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.  

Guy Things I Never Thought I'd Have to Know or Do

I'm all for gender equality, don't get me wrong.  But ladies, let's be honest:  We grow up expecting that certain things will be handled by the men in our lives.  Things like deep blizzard shoveling, for example.  Or... dare I say... toilet clogs.  But now that I'm going on 2 years of being a stay-at-home spouse with a very busy husband, it's finally dawned on me:  The days of "guy stuff" are over.  At least for me.  Here is a list of some of the things I never thought I'd have to know or do.

2003

1.  Deep Blizzard Shoveling.  If you're married to a man who's never home during daylight (or even nighttime) hours, someone HAS to clear the snow.  I once shoveled over 8 hours in one day.  Pregnant.  We live on a corner with two entrances (both with stairs and porches) and a bear of a steep driveway.  And we had a "nor'easter"!

Shoveling... it's not for perfectionists.  Especially our driveway.

2.  Toilet Troubles.  I remember the first time I cleared a clog... I assumed it was an extreme, once-in-a-lifetime situation.  LOL.  Since then I've learned all about all sorts of toilet troubles online and in discussions with my dad, our landlord, and the plumber.  Got a toilet problem?  I just may be your lady.

3.  Dishwasher Trouble-Shooting.  It turned out not to be fixable... but I was able to verify that for our landlord after a lot of research.  And without any water damage to our neighbors below!

4.  Massachusetts Plates.  I believe it took 4 trips to the RMV to finally get our MA plates.  With or without a baby, I did all 4 ... waiting over an hour each time.

5.  Need New Tires.  Good thing our tire blew out before winter arrived!  I'd had no idea all 4 needed replacing.  Now I know what to look for and how to tell... and how to get a good deal on new ones.

6.  Other Car Maintenance.  Oil changes, new wipers, brake adjustments... oh yeah.  And all with a baby in tow.


7.  Take Out The Papers And The Trash.  I don't get any "spending cash" for this but trash and recycling are pretty much all me.

8.  Steam Heater Maintenance.  I can't explain this if your house isn't ancient, but it involves keeping water at a certain level in the basement.  I think I made our landlord write it all down for me... that was before I gained confidence in these matters.

9.  Dryer Vent Fixing.  Actually I haven't done this yet because I can't reach.  But that's why it's been out for nearly a year.  I'm still scheming about how to get a chair down two flights of steep, narrow stairs.

10.  Installing the Car Seats.  It scares me that I'm even involved with this.

11.  Assembling Strollers, Furniture, and Baby Toys.  My parents would be proud.  And utterly shocked.

12.  Purchasing Big Heavy Items, like our Area Rug, and Hauling Them Home.  A big thanks to Kelly, who helped me out with the rug.

13.  Last, but definitely not least:  The time I had to fish a dead, stinking, fly-attracting rat out of my diaper bag and salvage what I could of the contents.  It had to be done... and it had to be done before that long hospital shift was over. 

I almost couldn't do it.  I think it took a few tries.

So all you female medical spouses out there wishing you could afford a house already... be glad!  I can't imagine how much more work that would be!  And I have, since childhood, *always* refused to mow the lawn.  ;)

Moonlighting Blues & The Best Soup Ever

Before I get into this AMAZING soup, a bit about our lives.  For one thing, I get way more hits that way (apparently I wasn't meant for food blogging) and for another, I do mean to document our lives for my children and other medical spouses.

So:

My husband's moonlighting paperwork finally went through and that means he can start picking up shifts where he'll actually get paid as a doctor.  Only problem is he's still working as a resident!  His "senior resident" year was supposed to be a cakewalk but the ACGME passed a new rule this year that limits hospital shifts to 16 hours.  To compare, my husband often worked 30+ hours on his shifts as an intern.  So... someone has to pick up that slack.  And whereas at my dad's hospital they're turning to NP's (nurse practitioners), MGH knows it has an even cheaper labor source in its senior residents - heck, they're salaried so it's a FREE one!  So weekends my husband should have had off, and evenings he should have been home... he's working for *you*, MGH interns.  Enjoy your sleep!  Oh and be warned... if you're counting on moonlighting money, like we were... well, it's not so easy to find the time for it.

If you're wondering whether this is depressing, um, no, it's AWESOME!  Not.  This was supposed to be "the good year" and basically he'll now either work his days off or if we're "lucky" he'll moonlight them.  So sad, especially for Matthew.  I do some full-day baby-sitting and I've been lucky to do a little legal work from home recently, but living in Boston on a resident's salary with $1400/month student loan payments and a baby ... doesn't actually add up, people.  We're out of the money I saved lawyering and that means we need [significant] cash.  And as a friend once put it, my husband and I "don't have any fat to trim."  We're already living in extreme frugality.  (and *please* don't ask me "whether I've considered" going back to work ... it's a little insulting, frankly; if I thought that was a good choice for us right now I'd obviously already have done it).

What a rant!  Clearly my Italian side doesn't permit unlimited Pollyanna-ism and when even my husband's Scandinavian stoicism has devolved into cynicism, the only cheery disposition to be found chez nous is the baby's.  Thank God for him!

