Designing our “Best Life” with help from Montana Money Adventures Mentoring Questions

One of the biggest “Aha!” moments for me came from finding Jillian from Montana Money Adventures, initially while listening to her podcast on ChooseFI and then reading her article “Big Family Minimalism,” on Cait Flander’s website. I signed up for her email list in order to gain access to her awesome Resource Library, which contains mentoring questions and “Let’s Chat Worksheets.” These are pages of guided discussion and questions that can really challenge us to address what our true goals and passions are, instead of simply following the path of least resistance and hoping we end up somewhere decent.

This idea of intentionally designing the life I want started during my 3rd year of training when I realized that I wasn’t doing ANY of the stuff I enjoyed and was suffering from severe burnout as a result. After a few years of pondering these topics on my own, I was ecstatic to find Jillian’s excellent guidance. Answering these questions is HARD! Josh and I have been working through them together, and we can only do a few questions at a time before we are a little worn out mentally, and it takes us a few days to complete a worksheet. Nevertheless, going through the worksheets together has been a wonderful exercise for our relationship; it has gotten us communicating about these ambitious big goals and deeper motivations, and it has definitely helped us understand one another better. We will often be mulling over the same question and, lo and behold, come up with the same answers. It’s also amazing to hear him come up with a totally different answer than mine, as I then have something entirely new to consider. I definitely recommend these resources to any individual or couple who is interested in mindfully constructing their lives and purposely cultivating relationships, careers, possessions, time-management skills, etc.

I contacted Jillian by email to ask her permission to post the worksheets completed with our answers, and she graciously agreed. If you find value in these posts, please head over to her website  and sign up for her email list, so that you can have access to her entire resource library. She never sends emails that aren’t very insightful and beneficial.

We decided to start our mentoring questions with the worksheet titled, “Highlight Reel.” The following is our completed worksheet…
What were the most significant moments from the last year?

Joy graduating general surgery residency.

Esmé being born.

Starting our website and podcast.

Starting research year.

Joy taking time to spend with the girls, having a real maternity leave with this one.

Finding FI information

Interviewing for jobs together.

What are our best memories from the last 10 years?

Eddy being born.

Esme being born.

Trip to Big Sur.

Matching at Mayo.

Music festivals together.

10 year anniversary

Choosing our sub-specialties—being liberated from pressure of doing cardiac/peds neurosurgery

Family vacation to smoky mountains

Family get-togethers in Nashville

Watching Archer on maternity leave with Eddy (seriously one of the most fun memories I have. We watched two episodes every night and laughed our heads off).

Camping trips

Duluth trip

Joy-trip to Ukraine and Guatemala

Joy-trip to ACS 2017 meeting global surgery sessions

What do we wish we would have done in the last 10 years?

Travel more for global health projects

Gotten an MPH or MBA during residency

Been more active in global surgery world instead of putting it on hold for training

Gone on more family vacations

Decided to do trauma earlier, let cardiac go earlier, not let myself become burned out

More date nights

What are our most significant achievements? What are we most proud of?

Beautiful girls. Toddler who is very sweet, affectionate, and confident.

Breastfeeding for 2.5 years.

Strong marriage through all of education and training challenges and parenting. Staying best friends and supporting one another.

Couples matching at Mayo.

Both of us succeeding through specialty training.

Living below our means during training despite needing SO MUCH childcare.

What would be amazing to see happen in the NEXT five or ten years?

Significant involvement in high-impact global surgery projects focused on alleviating suffering.

Network of folks working toward the same goal.

Girls traveling with us frequently and understanding our mission.

Spending down time near our extended families (hopefully moving closer to home)

Financial independence with funds for early mini-retirement.

Indie Docs having regular post and reaching anyone who might find it helpful (easily visible).

Financial highlights:

What are a few money goals we would love to hit? In five years? Ten years? Twenty years?

5-years: Debts paid, Financial independence with enough $$ for mini-retirement, couple of investment properties to maintain income while overseas, kids college funds fully-funded.

10-years: Enough money to give away generously to projects we believe in, passive income to sustain personal finances and giving and Indie Docs ventures.

20-years: Solidly funded full-retirement accounts, high-impact projects that are self-sustaining and more projects that we are investing in.

Do we have a net-worth goal?

Sorta. Arbitrary “fat-FIRE goal” of $3-3.5 million. Highly subject to change.

Passive income goal?

$3000/month or enough to just tread water when we are out of the country or not working (don’t really know about this number specifically )

Is our goal to pay off our home?

Yes

Certain amount or percentage donated or in a donor-advised fun?

Would like to eventually be able to donate all income.

Certain size inheritance to pass on?

Enough to fund kids retirement so they are able to pursue whatever career they are most passionate about.

