Married to Medicine

Married to Medicine

Wednesday, March 14, 2012

Golden ticket... or golden handcuffs?

Some very good friends of ours recently struggled greatly with a decision... a decision we still struggle with probably once a week:

Do they leave (or should we have left) St. Louis and come out to Boston (MGH) for his residency?

It may seem like a no-brainer.  MGH is, for all intents and purposes, "The" Harvard-affiliated hospital that for most medical specialties is the most competitive in the nation.  Adele just had her vocal chord surgery here last November.  Yet my husband and I go round and round on whether it's been or will be worth it for us to have come out here for this program.  I ultimately emailed our friends telling them that although we'd thought at great length about how to advise them, we still found ourselves vacillating between "You can't not do it!" and "No... RUN LIKE HELL!!!!"  They replied that their thoughts were exactly the same.  It's a very tough decision with the highest of stakes involved - both for the prospective physician and for his or her family.

Do you want your family's struggles to be worthy of reality TV?  Maybe not...
Finding out that MGH wanted my husband was quite the feeling.  Their (discreet) indication probably cinched things for us... even though we calculated we couldn't afford Boston unless I continued to practice post-kids, which neither of us wanted.  Still, we found a way.  I stayed in St. Louis alone five long months after he left and we saved up my salary.  We also relied upon having been told that we could "practically double his salary moonlighting starting second year" (HA - 2nd years can't moonlight at MGH).

The financial stakes were high, and so was my husband's upcoming fatherhood.  He didn't want to miss out, and neither of us wanted our children to miss out on their father.  Thus it was very important to our decision that MGH told us that they were "old school" - and at the time, they were.  They told my husband that he would work harder his intern year than most residents, but that the rest of it would be easier.  We thought that sounded great - sacrifice while I'm pregnant so our children could have more time with their father.  Of course, none of that ever happened.  Second year was harder than intern year (nearly unimaginable) because MGH shifted work up as it came under fire for interns blowing through the 80 hour/week limit.  And this year has been just as bad, both because of another new ACGME rule (limiting intern shifts to 16 hours from the previous 30, again, work flowed up) and because my husband now needs to moonlight constantly just to make ends meet... since he couldn't last year after all (not that he'd have had ANY time to!).

The mood when my husband went back to work - 12 hr shifts with another 2 hours of commuting.
Sporadic days off only, needing to sleep through many of those.
Hand on pager.
Anyway, our decision was made under those (false) impressions and I can't say either of us would have been able to pull the same trigger knowing then what we know now.  As little M's mommy, and having been raised by a child therapist, and believing Harry Chapin nailed it with "Cat's in the Cradle," I probably could not ethically do it.  This evening when we got back from the park for dinner and a bus went by but didn't stop, M - a sweet, mellow kid - burst into tears and lay on the ground crying "Da-deeeee!  Da-deeeeee!"  His cries continued sporadically inside, no matter what I tried to distract him with... and he finally looked longingly and hopefully toward the door, sighed deeply, and put his head to his chest and sat down.  Watching that made me cry too - it would break any mother's heart.  How do you tell your child, who hasn't seen his dad for 5 days, that he likely won't see him again for another 5 days?  How do you do that month after month after month?

Thus I have an enormous amount of respect for another friend who was also invited to interview at MGH, who also could have gotten in, but who did not blink an eye at not ranking it.  She crossed them off her list immediately after interviews.  Pretty much everywhere else she interviewed had assured her that they were "supportive" of families.  MGH... quite the opposite.  At least they're honest!

And so neither of our two prospective resident friends or their families will be joining us out here in Boston.  Their decisions and sacrifices were made largely for their families, but will also impact their own health, happiness, and experience of 7-8 years of their lives.  I have a lot of respect for that, and a bit of relief for them as well.  The current MGH interns are working *even more hours* than they did back when my husband went through, because this year's new 16-hour shift limit has created massive inefficiency at the hospital with complex hospitalized patients receiving new doctors twice as often, and those doctors (residents) needing to prepare for more frequent but shorter shifts and debrief from them as well (not to mention commute to and from them).  While many other hospitals (like my father's, UW-Madison) have absorbed the additional work by hiring N.P.'s, MGH seems to just spread it around among residents.   

Also factoring into my friends' decisions was the "Boston reality" for their respective spouses.  Basically, for the medical spouse, the decision to come out here not only means saying Goodbye to your spouse for 7-8 of your best years (including those precious baby days)... which alone is pretty sad to swallow... it also means saying Hello to a *wicked* hard city to live in, alone - REALLY alone, day in and day out and most weekends - and REALLY poor.  When your friends stress about how hard it is to have more than one kid, you'll wonder how you'll ever do it, since they have husbands from 5:30 on and all weekend long (not to mention greater financial resources).  Meanwhile, going to MGH isn't exactly like going to Harvard Law.  Physician and even academic salaries are much more "set" than most professions, where a pedigree could drastically alter your career path.  Sure, there's the chance that your research career could really take off and do crazy things.  But it's all sort of vague and as our friend put it:  "Even if you're wildly successful someday, you'll never know that it was because you went to MGH for residency."

