what I wish I'd known before residency

You like that ominously somber and cliché title? I thought you might. I got the following email {edited a bit and author's name withheld!!} earlier this week and it wasn't unlike a lot of similar emails I've gotten so in the event that any other residency-esque emails are in the future works ... I thought I'd type this out since Simon is currently on a decent rotation and I won't be irrationally tempted to write a scathing diatribe about the past 3.5 years.

My husband is interviewing currently and we match in March and I am stressing out and am unsure how to handle this entire process. I am extremely close with my parents and all of the programs we are considering are minimum 6 hours away. I'm terrified of moving but happy that he is even getting interviewed at these incredible programs and knowing that someone would be proud to take him. We're considering children soon and I feel lost about leaving and having kids away from our families and any support system. I was hoping that you could give me some insight or advice on this roller coaster ride that we are about to embark on. 

*Grace again! before I answer I have to give a disclaimer like the funion that I am ...

I realize that my situation could be a lot more difficult. I could be a single mom, Simon could be deployed, Simon could be unemployed, and the list goes on and on. On the totem pole of difficult situations - ours ranks pretty low. I know that. If I sound like an ungrateful b, that's perfectly understandable and I could keep my mouth shut (or my keyboard untouched, polite laugh) but I've read a few "it's totally fine!" accounts of residency experiences from the wife's perspective and I felt a lot a bit duped. Simon is at a great program that does a phenomenal job of giving as many two day weekends off as possible and it is absolutely the best fit for him and our family for countless reasons. I just don't think there's any escaping a lot of the necessary realities of medical training.

With that disclaimed ... I'm probably the worst person to talk about this because I can't truthfully paint the rosy picture that some spouses might. I'm sure there are some couples that have been genuinely and pleasantly surprised by their residency experience because they were expecting much worse or the resident went into a relatively "easy" (in quotes because I don't really think there are any easy programs out there) field - as far as hours go or they have more optimistic temperaments than I do. We are not one of those couples. I think Simon had a much better idea than I did because as a med student he shadowed residents and knew how many hours they logged at that hospital and he encouraged me to talk to residency wives to learn what I should expect but I said I was sure I got it because "how much worse than med school could it BE?!" and I could handle it. Laugh laugh LAUGH. 

Let's break it down.

brace your lonely nerves: July of 2011 was a bit of a shock to my system as I found myself staring at a baby Julia while both of us sat on the kitchen floor in a new house in a new city mindlessly snacking on cereal straight from the box at what felt like 5pm but no, how could be a mere 10:00 in the am?! Day after day after day. No matter the residency (OB, Family Medicine, Surgery, Internal Medicine etc.) the hours are always going to be really long on some rotations. The nature of the medical beast is generally unpredictable and emergencies tend to arise at the end of shifts and patients always take priority over getting home for dinner - as they should. I'm not sure I necessarily understood that when Simon was "on call" he would be at work on the weekends for a minimum of 24 hours and not at home with a pager or at work getting sleep. Depending on if he worked overnight - when he got home he would need to sleep. This was a tough pill to swallow because I was so lonely and ready to interact with a human that could talk in sentences but eventually the shock wears off and it just becomes a fact of (temporary!) life.

the first year is the worst year: I can't speak for all residencies but I think getting acclimated to the rigor of the hours makes intern year the most difficult for both the resident and the spouse. After the first year, there's a better idea of what to expect during each rotation and I learned to set my expectations bar SUPER low during certain months to occasionally be pleasantly surprised. The interns are at the very bottom of the food chain and are learning a whole lot in a very small window of time. They tend to do a lot of the busier grunt work (so it seems) so second year seemed to be a little less of a grind for Simon as his autonomy and responsibilities changed for the better. 

holidays are hard: Unless you live near family and are able to travel to be with them ... odds are good that you'll spend a Christmas and Thanksgiving or two or three alone. The first Christmas Simon was working and Julia was throwing up and I was still in a bit of a postpartum haze after Sebastian so I think that set the bar pretty high for future and subsequent Christmases have been so much better. Simon's second year he was working a 24 on Thanksgiving and it was a beautiful day outside so I took my 32 (? I think) week pregnant self and the two older kids for a walk and saw countless families in our neighborhood walking into homes bearing casseroles and smiles and my baditude hit a real sour note. We tried to visit Simon who was busy (again, understandable! he was at work!) and I gained a huge appreciation for this past Thanksgiving when Simon was very much not at the hospital. 

expect no paternity leave: It's just not in the cards for most programs (although! I did hear something about some sort of mythical Psych program that gave three weeks of paternity leave .... say que?!) which is understandable but difficult when baby arrival times are unpredictable and you don't live near family. No one was able to come after Phoebe was born (although my wonderful friend Caitlin came a week later while Simon flew to an interview because she's an angel) and 7.5 months later I'm still feeling a little bit mentally fragile which is probably the most pathetic thing you've read all day, I know.

but having kids is totally doable: I would never discourage anyone from having kids during residency because having babies is always an adjustment and there's never a good or easy time to have them. The kids are mostly clueless that Simon is gone on some weekends and holidays and think it's totally normal that he sleeps "in his bedroom" at the hospital some nights and they LOVE visiting him. 

I think (?) most programs have pretty good health insurance so the cost is feasible and I would imagine after surviving the newborn phase during a tough rotation (hello night float!) ... any future newborn periods will feel relatively easy and breezy. 

it's not mission impossible: There will be some rotations with a light call schedule and decent exit times and you'll wonder why you ever thought residency was tough, you big baby!! And those months will save your sanity and keep you chugging along. It's tough for me to remember that eventually allllllll the med school loans WILL be paid off and that Simon will be able to take pager call on the weekends and there won't always be a month of nights looming in the near future. We've learned to really appreciate the weekends that Simon has off because they feel like such a luxury sometimes and I'm really thankful for that. 

it's important to be kind and gentle: with yourself and your spouse and remember that you're on the same team. It's easy to default to frustration with each other when there's snag in the schedule or weekends are anything but a breather in between rough weeks but it's not productive. It's perfectly acceptable to slip yourself straight into super survival mode on the more difficult months and turning your parenting blinders to level: HIGH so that you don't start comparing your survival tactics to other families who might be more on the thriving end of the spectrum for that particular season of life. 

it's a marathon, not a sprint: gross, I hate that phrase - I'm sorry! Julia was nine months old when Simon started his intern year and she'll be seven and a half when he is completely finished with his training. It's been vital for me to take it a rotation (four weeks) at a time. Yeah, yeah, "the days are long but the years are short!!" (I hate that saying even more) but the days can feel e-t-e-r-n-a-l and even though the years do pass at a relatively decent clip, it's not helpful to dwell on how many more night shifts you have to go because, it's just not (but 30 - I broke down and counted like the immature toddler that I am). 

it will all be worth it: Or so I've been told. Jury's still out. ;)

Reading this back - it makes it sound like I think I'm the one working the crazytown hours under lots of stress and little sleep. I don't! Simon is the true hero here and I know that. I think I get the lonelier side of things which is mostly my fault for not branching out more.

And also! I think the title is stupid because I think I had to experience all of these things to know and learn them for myself. It's like thinking if someone had (maybe they did!) sat you down and wagged their finger and outlined exactly how sleep deprived you would be post-baby ... it would actually prepare you for your new and enlightened fatigue but of course it wouldn't! I think every spouse would write something different (although I talked to a residency husband the other night who seemed to share a lot of my same thoughts and I appreciated the solidarity so much) so take this novella with a grain of iodized (or sea - if that's your poison).