(Editor’s Note: This week we are reposting an important piece shared by one of Physician Family’s regular contributors and licensed marriage and family therapist, Kim Blackham. In this blog post, Kim’s surgeon husband offers 10 tips on successfully maintaining the delicate balance between marriage and medicine. This post originally appeared here on Kim’s website, where you can also learn more about Kim and her extraordinary efforts with medical marriage.)
All bleeding stops…eventually. So the saying goes.
Medical residency is tough–it’s physically, emotionally and intellectually exhausting. The demands of medical training consume our time and our energy. It’s the nature of the beast. Add in a marriage and maybe a few kids (we have four) and finding balance between medical training and family relationships can become a daunting challenge.
For my wife, Kim, and I, four years of medical school, seven years of general surgery residency and now two years of surgical oncology fellowship has been more difficult than I ever imagined. Unpredictable schedules, 80-100+ hour work weeks, weeks of night float in a row, less than minimum wage—these stresses bruise, abrade, and lacerate our relationship on a consistent and persistent basis.
Tragically, as a result of residency’s demands, I’ve seen relationships exsanguinate like a shotgun blast to the IVC. Others limp along like a slow GI bleed, fatigued by anemia but fighting on. While in medical school, my wife and I were told countless times that our marriage would likely not survive general surgery residency. Yet after eight years, we are not only surviving, we are thriving. Our marriage today is stronger than ever. It is not because we are immune or that we were never injured by the stresses of medical training. And we certainly didn’t have it figured out from the beginning. No, it has been a learning process. Fortunately for us, Kim and I found ways to hold pressure, ligate arteries and stitch up lacerations. Along the way, I’ve learned several things that kept us connected and maintained our marriage as top priority, even among the constant insults.
Acknowledge Your Spouse’s Sacrifice
After a year or two of medical school, I recognized my wife’s life would have been much easier had I chosen a different career. Our college friends had graduated and within a few years had solid jobs, new cars, fancy homes and a 40 hour work week. The years of poverty, the unpredictable schedule, the long hours and stress of it all affected my spouse as much as, and often more than, it affected me. At least I was fulfilling my dream to become a physician. I was able to experience the joys of healing, the satisfaction of a life saved and the approval of my mentors and colleagues. Like adrenaline, those things kept me going, making the difficulties of being a physician-in-training worth it. However, Kim didn’t experience any of that. Instead, the result of my career choice meant the burdens of maintaining our home, raising our kids and making ends meet fell almost completely on her. I tried never to make light of the challenges my training made for her. I never compared the sacrifices I was making (lack of sleep, lack of hobbies, lack of leisure time) to the sacrifices she was making. And somehow through my words and actions, she knew I appreciated her.
The evening I graduated medical school, I presented a diploma to my wife – an “honorary doctorate degree” – acknowledging that I didn’t graduate medical school alone, rather WE graduated medical school. I could not have done it without her and she could not have done it without me. The same was true for residency and now fellowship. To this day, her honorary diploma hangs proudly on the wall in our home next to mine.
Work at Work, Be Home at Home
During my internship, I realized that residency is insatiable—there is never and will never be enough time to satisfy its demands. There are always patients to see, labs to check, notes to write, pages to return, articles to read, conferences to attend, presentations to prepare and research to work on. Like a gas, those demands quickly dispense into whatever space it is given. If I brought work home, it quickly filled my evening at the expense of spending time with my wife and kids. So as much as possible, when I left the hospital, I left work behind. Even if it meant staying an extra 30 minutes to catch up on dictations or staying late one night to finish a presentation so I could be home the rest of the week. This way when I was home I wasn’t distracted. This helped show my wife that she was more important to me than being a doctor. After already spending 12 or more hours at work, she knew that once I was home, she didn’t have to compete for my time. The few hours I had at home each day were protected time – time I used to focus on the other priorities in my life.
