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.