Tag Archives: medical school

The invisible work of being married to me

I get a variety of responses when I tell people I’m a medical student

“Wow, you must have worked hard.”

“You’ve got to really want it if you’re going into medicine.”

Most people tend to praise me, but almost none of them praise my wife. Awhile ago, my wife and I were having lunch with a mutual friend. Somewhat randomly, this friend looked at my wife and told her that she must be a wonderful lady, that it must take a lot of strength and patience to be married to a student, and that she deserves a lot of credit.

My wife takes compliments about as well as I do, so she smiled a shy smile and spoke a quick “thank you.” Later, she told me how much she appreciated someone recognizing what she does. For all the successes of the feminist movement, people still fail to recognize all the effort and energy my wife puts into being what women have classically been–a wife (and someday a mother). She has a pretty impressive job, and people are more likely to remark on her achievements in the workplace than on the effort it must take to be married to me. She already knows she’s a star business woman, but it was a breath of fresh air to hear someone recognize that she’s a star wife as well.

Because being married to me means sitting alone while I study in the other room. It means finding hobbies she can do without me. It means worrying about where we will go when I graduate, what kind of doctor I’ll be, and how I’ll perform on the next test. It means going to bed alone three hours before I sleepily tumble into the covers next to her. It means scheduled date nights, quick dinners, and vacations constrained to scheduled academic breaks.

Yet somehow, she still manages to love me in a way I’ve never been loved. With her, I can talk about anything–even the interesting tidbit I learned in class or the strange experience I had with a patient. We share vacation memories, watch shows together, play games. She encourages me when I’m doing well, cries on my shoulder when she’s frustrated, and laughs with me about the ridiculous things in life.

She’s a wonderful lady, and she deserves for more people to recognize the effort she puts into our relationship. At the very least, I can take note of what she’s doing for me, because I certainly couldn’t make it through medical school without her.

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Behold, I am of small account

I’m way behind in my studies, so I woke up at six this morning before church to get some work done and catch up. Instead, I ended up reading several chapters of Job. I sat with my coffee for about an hour with the Lord, reading about Job–confused, broken, and ruined Job. This morning, I was feeling a little confused myself. If you scroll to some of my recent posts you’ll see what’s been on my mind–I’ve written about debt, my doubts, and the church’s failures.

Needless to say, reading Job sounded better than choking down more pharmacology. The passage was about men mining into the “gloom and deep darkness” of the earth, scraping the flinty rock, making slow progress, and perhaps emerging from a shaft with a few grains of gold, but with no wisdom and no answers to Job’s burning questions. I stopped when I had to leave for church, about midway through chapter 28, with man groping in the dark.

We went to church, then came home for a quick lunch, and I left to go climbing with some friends. When I got home and showered, I again sat down to study, but I got distracted and read the rest of Job, with his timeless and disturbing questions.

Why do the evil prosper?
Why do people suffer?
Why is God so distant?

The questions are phrased in poetry that somehow sounds beautiful even in modern English. Eventually God speaks, but without answering any of Job’s questions.

“Then the Lord answered Job out of the whirlwind and said:
‘Who is this that darkens counsel by words without knowledge?
Dress for action like a man;
I will question you, and you make it known to me.
Where were you when I laid the foundation of the earth?
Tell me, if you have understanding.
Who determined its measurements–surely you know!
Or who stretched the line upon it?'” (Job 38:1-4)

God overwhelms him, answering Job with more questions, almost as if to say, “Why are you confused about this? There are so many other questions you also don’t understand.” Over the pages at the end of the book, the Lord dazzles Job out of his confusion, and Job can only answer God with silence:

“Behold, I am of small account; what shall I answer you?
I lay my hand on my mouth.
I have spoken once, and I will not answer;
twice, but I will proceed no further.” (Job 40:3-5)

By the time I finished Job, it was time to visit friends again, and my wife and I had a wonderful time with them. My books sat stacked on my desk–I still haven’t even cracked them open yet. I don’t usually have so much trouble focusing, but today I couldn’t get away from Job. I’m quite sure God was overwhelming me also. My confusion faded away, because who can understand God? If God is real, shouldn’t he be complicated, and even confusing at times? If I ever think I understand God perfectly, I hope I’ll have enough sense to realize that I must be making some terrible mistake in reasoning. God is confusing because he’s real. There will always be some unanswered questions. “Behold, I am of small account.”

