Med School Confidential

by Robert H Miller

  “Whew,” you’re saying to yourself. “Life isn’t supposed to be this hard! Will it really be that awful for the next ten years?”

  The answer is no. The pains and joys of med school ebb and flow like anything else. Much will depend on how you work out your day-to-day life, plan your fun, and compromise on the small stuff. The bottom line is that you should invest yourself in understanding what med school is all about as it will affect your life, too.

  HOW WILL YOUR MED STUDENT BE SPENDING HIS OR HER TIME?

  The medical training process is long and very confusing to outsiders. Each phase has distinct advantages and challenges for couples and families. Here’s a thumbnail sketch of the phases and what you can expect from each.

  Applying to school/premed years

  Applying to medical school is one of the two most stressful times during the tenure of medical training. (The other will be preparing for Match Day for residency.) Not only will your partner be spending thousands of dollars and years of time preparing to take the MCATs, struggling to excel in prerequisite classes, and completing all of the inane paperwork and applications only to wait impatiently for a response, they will also be second-guessing choices at every turn. Even if your partner is incredibly self-assured, it will become your job to help sort through conflicting emotions about going to medical school at some point during this process. This can be a very precarious position as you want to be supportive, but at the same time this may not feel like the right choice for you. You’ve probably been able to keep yourself at a distance from the “future life” discussions up until now, and you’re just beginning to realize that this is life-altering stuff going on. Engage in these discussions with your future med student and become a team player. The decision of where to apply will directly affect you as well.

  Once your med student has been accepted and has made the decision to go, try to decide where together. Chances are good that you may have to leave your job, family, or close friends to make a new life in another city. Look at jobs in your new market, check housing costs, think about your interests, and determine which of your location choices might have the most opportunity for you to do things that you like. It will be disillusioning to arrive in a new city only to realize that you are spending a great deal of time alone or with a gaggle of medical students. The faster you can find avenues for your interests, the less resentful you’ll be of your partner and his new life.

  Preclinical training (or the first few years of med school)

  That first couple of years of school seem blissful to me now, although at the time I found them to be a stressful transition from both of us working. You will start to feel the pull of your new role in logistical and emotional support for your partner’s newfound life. The best news is that while your spouse will have a ton of classes and labs, plus work to prepare and memorize, evenings and weekends are open. Granted, a majority of that time will be dedicated to studying, but most important, med students will have the freedom to schedule out-of-school time. You may even be able to block off regular time together every day. Your joint time will be more constrained, however, as they will feel the constant pull of the books.

  In addition, your med-student partner will have regularly scheduled school breaks and the first summer off. Watching your med student relax back into the person you once knew and loved is very reassuring, even if short-lived. Take advantage of these early vacations. Spend as much time together as possible. Vacation cheaply and do all major house projects or moves during these times.

  Clinical training in med school

  At the end of the second year of school, most med schools start sending their students on clinical rotations. The daily routine is no longer at the discretion of your med student, and the pressure of treating actual patients and answering to actual physicians rises. Many rotations will include call nights where med students usually sleep at the hospital—if they sleep at all—and return home the following day around noon. Then they’ll crash and sleep through the afternoon and night, only to have to be back at the hospital the next morning. When they’re not at the hospital, they will still be expected to read and prepare for end-of-rotation tests or papers. Most rotations will last about a month, and with every change there will be a whole new crew of coworkers to meet and systems to learn. Some months will be blissful, with an easy schedule—no call and hopefully a subject your partner loves. Others will be sheer hell.

  Be prepared for a change in attitude from your partner once clinical rotations begin. They’ll be much happier, even though working hours increase. Clinical training is exhilarating to most med students—after all, treating patients is why they went to med school. Unfortunately, it also signals the end of their day-to-day freedom. They always have to show up and rarely get to make their own schedules. For those of you working in the real world, this may be a welcome change as most months they’ll have a 7 A.M. to 6 P.M. working schedule, have time during the day to study, and will be truly free some evenings and weekends.

  Some of the worst rotations in terms of schedule are surgery, medicine, ob/gyn, and emergency medicine. During these months, they will get the least amount of sleep because the hours are odd or early and there will be regular call shifts where they are responsible for a number of patients through the night. They’ll come home exhausted and demoralized. All day long, everyone will have been asking them questions about what they know in the particular specialty, and they will be required to perform on almost no sleep. It’s as bad as you’ve seen on any TV show. Do not plan to get married, have a baby, or go on an expensive vacation during these critical, stressful rotations. You will be disappointed at your partner’s ability to help out or actively participate in something that is so important to you and should be to both of you.