Anyway, my husband will be working Thanksgiving AND Christmas.  Woot.  Thanksgiving for free - allllll weekend - and moonlighting all Christmas.  No family in the area.  I don't think I can convey to those of you whose spouses have holidays off how depressing it is to face them alone, with a baby.  Everything is closed and everyone else is having those moments that life is all about, but you're just trying to figure out how to fill the time until the stores open again the next day and you can be excited for some grocery trip and seeing other kids at the park again.  In June my husband will start fellowship, where the first 1.5 years are supposed to be pretty bad.  So basically we're both looking forward to January of 2014, when my husband will be in the lab and things will finally be normal (if we can remember what normal is by then... and if they're actually normal...).  Sigh.  But as I told my own doctor, there are starving people in Africa.  Hmmm.  She still wants me to get therapy.  Her husband did the same programs, by the way...

On a brighter note, my brother's wife Adora (aptly named - we ADORE this girl) urged me to try this soup last year and I have to say she found a MAJOR gem.  Be sure you use good ingredients - sweet ripe pears and fresh ginger - or it won't turn out to be perfection.  But please, give this a whirl.  It's heart-healthy too (with substitutions) so I'll have to double post it on my HeartHealthyFoodie blog.  And it's actually fairly easy - if you double the recipe, you'll have a healthy veggie side dish with no cooking for many meals to come.

Curried Butternut Squash and Pear Soup

Finished Product.

Ingredients:

1 butternut or acorn squash
3 tbsp butter (heart healthy:  substitute Smart Balance Sticks)
1 onion, chopped
2 cloves garlic, minced
3 tsp fresh minced ginger root (all produce sections have)
1 tbsp curry powder
1 tsp salt
4 cups chicken broth
2 Bartlett Pears, cored and diced (okay to leave peel on)
                                                                                      1/2 cup cream (heart healthy:  substitute milk)

(1) Roast the squash by slicing in half and removing seeds, and placing flat side down on a cookie sheet lined with parchment paper or aluminum foil.  Roast in 375 degree oven for 45 minutes.  When done, remove pulp from peel and set aside for later use.

Acorn squash before roasting. But go for butternut squash if you can find it.

(2) Melt butter in large soup pot.  Stir in onion, garlic, ginger, curry powder, salt, and saute until onion is soft. Add chicken broth and bring to a boil.  Add pear and squash and simmer until pear is soft (about 30 mins).

Peeling and mincing the ginger root.

Sauteeing butter, onion, garlic, ginger, curry, salt.

Core the pear.

Easy pear dicing.

SO easy.  Scoop up with spatula and add to soup.

(3) Here's the labor of this recipe:  If you don't have an immersion blender, you need to transfer the soup to a food processor or blender in batches and blend until soup is pureed.  I highly recommend getting an immersion blender though.  They're not very expensive and they can pay for themselves easily when you use them to make your own baby food.

Immersion blender.  Perfect for making your own baby food - or heart healthy smoothies.  $28 on Amazon, makes a great gift.

(4) Return soup to pot.  Stir in cream (or milk).  Reheat.  I like to serve with a dollup of low-fat sour cream in the middle.  So fancy right?

Double batch, baby.  It freezes perfectly in any container.

Enjoy :)

Finally! A Great Family Weekend (+ German Apple Pancake Recipe)

Usually if I want to think about an amazing weekend packed with all sorts of fun and family and friends, I read Erica Carlson's blog.  This girl has such a great life and such a sweet way of appreciating all of the little pleasures life offers... I love her blog and can't get enough.  Plus the recipes are fabulous.

But this weekend I was thrilled to be in my own life.  I didn't spend a single day of it pretending it was still another weekday while figuring out how to fill the time with my husband at work and my few Boston-area friends spending quality time with their own families.  Instead, ALL weekend, *I* got to have quality family time.  And by ALL weekend, I mean that he didn't even work from home.  I can't recall the last time he even had an entire weekend "off" (August, I think!) but I assure you the last time he actually didn't work over a weekend was before he started residency, over two years ago.  And he did have his scheduled vacation last month, which was great... but it was crazy-busy seeing no fewer than sixteen friends in St. Louis and nineteen family members in Chicago and Madison.  Whew!

Anyway, we needed a weekend together as a family.  I don't think I even realized how badly we needed it until we finally had it.  Bonus:  My husband even managed to wake up well before noon both days.  Although he did spend Friday and now Sunday evenings sleeping from about 8:30 on.  And thus I sit here blogging...

Loving his daddy time.

But seriously, we took full advantage.  It was Halloween weekend, and the coolest thing to do in New England at Halloween is definitely to go to Salem.  You know, Salem... where they executed all those innocent people for being witches.  Par-tay!!  

But tragic human depravity aside, Salem is a really neat place to go in October.  The Witch Dungeon Museum is FASCINATING.  First you watch a reenactment of portions of the actual 1692 trial transcript of Elizabeth Proctor.  She was accused by an orphaned girl she and her husband had taken in as a servant and treated as their own.  She was found guilty but because she was pregnant, her execution was delayed until the hysteria was over.  Her husband was not so lucky; he was executed.  Largely for standing up for her - so sad.  Their graves, along with the graves of many of the other 20 convicted and executed "witches" can still be found in Salem.  I mean how weird is it to live down the highway from where that all went down?  BTW local cemeteries are awesome this time of year.  The first time I saw one I thought it was an elaborate Halloween display.