Lifestyle Highlights

Any health/physical highlights that seem exciting to you?

Staying healthy and energetic, being able to do certain body weight exercises like pull-ups and pistol squats, and increasing flexibility to stay injury-free (for Joy).

General fitness, daily exercise would be a win (for Josh). 

Any relationship highlights you want to add?

We want to be more intentional about doing fun and exciting things together, being more affectionate, having deeper conversations.

Get to work together on passion projects.

Travel goals?

Definitely want to be traveling regularly to sites of our global surgery projects.

Also would like some fun adventure travel to unplug and recharge.

Work highlights you would love to hit? Certain position/rank/awards/contribution?

Become confident and experienced surgeons.

Don’t care about rank or position.

Would like our practices to be impactful for local community.

If I’m running a private practice, would like to be maximizing impact and using smart financial strategies and tax strategies to run the business successfully.

It would be a huge bonus to be able to get back into academic medicine within the sphere of global health so we can be 100% into global neurosurgery and global trauma surgery AND teach residents AND publish high-impact projects that lead to real progress in these areas.

What would a highlight in your schedule be? In 10 years, about what would you like to be able to look back and say, “We always made time for…”

Time for family and each other. Want to have time to indulge in play activities in the evenings, take our time with meals and housework without feeling like we are rushing through the daily routine. Time to travel. Time for birthdays and special occasions with cousins.

Are there any highlights you want to create from your hobbies?

Start white-water kayaking and more “glamping” adventures in the mountains, time outdoors. 

Impact Highlights?

What kind of impact do we want to leave in the world?

Alleviate suffering for a lot of people permanently, sustainably.

Create some new trauma systems where there aren’t any currently.

Improve the resilience of current trauma systems in settings of disasters.

Happy and generous, empathetic kids and grandkids

Create some training programs for neurosurgery, trauma and general surgery.

How would we finish these sentences?

The world is better because I…

Used my training to impact communities.

Paid attention to what people need.

Used my income to help people.

Told the stories of hard-working humanitarians.

Tried to help.

People around me are better because I …

Worked on my weaknesses.

Tried to become kinder, more thoughtful, and generous.

Don’t allow myself to become over-extended and grouchy, not exist in “survival mode” which makes us just try to make it through the day and through interactions with others. Make sure each interaction is dealt with thoughtfully and mindfully paying attention to that person. Treat people as people and not a task on the list.

When my time on this earth is done, how do I want each of these people to describe my contribution: Spouse, kids, extended family, coworkers, community members, customers, friends?

This section is pretty personal and unique for each individual, so I just left this set of questions here for you to ponder on your own. 

For Conversation:

What’s your “most important” and what is “the rest”?

(Joy) My most important is having a happy marriage, making sure Josh feels loved and cherished, loving my two girls and keeping them safe and healthy, and having a career that feels like a calling. For me, “the rest” is academic prestige, stuff like cars and a fancy house, yuppy vacations.

(Josh) Most important: Caring for the poor. If I get to the end of my life and haven’t done that, I’ll think I haven’t done the thing that was really important.

What kinds of things do you want on your highlight reel?

Joyful and hard work that made a lot of people’s lives better. Generous giving of our time, money, and energy.

By creating more financial freedom, what would that make possible?

The main thing that having financial freedom would make possible would be control over our schedule so that we can travel and work overseas. We would also be able to choose any job or assignment that was a good fit for us, and we would be able to give generously to causes that we were passionate about.

Burnout, Recovery, and a Better Life

Trigger warning: This post contains references to burnout, depression, and a brief and non-specific account of my friend’s suicide. 

I was reluctant to write this post, but I can’t get past it to write others until this one is out there. I’ve been mentally ruminating on what I should say for weeks. I’m convinced this topic, although widely discussed and written about by physicians, is still in the stage where sharing our personal experiences might be what helps someone else fend off their own struggle with burnout and depression, as there are few institutionalized solutions or strategies for dealing with it. And perhaps for myself, sharing without shame is a form of therapy.

2010, residency interview trail.  In my smart gray suit and burgundy blouse, I focused on maintaining eye contact and a slight smile as I introduced myself to my interviewer, a heavy-set man with a bushy mustache and friendly face, somewhere in the Southeast. First question, “So I’ve looked through your CV, and I have to ask you…what are you doing here? You and I both know you’re not going to rank this program.” Well, actually I’m couples matching with a neurosurgery candidate, so I’ll be ranking all programs and your program has a good cardiac surgery department and research capabilities, so…awkward.  Ok next question. “You are like the medical version of a gym-rat. You like never leave the hospital. Don’t you know you’re going to burn out?”

I was adamant that I was doing what I liked. Of course I was not going to burn out, thank you very much.

