakes: Part 3

If you haven't noticed I am much harder on myself than anyone else is. As I have been thinking about mistakes made this last year I can't help but see some of them as only half mistakes. After all, every time I drive my van I am not cursing the darn thing. No, I actually love it.  And while "it" doesn't necessarily make me happy, I do derive some measure happiness from it.

The same could be said for all those celebrations. I still wish I would have used a different word for those extra times we ate out because we were just too lazy/tired to cook that day, and suddenly had the option of doing something different.

Occasionally, I look at two presents my husband bought me and wish he wouldn't have. But I don't necessarily want to sell them either. I suppose with a real mistake I would be selling them right?

He likes to give gifts, and has excellent taste, and might have gone a little overboard. We all know those kids whose parents don't allow them to eat sugar and than they get invited to a birthday party and gorge themselves on sweets. I think that is a fair description of what may have happened to him (and I went along for the ride). And this is a little confession within a confession: I might have hurt his feelings with my demand to stop buying things which might explain why for the last 9 months the gifts have been, well, like they always were before.

So where is the mistakes? My ramblings above probably should have made the previous post.

Mistake #3 - Not Being Prepared for End of Training Expenses.

This one may seem like a no-brainer, everybody knows the last year is the most expensive. Maybe. But here is something that really stinks: when you do a fellowship is like having two "last years" and that most certainly stinks.

Our last year of residency was expensive partly because of a house I don't want to write about, but must. My feelings on owning a home during residency are nothing if not strong. Owning is a huge risk. Only you can decide if those risks are worth it. If I had to do it over again I would have rented.

Our fellowship program didn't provide any assistance for moving/relocation, the fees, the licensing, the DEA, all those agencies that require documentation and approval before you can actually begin. It was a brutal year.

By the time we received the stipend things were bad. We had made a vow to not carry balances on our credit cards and this was the first time that it looked like there was no other way. We had already liquidated everything we had. There was nothing left. And then the stipend came and saved us from breaking a vow we had made and successfully kept for years.

Then you discover it is all gone. through a combination of spending/celebrating and more fees/licensing/boards  Yes, you read that right. Gone. In 10 months it feels like it just evaporated. We had a few things to show for it and a great vacation, but that's it. Not a dime was saved.

By the time my husband received his first real paycheck we were broke and putting our groceries and gas on a credit card because we knew he would be paid before the statement came due.

It is an interesting feeling to be so poor and so rich at the same time. We still had our humor and laughed at the situation. My husband is removing a brain tumor in the morning and then listening to his wife cry in the afternoon over not having any money in the checking account. It is funny.

We kept asking ourselves, how is this possible? Well it is. Money is like sand through your fingers - you have to make an effort to keep it from spilling out. We received the stipend and gave up our hold and it slipped through our fingers. It was an expensive lesson.

Here is the warning, given in love, from someone who was recently there:

Nothing compares to the feeling of security and comfort that comes from being prepared. It is truly priceless. And isn't that one of the things you are looking forward to having when you are "done"? The good news is you don't have to be done to have a sense of security. Unless you make an actual plan (that hopefully you and your spouse agree to) you are going to come to the end of your journey in utter disbelief.

You are going to need money in the bank at the end of training, not just promises of money on paper to be paid at a later time.

Although this isn't our particular situation, you don't want to be in such a financial mess that you take the very first offer you are given because you need the money. Desperate people do desperate things. Don't be in a desperate position.

Suggestion:

Before you start a spending frenzy or relax your hold, talk about what you want that stipend to do. Are you going to buy a house out of residency? Are you taking an extended period of time off? Are you having a baby? Are you buying furniture? What are your priorities? Make a plan, allow for the unexpected, and then work the plan! Its not enough to just make the plan, you have to discipline yourself to make it happen. Two different banking accounts are a good idea for things like this too.

Do some quick research into licensing fees for your state and set aside whatever amount you need. They are always more expensive than you think. Better yet, have those fees worked into your contract!