As the doting spouse, I find myself tending to believe that my husband will be on top of the world no matter where he goes.  He certainly has been so far!  Not to mention the fact that Barnes/Wash U is not too shabby as one of the very top hospitals in the nation.  So it's a hard for me think about the time he's missing with Toddler M and the damaging fatigue his own body has endured over the past few years - he's taken to joking about how he's going to die young, and it's terrifying for me because he's at least half serious.  Not to mention the financial relief we'd have had by staying in St. Louis due to their PSTP option (LOTS more salary and a year less of residency for those ultimately pursuing research), the normal cost of living, and my being able to work another year before staying home.  Out here, we *don't* make ends meet on just his salary, and we have no way of saving significantly for a house, M's college, retirement, or anything really... and we won't for another 4.5-5.5 years, when we're 36-37 years old(!!!).

So it's a very tough choice, one I'm not sure we'd be able to make again, given the current situation.  And I'm happy for these friends.  As Match Day approaches I'm positive they feel good about their choices.  And I'm positive they're each headed toward the phenomenal careers of helping and healing for which they are destined.  

Monday, March 5, 2012

Fresh Strawberries and Whipped Cream Cake

I know strawberries aren't in season yet (what, June is still 3 months away?) but right about this time of year I start craving the fresh flavors of spring and summer and yesterday I just had to jump the gun.

I chose this recipe because very little is added to the whipped cream to stabilize it.  Other recipes I found called for mascarpone cheese or cream cheese... I just wanted the pure, fresh flavor of berries and cream. Plus, this recipe has a great tip for stabilizing whipped cream so that you can use it in place of frosting on any cake you want.  My family's birthday tradition has long been a chocolate cake with whipped cream frosting - love that I can now make my own from scratch.

Last, I love that it uses a from-scratch butter cake.  Shortcake is so often plain and dry.  This was the perfect texture and oh-so-moist... especially after drizzling the bottom layer with the strawberry juice!

NOTE:  If you do prefer a cream cheese whipped topping with your berries and cake, Allrecipes has a very good "Sturdy Whipped Cream Frosting" recipe - just omit the almond extract.  It's fantastic on chocolate cake too.

Fresh Strawberries and Whipped Cream Cake

Got rave reviews from my husband's colleague and her husband, who had us to dinner last night.
For the Butter Cake:
  • 3 tbsp (approx) unsalted butter, for greasing pan
  • 3 tbsp four, for dusting pan
  • 1.5 cups flour
  • 1.5 teaspoons baking powder
  • 1/4 teaspoon salt
  • 1 stick + 1 tbsp unsalted butter, room temperature
  • 1/2 cup caster "superfine" sugar (baking section - Domino's box looks like this)
  • 1 tsp vanilla
  • 2 large eggs plus 2 large egg yolks
  • 1/2 cup whole milk
  1. Try to allow time for the butter, eggs, and milk to come to room temp.  If that's not possible you can gently nuke them in the microwave in 10 second increments, but be very careful with the eggs because they cook FAST that way.
  2. Preheat oven to 350.  Using a small pastry brush and melted butter, butter bottom and sides of an 8 inch round cake tin.  Alternatively, you can use a paper towel with the butter to grease it on as well.  Line bottom of tin with non-stick baking or wax paper; butter paper and then flour bottom and sides of tin.
  3. Sift together the flour, baking powder and salt into a medium-sized bowl.  Whisk to well combine, set aside.
  4. In a mixer, cream the butter, sugar and vanilla on high speed until light and fluffy.
  5. Add the eggs and yolks, one-at-a-time, beating well after each addition.
  6. Reduce the stand mixer speed to low, add the flour mixture in thirds, alternating with the milk in 2 additions, beginning with the flour and ending with the flour; beat until just combined (do not over-mix).
  7. Pour batter into prepared cake tin.  Spread evenly.
  8. Bake 30-35 minutes, until a toothpick or cake tester comes out clean. 
  9. Transfer to a wire rack; let cool in tin for 10 minutes.  Remove cake from tin and return to wire rack to cool completely.
Before baking.
For the Strawberries and Cream:
  • 1.25 lbs or about 20 ounces fresh strawberries, hulled (green removed) and thinly sliced
  • 1/4 + 1/4 cup castor/superfine sugar (see above link)
  • 1.5 cups heavy whipping cream, cold
  • 1 teaspoon unflavoured gelatin (aka gelatine) - baking aisle by jell-o
  1. In a medium-sized bowl, stir together the strawberries and ¼-cup sugar; set aside.
  2. Place two tablespoons cold water into a small-sized saucepan and sprinkle with gelatin; let soften 5 minutes.  Place saucepan over low heat, and stir until the gelatin is dissolved.  Remove from heat and let cool.
  3. In the bowl of an electric stand mixer fitted with the whip attachment, whisk the heavy cream and the remaining ¼-cup sugar until very soft peaks form.
  4. Continue to whisk, and gradually add the gelatin mixture; beat until soft peaks form.
Soft peaks.  Don't let it get too stiff.
For the Assembly:
  1. Using a long serrated knife (like a bread knife) carefully cut the cake in half horizontally.
  2. Place the bottom half, cut side up, on a cake stand or plate.
  3. Drizzle the juice from the berries onto the cake.
  4. Evenly arrange half of the strawberry slices over the bottom cake layer.  Refrigerate the remaining berries.
  5. Top the strawberry layer with half of the whipped cream, leaving about a 1 inch border.
  6. Place the top half of the cake, cut side down, onto the layer of strawberries and cream.
  7. Top the cake with the remaining whipped cream.
  8. Refrigerate the cake at least 1 hour, up to 1 day max.
  9. Just before serving, top the cake with the remaining chilled strawberries.
Sliced down the middle and drizzled with fresh strawberry juices.
First layer of strawberries.
Alternate view.
First layer of whipped cream.
Ready to refrigerate until until dessert time!