2014, 3rd year of general surgery training. I was edging ever closer to entering the integrated cardiac surgery track I had committed to during my 4th-year med school away-rotation. The advice from my wonderfully supportive mentor, Dr. S, back home echoed in my mind, “If you go up there to do this, you have to follow through. Don’t punk out. Don’t be one of those women who gets washed out.” The problem was, I was conflicted about cardiac vs. trauma in med school, and I remained so those first few years in residency. I reasoned that in the worst-case scenario, I could just do the integrated cardiac training and then be a trauma surgeon; it’s just an extra year of training, that’s doable, right? In any case, I was not going to quit.

I have had a few other instances in life of not knowing when to quit. In the first grade, my teacher gave explicit and strict instructions to not interrupt her lesson for any reason; I’m pretty sure she gave the example of not even for the bathroom. And then I had to go really bad. But I said nothing, and her lesson seemed like it yawned toward eternity, and of course, I ended up sitting in a HUGE puddle of urine as my neighbor silently laughed his head off. I was quite confused when my mother and my teacher both admonished me to simply raise my hand and ask to leave next time I had to go that bad.

To get a discount on my prom dress, I posed as a “human mannequin” in the mall. I could go hours without moving a muscle. Teenage boys would try to get me to move or smile, and I was so determined that I would have tears rolling down my face from dry eyes before I gave in. I was also undefeated in staring contests; I still do not know my upper limit of standing still.

3rd year of med school, Dr. S informed me that there were no residents on his service that week, so if I showed up I could scrub all day every day and be 1st assistant. Needless to say I was PUMPED. By the end of the week, I was taking 600 mg of ibuprofen before every case to deal with the neck pain, but having a blast. We had a case that was going great, and so true to routine he ordered for the room to be warmed up in preparation to come off pump, but then we weren’t actually able to come off pump for quite a while. The surgeon ran through various maneuvers and waited patiently for the right constellation of labs and monitor feedback. Minutes stretched into hours, and I could feel beads of perspiration dripping down my shirt and legs. The room was over 80 degrees. I started to feel faint, and so I held a valsalva maneuver to get my blood pressure up; that helped. I tightened my leg muscles, shifted back and forth, flexed my calves, and kept myself from passing out at the table. This went on for another couple of hours. If I relaxed, I got light-headed and the room would start going dark, so I’d tighten everything back up. Finally, at a point where I was starting to hear that high-pitched screech that comes right before you really pass out, the surgeon told me to go scrub out and take a little break, since it was obvious it would be another 30 minutes. I went to the locker room, collapsed on a bench and ripped off my dripping wet scrubs. I looked down at my legs and saw that they were covered in petechia up to my thighs. I put on fresh scrubs, guzzled a glass of water, and went back in to finish the case.

There are other examples, but I’ll wrap up this digression by saying that I might be one of those few people that Angela Duckworth references in Grit who really doesn’t know when to quit.

So back to 3rd year, I was flying high after coming off of one of the hardest but most enjoyable rotations in residency, where I was the senior resident with one of our most respected and demanding surgeons in the program. I had also just returned from my trip to Ukraine with Novick Cardiac Alliance, where I learned how much potential there is for advanced-level surgery care in lower-resource settings.

OR in Ukraine, with a viewing theatre in the ceiling.

Having wanted a career exactly like Dr. Bill Novick’s since med school (He founded cardiac programs in low-resource countries all over the world), I should have been sure of my direction, but small doubts were persistent as to whether cardiac was the right field for me. I was more interested in the bombings on the Ukrainian border a short drive away from our site than in our pediatric cardiac cases. I couldn’t deny that I was a little bored with cardiac, which was a very troubling concept, but one that I shoved aside. I couldn’t quit.

I felt great going into my thoracic surgery rotation, which was a big test for whether the integrated cardio-thoracic spot would officially be mine. Only a couple of days into the rotation, I felt myself faltering. After a couple of weeks, I was drowning. Nothing I did was right, nothing I said was right, I was never where I was supposed to be when I was supposed to be there, and I felt like my brain was 10 steps behind me at all times. I confided in trusted mentors that I didn’t know why I was failing so miserably. I didn’t get it and I was frustrated and terrified of failure.

One of the fellows, T, knew Dr. S from back home. He gave me compliments every day, telling me how highly Dr. S thought of me and all the nice things he would still tell people about me. T was a meticulous clinician, and shared with me his routine for rounding, which was truly exceptional. I tried to emulate him. He was probably the nicest person I’ve ever met, especially within the hospital, and his encouragement kept me going.

