What are we waiting for? Holding-back vs. casting-off into the global surgery world

We are overdue for a “state-of-the-union” post. Part of the reason is because I started this blog in a big state-of-transition; I was at the end of residency and then at the end of pregnancy, so any post about where we are would have been instantly obsolete.

I can do a brief recap of the past 6 months or so (a more full audio version of a lot of this is in our first podcast episode).  I had just decided to take a research position here in Rochester so that I could take maternity leave and care for the girls during Josh’s chief year (sans au pair), and Josh and I were starting to interview for real jobs. This job-hunt prompted the serious discussions about how we still wanted to do global surgery, and so I started researching the topic obsessively, and getting overwhelmed by all the information and options regarding huge, life-altering decisions. So I started the website and blog, wrote a few posts, graduated, started the podcast, and had a baby.

As we will emphasize time and again, we started this project because we needed a way to organize the information we were finding and because we wanted to tell the stories of inspiring humanitarian health providers. We are not the stars of this show; we are the naive amateurs trying to join the bigger leagues.

Despite that awareness about ourselves and vision for Indie Docs, I had a conversation last night with Josh that made me a little sad. He expressed regret for not “doing more” in residency. Back in 2005, his motivation for taking his very first college-level science class (Basic Chem 101) was to become a doctor and do global health work (after reading Mountains Beyond Mountains). That goal wove it’s way into countless conversations regarding specialty choice and long-term plans beyond residency. Josh spent a month in Uganda as a 4th year elective in med school (while I was on another away-rotation) with the Cure hospital, and he had a fantastic experience. Mayo has generous funding for short humanitarian surgery electives but no formal program for long engagements during residency; I enjoyed two such trips, one to Ukraine and another to to Guatemala, but Josh hasn’t travelled for a medical trip since Uganda.

My response to Josh was to list all the reasons for us not traveling more. In 2012 we became a two-resident household, both in surgical specialties, and I was proud of us for just keeping it together through training and the birth of our first child. We needed lots of help, from our au pair and day care and one another, and I honestly didn’t feel like galavanting around the globe was a huge priority. I didn’t have any doubts about humanitarian work as a long-term goal that felt like a road-test was needed.  Honestly, before I became a chief resident I wasn’t super useful on medical trips, which is a bad feeling after taking all the effort to go. This is the same sentiment I had back in college and I was teaching math and English in Nairobi when I decided to become a doctor; I wanted to do something concrete and unequivocally helpful (education IS definitely important, but there were plenty of local educators who needed the work, and it didn’t quite feel like my purpose in life). In another sense, I felt like Josh and I took somewhat of a mental break from the subject of global surgery, and if we were really meant to do it I thought we would return to that goal. And we did. So in short, I supposed I felt like we were biding our time, doing the necessary hard work of getting excellent training, and enjoying some aspects of life in the meantime (namely starting our family).

Despite these points, I don’t want to dismiss Josh’s feelings. It is entirely possible that the above paragraph is nothing but a pile of excuses and we absolutely should have done more. We could have gone for MPH degrees during training, adopted a passion project overseas, made a serious effort to travel together, been more generous with our money, volunteered more here in town, etc. Like Dr. Dupont discussed in his podcast episode, we could have foregone buying a house, gotten more serious about slashing our debts, and maybe set ourselves up to travel sooner. I will absolutely admit there is more that we could have done.

So why didn’t we? Like I alluded to earlier, being so busy and stretched so thin probably had a lot to do with it. There is a buzzy word that I think applies here: that of the “scarcity mindset.” We never had enough time to spend together. Our money was relatively tight and I’m a big saver; it’s hard for me to spend money on travel. With the birth of our first daughter, I was worried about having enough in the budget to cover 80 hours per week of childcare (we definitely dipped into our savings those two years). Additionally, I simply didn’t have the bandwidth to pay much attention to this idea.

In a way, Josh’s regrets represent the real and present danger we are in professionally. If we slacked off and made excuses during residency, how much more likely will those mistakes be as we acquire more responsibility. Josh often refers to a statement by Sam Adams founder Jim Koch that some things are scary but not dangerous and others are dangerous but not scary (paraphrasing, he will have a full-post about this up soon); I think this situation falls under that latter category. It doesn’t feel scary to grind out an over-loaded daily life, but we might look around a decade later and realize we haven’t accomplished our goals and haven’t found our greater purpose (or get majorly burned out).

So whatever the reasons, legitimate or not, that we’ve had for inaction in the past, the time is here for transformation. We are beginning to plan for our first humanitarian trip together as a family; I will write about our destination, financial strategy, and timing in upcoming posts. I was recently challenged by Episode 1 of the So Money Podcast (hosted by Farnoosh Torabi) with Tony Robbins, in which he says that being generous helps us to avoid the scarcity mindset by convincing our subconscious that we have enough to give, and if we don’t give when we have a little money, we certainly won’t give when we have a lot of money (paraphrasing again). So we will also establish some causes to support on a regular basis rather than just the helter-skelter giving we’ve been doing until this point. And of course, we will continue to make a big effort to post useful content on this website and tell the stories of inspiring humanitarians making the difference with their hard work.

One thing I must address briefly at this point is the reason that we won’t be moving to a medical mission immediately out of training. I will do a complete post on this topic soon, but suffice it to say that it doesn’t make sense from a financial or professional standpoint. We have debts, namely student loans, and very little savings.  At the same time, we have the potential to make what is frankly a huge income between the two of us, and I feel like there’s no way I could justify asking for charitable donations when we could essentially be self-funded in a few short years. We’ve determined that achieving financial independence is really the only pathway that makes a lot of sense for us. And, although we both were raised in Christian homes and are heavily influenced by many Christian ideals, we wouldn’t meet the standards to qualify for the same funding programs as our evangelical friends. Additionally, Josh needs to take neurosurgery boards in a couple of years, and we would both like to get some good experience as full-fledged surgeons before jumping out on our own in a low-resource setting. 

The project of creating Indie Docs has jolted us with motivation, and accountability, to push ourselves to learn more and do more. Establishing our plan of action with clear intentions and wisdom is requiring intense effort, but one that I hope will pay off not only for us, but also for other physicians struggling to find the best way to make this life-goal a sustainable reality.

 

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