stop, breath, and be careful in approaching things... together

I remember when I initially started writing this blog I was determined to show the "true" side of what it is like being married to a doctor, (in reality it's all awesome though, right??)  I wrote one night about how therapeutic it was to take a shower at night after everyone was sleeping, and just cry.  The next day, friends and relatives called to tell me that I needed to be more positive and limit the "sad and depressing" stuff on my blog.  That was four years ago. 

Last night I found myself in the same moment, thinking about that post written long ago, wondering if I would recommend it again, and thinking about whether I had learned anything new since that time long ago when I blogged about it.  My husband and I were at a stand still.  Everyone was asleep.  I was in the shower, weeping.

When my husband and I disagree on a matter, I often withdraw myself and prefer to think before discussing the matter further (matters that we really do not agree on).  My husband gets frustrated when I become quiet.  He sees it as a way of punishing him.  This is not why I do it.  I withdraw in order to think, to process rationally my feelings, thoughts, desires, frustrations, weaknesses, all within my current level of understanding.  The time to myself to analyze the disagreement then becomes an essential process for me, to grow in my ability to love, to forgive not only my husband but myself also, to increase my ability to understand my husband's opinion and reasoning.  Without this process I would merely let out everything verbally - while upset and uncontrolled - and then regret it later.  I am grateful that I can hold in my frustrations while I sort through my feelings.  I wondered if I my weeping in the shower would make me appear weak, like I couldn't stand up to my husband and express my feelings and desires but rather suffered in silence. 

I didn't feel weak.  I felt that I was putting our marriage first, ahead of my own agenda.

Sometimes I direct my frustrations (often due to the limits of our current situation) at my husband.  I do this often.  I wish I could recognize it earlier and stop myself before doing it.  Or at least change my approach in how I deal with the frustrations.  If I could present my thoughts in a way that do not quickly end up with both of us making it difficult talk through things and understand each others' reasoning.

It is easy for me to forget that my husband is a person - just like me - full of weaknesses, pride, dreams, etc. - and that he is developing in his abilities to love, forgive, sacrifice, etc. - just like I am.  I hope that I can do better in remembering this when I am frustrated, and take a moment to breath and analyze things before I present them to my husband, so that we can work through things together and not steer in completely opposite directions... particularly where I end up in the shower.

Because... I know my husband is worth it, and I know our marriage is worth it also.

I know it's mother's day... but...

I love Mother's Day.  I really love it.  My husband goes all out.  He bought me flowers a few days ago, presented a spread with crackers and a variety of expensive cheeses, he shaved his van dyke beard because he knows I don't like it, (even though two people recently told him he looks like Johnny Depp...), he took me to the temple, he brought me absolutely-to-die-for dark chocolate bars from Trader Joe's, and the list goes on and on. 

I have to admit that the day also makes me a little crazy though, largely because of all the trouble everyone goes to in order to give me gifts, (take me to the store, where is my money?, I need more money, when can Dad take me to the store?, don't look in my room, etc.), make me breakfast, make me lunch, make me dinner (I admit this is probably because I have to choose what they will make and I also have to do the shopping for the meals...). 

Each Mother's Day it is the same.  More than any other gift in the world, I just want my kids to get along for the day. 

I asked my husband if that sounded more difficult than preparing me breakfast.  He said it would be impossible.

While thinking about how I can possibly avoid feeling the huge amount of stress caused by the special day, I found this video.  I was reminded that I would not be a mother without my wonderful husband.  He works so hard for our family.  There is a Mormon Message about mothers also, but this video just touched me so deeply that I wanted to share it.

My life would be so different without a husband that dedicates his whole self to being a wonderful husband and father.  I know residency takes him away - a lot - but like the father mentions in the video, he is far from his family but he is always close by, always thinking of them.  I know this is how it is with my husband.

And I love, beyond words, how he makes it possible for me to be home with our children, to be there when they are exploring and testing the world, laughing, crying, sleeping, eating, and learning.  I love being their mom, and I love that my husband is their dad.

Okay, and beyond all of that, I totally want that little house in the video... and their fields of wheat, their endless acres of beautiful farmland, their trampoline, their stairway banister to slide down, their relaxed, rural way of life.  Oh my goodness, it looks soooo incredible!

trying to avoid eating sugar... well, except for dark chocolate

I decided last Monday to give up sugar... to eat healthier.  My sister decided to do it long ago (a few months).  Somehow, knowing my own sister had the will-power, discipline, desire to do it, and that she had been successfully accomplishing her goal, made me feel that I could do it also.  I read this article a few weeks ago and was really shaken up: It's the Sugar, Folks.  I was eating a lot of sugar, and my kids were too.  I wanted to change... really... but I didn't know how and my attempt to decrease (not cut out) the amount of sugar in my family's diet only lasted a few days.  "Let's make cookies!" I said after only two days.  But after talking with my sister last Monday, I decided that it was time.  My motivation was powered by the fact that I knew I was not eating healthy, and I wanted (really wanted) to be healthier. 