At our program, we have chief conferences for every rotation, where we go to the fancy auditorium, get onstage in our suits, present our cases from the rotation, and field questions from the staff. It’s a nerve-wracking event for all the senior residents, and we spend hours and hours preparing. I met with multiple staff to go over my case list. I studied for 15 hours one Saturday that I wasn’t working because I needed to make up for my poor performance on the rotation. I kept trying to meet with one particular staff member who would be leading the questioning for my conference, and who always met with residents regarding the conference in the past. She rescheduled with me no less than 10 times, even rescheduling a phone-call with me, and always at the last minute. Finally, the day of the conference she sat down with me, looked at my list, said it looked good with a finality in her voice that did not invite further discussion. I left that meeting knowing that I was about to get massacred; it was just obvious. Sure enough, despite my preparation, I fielded a rapid-fire of questions on controversial topics, and my brain was stuck in red-alarm mode. I could see the paper sitting in my bag discussing how there was no professional consensus on a certain topic, but my mouth just couldn’t say the words that demonstrated what I knew.

The next morning, my typically formal, reserved and always gentle attending greeted me with the words, “I was so PISSED last night! That was BEYOND inappropriate.” I had cried my eyes out after the conference, but I felt responsible for it all. I should have been able to do better. I should have done lots of things better. I took the blame despite more admonishing that it wasn’t fair to me. What’s fair got to do with it?

The remainder of that year was a downward spiral mentally. I had never outright failed professionally before. I continued to force myself to fight for something I didn’t really want. I relived all the moments of shame and humiliation over and over again, all day every day. I became irritable and would pick fights with my husband. During a car ride, I even heard myself say, “I am yelling at you because you’re the only person I can yell at that will listen.” Things had gotten very dark for me.

I was at my workstation getting vital signs one morning when I got a page. Our friend T was missing; he hadn’t shown up for work. So uncharacteristic and worrisome. I paged my other friend on a rotation with T to find out what was going on. I got another page, returned it, was told to sit down.  Two days after supper club and movie night where we had a great time, laughed and joked, where I consciously perceived that his presence was like a port in the storm for me, T took his own life. I wailed in the workroom, felt sick, then felt numb. I rounded. Cried, felt numb. Scrubbed into my first case, cried at the sink, went numb. Did the case. My attending asked what was up. I told him, cried, went numb again. Did another case, actually thankful for the distraction. My group of friends stayed in close contact all that week, tried to get together as much as possible. We were all scared, although we could say exactly why or what we thought would happen to us at this point. I couldn’t understand how such a kind and gentle person could…it’s still too painful to write.

I slipped further into a dark, heavy, and bleak state. I functioned at work, had rebounded to some level of good performance, but every day I felt like I couldn’t keep up with all the tasks on my to-do list. My mind frantically begged for a pause button. Weekends off weren’t enough to recharge; vacation time didn’t help either. Every day started with a panic over how much needed to get done and seemed to end almost instantly, with nothing but shame on my part for not getting to this or that. My life felt like it was careening forward at breakneck speed, and I couldn’t slow it down, keep up, or catch up.

I had no emotional reserve. I received feedback that I seemed miserable from my intern, but I felt like I was doing all I could to simply function at work. My marriage suffered.

Then, my elderly, cancer-ridden, sweet greyhound, Pfeiffer, died. We knew it was coming for months. But this tipped me over from what was probably severe burnout to full-blown depression.

One of my trauma mentors, Dr. M., had talked to me a few times over the years about a particularly hard rotation he had in residency, and he described his emotional state during that time as “suicidal-enough.” He didn’t have a plan, but said if his car happened to run off the road or something like that, he wouldn’t have been disappointed. That’s also how I started feeling. But I also became convinced that my husband would be better off without me, my friends were only friends because they felt sorry for me and were nice people, and although my parents loved me they would actually be better off without me too. I had intrusive thoughts about my car running off the road every time I drove. I thought, maybe with some measure of hope (if that’s what we can call it), that perhaps I would develop a terminal illness.

I also felt trapped. My fate as a cardiac surgeon was still unclear, or at least for the integrated spot. I wasn’t ready to quit because I didn’t want to be a quitter. I agreed to go back to thoracic for another audition rotation. I did fine but not stellar. Whatever, I didn’t care.

I recognized my symptoms of depression and was acutely aware of the danger I was in, especially after my friend, who was much kinder and gentler than me, had recently succumbed to it’s pain. I took an online questionnaire that pegged me as “severely depressed,” and instructed me to seek medical attention. I shared this information with my mother and told her I needed advice but I didn’t want to go to the doctor. Could we just talk it through? I thought her wisdom and love could pull me out of it. I didn’t want “depression” in my medical record, and I didn’t want to tick that box on professional forms in the future.

