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.
The horse is made ready for the day of battle, but victory rests with the Lord. (Psalms 21:31)
These words spoken by King Solomon truly sum up what the last several months have been for me. I had trials in every aspect of my life; some attendings were attempting to ruin my hopes for a fellowship match, and everything else was on the rocks...my marriage, my health, and my relationship with God. I could not understand why all of this was happening; I thought I had done everything as right as I possibly could. Like Job, I was challenging God to show my why I deserved all of this and you know what He told me...nothing.
Sometimes it is just your time to be tested; you may never get an answer as to why.
With that said, God has revealed his character to me more in the last several months than I have seen in my whole life. I have grown in every facet of my life, and while the process was oh SO PAINFUL, I am a better man today, and I am continuing to grow daily. There is so much I want to share, over the next several posts, but for now I will report the following testimonies:
- Despite other's best efforts, I did match at the top pediatric orthopaedic fellowship in the country, UC-San Diego/ Rady's Children's Hospital! I'm still on cloud 9 and can't wait to spend my year in a place that has produced so many leaders in the field, and that also happens to have 85 deg weather year round :-).
- My marriage was great before, but it is even better now. There is so much I have learned about what it means to be a surgery resident and a husband that I wish I had known before i started back in 2011. I will share these nuggets in ensuing posts.
- My health is better than ever. I lost 24 lbs and my BMI is finally normal lol.
- God has blessed my research efforts.
In you, Lord my God, I put my trust.
2 I trust in you; do not let me be put to shame, nor let my enemies triumph over me. 3 No one who hopes in you will ever be put to shame, but shame will come on those who are treacherous without cause.
4 Show me your ways, Lord, teach me your paths. 5 Guide me in your truth and teach me, for you are God my Savior, and my hope is in you all day long. 6 Remember, Lord, your great mercy and love, for they are from of old. 7 Do not remember the sins of my youth and my rebellious ways; according to your love remember me, for you, Lord, are good.
8 Good and upright is the Lord; therefore he instructs sinners in his ways. 9 He guides the humble in what is right and teaches them his way. 10 All the ways of the Lord are loving and faithful toward those who keep the demands of his covenant. 11 For the sake of your name, Lord, forgive my iniquity, though it is great.
12 Who, then, are those who fear the Lord? He will instruct them in the ways they should choose. 13 They will spend their days in prosperity, and their descendants will inherit the land. 14 The Lord confides in those who fear him; he makes his covenant known to them. 15 My eyes are ever on the Lord, for only he will release my feet from the snare.
16 Turn to me and be gracious to me, for I am lonely and afflicted. 17 Relieve the troubles of my heart and free me from my anguish. 18 Look on my affliction and my distress and take away all my sins. 19 See how numerous are my enemies and how fiercely they hate me!
20 Guard my life and rescue me; do not let me be put to shame, for I take refuge in you. 21 May integrity and uprightness protect me, because my hope, Lord is in you.
22 Deliver Israel, O God, from all their troubles!
I also saw numerous examples of what happens to kids with Blount’s disease who either go untreated or were treated inappropriately given there combined femoral and tibial deformities or who were treated appropriately with an 8-plate but for various reasons did not return for normal follow up until years later as seen below: Clinic also consisted of observations of numerous types of gait in kids with limb deformities to see how their bony alignment affected their functional ability. Below is the xray and associated video of a little girl with untreated hip dysplasia and her associated gait: Below is a video of a little boy with untreated club feet and some other unknown lower extremity MSK disorder. You can see here how he ambulates pretty well given his considerable bony malalignment: I could go on and on with the disorders that I saw, but the much cooler part of the mission trip was getting to operate on these children and see them get better. We started operating this past Monday basically non-stop until Friday. Operating overseas, even in a hospital as amazing the CURE hospital is definitely an eye-opening experience and showed me what is in store for my wife and I when we finally go overseas. Unlike the cush U.S. there are no Synthes, Stryker, or Depuy reps on hand to organize and replenish the instrument trays before and after surgery, so it was the task of the the residents and surgeons to rumage through the storage room seen below: Once the instruments are pulled and sterilized we go downstairs to the inpatient ward to see how the patients were doing that we operated on the previous day. The inpatient ward is painted wall to wall with beautiful murals of nature and really provides a peaceful setting for these kids who are often in more pain than we would like…not because they don’t have pain medication but because the nursing often doesn’t give the medication as prescribed. After rounds we head to the OR. Below is a video of what the OR suite looks like. And