The first day of "no sugar" was great.  No problems.  A few cravings (especially when my kids were fighting, whining, etc.) but I got through it just fine.

Day #2 was... absolutely horrible!  At one point I was pretty certain that whatever the reason for my new goal, (I couldn't quite remember what it was any more), it was NOT worth it.  Luckily I was driving my kids around to activities and did not have access to any sugar - I would have given ANY-thing for a chocolate chip cookie at one point.

Day #3 was not as bad... only difficult for my children, whom I also determined would cut sugar out of their diets (I told them that we had decided as a family, although it was entirely me who had decided - while my husband was working).  Z almost lost it when we walked past a Cold Stone Creamery.  Well, okay, he did lose it.  We regrouped later while eating some strawberries.

Note: I did decide that I would continue to eat dark chocolate (in moderation, of course).  I discovered recently that it has zinc in it, which aids in the production of progesterone.  That is important!  Too important for me to give up... okay, okay, plus I love it and I need some little sweet thing every once in a while (extremism doesn't really work, I think).  And the kids, or course, get sugar constantly.  A few examples:  E went to a birthday party on Saturday night, ate cake and came home with a goodie bag filled with candy; friends brought a plate of chocolate cookies to our house after church yesterday; Z and C went to a pre-kindergarten Teddy Bear Tea this morning and received gummy bears, Teddy Grahams, and rice crispy square treats; and chocolate cake was offered at an end-of-season soccer party this evening for E (luckily I swept them all out before the cake was cut).  All of this happened within a two day period.  There is sugar everywhere!!  So, I don't think I'm being "mean" as my kids keep saying, for eliminating sugar from our diet at home, because they still get sweets every once in a while.

I just read an article by Mark Bittman, the writer of The Minimalist food column in The New York Times for many years.  The article is titled, Healthy, Meet Delicious.  Here are a few thoughts from his article:

“What’s left to eat? I feel like nothing is safe.”  (I have honestly thought this same thing multiple times during the week.)

"Things are changing, and fast. Only 5 percent of Americans define themselves as vegan or vegetarian, but almost everyone believes he needs to eat better. What does “better” mean? ...much less junk, fewer animal products and more veggies. Could not be simpler."

Bittman concludes with: "...the primary challenge [is] to discover how to satisfy those cravings while staying as best as I can within the boundaries of what we know to be sane, or conscious, or well-informed — call it what you will — eating..."

For some reason I have substituted cheese as a way to satisfy my "cravings" for sugar... but I am not sure if that is actually better?  I don't think so.  I am trying to substitute fruits and veggies but my food bill is going out the roof!  

Day #8:  I have definitely noticed a difference in my body and mind.  It has only been a week but I feel better, everything feels better.  I sleep better, I wake up feeling more energetic, I feel stronger and happier inside, I handle stress better.  

Sugar really is evil, I guess.  Or rather, 'toxic', as it says in the first article (referenced above).  Can you believe that they have found sugar linked with diabetes (irrespective of whether someone is overweight or not) just like cigarettes are linked with lung cancer??  It is mind-boggling!  Particularly when you consider each thing that you, your spouse and your children are eating (and/or are encouraged to eat) - every single day.

Now the challenge is to continue eating healthy, as well as to convince my children of the benefits of eating healthy.  But, seriously, who would turn down a rice crispy treat?  I never would have before this week - they have always been one of my favorites!  But knowledge is power, as is experiencing the benefits of a new habit over and over again.  Hopefully, my kids will start now to make healthy choices in their eating habits - before they get set in their ways, like I am!

so many questions about sex...

There have been quite a few questions on my blog about sex - particularly the frequency of it in a medical marriage relationship.  Every relationship and individual are so unique, I wasn't sure (at all!) how to answer any of the questions.  So, when a friend sent me a link to this article, I thought maybe it could be useful to someone else reading on here:  How Often Should Married Couples Have Sex?  

A few interesting points:

* More experts now believe that sex is "a more emotional experience for men than for women".
* A social psychologist: "For some men, sex may be their primary way of communicating and expressing intimacy."
* A licensed marriage and family therapist: "Take sex away and [men] don't have the chemical stimulants that give them a sense of well being."
* A recent study published in Social Psychological and Personality Science: "People are better able to sustain desire when they are motivated to meet their partner's sexual needs, even when these needs conflict with their own preferences.
* Lead author in study: "We think people higher in sexual communal strength are more focused on positive outcomes in their relationship... They are having sex to enhance intimacy and feel closer to their partner rather than to please themselves, and this is what leads them to feel higher desire."