I researched strategies to combat depression. I exercised regularly, tried to get outside on every sunny day, eat healthy, connect with friends, talk about it with my mom, Josh, and my best girl-friend.

I longed for some canine companionship and so decided to volunteer to walk dogs with the local greyhound rescue group. I met up with them and instantly connected with a big yellow staghound. I picked him up on the first 50-degree Saturday of the year, and we went to a hiking trail.

My first hike with Ramble, when the sun literally and figuratively came out for me.

There was still a nice covering of snow on the ground that sparkled in the warm sunshine. It was a glorious day.  I smiled and my face literally hurt because I couldn’t stop smiling and laughing as we clumsily jogged up and down the rutted out, snowy trails.

We stopped at a bridge and just sat together, and the dog literally hugged me, draping his giant neck over my head and just resting there long enough for me to snap a selfie.

Staghound hugs are healing.

Ramble had a gift for making everyone feel important. Indeed, he convinced everyone that they were important with his confident affection. I thought about many things sitting on that bridge, including what my options were in life. I could do so many things still… I could learn a foreign language, write creatively, read some books, adopt this dog! I could be a trauma surgeon if I wanted. Suddenly, there were a dozen sunny paths before me instead of the claustrophobic walls of a dark dungeon.

Of course I got the dog, and named him Ramble. I created the life-motto of, “If I’m too busy for a dog, I’m too busy.” I decided I would never cross that line again; it was too dangerous. I made room for all the things mentioned above. I apologized to my husband and started doing fun things with him, like seeing as many indie-rock shows as humanly possible. It was a blast.

I sat through the meeting where I was told I did not get the integrated cardiac spot. One loud thought started flashing across my brain…I’m going to start a family! So we did. And I went all-in on trauma/critical care, and that felt so, so good. Trauma is just more fun, and I loved every day of my fellowship year. And  thus, What-is-More-Fun finally became a guiding light.

What actually changed for me that day with Ramble? Only one thing: Perspective. All of those possibilities in life were always there, but I couldn’t see any of them. I went from trapped to in-charge. It was a sudden revolution, but one that I’ll never forget.

I made some mistakes on this journey. I got lucky that I made it through; but not seeking medical help was a huge risk that is not worth taking. I know of residents with the most stellar reputations, who have won the biggest campus-wide leadership and teaching awards possible, who are open about being on anti-depressants. Anyone with symptoms of depression should seek professional help. One other excuse that I made was that my symptoms hadn’t been going on that long, so I couldn’t really be depressed, it was all situational, blah blah blah. Again, I urge anyone who recognizes these symptoms in themselves or a friend or relative, seek and encourage others to seek professional help. It’s just too important, you are too important, to settle for less.

I hope that I am able to spot the symptoms of burnout among my future residents. With my performance level dropping, seeming tired and overwhelmed by the schedule, even after asking for help and understanding from my staff, the signs were fairly apparent. Yet, I had only one single attending ask me during the course of the year whether I might be depressed after I confided that I felt overwhelmed with my to-do list every day (and at that point I summarily denied it). It seems that this is a common experience during 3rd year of general surgery, but it can happen at any time. I hope that by sharing openly about this issue, that someone feels less alone, and less trapped. The biggest lesson to overcome burnout for me was that I was in charge of my life. No one else could be expected to carry me to my desired destination, but I absolutely had the freedom, and responsibility, to make it happen. I learned the importance of knowing oneself and being honest about what I really want rather than what is expected of me.

Another concept from Dr. Angela Duckworth’s Grit is that having an overarching purpose in life helps one have grit, because even if you fail at something specific along the way, you will just find another way to continue the long arc of achieving your greater purpose. I’ve always wanted to do humanitarian medical missions. Indie Docs is about intentionally, methodically, making it happen. Several studies and sources have published that humanitarian medicine can combat burnout among physicians, and the reasons are fairly obvious. By helping those with less resources, we get that “givers high” and feel like we have an awesome purpose, and I truly believe there is nothing better in life than that.

There are many other great posts and discussions on burnout, but the one that really got my attention several months ago was the ChooseFI podcast with guest The Happy Philosopher, where he talked about his burnout and recovery; this got me reading his blog, and there are numerous fantastic posts about purpose, meaning, and his own story about burnout. This is a great resource to start with if you are struggling with it. I hope that my little contribution to the subject might connect with someone and help you know that you’re not alone, you’re not weird for feeling this way (over half of physicians have symptoms of burnout!), you’re human, you’re the boss, and you can make your life into a fantastic story that you’ll be happy and proud to live out.

Feel free to email me at joy@indiedocs if you’re struggling or just want to share your experience, or share your own story in comments below. If you have thoughts of self-harm, please call the  Suicide Prevention Lifeline at 1-800-273-8255 or seek help at your local emergency department. 