Don't forget money you might need for expenses between your last training paycheck and your first "real" paycheck.

It never hurts to have more saved, but it does hurt to have saved too little. Which side do you want to err on? Start saving now, it will be good practice.

Making Mistakes: Part 2

Thank you for all of your kind comments on my previous post. Once you make certain mistakes you know that they will never be made again. And speaking (writing) them out loud almost certainly insures that they never will be. I think we all know people who bought brand new cars from the dealership once and never again. And we probably all know people who always buy new cars. Neither decision on it's own it necessarily a mistake. That is what continually amazes me... the variables among individuals when making decisions is infinite. These are my mistakes, using my variables.

Mistake #2 - Celebrate Good Times, C'mon (dance with me now)

I previously confessed that once you start spending money it is harder to stop than saying no in the first place. Strange isn't it? But true. You can trust me:-)

Celebrating an accomplishment as long awaited as this, we are talking decades, is an important part of the journey. And I would never discourage a celebration.

Years before we actually signed a contract we talked about what we were going to do to mark the culmination of years of training and sacrifice. We decided that we would take a family vacation. A real family vacation.

What do I define as a vacation? A vacation is a place you travel to that is farther than a 3 hour car drive; it lasts longer than 3 days and 2 nights; includes experiences that you cannot repeat every 6 months; the lodging is better than what you have at home, and the food is better than 95% of the restaurants you have eaten in in the last 6 months; selection of activities appeal to the entire family and doesn't include sitting around watching cable tv. 

Up until this point we had not had a vacation as a family that didn't include traveling to see family once every other year and sleeping in guest rooms with children spread out on sleeping bags; eating at the kitchen tables that we grew up at; hanging out at home visiting grandma and grandpa, aunts and uncle, cousins, previous neighbors, etc. Oh, and one time for our anniversary we crossed state lines for a long couples weekend, alone. Once in ten years.

My children looked forward to this vacation since they could talk. Years before we would actually go they were telling people we were going. I was afraid that it would lose it's magic, but it never did.

Yes Magic! That was the name of the ship we were destined to sail on. It was going to be amazing. It actually was pretty amazing. It was 7 days at sea traveling to Cancun and The Grand Cayman Islands. It was pampering, it was entertainment, it was obesity inducing food (I did gain 5 lbs that week), it was everything we thought it would be and more. The looks on my kids faces was priceless and every day was amazing. They still talk about it. It was the best celebration we could have planned and money well spent. And it felt good to spend that money for this experience.

So how does this post make it into my series on mistakes? You must surely be confused.

Here is the warning given in love from someone who was very recently there:

We had chosen our "celebration" in advance, and then proceeded to name every other purchase that was out of the norm as a celebration. So what was the celebration? Was it the new cars, the actual vacation, the watch, the purse, the necklace? When everything becomes a celebration nothing is.

The night we signed the contract, we celebrated by going out to dinner. The night we mailed the contract back we celebrated. The day the stipend was deposited we celebrated. The van my husband bough me was a celebration of our good fortune. The car my husband purchased was his personal celebration. The necklace my husband bought me while taking his boards was a celebration of my hard-work and long suffering and his acknowledgement of it. The watch my husband bought me while on vacation was a celebration of our vacation celebration and a souviner. The extra pizza we eat each month was a celebration. Do you see what I mean?

A proper celebration happens once, it doesn't repeat itself every week, or every month.

When my husband came home with the van and then his car, and we had called those purchases celebrations,there was a moment when I was afraid our true celebration that we had been waiting for might not happen. It seemed ridiculous to take on credit card debt for our vacation that was supposed to be a celebration of having excess cash when before there wasn't. Thankfully, it didn't come to that. Don't jeopardize your planned celebration.

Suggestion:

Celebrating a major accomplishment is important, and please celebrate! Use the word celebration sparingly. Decide what that celebration will be, and enjoy it. Don't call delivery pizza a celebration. It's not (unless that is what you decided it would be).