Interesting, huh?  I think in general everything in marriage is similar to that... the more we sacrifice for each others' happiness, the happier we ourselves become.  I think I am very lucky to have a husband who is always willing (and eager, actually) to talk about our relationship.  He is very respectful and open about his emotional and physical needs.  I don't think this is the norm... and especially realized this after reading that article...

a few more details about The Match

The Match is next week.  I have a few family members and friends involved in it, so I decided to post details about how to prepare for it, as well as look into how it has changed since my husband matched.

Of course the best resource for information is http://www.nrmp.org/ - the actual website for the National Residency Matching Program.  But, I also found another article, Getting Into Residency: Most Important Factors, that lists a few key things that residency program directors look at when choosing who to interview and how to rank those that are interviewed for the match.  In order of importance:

1. Letters of reference from physicians in the applicant's desired specialty.
2. Step 1 and Step 2 scores (USMLE). 187 is passing.  A few examples of Step 1 average scores of those that matched into the following specialties:

• Dermatology: 221
• Orthopedic surgery: 217
• Otolaryngology: 224
• Plastic surgery: 221
• Pediatrics: 200
• Family medicine: 194
• Psychiatry: 197

60% of programs have "target scores" - or cut-off scores, (they won't even look at an applicant unless the applicant gets above a certain Step 1 score).  Also, almost a third of programs will not even consider an applicant who has failed Step 2.  The article emphasizes: aim for 227, the score that will almost certainly get you an interview, or a minimum score of 209.
3. Grades earned in the applicant's desired specialty (honors, AOA, etc.)
4. Medical school (relative depending on program and competitiveness of specialty)
5. Personal statement (often "used mostly as a screening tool" after the interview). Make sure it "fits" the specialty.
6. Volunteer and extracurricular activities, such as research, (though each program differs, research is very helpful for competitive specialties.
7. Away electives (rotations) - also very helpful for competitive specialties
8. Medical school performance evaluation (MSPE)

When programs rank applicants, the following are considered, in addition to the above mentioned points, in order of importance:
1. Residency interview.  Yes, that's all.  A lot of emphasis is placed on "interpersonal skills, professionalism, feedback from residents and house staff, perceived commitment to the specialty, ethics," etc. during the interview experience.

According to the article, the top three factors** involving how an applicant is ranked by a program are:
1. "Letters of reference from individuals within the specialty"
2. "Grades in clerkship in desired specialty"
3. "The most important factors are... evaluated during interview day"
(** For competitive specialties, research and away electives also weigh heavily.)

However, each program also differs in what type of applicant they are looking for.  There is an NRMP Program Director Survey where applicants can discover the specific goals and visions of residency program directors.  More information on that in the article referenced above (Getting Into Residency...).

Some good advice for applicants:
* Study the previous year's match results in order to determine the "highly competitive", "competitive" and "non-competitive" specialties.  You can find these at http://www.nrmp.org/.
*Find out how competitive the programs are that you are interested in.  Determine this by comparing test scores of graduates from previous years in a specialty's various programs.  These are usually posted on the website for that specialty's main group (i.e. American Society of _, or American Board of _)
* If your backup plan is to "scramble"into a less competitive residency program (i.e. pediatrics, family practice, psychiatry, internal medicine, etc.), just go ahead and apply in two specialties.  (Make sure letters of rec are not specifically recommending the applicant to only one specialty.)
* Spend a year in research and re-apply as a senior student.  Can do specialty-specific or a combined program such as MD/MBA, MD/MPH, MA/MD)
*Alternative training route - choose a specialty that can lead to the desired specialty
* Have a realistic "backup plan".
(Some of these ideas are from Dorothy Andriole, MD, Washington University School of Medicine St. Louis MO.)

BOTTOM LINE:
1. Develop strong relationships with individuals in the desired specialty and get awesome letters of rec from them.
2. Study a lot (get good test scores and good grades).
3. Develop your interpersonal skills (see #1).  Talk often with everyone around you that might have insights into programs, specialties and possibilities for your future, particularly your medical school counselor/mentor.

For applicants who do not match, things have changed since my husband was at that point.  Here is an article describing last year's match results, Highest Match Rate for U.S. Medical School Seniors in 30 Years.  There is now a computer program for applicants who did not match into a program, (much more appealing and effective than before, when individuals had to immediately start cold-calling residency programs and simply beg to fill one of their unfilled positions...)