 

Work, travel, exercise wardrobe in one? The holy grail of trousers.

#GirlMed indulgence here. Thanks to Natalie Wall over on Twitter @nataliemwall, who gave out the tip that these “On the Fly” Lululemon pants could be worn to clinic, I have found the workhorse everything pant.

I was reluctant to drop the $100 on them but totally justified it by thinking they could also work throughout my maternity wardrobe needs.

It is actually and practically true that a 26 week pregnant resident can:

Top is Old Navy $6 active apparel that I’ve worn approximately seventy-billion times over the past 3 years, pregnant or not.

1. Bike to work in these pants (mostly downhill).

2. Put on a blouse and flats (I also paired with a nice black sweater, and a lab coat for procedures) and look professional while rounding on patients

I will never have Natalie’s style, but I try.

3. Do a HIIT workout in these pants after work (after this 26 hour day, I actually I just rode my bike home, ate cake, and went to bed).

4. Wash and then re-wear on any trip in any airport.

5. Wear multiple times per week if really not dirty/sweaty and changing into scrubs immediately upon arriving to work.

6. Wear home and immediately get down and play with toddler…no harried suit-stripping on home re-entry :).

So one pair of pants can work in virtually any setting of my life short of a cocktail party. I never have cocktail parties, so…Awesome. Money, time, and closet real-estate well spent. I’ll be living in these pants for the next 14 weeks for sure. I might even get them in olive-green!

Happy Mother’s Day…Getting out of the “Mom Box”

I have to admit that I really feel like I have it all. I complain about my crazy and exhausting life sometimes, but I wouldn’t change it. I have the residency of my dreams and I’ve reached the end of my Chief year (Holla!!!), the man of my dreams (you’ll appreciate this more in a minute), and a beautiful and fascinating baby girl. I even have a borderline-magical beast of a dog that will get his own post one day, but suffice it to stay he’s my hero and definitely one of my besties.

There is a detail in here that is actually quite vexing to me, and it’s the mom part. We were married for 10 years before having a baby, and during that time, I was pretty hard core anti-motherhood. I read and related to articles examining the decision to never have kids. I was “not maternal.” I couldn’t talk to kids. I was impatient. I didn’t like clutter or messes. I was 100% career driven and proud of it. So what happened? Well, I slowly started to get to the point where I didn’t want to choose between a career and a family. Certain aspects of motherhood started to appeal to me, and for half a dozen little reasons that aren’t important, I decided I wanted a baby. I figured out that an au pair would be essential and also doable with our money and space. So I became a mother, fully expecting a tsunami of life-altering invasions of time and privacy that would leave me grouchy and struggling to maintain sanity. That’s what all the advice focused on, right? How to “survive” the first year. How your life as you know it gets destroyed by a baby and you deal with it for 18 years.

Well that’s not how it happened. From day 1 to now day 600-and-something, it’s been fairly awesome. Truly, I’ve loved it. I’ve given up lots of sleep, yep, and breastfed forever, pumped countless time between cases, felt the push and pull of work responsibilities and fatigue, but I’ve never felt like it wasn’t manageable or that it destroyed my life. It’s been fine.

How is this possible? Well, firstly I would say that I have no shame about asking for help raising this little angel. Yes it would have been more enjoyable to stay home more, I fully admit, but that’s not the path I chose or was meant for, so I enlisted the help of my two aunts when Eddy was an itty bitty (6 weeks to 3 months) and then an au pair plus day care as she got a little bigger.  She loves day care and our au pair, so even though her day from 6 a.m. to 7 p.m. routinely is with them, I don’t get stressed about that. Secondly, Josh and I have equal parenting responsibilities. I’ve observed that in many families, even where the woman works full-time, the mom is the “dominant parent,” responsible for much of the mental burden of planning and decision making among the family. Josh simply doesn’t have the reflex to push that stuff onto me, and for the most part I let him do things his way. Admittedly, Dad-style can be less polished (like when the baby’s clothes don’t match or fit and are out of season), but is reliably more efficient. I’ve actually adopted some of his techniques and been happier for it!

From the beginning, I have had a routine of bathing Eddy and safely co-sleeping (according to pediatric safe sleep guidelines), and so we spend all night together. This has helped me feel like I wasn’t missing her so much and I think it also strengthened our bond and made nursing much easier at night. I think another key has been that I learned a parenting style from my Mother-In-Law, who had a very late in life baby, that allowed for a full range and display of emotions from the little one without taking it personally or even reacting. I joined a gentle parenting group on facebook that reinforced these principles, and I think it saved my sanity and helped me maintain patience. I got into a discussion one time with a friend who was absolutely miserable trying to stay firm with their 1 year old over sleep training, and in that discussion I created a new mantra, which is “If snuggles solves the problem, there really is no problem.” I will fully admit, this philosophy is as much about my happiness as my child’s.