  By the fourth year, things will start moving hard and fast. During the year your med student will be choosing a specialty, applying to residency, and interviewing around the country. The range of diverse specialties offer varying lifestyles in the long run, and depending on the aspirations of your partner, your life could look very different if you are married to a cardiovascular surgeon or a family practitioner. Again, just like the med-school decision, be engaged in the choices and vocal about your hopes and needs for you and your future or current family. If possible, you should travel with your partner to the matching interviews at the most interesting programs. It helps keep at bay the intense feelings that you lack all control in the process.

  A word of warning: there is a ton of gossip and hearsay about programs and specialties, both within med-school circles and on the interview trail. You will feel unsure of how your partner stands at any program until the end. By Match Day, you will feel totally overwhelmed and completely freaked out.

  Hang in there.

  By the last spring of med school, after Match Day and before residency, your partner will feel more comfortable on the wards and will be excited about medicine, about you, and about the world. During their fourth year, most med students self-schedule their blocks of rotations and, yes, vacations! Many students try to pack their hard rotations at the beginning of the year to help weight their application for residency, and push their easy or free months until the end. In fact, Dan had almost three months off at the end of school. It was a blissful break. This is a great time to plan big life events, including a move. A lot of our friends either planned weddings or had babies near the end of fourth year in order to enjoy some kind of family leave. Be sure to take time off together. Try to leave medicine behind for a while.

  Internship and residency

  At last, they’re working, and hopefully in a field that they’re excited about.

  At this stage of our experience, I remember thinking that Dan and I could handle anything, now that he had finished med school and we had moved across the country. In a way, I was right. We’d established our systems for coping through incredibly hard months. The problem with internship and residency is that you find yourself coping for much longer periods of
time. The easier months come fewer and farther between, and sleep deprivation becomes a part of your daily life. During these years, your med student has an overwhelming sense of responsibility to the hospital that seems unending.

  These will be the times when you will wonder what you have gotten yourself into by falling in love with a doctor, especially if you have children. Keep reminding yourself that life will get better. Remind yourself regularly that many other couples have successfully charted this course before you.

  HOW TO SURVIVE MED SCHOOL AS A SPOUSE, PARTNER, OR SIGNIFICANT OTHER

  Before you start this long road your med student needs to know and understand a few things:

  You are not going to medical school, but you do have another life that isn’t all about medical school. This isn’t your career choice, but it significantly impacts you.

  You and your partner are a pair—you also need life support, both logistically and emotionally.

  Your partner will need to listen to your feelings about school choices and be willing to make compromises. Like it or not, this career is about you, too.

  You will be making serious sacrifices and your partner needs to be appreciative.

  It’s important that you remember to protect your interests, livelihood, and identity, even when you feel swept up in those of your spouse. Nevertheless, be prepared to provide a lot, including:

  Emotional support. One of the hardest things about med school is getting accepted. When med students start school they feel like everyone else is smarter and more prepared than they are. This is normal. Try to make your med student feel like success in medical school is possible. They will need the opportunity to whine about the workload, the lack of enthusiasm, the long hours, and the tough patients. At times, all you’ll ever hear about is how hard med school is for your partner, despite the fact that you will feel like med school is pretty damned hard for you, too.

  Financial and household support. While it might seem important to have your partner evenly share household tasks and financial contribution, it’s not realistic to believe that will happen. Try to see your life as a long-term partnership, and your investment will pay off as your med student chips in with homecooked meals and a clean house during easy rotations, and vacations and financial security in the future. Use the free time on breaks to accomplish major house projects or cleaning sessions, and try not to fill your short time together arguing about who last cleaned the floor.

  Flexibility. Your med student will be late and/or exhausted during many social engagements you share. The last-minute study/lab sessions, rotation or scheduling changes, and staying late on a shift or on a postcall morning will be regular occurrences. Try to be clear about what major calendar events are crucial and be flexible about everything else. Again, if you’re not flexible, you’ll spend hours arguing about things you can’t change.

  Patience and understanding. The classic story is the spouse who is angry and abusive when his or her med student comes home late from a shift only to learn that the med student’s last hour was spent with a family who’d lost a loved one. Before jumping to conclusions, try to hear the explanation and keep in mind how little sleep and how much pressure your med student is getting.

  No guilt trips. Making your med student feel guilty about how little you feel supported will only make you both feel bad. Similarly, however, don’t let yourself feel guilty for getting out with your friends or continuing to do things that you love to do, even if your partner can’t join you. You’ll feel less resentment and be able to be more patient and understanding about what your med student is going through. All in all, the more balance you create in your own life, the happier you’ll be and the more your partner will want to come home and join you.