Give yourself a small raise. If you have opened a separate checking account for your stipend to be deposited to, give your budget line items a raise. Increase your food budget 10%, set aside some money for a special date night out once a month. Decide how much of our stipend you will "use" and make a direct transfer to your household account once a month. Don't abandon your budget because you mistakenly believe you no longer need a budget.

There you have it, but there is more.

Making Mistakes: Part 1

About the same time I started this blog, I also began researching common mistakes, that we in the medical family make, so that I could prepare a personal defense sufficiently strong enough to prevent such unfortunate events from befalling my family. Quite an undertaking, I know.

I was going to be the best prepared and most informed spouse in history. I was going to be Super-hero ready! There would be no mistakes. I would not be tricked or deceived. Our performance would be flawless.

Guess what? Even knowing what pitfalls might be up ahead I walked straight into them. Not blindly, but fully aware of what the consequences were going to be. And for that moment I didn't care. Had I been able to look ahead to the next 12 months maybe I would have. That's life for you -  you don't get to see around the bend.

What do I define as a mistake? A mistake is something that happens because you did something that you knew you shouldn't have. You intentionally ignore logic and reason in the hopes that the consequences will not be as bad as you imagine them. Or better yet, that the consequences are imagined!

So let's begin. The mistakes are plentiful and I only recount them as part of my many confessions.

Mistake #1 - Making large purchases immediately following the long-awaited stipend.

Some residents secure jobs long before they are ever qualified to work. If you have a signed job contract 2 years before you can work, your stipend will be $XX,XXX divided by 24 months. If you obtain a job later in your training with say 9 months to go your stipend will be $XX,XXX divided by 9 months. The longer you receive the stipend the smaller the monthly installments are. The shorter the payment duration the larger the amount. (Depending on your speciality you may or may not receive a stipend and stipends very greatly among specialities.)

Immediately after signing the contract my husband marched off to the dealership. I was preparing myself to be mad... how dare he look for a car for himself. We talked about this, we weren't going to buy anything. And when we did we would replace our family van. I knew he hated the car he was driving, but it was reliable fuel efficient. We had a plan - but he was just window shopping. Where is the harm in that?

Perhaps he knew I wouldn't be too mad when he drove up in exactly the van I wanted. Every detail perfect. How can a girl say no to that gift? What was I supposed to do, ask him to return it? I am so weak! I think he was counting on me being in bliss for a good while so I wouldn't notice what happened next. Three weeks later he came would come home with his new wheels. And how could I say no? He has worked hard. I had a new van, why shouldn't he have something he liked.

This is how it happens. Once you start spending you can't really stop. If one of you gets something nice the universe demands that the other get something as equally nice. Messed up.

It is never a good idea to start spending money before you actually have it. I know that! We had to empty our savings account to pay for the title/licensing fees.

My defense game up until this point had been rock solid. I watched those dollars like a hungry hawk watches a mouse. I didn't blink. And then something happened. I looked away for just a moment, and it only takes a moment. I was distracted by beautiful things. I wasn't prepared for the euphoric feeling that would come with a signed contract. Hormones were released into my brain that made me agree to things I never would have considered under normal circumstances. My vision was blurred, my thoughts were cloudy, the words coming out of my mouth weren't the same ones I was speaking. It was an out of body experience.

The numbers on the paper were amazing. We had been saved! Our problems had been solved! I could take a break from my hawk-like ways! Money was coming our way! And the best part is that it would be there before the first payments on our two new cars were due. Spoken like a person who knows they just spent money they shouldn't have.

If I had to do it all over again I would stay focused like a hawk. That money would have helped considerably with a down payment, and that is what I really want. Our cars were just fine. Yes, they were old. Yes, my husband didn't like his. But they were cheap. And saying no to one purchase makes it easier to say no to the next. It is true. Sadly, the opposite is true. Saying yes to one purchase makes it easier to yes to the next.