again, as I have seen mission hospitals in other countries, I was very impressed with the facilities. If you were blind folded and brought in you might not be able to tell that you weren’t in America..except for the fact that everyone only spoke in Spanish. The highlight of my time again was working with the pediatric orthopods that flew down to take care of these big deformity cases. We performed big cases from Dega osteotomies w/ VDROs, medial plateau elevation osteotomies and application of taylor spatial frames, bilateral tibial and femoral osteotomies of severe blount’s disease, and the highlight was a rotationplasty performed for an iatrogenic short femoral (more handwork of a local orthopod). The xray below is of a 10 yo F who had a really short femur after a local orthopod removed a ridiculously large segment of her femur to treat her osteomyelitis: The defect was too large to perform a bone transport procedure so it was decided that the best way to treat her and get her walking again was to perform a rotationplasty. A rotationplasty in layman’s terms is where you turn the leg (from the knee to the foot) 180 degrees so that its facing backwards. This effectively makes the ankle joint into a knee joint and then they are able to walking with a prosthesis that is specially fashioned for them. This Mayo clinic video better explains it: So we finally started the case and while tense at times, it was a great refresher on anatomy as we basically had to isolate all of the structures that cross the knee or attach at the knee. Afterwards, the relevant muscles are detached and tagged for later repair. The most difficult part of the case is dissecting out the femoral artery and nerve and its many branches. It makes it more difficult when these structures are covered with fibrous tissue as was the case in this girl. Nevertheless, with careful dissection and attention to detail and some praying, it all went well, as you can see below: There were a whole host other cool cases, like the opportunity I got to do a SIGN nail (http://signfracturecare.org/) which is the defacto intramedullary nail for cash strapped mission hospitals. Below is a cheesy picture of me with Scott Nelson putting one in: I also saw the amazing ingenuity that goes into many processes that we take for granted in the U.S. Like putting on a spica cast after perform a pelvic osteotomy for developmental hip dysplasia. I'm so used to seeing this and performing this on a true spica table, but they dont' have one of those, or they had it and it broke. So they use a long stick, lot's of plasty, and a thin layer of fiberglass and the results are pretty much the same as seen below: I have numerous more pictures, but that would make this post longer than it really needs to be. To summarize, I had an amazing experience operating on these kids and they will forever be in my mind and heart. I am more sure than ever that peds ortho is the field for me and I'm excited about the prospect of spending a more long term mission period overseas once I'm done with my training in the U.S.
|Very regimented and predictable||Not enough variety. Every day I know that I either going to do a knee or a hip and I’m going to do it the same way I did it yesterday and the day before|
|Patients do extremely well often postop||Reimbursement not rising, meaning you have to do more cases to maintain salary|
|Growing patient base as babyboomers retire||When joints get infected that really sucks|
|Pretty good lifestyle as often times you can be done with 5-6 cases by 5pm (good for family)||You don’t get to operate on kids usually. Everyone is old|
Above is an ultrasound of my next child, a boy! The excitement I have felt about this new addition to my family is somewhat hampered by the knowledge that I am "unfortunately" having a black boy. When I first saw the story about Trayvon Martin, the very first thing that entered my mind was that that easily could have been me. I know it sounds cliche, but when I take off my white coat and my scrubs at the end of the day, and walk out of the hospital in my hoodie and jeans, I look like any other black Baltimore man. And for many people that means I am more likely to try to rob to or attack them than give them fix their fracture. I've seen their eyes as I walk through the parking garage without my hospital garb. They clutch their purses tighter or the walk faster to the crosswalk that takes them to the hospital in hopes that they can get there before I "might" do something to them. It doesn't matter that I have a terminal doctorate degree, that the last time I got in a fight was in 4th grade, that I'm more concerned about getting home to my family than going after their purse.
This event reminded me that still in 2012, another black child dead is less important than if it happened to someone of a fairer complexion. It reminded me that the world I am bringing my son into isn't much different than the one world that Emmett Till grew up in. There are still many details to be discovered and it may very well be that Trayvon, after being approached (a fact which is not in dispute) went on the offensive. But even if he did, the fact that he didn't have to be approached in the first place makes the loss for his mother even more difficult.
I've only been able to come this far secondary to all those who sacrificed their lives before me. If we don't make a stand now and make sure that people know that they can't get off easy by killing our sons then we have truly disgraced those who have sacrificed all before us.