I’m graduating in June of 2016, never again to traverse the halls of Johns Hopkins as an orthopaedic resident. When I entered medical school at Loma Linda University I never imagined that I would be in my current position. As you have read, much has occurred in the interim but over the years I observed how difficult it is to progress up the academic surgical ladder, while maintaining your Christianity and your marriage; adding kids to the mix only complicates matters. Because of all that I have seen and experienced, I have sought the advice of many who have gone before me within orthopaedic surgery and I have also sought God’s word. Here is what I have learned:
Finding balance between being a husband, husband+dad while being a resident has been a topic at almost every national orthopaedic meeting I have been too. Everyone always starts out their presentation on balance by saying that they don’t think they are the right person to give this talk, since they work all the time. But an important point to note first, is that balancing surgical residency, marriage, and parenthood is akin to balancing a basketball on your finger:
In order to keep the ball perfectly aligned on your finger, you have to stay active, constantly spinning it with your opposite hand. This is the first thing that I learned about balance in residency…its an ACTIVE PROCESS, requiring constant adjustments sometimes on a monthly basis sometimes on a daily basis. After each adjustment you find a new steady state. I have seen this personally in my own life and initially it frustrated me. At times I felt like a model dad when I would come home from work early, read to the kids, give them a bath, and put them to sleep, giving my wife a hand to do other things. Then I would start studying and reviewing my surgical cases around 11pm, only to fall asleep on my desk after 20 minutes. I would then wake up 5 minutes before I’m supposed to leave (even though my alarm was set for an hour before that), and then rush out of the house, without praying and barely brushing my teeth. Then there were nights where I knew I had tough cases coming up the next day, so rather than come home after I got off at 7:30pm and study for the cases at home, I would stay at the hospital until 9pm studying , and then come home. As a surgeon, I felt more prepared then than ever, but my wife, unbeknown to me ,had been hoping to spend time with me or had wanted to tell me about how terrible her day at work was. But by the time I got home at 11pm, she was half asleep; keeping all of the issues at work that she wanted to let out inside until I “had time”. This equals Good surgeon + Bad husband.
So what do you do? Like I said, small adjustments do need to be constantly made, however I sought further council in God’s word. 1 Corinthians 7:5 in the NIV version says:
5 Do not deprive each other except perhaps by mutual consent and for a time, so that you may devote yourselves to prayer. Then come together again so that Satan will not tempt you because of your lack of self-control.
To rephrase it in even more modern tongue, the Message translations says:
2-6 Certainly—but only within a certain context. It’s good for a man to have a wife, and for a woman to have a husband. Sexual drives are strong, but marriage is strong enough to contain them and provide for a balanced and fulfilling sexual life in a world of sexual disorder. The marriage bed must be a place of mutuality—the husband seeking to satisfy his wife, the wife seeking to satisfy her husband. Marriage is not a place to “stand up for your rights.” Marriage is a decision to serve the other, whether in bed or out. Abstaining from sex is permissible for a period of time if you both agree to it, and if it’s for the purposes of prayer and fasting—but only for such times. Then come back together again. Satan has an ingenious way of tempting us when we least expect it. I’m not, understand, commanding these periods of abstinence—only providing my best counsel if you should choose them.
If you are in a surgical residency and are married you will know exactly what I’m talking about, but if you aren’t you will soon find that the daily stress you are placed under as a resident can truly drain you empty of every last drop of emotional and physical energy, both of which are key components when being intimate with your spouse. Many nights you will get home at 11:30pm to a spouse who has been waiting to be with you, only be realize that you have nothing to give them at that time. Or maybe you try but you are so tired that the experience is so-so for both parties. Hopefully these experiences are few and far between, and hopefully they are overshadowed by those periods of time when you have a weekend off or are on vacation, or your research block when you can really get rest and spend quality time. But if you are in the midst of one of those periods where you are working your tail off and there is no break time on the horizon, how do you comply with what the word of God says?
First and foremost it is very important that you and your spouse have a real conversation about this issue. She or he needs to know exactly what happened to you that day; they need to know exactly what made you so stressed, and how that made you feel…even if they can do nothing to make it better. Then you need to listen to them, because even though they are likely working a job that is 98% less stressful than what you do, or even worse in some husband’s minds…they don’t work at all out of the home, their stress is their stress. And if you belittle their stress because yours is so much more, then eventually that may open an avenue for Satan to split you apart perhaps by sending someone who is willing to listen to your spouse. So after you have done all the listening you can and you have expressed yourself about your day, then its important to either muster up the energy to give your spouse what he/she needs, or be honest with them and say, “Honey, whether I want to or not, I will be asleep in 3 minutes because I’m so exhausted, but I know you have needs and I want to be there for. Can we reschedule for 2 days from now or tomorrow night? I will make sure to get home as soon as possible. Does this work for you?” Now hopefully you are true to your word and you don’t post-pone 5 or 6 more times, but you get the point. These conversations are part of the mini-adjustments that need to occur sometimes daily in order for you to find balance in your life.