Cemetery at Harvard Square

Next, you tour the dungeon.  Although it's just a reconstruction of the original, it attempts to be historically accurate.  Back then, you had to actually pay for your own time in prison (don't tell the Republicans!).  The wealthy could afford their own cells, and the middle-class were in communal cells.  The poor were in "coffin cells" - cells that were about 2' x 2'.  Like a coffin except you had to stand up.  The entire time you were imprisoned.  #FateWorseThanDeath.

Anyway, so we spent a spooky, rainy afternoon in Salem.  When the rain started to freeze, we picked up a chicken pot pie from the acclaimed Ken's Kicken Chicken (Amazing!!) and headed home, stopping off at Wilson Farm for some of their hot spiced cider.  Back at home we ate our warm pot pie and cider and watched the snow coming down in huge, wet flakes.  Once M was in bed we sat down to watch Knocked Up, decided we hated it, and about fifteen crappy Netflix movies later we settled on The Spitfire Grill.  Fabulous Saturday.

This morning I got up early with M and cooked my husband an autumn breakfast feast while he slept in. If you at all like apples, give this one a try.  It's really quite easy SO good.  A great way to have "pancakes" and actually be able to sit down and eat together instead of running back and forth to the kitchen to flip new ones.

German Apple Pancake

4 eggs
1/2 cup flour
1/2 tsp baking powder
1 tbsp sugar
3 pinches salt
1 cup milk
1 tsp vanilla
2 tbsp butter
1/2 tsp nutmeg


1/2 stick butter
1/2 cup sugar 
1/2 tsp cinnamon
1/2 tsp nutmeg
2 Granny Smith apples, peeled, cored, and sliced to about 1/4 inch thickness


In large bowl, stir or blend eggs, flour, baking powder, sugar, salt.  Slowly stir in milk.  Add vanilla, melted butter, and nutmeg.  Set aside for at least 20 minutes, hopefully 30.


Preheat oven to 425.  Melt the butter in a skillet or large pot or saucepan.  Add remaining ingredients.  Saute 3-5 minutes, until apples are slightly cooked and sitting in caramel.  Pour apple mixture into pie dish.  Pour pancake mixture on top.  Bake 15 minutes at 425 and another 10 minutes at 375.  

SO GOOD.  Perfect for a fall weekend breakfast.

I did serve this with Breakfast Potatoes.  SO unhealthy but SO GOOD:

Dice up 1 large-ish red potato.  I like it diced small.  Boil for 5 minutes.  Drain.  Start heating it in a small pot.  Add finely diced onion - about 1/6th of a whole onion for each red potato.  Add finely diced or pressed garlic - one clove per potato.  And 2 tbsp butter.  Heat and stir, sprinkle with paprika.  Add salt and pepper to taste.  Add more butter or onion if necessary.  Cook until desired doneness - I like them slightly crisp on the outside but chewy on the inside.  SO good but *SO* bad.

Anyway, if you're still reading, wow, thanks!  This was one long and disjointed blog entry.  But my main purpose with this blog is to capture our lives, largely for my children.  And this weekend was one I don't soon want to forget.  We finished off Sunday by finally working together on some projects around the apartment (cleaning out the office).  It felt SO good.  Later in the afternoon we did a 3.8 mile walk to and from Wilson Farm for "apple cider donuts" (they're big out here), more hot spiced cider, and a haunted hay ride for M.  Dinner together.  Perfection.

Reentry Shock: "I am not one of your nurses."

(let me preface with the disclaimer that my husband and I both laugh when I resort to making the title statement of this entry).

Last week, after a brutal spring of bad rotation after bad rotation after someone else's bad rotation on the hit list, we finally reached a glorious milestone in the grueling world of residency:  My husband became a senior resident.

Back in the old days (as in, just a couple years ago) senior residents lived The Life.  They'd put their time in and could relax as junior residents skillfully managed the interns.  Many even made good money moonlighting while they were officially working their senior resident shifts.  No more.  The work is flowing up in an effort to protect interns (and their patients) from the notoriously hellish existence of those early residency years.  Most practicing physicians I've spoken to believe the regulations have recently gone too far, and that patient care is now jeopardized by too-short shifts (meaning a complex hospitalized patient gets a brand new doctor every 16 hours now, instead of every 30), among other issues.  Suffice it to say that it needed to change back when my dad went through it on Q2, but even with our crazy commute my husband's intern year wasn't that bad.  What was bad was his junior year, when the work flowed up to residents who already had a full plate.

In any case, all of a sudden my husband is back "at home" (working regular hours).  Well, for a few weeks anyway.  This is the moment we've been waiting for, and the moment to savor before he's onto the next bad rotation, and then his brutal first year of fellowship. 

So... why is it fraught with frustration?

I'm sure the medical spouses (and significant others) who do read this blog can relate.  It's the "reentry shock."  Suddenly your medical spouse, who is used to being "The Boss" in his or her world, is supposed to be someone else's equal - *your* equal.  And the goal is no longer efficiency...  it's happiness and contentment.  Move over Mars and Venus:  We're talking a whole new galaxy here.