Loyalty Begins with Words
With the strains of medical training on relationships, we naturally look for advocates – we want to find someone who will validate our side of the story. I experienced such a scenario dozens of times – a doctor speaking negatively about their spouse to co-workers or friends in an attempt to feel justified or be validated. And what often happened? Others join in, relating their own situations or complaints. Rather than smolder the tension between spouses, the fire is fueled. As I witnessed such conversations, I made a conscious decision never to participate. In fact, you will never hear me say a negative word about Kim to anyone – not friends, co-workers, siblings or parents. Instead, whenever I talk about Kim, it is always positive no matter what we are going through. And she does the same when talking about me. Knowing that we never speak poorly about each other or our relationship has created tremendous trust and loyalty.
There is No Room for Criticism
Life as a resident is tough. Life as a resident spouse is uniquely but equally challenging. The inherent demands of residency leave little time or energy for anything else. Mistakes are made. Responsibilities are unfulfilled. Screw ups happen. Duties are left unattended. Promises are often broken. I can’t recall all the times I promised to be home at a certain time or to make it to a scheduled arrangement only to show up hours late. Or the times I forgot an important family event and left my wife managing solo. On the flip side, the challenges Kim had of running a household with four children and working herself meant some things were left undone at home as well. As we’ve negotiated these challenges, we discovered there is never room for harsh, critical comments. Such situations can be frustrating and hurtful, but criticism only added insult to injury – especially when we were both doing the best we could. In those moments, it helped me to assume that responsibilities, duties, or promises weren’t intentionally being neglected, but rather Kim was truly doing the best she could under the circumstances. And Kim learned to assume the same for me which allowed us to work better as a team and together tackle the challenges.
Allow Your Spouse to Dream While You are Fulfilling Yours
Since the day she graduated from college, my wife wanted to get a Master’s degree in marriage and family therapy. That goal was set aside as we started a family and as I started medical school. She planned to enroll once my training was over and the kids were in school. Then, medical school turned into residency with talk of fellowship and pretty soon Kim’s dreams were to be postponed more than a decade! So when Kim got the urge during my intern year of residency, she enrolled in a Master’s program and by the time I graduated, she had a thriving part-time private practice. Taking classes and later doing an internship were incredibly challenging to juggle with my busy schedule and four kids, but I encouraged it. I wanted to support her dream as she supported mine. And together we made it work. I suspect most resident spouses have postponed some goal or dream in support of his/her spouse’s medical training, whether it be education, a new job, a hobby, children, etc. Medical training is a long time and delaying those dreams too long can lead to resentment, anger and loneliness. Whatever it is, allow your spouse to dream and support him/her anyway you can.
Minimize the Impact of Financial Stresses During Residency
While being a doctor may come with a comfortable salary, becoming a doctor comes with years of tight budgets, massive debt, and delayed gratification. Kim and I lived solely off student loans during medical school—during which we had two children. At least in residency we stopped accumulating debt, but working the equivalent of two full-time jobs for less than minimum wage and still living paycheck to paycheck for years has been extremely stressful. Managing our finances under these constraints has been a difficult and ongoing learning process. I don’t have all the answers, but we have done several things that have helped. First, while the amount I owe in student loans could buy a small mansion, we do not have any consumer debt. Second, both of our cars are over twelve years old and have been paid off since internship. Not having a car payment for years far surpasses the desire to drive a newer, more stylish car. Third, Kim and I never spend over $100 on something without talking about it first. Fourth, rather than blame each other, we blamed the process. When finances were overwhelming, I made sure she knew I was aware of how hard she was trying to run our household on less than we needed. Likewise, she never blamed me for not providing enough for the family when I was already working 80-100 hours a week. Lastly, I have never viewed the money I earn as mine. Kim works just as hard as I do to maintain our family. We chose early on for her first priority to be home with the children and for me to provide financially. Even when she accidentally says something about it being my money, I quickly correct and remind her that it is, always has been, and always will be, our money.