Here is the warning, given in love, from someone who was very recently there:

It is going to be hard to get that check(s) and not do something with it. You will be tempted by 100 things every day. Keep your eye on the ball. What is it that you really want? What are you willing to sacrifice to get it? What is a few months longer in the whole scheme of things? I can tell you it isn't long at all! Look at how far you have come.

Don't fall into the trap that you've worked hard and deserve this, whatever this is. Yes you have and you do, but you deserve more - and there is more. Make a plan, and stick to the plan, and then forgive yourself when you don't follow it exactly and try again. Don't give up on the plan just because you didn't follow it exactly one day.

Suggestion:

Open up a new checking/savings account at another bank before you sign your contract. When the HR office asks for a deposit slip for  your stipend give them the new account. Don't let it get mixed into your everyday checking account or it will get lost (spent). Unless your plan is to spend it all, then don't go through the trouble of opening up an account at another bank. That's a waste of time:-)

There you have it. The first of many mistakes. Stayed tuned next week for mistake #2 - I am coming clean!

Time For A Bigger Ring

Every now and then something unexpected happens to put a smile on my face. This weekend gifted me one of those such moments and it happened at the car dealership of all places.

Due to an unfortunate event (another story) I needed to take our van in for some emergency work and some regular maintenance. Fortunately, my husband was violently ill and couldn't work. How sad that I was ecstatic that he was home, even if it was because he was so sick he couldn't stand up straight or be more than 10 feet from a bathroom. It's the small things that make me happy:-)

A trip to the dealership could not have waited. We are talking embarrassing sounds, and something dragging on the pavement. This isn't a mechanical blog so I won't try to explain. I am glad that whatever my husband ate the previous day decided to wreck havoc when it did. Again, sorry he had to suffer, but his suffering was my bliss. That sounds bad too.

But imagine for a moment going to the dealership with 4 kids. Yeah, no fun!

So I am at the dealership all by myself on a beautiful morning. I sat outside and talked on the phone to my friend from two moves ago and I am having a great time. An uninterrupted phone call! All the while feeling guilty that I have left my kids with a sick man who won't be able to do anything if they need him. The house could burn and he would be in no shape to save anyone, not even himself. It was the same as leaving my children alone, but without a crime being committed. But I'm alone.... finally!

And it just gets better. My car is finished and ready to go in less than 2 hours. As I get in my car and ready to pull away this young man walks over to my van and motions for me to roll down the window. I wonder what I have forgotten or what it could be. This is what it is:

Him: shyly. "Um, hi. I don't usually do this .......... but, are you married?"

Me: flattered. "Yes I am".  In my head thinking do you see the huge van I am driving? Unobservant, not my type.

Him: fumbling for his business card. "Oh, well. Um, my name is X and if you ever need anything and the dealership is closed you can call me and I can get you in touch with whoever you need. I don't work in the service department, I work in sales, but I'll do what I can to help you out".

Me: creeped out, but take the card. "Thank you, X. I appreciate that. Have a nice day."

Yes, it was a little creepy, but come on I am nearly 40 and can't remember the last time I was hit on. Maybe this doesn't even qualify as being hit on, but that young man was in his late twenties, a good decade younger than I am. Either my beauty products are doing what they claim to or he needs glasses.

Driving a mini van may not be enough to advertise my marital status, maybe I need a bigger ring. My husband would say I just need to wear the ring he gave me. Yes, I should but my hands are in a permanent state of swollen. So maybe I do need a bigger ring.... just not the kind I was originally thinking.

So Now You Tell Me!

It was an ordinary day in my ordinary life. I was making a trip to my local Walgreens to pick up a print order and my monthly visit to the pharmacy counter. I finally ran out of those samples, but my previous insurance covered them 100% - so awesome of them. My new insurance doesn't and at $95/month I am rethinking some of my options. So I found a coupon online and only pay $45/month. What exactly is it I am paying for? Oh, yeah.

This isn't a post about the price of birth control. It's a post about all the other stuff no one has ever mentioned to me until today. Technically two days ago.