In the medical world, your spouse is prized for his (or her) ability to make tough decisions quickly, and to be sure of the decision made.  When my husband talks about why he loves MGH, and why he believes physician training can't be a cakewalk, he'll say he doesn't want to be one of the physicians who wavers or is unsure for lack of training.  The physicians he looks up to are the ones who know their stuff - cold - and can practice medicine with confidence and efficiency.  The better a doctor you are, the faster you'll catch things, and the less your patients and their families will suffer.  And he's seen mistakes... even at the revered MGH. 

But how does this translate to being at home?  Well... it sort of doesn't.  If one "partner" is making lightning-speed decisions and just announcing them to the other partner... especially if the other partner has more experience with, say, how a baby's schedule needs to work... it just doesn't work.  Compromise is key in relationships and homes. (By the way, can anyone even imagine him being this way?  Our college friends out here are shocked at the transformation... at first they thought it was Boston, but it's definitely the residency.)

Even AS I'm typing this and reading it TO my husband - and we're both laughing - he is insisting that I go on my run now so that I can bring back portabella mushrooms and he can make a caprese salad for lunch.  Okay... but what about the fact that I don't want to jog while holding my wallet and mushrooms?  No, no we "have to try new recipes!" he declares.  This would be great in the hospital:  Doctor sees the best end-game solution and sacrifices all to achieve it for patient.  But home isn't about the end-game... it's about enjoying life and stopping to smell the roses.

To be honest, I don't think there's a great solution here.  I just assume that being one week into a "normal" work schedule isn't enough for my husband to really be "himself."  Plus, sometimes it's good - he's been grilling up culinary masterpieces this weekend and we had the Andersons over for a truly gourmet dinner (even if it did result in a super messy kitchen and an off-schedule baby).  He also forced me to go to a pilates class that I ended up loving, and will now go to every week.   So, I find myself choosing my battles.  I don't think I'll be jogging with my wallet and portabella mushrooms in tow; he'll have to understand that.  But if he wants to bring grilled-veggie gazpacho soup to our get-together today, sweet; I will relax about the kitchen getting messy :)

Once a lawyer, always a lawyer. At least if you're a mom.

As a lawyer, you either innately possess or you quickly develop the following qualities:

• The ability to develop and maintain a strong sense of loyalty to your client;
• The love of a good fight or debate; and
• The ability to say anything that needs to be said without caring what anyone else thinks.

These all came naturally to me (a little too naturally...).  But another quality did not.  As a lawyer (really, as a litigator) you basically need to be a very suspicious person, and generally assume the worst of others at all times.  This goes for the opposing counsel on a case - who may have been a colleague in law school, and even - or especially - for your your own client.  Anything else will only land you in a pot of hot water.

Natural or learned, these qualities have stuck with me into motherhood.  My love for and loyalty to my son is absolutely beyond comprehension, I would lay down my life for him without question (true of all good parents, of course).  I certainly loved him "at first sight" in the hospital, and I believe I loved him with my whole heart even then.  Thus I can only conclude that my heart periodically expands as I experience the deeper and more intense attachment that comes with watching his sweet personality unfold before my eyes, and creating memory after memory with him.

So as a loyal, former-litigator, suspicious-of-everyone mom, I have major bone to pick with the system that just cost my son 3 full days and 2 evenings of his father's very limited and very precious time with him - and may well cost him next weekend too, after which we won't have weekends for awhile (update:  it did.  UGH.).  What sort of a system, you might ask, is that?  It's called the "hit list" and it's what most hospitals do when a resident is out sick or on a family emergency.  Basically, everyone has a few weeks "on the list" while they are otherwise working good, 9-5, no-weekend rotations.  Then, if someone on a bad rotation has an "emergency," the person from the good rotation has to step in and cover their crazy hospital shift, most often working overnight for them.

Seems sort of fair right?  "What goes around comes around"?  Well, in theory.  Except that there are no rules establishing what is and is not a valid reason to use the list, or how many days you get for certain types of emergencies.  This, according to my father and other medical family members, worked fine until more recently.  But as the culture of medicine changes, these lists are used more and more frequently for lesser reasons... by some residents, not all.  The results is an asymmetrical redistribution of work - and nobody is paid a dime for the extra hours they pick up.

But even if everyone could still be trusted, there's plenty of reason to get rid of such an inhumane system.  Back when I was pregnant and worried I would deliver early (Ha...ha), my husband was not comfortable with the idea of having to use the list for my delivery, thereby slamming some other colleague with even more work and less sleep than that person already had that year.  I knew that he'd at most take 3 days off... probably even if I had delivered by cesarean section.  There is simply no way my husband would ever have any colleague cover a week's worth of bad rotations for him, for any reason.

It's too bad, isn't it, that they don't make the system more humane for everybody?  Perhaps residents who are "hit" could recoup their extra hours by getting days off of their next easy rotation, since their presence on those rotations is not truly necessary.  Really, when your family time is already at a major premium, each resident should finish the year at least having had the limited time they're owed. 

I've long since been annoyed with this system and its vulnerability to abuse.  But as the loyal, protective, suspicious mother that I am, I just spent this long holiday weekend absolutely stewing over it.  Why?  Because a week ago today my husband was hit for FIVE DAYS, including this long holiday weekend he should have had with Matthew - and two evenings.