I’ve been thinking about parenting in the context of pursuing humanitarian work and the Indie Docs lifestyle quite a bit. Josh and I have talked about the best way to raise our kids and make sure their education doesn’t suffer. In the process the topic of being flexible has come up, as has different parenting cultures. Josh sent me this article the other day: Secrets Of A Maya Supermom: What Parenting Books Don’t Tell You, and it was a great article talking about how skewed our idea of parenting is in Western Society. I love the author’s imagery of how we have put parenting, motherhood, in particular, but this is relevant to the many stay-at-home Dads I know, in a box and expect one person to do it all. It’s not normal or necessary, and I think it generates a lot of anxiety and misery among parents. Of course, reading the article I felt validated in my parenting style (after being called “crunchy” a few times in various contexts) and in my skepticism of some parenting advice I was hearing over and over (like hard-core sleep training, we can have that discussion another day).

Perhaps more relevant to Indie Docs per se is the fact that we will demand a lot from our kids as we pursue this mission in life. They will need to understand that a huge portion of our time and money goes to help others. They will have to be flexible and adaptable to other cultures, and will likely sacrifice some aspects of the prototypical American kid existence from a social or sports context.

Now to inject some reality that life is not a fairy-tale. I got mastitis 3 times on a rotation where my attending would not let me pump. I was so tired one time that I came home and while holding Eddy to nurse her, I hallucinated that it was raining inside my kitchen. I’ve gone on a job interview just to have a night away in a hotel, and I felt FABULOUS after getting that night of undisturbed sleep. I’ve let the au pair feed Eddy her dinner while I hid in my room either power napping or vegging out for 20 minutes. Our marriage has undergone a tectonic-plate-shifting adjustment, and I had to delve into relationship podcasts and articles to try to undo some of the damage done by the paucity of quality time we had together. Going back to work when Eddy was 6 weeks old was one of the hardest things I’ve ever done in life, and her sleep habits only got worse over the next 6 months when she was waking up every 2 hours to nurse. But we coped and managed and continued to enjoy the moments and milestones along the way.

Fortunately, I did not experience postpartum depression, or have a colicky baby, or have any major medical concerns that would be much more challenging and beyond my control.

This is a huge topic that is both paramount to life as a physician parent and in related to upcoming big decisions about where and how to raise our kids. I hope to become more open minded in how I guide my little one through life, and most of all I hope I can maintain the inner peace that motherhood has brought to me. And to any reluctant trainees contemplating whether it’s worth it, I can offer my anecdote that having this child in my life is the most interesting, entertaining, and warm-fuzzy-feeling-inducing thing I’ve ever done. As The Ruth Bader Ginsburg has said, having a career and being a mother gives balance, and one helps you find respite from the other. I hope everybody finds their tricks and techniques that can make this huge responsibility wonderfully enjoyable.

Happy Mother’s Day to all moms out there making it work! 

 

Is Financial Independence the Key to a Global Medicine Career?

If I had to point to one single resource that has motivated and inspired me like no other these past few months, it must be the “FI” community, particularly the Choose FI podcast.

I am a complete newbie to this world. In fact, I got connected to “Physicians on FIRE” on facebook (through my Physician Moms Group), and I did not know that FIRE was an acronym for Financial-Independence-Retire-Early. So for anyone out there as clueless as me, FI stands for Financial Independence, and it’s propounded “Fye.”

At first encounter, this seems like a fairly narrow focus. I was peripherally aware of some nuts who wanted to retire by age 30 and did all sorts of weird financial acrobatics to accomplish this, but I did not consider any of that relevant to me. I finally listened to one of the Choose FI podcast as I was exploring options for accomplishing the Indie Docs lifestyle (although I did not have that term for it at the time). Josh and I kept discussing the best plan for funding our dream of being humanitarian physicians, and without charity funding it seemed that achieving financial independence was essentially mandatory. Otherwise, debt obligations alone would be prohibitive to traveling and working for little-to-no pay. While religiously affiliated programs and some fellowships exist that can fund 1-2 year projects or even longer missionary careers (topic for another post), we ultimately decided to leverage our income potential to control our own destiny. Hence, my portal into the Financial Independence world.

I quickly discovered that FI is so much more than extreme budgeting, saving, and investing. Mr. Money Mustache was for me, as for many people, the gateway to a whole new mindfulness toward how I should spend my attention and time in addition to money. He calls out many ridiculous notions of consumerism in a compelling and entertaining way, and at this point I’m practically inhaling 2-3 of his archived posts every day. On a very practical level, he convinced me to ride my bike regularly to work and for errands around town, and this has been a very enjoyable, economical, and healthy transition. His post “What do you mean ‘You Don’t Have a Bike’?!” is what first intrigued me–Click the hyperlink to judge for yourself!