Here is the description of the program from the article referenced above:
"For individuals who were not matched to a residency position, the NRMP debuted the Supplemental Offer and Acceptance Program℠ (SOAP℠), a new process developed in partnership with the Association of American Medical Colleges (AAMC) and in consultation with student affairs deans, residency program directors, resident physicians, and medical students.  Designed to help streamline, equalize, and automate the process for students who are not matched initially, SOAP replaces the “Scramble,” the unofficial name for the period of time during Match Week when unmatched applicants contact programs with unfilled positions.  Under SOAP, the NRMP makes available the locations of unfilled positions so that unmatched students can submit applications for these positions through the AAMC’s Electronic Residency Application Service^® (ERAS^®).  After receiving applications through ERAS, residency program directors create a list of candidates in order of preference and the NRMP offers positions in that order in a series of up to eight rounds.  Applicants are able to receive multiple offers in a single round; if an offer is accepted, it is binding."

Important note: I am not an authority on The Match.  I pulled all of the above information from the referenced websites and articles, my husband's opinions and random forums found via google.

And just remember during all of this fun stuff that residency is much, much, much, much, much more challenging and excruciating than medical school... (of which memories we now view longingly as a "PAR-TEE!!")

a possible way to increase efficiency and mutual understanding in a family...

This is an article with some very interesting parenting ideas: Family Inc.  I had studied many of the ideas while doing my masters degree, but never thought to apply them to my family's dynamics and daily mechanics. 

My husband and I actually decided to incorporate the idea and had a family meeting to discuss a few of the points in the article.  It was amazing to see how my 10-year old son became engaged during the meeting.  If I can be consistent in applying the ideas on a daily basis, I think it could possibly be incredibly beneficial to our family, our relationships, and our daily excitement(s). 

I feel like I want to buy the book, The Secrets of Happy Families... especially since I can't fathom why someone would recommend that I cancel date night (!!)... that's really the only time my husband and I talk... 

progress

My husband and I attended BYU.  I wasn't aware that these conversations had started... I am relieved that they have. 

I hope it continues to get better.

switching gears... maybe

My mom told me recently that my blog is depressing... and not fun to read at all. I laughed (hard) and agreed with her, saying, "I don't even want to read it... or write in it!" This was not my original intent when I began to blog. I wanted a place to write about interesting experiences, to encourage and provide insights to others in the medical field, to find support and humor while connecting with others having similar experiences, to know that I was not alone in my preoccupations, fears, loneliness, excitement, and humorous undertakings as a wife of a medical resident and also as a mother. I found strength - often - particularly in comments made by others, and also in the process of writing down my thoughts and exploring my feelings. I liked it - a lot. I'm not sure where I went wrong... where I began to only blog when I could put into words some sort of tragic occurrence, like a marital argument or parental breakdown. I needed to write these down, and of course ended up here, where I had established a comfortable place for me to write. My mom encouraged me to start a journal for those experiences... and move on to better and more positive blogging - especially because I am a very positive person anyway. We'll see if it works! (Just wanted to let you know my plans...)

a thought worth reflecting on, over and over again

and now... life goes on

My husband and I talked.  And talked and talked and talked.  The other night - after I wrote the post below.  I received amazing advice to "stay positive" and "be myself" and decided to call my husband before going to sleep (he was on call).  With the intent to be positive and loving, I approached our argument with a very different perspective than I had earlier in the day - and it helped tremendously.

We were actually able to talk - especially since I stopped attacking and complaining.

But, even with my positive attitude, all of it was painful... but totally worth it.

I feel like I recently have written something similar to this... us discussing our deepest desires, priorities and beliefs... exploring various ways to work around differences and forgive each other for hurtful comments and deciding on ways we can support and love each other in new ways.  Oh the drama of this year!  I cannot believe how much we've been through in seven short months.  It seems like the drama we've experienced this last year of residency is more than double the amount of drama we had during the other ten and a half years of our marriage combined. 

However, after this last argument, I was impressed by how much more deeply I came to know my husband, how much more I felt I had given of myself to him, how much more we came to understand each others' needs and desires, and how our love for each other becomes so much richer and stronger as we forgive and sacrifice for each other. 

I am so grateful for my husband, he talks through things - sometimes much more than I would like to - but we can always work things out.  He persists in ensuring that I know he loves me and will do anything to make me happy.  At one point during our argument my husband said, "I would be willing to quit everything tomorrow if you asked me to."  Isn't that sweet? 

I can't imagine being married to anyone else.   

Any.  One.