Post-Test Party Time!!! (Except for an Unhappy Wife)

Being a second-year student, I’m not nearly cool enough ever to be “post-call”. I am, however, cool enough to be post-test, and every third Monday, I party like a rock star after my test is over at 4pm. (Today “partying like a rock star” = writing this blog post.)

The only problem is that my wife usually doesn’t feel like partying like a rock star. Go figure. Why someone wouldn’t want to stay up late and party after one full day of work, and with four full days of work still to follow, is completely beyond me.

Today my wife came home to find me gleefully doing nothing, but she’d had a very bad day. In fact, her day had been so very bad that she was in a very bad mood, and all the pet names, jokes, stories, and conversations I could think of couldn’t cheer her up. We ate dinner without talking about much of anything, and she went to bed after reading a bit of her book.

Sometimes, my wife and I find that our moods are incongruous. Perhaps I’m stressed and she’s relaxed, or maybe she wants a serious conversation and I just want to watch TV. The strange thing is that her mood markedly affects my mood. If she’s sad, I usually end up being a bit more sad than I was before. This is true even if she’s sad about something I have no emotional attachment to. I am emotionally attached to her, and I can’t be happy knowing she’s unhappy. My wife and I share a lot of things, and to a certain extent, we even share our emotions.

Thankfully, my wife is a very positive person (except for the occasional bad day), and I spend most of my life getting a little bit happier when I’m around her.

For med students, debt stifles idealism

Forget the youthful idealism you started med school with, real doctors need to look out for number one. This constituted about 50% of a talk I attended over lunch the other day. The speaker was talking about the need for doctors to be politically active not only out of concern for our patients, but also out of concern for ourselves. He was interesting, but I disliked the amount of time he spent talking about physician income, the cost of malpractice insurance, Medicare reimbursement, and money in general. It’s not that I think these things are unimportant–I think they’re terribly important–but these things aren’t why my classmates and I are in medical school.

Originally, when I decided to go to become a doctor, it was because I wanted to do missions work and help people in desperate need of medical aid. I’d still love to do this eventually, probably part-time or over a short term, but I haven’t yet taken enough steps toward missions work to be headed in that direction.

I am, however, headed in the direction of having a tremendous amount of debt–about $250,000. My wife routinely reminds me about what a huge sum of money this is. The loan repayment calculator at finaid.org estimates I’ll need a salary of at least $181,000 and ideally $345,000 to repay this loan. The more often I look at my loan statements and my financial aid “award,” the more pressure I feel to make a lot of money. How can I care for my wife if I don’t? How can we have a family?

If there’s anything that squashes the idealism of young medical students, it’s the need to acquire the realism of a working physician.

The 2009 AAMC Graduation Questionnaire found that the average education debt of medical graduates in 2009 was $156,456. The loan calculator suggests that a graduate with this amount of debt ideally should be making $216,000 to repay this loan. The OOH from the US Bureau of Labor Statistics states that primary care physicians have a median annual income of $186,044. (The median salary of “specialists” is $339,738. And we wonder why we have such a shortage of primary care physicians.)

My concern about debt increases with each semester, and if I bring it up among my friends, the main response I receive is that we should quickly do away with that topic and move on to something else. Likewise, I’ve found there’s no better way to ruin an evening with my wife than to bring up the subject of student loans. (Without a doubt, reducing tuition costs would encourage more students to enter primary care.)

It’s not that I didn’t look carefully at the numbers before I started. For one thing, the loan calculator above assumes that paying anything more than 20% of “discretionary income” for loans is “financial hardship.” I grew up in a lower-middle class family, and I’m pretty sure that if I’m making $150,000 a year then I can afford to pay a bit more into my loans. If I do choose to go into a specialty, I really shouldn’t have any problem at all.