Yes, OVER a week ago we found out that someone in his program declared she was using the list for EIGHT DAYS.  I won't include the details in a public posting, and I don't need to.  My husband wouldn't have used the list for eight days unless I was delivering our child and whether I'd live through the delivery was unclear for all eight days.  While such a situation may be medically possible (or may not...) even if it is, how did this person know a week ago TODAY that she'd still need to be using the hit list... today?  Sorry, people.  Not believable.

If this were the first time this had happened to us, I might be less infuriated (well, probably not).  But each time my husband has been hit (three so far, in the year and a half I've lived out here) it's always been a sort of questionable story.  One girl called my husband in to work her overnight shift when she found out her grandpa died - not for the funeral, mind you, just for finding out that he died - she must have hit somebody else to cover the funeral.  Most professions, like teaching, don't allow you to suddenly leave work in the middle of the day for the death of a non-immediate family member.

The key word here is "profession."  As the "culture of medicine" changes, physicians are increasingly seen as employees and they increasingly see their own work as "shift work" instead of defining it through their patients.  That's another blog post though.  The other time he was hit was for a Sunday evening overnight shift, Superbowl Sunday - a day in advance.  What kind of a family emergency is scheduled in advance for a Sunday evening, during the Superbowl?  We still have no idea.... because that person never even bothered to email my husband and thank him and explain.  EVER.  Two out of the three hits never even contacted him personally.  If you think I'm going to give these people whom I've never met the benefit of ALL reasonable doubt after THAT, sorry to say, think again.

What a stupid system.  I can think of at least five ways to change it and make it better, off the top of my head -

(1) Follow the neurosurgery program's example, and have the person using the hit list repay the time to the hit person.  [Can you believe this isn't done automatically??]  That way, people would only use the list for situations they *themselves* were willing to put in extra time for later - instead of having a colleague put in the extra time.  And they wouldn't have to feel guilty, like my husband would, for using it. 

(2) Most simply and painlessly:  As I mentioned above, give the hit person as many days off of a later easy rotation as they were hit for. 

(3) For each hit shift, put the person using the hit list on the list for additional weeks.  Example:  A hits B.  A covers B's next weeks on the hit list. 

(4) Pay the hit resident as a moonlighter, since that's what their extra time is worth anyway.  My husband just worked an additional 55 hours over 5 days and is not getting paid a dime more.  He may work another 30 this coming weekend.  Ridiculous!  Still, I'd rather the time back than money; I'd prefer solution (1) or (2). 

In any case, I'm not afraid to say:  As a mom, I'm pissed.  This system is a truly awful one.  It was one thing last year when I was the one paying the price... I kept my mouth shut.  Now that it's my son, and I have to watch him look around for daddy in the mornings and sometimes at bed time, and then give up looking.... you can bet I'll be opening my mouth to anyone who will listen.  Sadly, pretty much nobody.

Sleep-Deprivation: T-3 Days

Do you ever wonder what would happen to you if you got about 4 hours of sleep a night for twelve nights in a row?  Personally I think I would probably die.  Or at least have a really icky stomach starting on day two out of twelve, and feel horrible in every imaginable way.  Then on days 5 and 6 I would start refusing to do anything but sleep, and shouting at anyone who bothered me - no matter what was on the line.  If I lived to see day 8, I'd definitely die by day 10.  Well, so far, on day 9, my husband is still alive.  But last night it became apparent:  We're nearing the end of what even he can do.

He got home early, 8:30 p.m.  It felt like heaven.  Dinner was still warm from ME eating it, and he gobbled some down.  Then he got to work on the computer, writing notes or whatever he still had left from the day.

Around 9:30 p.m., he threw himself on my lap on the couch and told me to wake him up "in an hour."  I knew right then that if successful at waking him, it would be a painful experience for both of us - painful for me just watching his body cling as fast and hard as it could to more sleep while his mind struggled to rouse it.  Ouch.

Indeed this is what occurred.  I tried several times to wake him, to no avail.  He'd bolt straight up from the anxiety of sleeping with the awareness that he "shouldn't" be, and then collapse in a heap again.  Let me tell you, watching someone you love be physically tortured with sleep deprivation, while worrying what it's doing to their long-term health, is enough to make any spouse fantasize about storming through the hospital and yelling at anyone potentially contributing.  Whiny and demanding patients... "the system," generally... any first year residents ("interns") who aren't quite working as hard for my husband as he did for his JAR's last year... anyone.

This is why I encourage anyone involved with a resident to watch the ABC series "Boston Med."  You can watch online here.  It's basically an 8-episode documentary covering the Harvard-affiliated hospitals MGH (my husband's hospital - yes, he knows most of the physicians in it; it was filmed the year before we got here) and Brigham and Women's.  Even if you're not into the medical scene, I still cannot recommend it enough.  I think I cried several times an episode, and I know plenty of non-medical people who absolutely loved it.  But for a medical spouse, significant other, or family member, it gives you a window into what it is they're DOING all those hours away from home.  The stories of the patients will touch your hearts... it's so much easier to sacrifice for a cause you understand and can clearly picture.  And you'll appreciate that the series also covers the spouses and significant others - and children.  Their sacrifices and experiences made it to ABC 10/9 central and attracted 5.37 million viewers, nearly tying Dancing With The Stars.  Pat yourself on the back!