What about if you have children? How do you give both your spouse and your kids the time they need while preparing for the 5 cases that are scheduled, knowing that rounds are at 5:15 am the next day? I have gone through so many different plans trying to get this right, but John Flynn, who is a pediatric orthopaedic surgeon at CHOP and who is also well known for his work-life balance finally gave me a break through during one of his talks and hearken to the message in Proverbs 15:22, where it says, “Plans fail for lack of counsel, but with many advisers they succeed”. Dr. Flynn’s concepts include:
1. Give your family the best of your time…first. Meaning that when I get home, for the first hour I am not on my phone discussing patient care, I am not on my computer checking Facebook, I am not watching the latest Netflix House of Cards episode, I don’t plop on the couch and turn on ESPN to clear my mind, etc. For that first hour, every ounce of my attention is focused on my kids and my wife. This is truly quality time, uninterrupted. Dr. Flynn even goes so far as to turn off his phone for that first hour when he gets home. After this hour is done, then you go to your office or Starbucks and study/prepare for the next day work wise. Even though it was only an hour, the amount of quality time you spend was so concentrated that I have found that my family is more than willing to let me get to work with few interruptions.
2. Sleep less (“Do not love sleep or you will grow poor; stay awake and you will have food to spare, Proverbs 20:13). Honestly, if you are a surgical resident, you are already genetically programmed to run on less than 5-6 hours of sleep per night. Some nights I can go to 3 hours of sleep or 1.5 hours of sleep. Use this gift wisely when needed. If I have a big project or case coming up. Rather than staying at the hospital for 4 hours to finish it, coming home super late and not seeing your wife and kids awake for the 3 night in a row you could come home, spend your hour, then go to bed early, like a couple hours before midnight. Then wake up super early, like around 2 am when your mind is rested and knock all the work out. Or you could just stay up throughout the night. I find the sleep more satisfying when I get a couple hours in before midnight and wake up crazy early, even if its like 1:30am.
3. Remember that your kids, especially when they are super young (less than 8 years old) will love you always. You almost can’t make them unlove you. Your spouse however has a higher capability of being fed up with your job, your attitude, your chronic tardiness, etc. If you have to err on the side of who the spend time with..your spouse or your kids, spend the time with your spouse. Residency truly is harder on them than your kids, so allocate your resources accordingly
4. Try to include your spouse on your educational trips. I’ve been to a lot of states throughout the country to present research projects, but its only recently that I made a point of letting my wife know months in advance when these trips would be to see if she could come even for a couple of days. These little get aways, even though it includes work for you, keep spontaneity and excitement in your marriage
5. Always try to be home for dinner. As a resident, this is often impossible, but as an attending with more control, this is very doable
6. While it is important to be open with your spouse and what exactly happened at work, so they can understand your stress, you can bring EVERYTHING home, or else you may just depress them deeply. (Again, you know your relationship better than anyone, so feel it out). Dr. Flynn made a point of when he comes home, he spends a couple minutes clearing his mind of the anger, the stress, and the frustrations for the day. And he puts a big smile on his face in preparation for walking into his home. This is something I’m personally still working on.
And finally, i leave you with this powerful text from the word of God:
And I saw that all toil and achievement spring from one person’s envy of another. This too is meaningless, a chasing after the wind (Ecclesiastes 4:4).
I am by not means a pastor, but when I read the text above it points my mind to the general rat race that is surgical residency. Everyone is going to the OR, reading for cases, seeing patients in clinic or on the inpatient side. But the additional things that really get your name out in the open such as writing and publishing articles, joining hospital committees, writing book chapters, traveling to one course after another, doing podium presentations at regional or national meetings, etc. All of these additional things while usually not required generally elevate your name nationally and within your department..in your attendings’ eyes. There is nothing wrong with research; I have done quite a bit of it. But one mistake I think I made was looking at some of the residents in my class or even some below me who had 20+ publications and 10+ book chapters and doing my best to compete on their level. But these folks don’t have a wife who is also a resident; these folks don’t have 2 small kids; these folks have their job and maybe a girlfriend or “right now” friend. If I do research or write a book chapter it should be because I’M interested in the topic, not because I’m chasing after “The Joneses” in surgical residency. Doing all this work with that type of skewed motivation drains you at baseline, and even worse, takes much needed time away from your wife and kids. So at a certain point, I started saw no a bit more and I started choosing projects that really fit with my future goals and that I was actually excited to work on. I also started to do more of this research at work or after my wife and kids went to work so that when I was awake and could spend quality time I was actually available.
I hope that this post will help current residents early on in their training not repeat the same mistakes I made. Remember that residency is only for the next 3 to 7 years. And even your career at best will last for another 40 to 50 years after that. Your family is FOREVER. When its time to bury you, it won’t be the surgical nurse or your intern who are there for you, but this family that God has made you a steward of. Be careful to be a trustworthy and faithful steward.