That being said, I applied for an NHSC scholarship last spring. This is a government scholarship that pays for medical school if you agree to practice primary care in a medically under-served area for a certain amount of time. I’m currently waiting to hear whether I’ll receive an award this year. Since I prefer to go into primary care anyway, this would be a pretty sweet deal for me. I would likely make significantly less money than the average physician, but I would also have a very manageable amount of debt. While this isn’t the missions work I dreamed of in high school, it’s pretty close, and there are a lot of people in the US who are in desperate need of medical care.

NHSC is a wonderful government program, but it only solves a part of the student debt problem. If I’m awarded a scholarship, I can focus on caring for patients without worrying about loans, but my classmates will make their decisions with $200,000 weighing heavily on the scales.

And if I don’t receive the scholarship?

Well, I can only spend so much time calculating, talking to physicians, and looking up salary statistics. After I’ve done as much as I can, all I can do is trust the Lord to care for me.

Therefore I tell you, do not be anxious about your life, what you will eat or what you will drink, nor about your body, what you will put on. Is not life more than food, and the body more than clothing? Look at the birds of the air: they neither sow nor reap nor gather into barns, and yet your heavenly Father feeds them. Are you not of more value than they? And which of you by being anxious can add a single hour to his span of life? And why are you anxious about clothing? Consider the lilies of the field, how they grow: they neither toil nor spin, yet I tell you, even Solomon in all his glory was not arrayed like one of these. But if God so clothes the grass of the field, which today is alive and tomorrow is thrown into the oven, will he not much more clothe you, O you of little faith? Therefore do not be anxious, saying, ‘What shall we eat?’ or ‘What shall we drink?’ or ‘What shall we wear?’ For the Gentiles seek after all these things, and your heavenly Father knows that you need them all. But seek first the kingdom of God and his righteousness, and all these things will be added to you.

Therefore do not be anxious about tomorrow, for tomorrow will be anxious for itself. Sufficient for the day is its own trouble.”

-Matthew 6:25-34 (ESV)

“When I’m a rich doctor…”

The list of things my wife and I are going to do “when I’m a rich doctor” has gotten rather long. Actually, we never really used this phrase seriously, but we do throw it around in jest quite a bit. We’ve thought of graduation from residency as the time when I’ll be what my wife calls “a normal person.” I’m not quite sure what she means by “normal person,” but as far as I can tell, a normal person is someone with time and money. Money is something I don’t need much of, but time is something I could use.

During medical school, I’ve seen less of my friends, and I’ve struggled to spend time with my wife. I haven’t exercised as much as I should. Perhaps worst of all, I’ve struggled to find time to pray and study Scripture.

“I can do all of these things when I have more time,” I usually tell myself. The problem is, life starts now. I may not ever have more time than I have now. No test, class, or student group is as important as my relationship with my friends and with God. Training to be a doctor is my life for the next seven years, and if I let my friends and family fall to the wayside, I’ll be very distant from them “when I’m a rich doctor.”

Med school year 2 to date–as a list!

Highlights so far:

– We start preceptorships with clinicians in a few weeks!
– I’m taking a “Critical Care Medicine” elective that’s almost as exciting as a preceptorship.
– My classes are very interesting, and they seem more relevant to patient care than much of the material last year.
– This most recent weekend with my wife–sometimes we just have a lot of fun together.

Low-lights so far (whatever that means):

– I still seem to be perpetually behind–I guess that’s just a fact of life in medical school.
– The classes are far more interesting and relevant, which means I feel a lot more pressure to do well in them, which means I’m working a lot harder.

In fact, I’d better go study, being as I’m behind and my classes are important…

I’m the cream of the crop, I rise to the… middle?