Anyway, Boston Med will help... but in the moment of watching your spouse suffer, you'll still be a less-than-happy camper.  Last night, by the way, was not even as sleep deprived as my husband has ever been.  Twice last summer he averaged two hours of sleep a night for three nights in a row, which I believe was even worse.  Or maybe just equally bad.  In any case, for the first time ever I was unable to rouse my husband to finish his work.  On the forth "jolt" he bolted all the way to our bed.  This morning at 4:40 a.m., after I finally convinced him to wake up (about twenty minutes after his alarm originally went off - he costs me more sleep than Matthew!) I asked him if he had work left from last night and he got confused and said he thought I "made him go to bed."  Sigh.  We'll have to set that one straight if I'm still up when he gets home tonight!

The Usual Scene

Why is it this way?  That would make this blog post too long.  Suffice it to say that my husband believes in this system of training, and thinks that attending physicians (doctors who are all done with residency) who lack experience and/or short physician shifts causing complex hospitalized patients to be assigned a brand new doctor every 16 hours... the type of which they're about to implement next year... are more dangerous than having a tired resident but an attending who has "seen it all" in their own rigorous training.  And let's not forget that if we had more money or lived in a less-expensive town, the commute could be a lot less (or nothing, like it was in STL) and that would add 2-3 hours every night for sleeping.  But here we are!

So here's to hoping he makes it through the next three wake-ups, so he can sleep plenty on his weekend off.  I bought a cinnamon roll for a surprise tomorrow morning... poor guy.

Pure Love

Today was my baby's six month birthday. 

I'm sure I echo every parent out there when I say I can hardly believe it.  Six months is so... measurable.  It's half of a year and there are only eighteen years!  Oh my gosh.  I can't let myself think this way.

Anyway, we had a great day.  It was the first really sunny, warm (well, warmish) day.  Daddy is working all weekend, and not home during baby's waking hours... so it was just "Mommy and me."

After our usual morning routine, we made a special breakfast trip to Panera.  Baby loves any change of scenery and enjoyed his time looking around and babbling at Mama.  Mama enjoyed her usual, asiago bagel with sundried tomato cream cheese and hazelnut coffee.  Yum!  (ahem, yes, this is a cheat day... so far I've only lost one pound, which I chalk up to my baby waking for the day earlier and earlier, thus never leaving me more than 6-7 hours sleep!  Better luck next week...).

Back at home, as a sort of "birthday cake," baby enjoyed his very own bite of Mommy's zucchini bread (literally, Mom's Zucchini Bread from allrecipes.com, but with half whole wheat flour).  To my delight, he not only loved it but became angry when I wouldn't give him more!  I've long been on a quest to try as many new recipes as possible in order to find the very best ones to be the staples of my children's childhoods.  Don't judge me!  That's the kind of thing I love.  I want our "menu" to be very seasonal, so different flavors will work with the weather to bring back what I hope are happy memories.  I'm currently working on a master list of Christmas recipes so that I can whittle it down - because I know I need to choose just a few to be "the" Christmas recipes, enjoyed by my family year after year.

Later we went on a long walk on the Minuteman Trail.  Just our usual routine, but the sun was nice.

He was in the sweetest mood ever this evening.  Oh how I wished Daddy could have seen it!  He was smiley and sweet, and very intent on staring at and snuggling with me.  I tell you it was pure heaven.  As I carried my freshly bathed cutie to the chair for our bedtime book, he stared up into my eyes, gave a huge toothless grin, touched both his hands to the sides of my cheeks, and exclaimed "Aaaaah!" in delight.  I never want to forget these moments!

Sometimes I get so sad when I realize that this "baby" is a temporary being.  Already, my "newborn" no longer exists.  Of course he's very much the same person, but he's a different creature, if that makes any sense.  I wish I could have stashed away even just an hour or so of his "newborn" time to dole out to myself over the years.  The flipcam is the best we can do, I guess.

Happy birthday, Baby.  You are my magic.

Par for the course...

I'll admit it.  I'm having kind of a rough night.  And with 3 hours to kill before bedtime, a clean house, food to last another 4-5 dinners already made... I'm going to write about it.

I woke up this Friday morning SO excited.  Mark finally has a weekend off, and that hasn't happened for at least six weeks.  I think it may actually be the first weekend he's had off since Christmas but with the post-holiday craziness and general baby-still-wakes-up-once-a-night sleep deprivation I really can't remember much that far back.

I wore a cuter-than-usual outfit and dried my hair.  Put on make-up, the whole nine yards (well, once you're a mom there are really only about 2-3 yards).  Mark worked extra late last night so that we could have "more of a weekend" so I figured he'd be home early, maybe even 7 or 8 pm.  When the baby spat up in my hair (baby's favorite thing ever is to suck on his his thumb wrapped in my hair) I actually re-washed my hair in the sink, with shampoo.  I made sure the apartment was clean so we could really enjoy our surroundings this weekend.

I started looking at nice brunch places on the internet.  Mark had Valentine's Day off, randomly, but we haven't yet celebrated.  On the day of the holiday, I was on my way back from visiting a friend in Oklahoma.  Knowing he had the day off, I skipped dinner on my layover in anticipation of some sort of cute Valentine's Day spread he might have made for our happy reunion.  Unfortunately, though, there was nothing.  He spent the entire day sleeping - he actually slept 21 hours waking once to eat while I was gone.  So he hadn't had time to prepare anything.  I was kind of sad, but it's hard to fault anyone whose body is desperate to get twenty-one hours of sleep.

