Hopkins
We have been watching the ABC show Hopkins this summer. It is always riveting to see real-life medical shows. We used to watch Trauma: Life in the ER, and Resident Life on TLC, and we also got into Houston Medical when that was on a few years ago, and we watched the first version of Hopkins, called Hopkins 24/7. The show Hopkins takes place at Johns Hopkins in Baltimore, MD. I got totally sucked into the drama of the resident Brian Bethea and his wife, Amber, who were having marital problems. At one point they said they were getting a divorce, but at the end of Thursday’s show, they said they were going to reconcile. I think that this show really highlights the sacrifice that many families make while one spouse is training to become a physician. Originally, I was going to focus on this issue from time to time in my blog, but I guess that it has become such a part of my life that I don’t really focus on it anymore. Also, when you have a child with a developmental disability, your perspective on what’s important in life can shift.
Don’t get me wrong, I still get upset when Bob’s work takes precedence over our family time. I understand that physicians have to put the patient first, and they should. But for example, this week Bob was on vacation, and was told by the head of his group that he had to be available for consultation because he is the only one in his group who has a fellowship in his area. (The other guy quit a month ago.) This has been hard because of course, it’s wrong to have to work on vacation, especially when the other guy quit because of the situation created by the head of the group. On the other hand, I really do understand that the patients need Bob’s expertise. But in the long run, is a burned-out physician what you want? The conversation they showed during the last Hopkins show had Brian and Amber discussing the 80 hour work week that the AMA has put in place to avoid burn-out. Of course, you can see by watching the show that most residents, especially in surgical residencies, don’t follow this guideline. Do you think they counted the hours they were going to and from the hospitals to harvest the organs for transplanting? Of course not! That would be “down time,” only the time doing the surgery would be “work time,” and yet, they are away from their families during this time. In radiology, the time you are taking call from home on the computer, only the actual time reading the case is counted. So, you could get a call at 11:00 pm, 1:00am, and 3:00 am. On paper, if each call takes 45 minutes, it looks like you worked 2 hours and 15 minutes. Wow, sounds easy, right? But if that is the case, and you get back to sleep after 15 minutes, you have from 12:00-1:00, 2:00-3:00, and 4:00-5:30 to sleep before you have to get up to work the next day. I don’t care how motivated you are, this disjointed sleep creates problems in your functioning. Hopefully for the patient, not cognitive functioning, but it does create a crabby person. I can tell you that it is hard to be married to someone who is in this situation. Imagine being on-call a couple of times a week! Bob was lucky if he was on-call only once a week as a resident, and that doesn’t include weekends! And I have to say that the surgery residents really do have it the worst! When Bob was on surgery rotations during his internship, they were the worst months of his whole career! I feel that I can relate to the Betheas pretty well. Bob and I went to the same grade school, high school and college. I don’t remember when I was first introduced to him. (The Betheas met in the Sixth Grade.) Bob did his fellowship at the Mayo Clinic in Rochester, MN, which is in the same bracket as Johns Hopkins for quality of medical care. It really is sad when people who know and love each other that well, and who have such a shared history, have marital problems caused by the stress of residency.
Bob and I often felt the stress, too. Lucky for us, we had Anna halfway through his third year of residency, so we were on the downward slope. Of course, kids do add a lot of stress, as they would in any relationship. But they also ground you and humanize you more than you know. After I had Anna, I know I became a better teacher. I would see some of her little mannerisms in the kids, and I just felt such a feeling of motherly protection towards my students. Bob said that he felt much more protective towards other kids he would see, too. Don’t we want to encourage and support this in our young doctors-in-training? When the attending physician who threw the party for the residents on his “service” during the Hopkins show this week basically said that Amber needed to be more understanding of the demands on Brian’s time, and that many of the residents were coming in with children, as if that were a problem, I thought about how unrealistic and out-of-touch he was. Do we really want physicians who have no family, and no support system at home? Do we want physicians who have spouses who sit on the sidelines and whose basic role in life is to only support their spouse?
Medical school and residency are hard on the spouse. Your life is always up in the air, and out of your control. During school, you don’t know where you will be for residency until the match. During residency, you have the same situation for fellowship if your spouse is going to do a fellowship. Then, where will he or she get a job? It is like being married to a military man, without the support that the military families give each other. (Of course, I mean during times of peace. I am not equating this life to the stress of sending your loved-one off to war.) Then there are the financial difficulties. I know many people would not want to hear this, thinking, “You’re a doctor, you are rich!” but that’s not the case these days. Residents used to get a stipend, which was not taxed, so they could afford to have a spouse stay home, not in the lap of luxury, but making a modest living. Now, residents get a salary, which is often less than a teacher. I made more than Bob for most of his career so far. And during school, there is no salary, and often many loans. Then, when they are attending physicians, their salary has been severely strapped by the insurance industry, and there are big medical school loans to pay off. Couple all of this stress with the stress of making life-and-death decisions on a daily basis, and you have a cauldron of trouble for most marriages.
When Bob was in school, there was a teacher I worked with who every time she saw me would tell me how everyone she knew from “that medical school” who was married ended up divorced. She just loved to tell me that because I think that she was jealous of us. She thought that being married to a doctor was a dream-filled life. But the reality is that it is filled with stress, just like anyone else’s life. And don’t think that when the residency is over that the stress will leave. If anything, it is worse, because the attending doctor really has the last word, and there is no one else to take the heat if the wrong decision is made. That is a whole new level of stress to deal with. Bob is constantly mulling over cases in his mind, asking himself if he made the right call, etc. His dedication and committment to the patients and to getting it right are commendable, but when you are never able to let it go, it does add stress to your life.
So there you have it! Being married to a physician is not a bed of roses! However, if it is your spouse’s calling in life, and he gets satisfaction from helping others, it can be a rewarding life for your family. I hope that the Betheas are able to stick to their marriage and remember why they fell in love in the first place.