  Gentle reminders about balance. Be the gentle reminder that your med student needs to rest, eat well, exercise, and stay mentally healthy. It’s important to not get caught up in the pressure of school and performance on the wards. Med students will be more successful if they get out of the hospital more frequently than they think they can. If that means bringing dinner to the hospital on a call night or letting your med student sleep in at home when possible, do it.

  Downtime alone. The one thing that I frequently forget about Dan is that he gets very little downtime alone. Most of his hobbies or interests fell to the wayside when med school began and we got married. When he’s home, I always have a list of things we need to accomplish or friends and family we should see. I have to remind myself that he needs time to himself to recharge.

  While it may seem that your partner’s needs are unending and your nerves are regularly frayed, things will usually get better. This is a long road and medical school is only the first part of the training. Most of your coping skills will be put to the test during your partner’s internship year. We’ve already touched upon some of the coping strategies listed below. Use this expanded list as a reference during stressful times. Hang in there and know that you’re not alone.

  COPING TIPS

  Keep living your life. Just because your significant other can’t hang out with friends and family doesn’t mean you can’t. Be sure to still enjoy the activities that you love even if you must enjoy them alone. It will be hard for both of you, but you will resent your partner less if you don’t spend hours waiting to do something together.

  Find a social and emotional support system. If you’ve moved to a new city, be sure to find a way to meet people and make friends. It’s lonely when you’re on your third weekend alone in the month and it seems like everyone else is out with their boyfriend or girlfriend. Many med schools have spouses’ groups that get together every so often. Make friends with other spouses—they know what you’re experiencing better than anyone and can often make suggestions about ways to cope, or they can just provide emotional support. During med school and residency, a bunch of us started getting together regularly for dinner. Most of us were new to the area and we quickly became fast friends.

  Get rid of the guilt. Try not to make your med student feel guilty for things they already feel bad about, and try not to let them make you feel guilty because you’re not in med school. Set reasonable expectations and then be very frank when your med student isn’t meeting them. Give them time to make things up to you.

  Be clear about your needs and boundaries. Med school will take over both of your lives if you’re not careful. Decide early on what you need from the relationship for it to survive, then set clear boundaries on what does and doesn’t work for you. Again, these expectations have to be reasonable or you’ll fight over them all the time. I really needed a little one-on-one time with my husband every week—no TV, no kids, no parents, no friends, just the two of us and some time to catch up when he wasn’t asleep. I also hated waiting for us both to clean the house, so we stretched a corner of the budget and found a way to pay someone to do it for us. If you’re clear about what your basic needs are, your partner can do everything possible to meet them and can make it up to you when it’s not. Sometimes it will not be enough, but it will help you survive the rough months.

  Have opinions and express them gently. Try to listen to your med student’s trials and tribulations, ask a lot of questions, and take an active part in decision making about a medical career. Most choices will affect both your lives. Play an active role in discussions about your med student’s specialty choice and talk about the residency programs of interest. Do research on your own about which cities to live in and which programs encourage resident wellness. Be a sounding board but don’t be afraid to formulate and express your own opinions about what might be best for you as a couple.

  Don’t hide your emotions. Being afraid to tell your med student that you are unhappy will only create resentment that you can’t shake. Speak up when you were hoping for different outcomes and when you’re happy that things are working out. Time wasted on wondering how the other is feeling is time you could have spent doing something fun together. Talk about what you’re thinking about and try to let i
t go. Med students don’t have extra time for worry.

  Combine your calendars. It’s stressful to you when your med student disregards important, planned events, and it’s stressful to him when you’ve planned them during major study pushes or hard rotations. Try to understand what months and which classes will be overwhelming and be respectful. At the same time, get important dates like weddings on the calendar so your med student can get those days off early and won’t agree to volunteer at the homeless clinic in the middle of that weekend.

  IS THE END EVER IN SIGHT?

  Truthfully, yes and no. Residency will be much worse in terms of sleep deprivation and free time at home. But your doctor partner will have more responsibility, more control, and will be hassled less by the attending physicians. They’ll be happier. They also can start looking at their work as work, and therefore leave it behind them at the end of the shift. Depending on the specialty that your spouse chooses, medicine may always be a lot of hours and focus in their life. Being that so many docs start out hoping to “help people,” that’s usually what we love most about them. The best advice we ever received is to help your spouse and yourself keep some balance in your life. Everyone does their job better when they are able to step away from it once in a while.

  You can survive medical school as a spouse. All it takes is a lot of patience, care, and understanding about your and your partner’s mutual needs. Because the training is so thorough and the workload is so intense, becoming a doctor is not a decision to make lightly. In the end, the benefit to being a life partner to a doctor is knowing that your partner really is helping people feel better, and you can find solace in the knowledge that in no small way, you helped to make that happen.