He thought we'd celebrate on his upcoming weekend off, now this weekend.  The plan was to go to a nice brunch so that we could bring the baby.  We really don't do anything without the baby because in my opinion, the baby is already getting jipped on daddy-time and the baby's needs are my #1 priority.

Anyway.  The point is I had different websites of brunch places pulled up and was so looking forward to this evening.  The baby took a later evening nap so I thought maybe there would even be a little father/son time tonight.  I imagined a happy reunion, putting the baby to bed together, discussing brunch places for tomorrow morning, maybe watching a Netflix episode...

But 5:00 came and I hadn't head anything.  Then 6:00.  Then 7:00.  I put the baby to bed at 7:30.  By then I knew that in spite of last night's extra-late night, this was not really going to be an evening together; with a 60-90 minute commute, once it gets to be 7:30, it's sort of all over.  Sure enough, just before 8:00 he called.  To say he'll be working really late again tonight.  Later than 11:00, my bedtime, so I won't see him until tomorrow morning.  Apparently, because he has two days off in a row, he has a lot to prepare for the resident who will be covering his patients this weekend.  Or something. 

That would itself be sort of sad, but the reality is that I really won't see him until tomorrow afternoon.  He won't get to bed tonight until after midnight.  Since he has now gone twelve days without a day off, and gotten under 5 hours of sleep each of those nights, he probably won't even be able to wake up until 3:00 pm-ish.  So suddenly his one weekend off after 6 weeks and for another however-many-weeks is really only a day and a half.  There's no Friday night.  There's no Saturday morning.  There's no Saturday afternoon.  On Sundays we'd usually go to church and community group but this is basically why we've become non-practicing Christians:  The rare Sundays off are either slept through or needed for the family time we otherwise simply won't ever have.

So here I sit, a little depressed and wondering if I should read for my book club or watch Twilight. 

When I mention Mark's schedule to people, I hear a lot of "But it's only temporary, right?"  Um, if you can consider 17 years temporary, sure, it's temporary.  Totally temporary.  I'm 30 and this has been the drill since we started dating when I was 18.  I'm married to a perfectionist in the medical field.  Even when we were in college he was always pulling all-nighters, and gone weekends all over the state running track and cross-country.  And now he's at MGH, which is fabulous for his career but would take a hefty toll on anyone's family life.  This year was already supposed to be better.  Last year, his intern year, was supposed to be the worst of it.  And he worked well over 100 hours many weeks.  But when MGH realized it needed to crack down on the 80 hr/week limit for interns, it shifted work up to junior and senior residents.  This year has actually been worse than last year.  And I just heard that next year, as senior residents, they're now scheduled for a ton of 12-hour overnight shifts.  In my experience those are just as brutal as their thirty-hour call shifts because when they do have a day off, they sleep through the ENTIRE day off and are up all night.  Then the year after that (2013-2014) will be his first year of fellowship, which is supposed to be just as hard as the first year of residency was.

Sigh.  If I were the person I sometimes wish I were, I'd just snap right out of it and continue being happy.  I'd think to myself "There are starving people in Africa!  I have it SO good, I should be nothing but ecstatic about life!"  Or at least "I could be a truly single mother!  At least I'm a single mom who doesn't have to work!"  But honestly, when I hear about people with really rough lives, it's not much of an upper for me.  I actually have a hard time enjoying what I do have when I am truly happy - which is most of the time - because I want everyone to have what I have before I can allow myself to enjoy it.  Every time I marvel at my healthy, beautiful baby, it's tinged with the awful knowledge that other parents out there exactly like me are watching their babies struggle with terrible illnesses and disabilities... oh I'm crying just writing about it.  And several times a day I'll feel such satisfaction that my baby is so loved and well-cared for, only to have it followed by a crushing sadness that there are babies out there exactly like my precious son, just like him who are not being loved, or who are being abused, and they are every bit as innocent and sweet as he is, and they don't know any better.  It breaks not just my heart but my soul to think of that.  I can hardly stand it.

Anyway, all that is to say that I'm feeling sad tonight and I'm not someone who can snap out of it by thinking of other people in worse situations.  I'm still thankful for what I do have, don't get me wrong... but for me, being thankful for what I do have necessitates being sad that others don't have those things, and it's all well and good to keep in mind but it doesn't add a spring to my step.

So, here's to hoping tomorrow is better.  Tomorrow afternoon, I suppose.

Yup, I'm starting a blog.

It's time to face the facts:  My scrap-booking supplies have been in a box in the attic since I moved to Boston about sixteen months ago.  Prior to that, they spent six years in a box in a closet, since we didn't have an attic in St. Louis.  The last scrapbook I made covered my senior year of college, a (gulp) whopping eight years ago.  And while I love my college scrapbooks, and my husband begs me to "create more memoires," I think it's time to admit that it's just not going to happen. 