The elderly man behind the pharmacy counter at 9:30 pm innocently asked if I was taking a multi-vitamin daily. I thought that was a strange question. I would have expected something related to taking the actual pills he was handing me. I told the honest truth - no, I am not taking a multi-vitamin. He then tells me that oral contraceptives can deplete the essential vitamins (B6, C and Folic acid) in your body causing you to be tired, fatigued - and I stopped listening right there. Oh my goodness, I don't have to be tired forever!

I am not a blind drug user. I read the information packets that come with them. Never once did I read about tiredness or needing to supplement with vitamins. If the vitamins are being depleted with the pill itself, why not add the vitamins to the pills! C'mon people.

"Side effects may include: breast tenderness, headache; nausea; stomach cramps or bloating. This medicine may cause dark skin patches on your face. If you wear contact lenses and you develop problems with them, contact your doctor. Contact your doctor immediately if you experience breast pain, lumps, or discharge; calf or leg pain, swelling, or tenderness; change in amount of urine produced; chest pain or heaviness; confusion; coughing of blood; fainting; irregular heartbeat; left-side jaw, neck, shoulder, or arm pain; mental or mood changes (eg, depression); migraines; missed menstrual period; numbness or weakness of an arm or leg; one-sided weakness; persistent, severe, or recurring headache or dizziness; persistent vaginal spotting; severe or persistent trouble sleeping; severe vomiting; swelling of the fingers, hands, legs, or ankles" - and the list keeps going.

Of all those things, that are rather serious, I have dismissed all of them as being crazy - but when my pharmacist mentions tiredness I get all concerned about that! Why, because energy is what rules my life. Without it, nothing gets done. With it, I can do anything. I have been complaining about being tired for years. I feel like I haven't been on top of my game for a long time. Did you notice?

So I have been tired for the last two years and no one thought to tell me that maybe I should be taking a multi-vitamin. Not even the doctor who I am married too! I can't blame my OB/GYN because I haven't seen her in two years. But every month that I picked up those pills and for the decades before that, no one mentioned the need to take a vitamin.

I went through a vitamin phase. Before getting pregnant, and while pregnant, I took those prenatal pills, and afterwards until the bottle of pills ran out. Then I relied on my "healthy" eating to do the rest. I am still a big proponent of using food to get your vitamins - it seems to be the right way. But obviously something is wrong in my diet, my lifestyle, my whatever.

I left the pharmacy with a bottle of multivitamins. When I got home my husband said we already had some in the cabinet. Go figure.

What annoys me is that the correlation between me and fatigue has always been written off as "you have four kids", "you have a lot on your plate", "what do you expect with your lifestyle". All excuses. What if the real problem is the birth control pills themselves?

And that started a whole different train of thought. I am tired of messing with my body! Yes, the pills are working and doing their job - but maybe I am TIRED of the side-effects. I am tired of being tired, the migraines at that special time, maybe that's why those last 10 lbs aren't going any where, what else am I doing to my body that is causing harm that could be taken care of another way. There must be another way.

And that is how you find yourself up all night reading articles online about birth control, hormones, natural family planning, and alternatives forms of contraceptives.

What would it feel like to not be filling my body with chemicals to change the chemicals that are already there to prevent my body from doing what it was meant to do? What would it feel like to be drug free?

Medical Mondays Kicks off Fall!

So, it's October. Once again I marvel at how that happens, the days are just flying! Fall is my favorite time of the year, and of course this day is my favorite Monday of every month. I hope you feel the same.

Are you confused if you qualify for the party?


If you have a pager interrupting your life... you DEFINITELY qualify!
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Doctor? Nurse? EMT? Chiropractor? Vet? Dentist? Therapist?

MA? NA? PA? DA?

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Are you a nursing student? Medical student?

Intern? Resident? Fellow?

You get the picture, right? Come on, now... don't be shy! Let's keep growing and meeting new bloggers, so we can build a community of support and friendship, learn from one another, and share our stories.

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