For most of my life, I have been among the best of my peers in everything academically related. This changed for me in medical school, as it does for most people. The thing a lot of first year med students have trouble dealing with is the fact that nearly every one of their peers was also at the top of their college class. Unless you have a rare intelligence (or are masochistically hard-working), you won’t be at the top of your med school class.

Don’t get my wrong, I did just fine during my first year of medical school. I’m going to be an excellent physician. My grades are good, and there are plenty of students who didn’t do as well as me. My point is that there are also plenty of students who did much better than me. The ego I had going into medical school was tested and found to be much too big for its britches. So at the end of my M1 year, I was feeling a little defeated, since, like everyone, I’d been hoping to be the best of the best. In a fateful coincidence, I also didn’t have anything to do over the summer. I’ve always been good at research, and a professor at school had invited me to work in his lab over the summer. Hungry for some good hard science (which I’ve always loved) and the chance to do something I’m actually good at, I decided to do a little bench research. I don’t anticipate that it will look particularly good on a resume, I just thought I’d enjoy it.

The summer was wonderful. I was a scientist now. No longer a dejected first-year medical student, I was seeking to know something no one on earth has ever known before. My project was to isolate and characterize a protein involved in RNA processing. I started out very excited, working hard at transfecting bacteria with cloned DNA so they would produce massive amounts of the protein I was interested in.

Then, for awhile, I got discouraged–having come from a physics background, I wasn’t quite aware of the grueling hard work and failures that come with biomedical research. For awhile it looked like I might not even isolate my protein, let alone characterize it. But finally, two weeks ago, in the eleventh hour of my summer, I got protein! I grinned from ear to ear when I saw the big black splotches of protein in my gel. I even had time to run a few experiments and find out a little about how my protein behaves and what its function might be.

Now I was really something. Not only had I done some real science over the summer, but I’d finished the project I’d proposed to do. All through the summer, people had been asking me about whether I was doing an MD/PhD, and I started to seriously consider it. I was good at this, and I could just imagine myself being the best of the best again, doing cutting-edge research and understanding things no one else understood…

I guess the ego comes back easily. Since my grades are only good, and not excellent, it’s unlikely I’d get accepted even if I wanted to spend three extra years in medical school. So on Friday it was out with the research, and this morning it was in with more medical school. Back to the still slightly-dejected, middle of the bell-curve life of me as a medical student.

(Again, don’t get me wrong. I love medical school, but a little conceited part of me still misses being on top.)

“My heart is not proud, Lord,
my eyes are not haughty;
I do not concern myself
with great matters or
things too wonderful for me.
But I have calmed myself
and quieted my ambitions.”
-Psalms 131:1-2

The Last Summer of My Life?

My second year of medical school begins on Monday, which means 70+ hours a week of class and studying, little sleep, and quite a bit of stress for the foreseeable future. The summer break after M1 year is the only summer break in medical school–for the final three years school goes straight through June, July, and August. This past summer has been amazing–I went fly-fishing in Montana, visited the Maine coast with my wife, relaxed on weekends and evenings, and spent my days doing research in a lab at school.

Last year, as the M1 class discussed summer, the M2s frequently gave us lots of advice, usually referring to this summer as “the last summer of your life.” The advice was predictable–have fun, travel, see family, don’t do anything stressful–but did they really need to be so ominous about all the other summers we’re going to live through? What exactly am I getting myself into?

For all the complaining we do, medical students are pretty fortunate people–the AAMC says only half of applicants to medical school are admitted. As medical students, we get to sample a number of specialties before choosing our career. In most fields of work, this isn’t an option. Once we finally do start working, our wages are pretty reasonable, even with all the debt from school. I know medicine is going to be difficult and time-consuming, but it’s also going to be interesting. No other field of work has such a blend of cutting edge science, social interaction, and the opportunity to directly make a difference in someone’s life. God has blessed me by allowing me to become a doctor.

So am I really about to end the last summer of my life? I don’t think so–I only took three weeks of real vacation this summer anyway. There will be plenty of other summers, and although I’ll be working hard, I’m pretty sure I wouldn’t want to be doing anything else with my life.