So, like many moms (and dads) before me, I'm attempting to document our family life in a blog.  I'm calling it "Married to Medicine" because our life pretty much revolves around and is dictated by my husband's career.  That may sound antiquated, but it's actually brought about by simple necessity.  I would love to have one of those idyllic (but perhaps mythical) modern marriages where housework and childcare are shared 50/50.  Actually, 80/20 would be great, since I'm a stay-at-home mom!  But when your husband works 80+ hours a week and commutes another 15-20, the reality is that when he's home, he's asleep - or if he is awake, he's far too tired to help.  As I write this, at 10:22 p.m., I'm expecting him to walk through the door sometime in the next fifteen minutes.  At that point we'll finally eat dinner, he'll check his email, and we'll briefly discuss anything that needs addressing, allocating up to 5 minutes for any life-or-death situations.  He'll then go to bed around 11:30 - later if he took any work home with him.  I'll follow shortly, after the kitchen is cleaned up.  Less than five hours later, at about 4:20 a.m., his alarm clock will go off.  At that point I'll literally kick him out of bed, which will be painful but necessary for both of us.  Shortly thereafter, our five month old will wake up hungry.  He'll be nursed and put back down, and he and I will sleep until around 8:30 a.m., waking up to the daddyless home that is our status quo.

To be clear, my husband isn't "working late" tonight.  This is par for the course.  His next day off is 9 days from now.  Until then, he may see our son awake briefly every several nights if he happens to get back a little earlier, and if the baby stays up a lot later.

And so Daddy's career is a pretty dominant force in our daily lives:  When do we next get quality time with Daddy?  Where will Daddy's career take us next?  How long can we count on living in any one place?

 "Daddy's Home!!!!!"  (it's very exciting)

"Daddy" is currently an internal medicine resident at Massachusetts General Hospital in Boston (a Harvard affiliate, and the main hospital featured on the ABC show "Boston Med").  He's about halfway through three years of training to become a board-certified internal medicine physician.  Technically, he's already a "physician" and shoulders enormous responsibility in the trial-by-fire environment of MGH.  After this is over, he'll have another four (yes, another four) years of hematology/oncology training that could be here or could have us moving as far away as Seattle or Houston.  His post-college academic and professional training will ultimately total thirteen years.  Thirteen years of sacrifice on both our parts - sacrifice of income, retirement and college savings, but above all, a sacrifice of what I consider everyone's most valuable resource and gift:  Time.  Weekends, evenings, vacations, holidays, movies, friends' and family weddings (I almost always attend spouseless, often dancing with my dad if he's there) ... Time.  A mommy friend of mine who is herself a physician recently explained that it's never just one spouse who attends medical school and residency; it's always both.  And I will confess to having felt a surge of gratitude and even relief when one of my husband's attending physicians (i.e., his boss) complimented *me* on my husband's top-notch doctoring.  When I thanked him but disclaimed that I couldn't take any credit, he said "Oh YES you can!" 

And I do try my best to run our home such that he doesn't have to lift a finger here - I don't plan on doing that forever, but for these years we're really both just trying to get by.  My goal as a mom is for the limited hours during which "Daddy's home - and awake!" to go straight to our son.  So I've taught myself to do it all, even the guy stuff.  Definitely not a natural part of my personality, and certainly not always easy with a baby in tow.  But well worth it.

I'm sure that many reading this might think of me as some kind of anti-feminist or martyr (ugh!).  While it's true that in addition to the above-mentioned sacrifices, I gave up my bar license, a truly "perfect fit" legal job, and all of my professional connections when we moved out here for his residency ... plus even remote proximity to family and many dear friends ... BUT (and this is a big but), I'm doing exactly what I want to do, and not all parents with the desire are able.  I'm staying home with our son - in spite of my law school debt.  I'm still not sure that I actually "can" do it.  As in, I'll often say I feel "blessed to be able to stay home" - but I'm not sure I'm actually "able" to, by anyone else's definition.  My husband ultimately wants to go into oncology research, so after this thirteen-year haul and our mounting educational debt - mounting because his resident's salary doesn't allow us to make our crazy-high student loan payments - he won't ever have a "doctor's salary."

"Well why did you go to law school then, if you wanted to stay home??"  It sounds crazy, I know... 

But I enjoyed law school, I enjoyed my 3 1/2 years of practicing, and I'm glad I didn't shortchange myself in "being all that I could be."  I have no regrets, but I do have a lot of financial anxiety over our combined educational debt.  When my husband and I started down our medical/legal grad school paths, we had no idea he would fall in love with research and choose a career that would pay a fraction of private practice medicine - and oncology research at that, which entails 7 years of post-med school training before you EVEN get that salary.  We assumed money would be fine.  And as a general rule, I don't (or didn't) believe in women making any career decisions based on a wanting to later stay home with children.  These days I don't know what I think about that... I do expect my husband to, eventually, balance his demanding career with our family's needs - and by balance, I mean sacrifice.  But you can't know, as a happily married grad student, that you'll even be able to have children.  Would I still do law school again if I knew then what I know now about our finances?  I guess I can't answer that until we see about kids' college and retirement.

Basically, *both* my husband and I are of the "follow your dreams" generation.  We've *both* made choices that were economically difficult, in pursuit of those "dreams."  But part of what drew us together, and maybe one of our few truly shared personality traits, is our intense idealism.  So we're both living our dreams in this household.  And just hoping that our son won't someday read this and say, "But guys, what about *my* dreams??  Like [insert expensive private college he worked hard to get into]?"

Ooooh this is really long.  LOL!  I guess my other reason for blogging is I have a *need* to write.  It was always my favorite part of practicing law.