Saturday grocery trip. Hauled a full load of groceries in the bike trailer with Eddy. Workout-check.

While riding my bike, I’ve listened to several more episodes of the ChooseFI podcasts, and discovered resources like Get Rich Slowly, Raptitude, Frugalwoods, Making Sense of Cents, and many other blogs. I explored the travel rewards section of the Choose FI website and listened to the Travel Rewards podcast episode. This topic also deserves an entire post in it’s own right. The obvious practical implications of finding a way to travel at a huge discount would be a total game-changer for humanitarian physicians. I realized that I had done a very mini-version of their travel hacking by opening the Chase Sapphire credit card years ago and using the miles for airline tickets and recently a sweet deal on a rental car, and subsequently opening two Delta cards between myself and my husband to qualify for bonus miles and free companion tickets. So in the past 6 years we have played this game 3 times, but not in a super-savvy way and totally unaware that there was a whole busy and geeked-out world of travel hacking teeming below the surface.

Yesterday, I listened to the Choose FI podcast episode 48, which featured Jeff from The Happy Philosopher, a radiologist who experienced severe burnout and found a path to professional fulfillment and happiness again as he pursued financial independence. The episode gets fairly deep into a discussion about burnout and it’s effect on all aspects of life, and practical approaches to emerge from this crisis. I myself have experience full-fledged burnout and will definitely devote a post to this topic, and I was again amazed at how relevant the FI discussion is to so many of life’s complex emotional problems.

On the most basic level, achieving FI will open up possibilities to spend our time and money on the projects we are most passionate about. One of the earliest steps in the path to FI is becoming debt-free, and this is a particularly large hurdle for many physicians. It seems that the college and med school tuition and student loan structure are practically designed to keep us working as many hours for as long as possible just to pay back this obligation. When we get past residency and find a “real job,” our work schedules are optimized for billing, and many physicians would find it impossible to spend a significant amount of time pursuing humanitarian projects; in fact, I personally know several wonderful physicians who devote over half their vacation time to short term projects. In addition to paying back the loans, we need to make up for a decade of lost time funding retirement accounts and other funds, such as kids’ college.

However, if you can imagine that suddenly you are financially independent, the game changes drastically. You can insist on a part time schedule, find a work-share situation with another physician, or simply walk away forever. Even if you have a full time physician job that you love, it frees up your financial obligations to make a huge impact on your passion projects rather than paying back the bank.

Josh and I have just started investigated new strategies to start our FI journey. I love the easy equation that comes up often on the Choose FI podcast that (Money Made) – (Expenses) = Your Gap, and the Gap is what you invest to achieve FI. Our income is relatively fixed as two residents, but I do supplement with teaching courses and plan to do Locums this year for some bigger boosts. The big category I’m fired up about now is minimizing expenses to maximize our Gap. I’ve started taking my lunch to work, riding my bike to work, really cut dining out. (I truly enjoy my PB&J, which is super charged with rich omega-3 supplemented peanut butter, rhubarb and strawberry jam, and gourmet whole grain bread).

Packed lunch for the playground, pretty identical to work lunch except more “snacks” for Eddy.

I bring my coffee to work every morning; I don’t have a coffee thermos that I can toss into my backpack, so I rigged one using a mason jar and a breast-milk insulated carrier from my diaper bag (see photo), and I have no plans to upgrade as it works great. We have always used cloth diapers at home (day care requires disposable), and it is a huge money saver that is so easy I have no idea how all families don’t at least have a hybrid cloth/disposable diaper system.

After July, we will no longer employ an au pair, and I will be able to cut out a smart phone line and cable and sell a car (saving money on the insurance also). At that point, I’ll look into budget smart phone carriers to try to find something cheaper than Verizon (have a feeling that will be pretty easy). We have a few low-interest debts that I will look into paying off, but we are in a debate as to whether it’s wise to use part of our emergency fund to do this when we are only a year away from both having full-time attending jobs and can reasonably float these small loans a little bit longer. I think we are paying too much for house and auto insurance, so I’ll look into switching that in the next few months. I have to take my general surgery boards in July, so some of these items will have to wait until that task is complete.

We will revisit FI again and again on Indie Docs, as well as explore other ways of funding a humanitarian medicine career. For now, enjoy visiting the amazing resources available through the hyperlinks above. Please leave comments with your favorite financial blogs, websites, or podcasts, as well as any practical tips and tricks you have for maximizing The Gap.