Keep the Romance Alive
I’m sure we received the same counsel you did on your wedding day: “Keep courting your spouse your entire marriage.” True, it is great advice, but the stress and time constraints of residency can easily push aside our commitment to courtship and romance. My wife and I found little ways to show each other our love, appreciation and commitment–love notes left on the kitchen counter; a thoughtful text in the middle of the day; candlelight spaghetti dinner after the kids went to bed. Two specific things she and I did to keep the romance in our marriage were weekly dates and yearly trips. It certainly pinched our budget, but as often as we could we would go on a weekly date – out to dinner or just take a walk in the park. Additionally, each year we used one of my vacation weeks to get away alone together without the kids. We didn’t visit family or friends, instead we spent a week in New York City or rented a cabin in the mountains or took a Caribbean cruise. Our trips gave us something to look forward to and they energized us to push forward another year. It’s hard to imagine how we would have managed otherwise.
Contact Your Spouse BID and PRN
For me, the pace of residency often leaves little time to think of other things. I routinely forget the day of the week and struggle to remember my wife’s schedule. I often lose track of time until 5 or 6 in the evening. All the while, my wife is busy living her almost completely separate life. More often than not, come 5 or 6 pm she is left wondering if I will make it home for dinner or not. Being away from each other for such long hours day after day can easily lead to feelings of solitude and disconnection. I learned that contacting my wife in the middle of the day and later to let her know what time she could expect me home made a big difference. All it takes is a short text message while riding the elevator or a quick phone call in between seeing patients. These brief contacts allow us to feel more connected and more a part of each other’s lives. It makes her feel important and lets her know I am thinking about her.
Make Time Each Day to Connect
Some of the hardest times during residency were when we went days or weeks without spending quality time together. There were times we only crossed paths a few times a week. Over the years, we learned how important it was to connect every day. My suggestion: no matter what time of day or night you come home, put aside all other things and reconnect. Talk about her day. Take a walk in the neighborhood. Snuggle up to a movie. Plan your next vacation. Read a book together. Whatever your “thing” is, do that. And do it regularly. Think back to the things you enjoyed doing together when you were dating. Those activities bonded you together then and will keep you connected now.
Do Not Allow Medicine to Become Your Jealous Mistress
I love being a surgeon. I love being a surgeon. The awe of human anatomy. The adrenaline rush that comes with each incision. The satisfaction of dropping the tumor-inflicted organ in a bucket. Congratulating cancer survivors on cancer-free surveillance scans. I can’t imagine a more rewarding job. But surgery is not my top priority and never will be. Over a hundred years ago, William Osler gave the following “advice”: “Live a simple and temperate life, that you may give all your powers to your profession. Medicine is a jealous mistress; she will be satisfied with no less.” The demands of being a physician challenge every other priority in my life. Unfortunately, there have been casualties—the “jealous mistress” has usurped pickup games of basketball, snow skiing, traveling, causal friendships, camping trips, holiday traditions, etc. However, throughout the past 12 years of medical training, I’ve made a daily and conscious effort to show Kim she is the most important part of my life. If I had to choose between medicine and her, she knows without question that I choose her. My final bit of advice is don’t allow the jealous mistress to displace your spouse from the position of your prime importance. Whatever it takes, make sure he/she knows that they, not medicine, matter most.
The next steps to take to protect your medical marriage:
1. Find out how strong your relationship is with the free relationship assessment.
2. Download the free eBook – The 9 Characteristics of Master Couples.
3. If you are a physician or physician’s spouse, join our Nurturing Medical Marriages™ Facebook Group. We’d love to have you!
4. Support other physician couples by sharing the post with your friends and followers.
Kim is a Licensed Marriage and Family Therapist, Certified Emotionally Focused Therapist, popular presenter and speaker and media expert. As the wife of a surgeon, Kim is passionate about helping medical marriages thrive. She leads marriage retreats for physician couples, hosts the Nurturing Medical Marriages Facebook Group, and meets privately with couples for intensive marital therapy weekends. You can find more information by visiting her website www.kimblackham.com, joining the Nurturing Medical Marriages Facebook group, or contacting her directly at [email protected].