Chapter 30

Chicago

Winter 2013

Let’s just say this: residency is a trying time for a marriage.

There were half a dozen other wives whose husbands were going through the orthopedic surgery residency with Dave. We called ourselves “the Rush Widows.” These women understood how much it absolutely sucked, but no one else really could. I cannot tell you how often I heard some variation of the refrain from my friends and family whose husbands were not in medicine: “I could never do it!” or “I could never be married to a doctor!”

Well, I’d think, I don’t really have a choice, do I? The man I fell in love with happened to choose medicine—surgery—as his career, so I either leave him or go along for this difficult ride. So there we were. And it was definitely a difficult ride.

I realize that there are many difficult and even dangerous jobs out there. I have two brothers who have deployed to combat zones with the military, so I realize that there are jobs in which men and women put their lives on the line every single day. I also realize that there are many, many people in this country who struggle to find work and to feed themselves and their families, and that a surgeon in a white coat is not a member of society likely to earn anyone’s sympathy. I acknowledge and respect that, and I do recognize that once the training is done, orthopedic surgeons are more than generously compensated for their work.

But I do believe that medicine deserves its place in the pantheon of highly difficult jobs, particularly during the training years and particularly when you consider the strain it puts on the family balance. The length and rigors of training alone would send most sane people running for the hills: there are four years of premed courses, then the Medical College Admission Test (MCAT), then four years of medical school, then for most people a few years for research or private-sector work to round out their résumé at some point in there, then a five-year residency (give or take), and then a fellowship or two after that. While the rest of the people with whom you graduated from college are likely focusing on first jobs and then making their ways up in their careers and salaries, medical students remain in school and in training—very difficult school and training—for their entire twenties and then some. All the while they are getting paid an offensively low salary (if they’re getting paid at all—for many of those years, they are paying exorbitant sums for training and schooling; many medical trainees begin their careers with hundreds of thousands of dollars of debt). The schedule and the lifestyle are punishing; Dave once computed what his residency pay came out to when his salary was distributed across the many hours he worked, and it was well below minimum wage.

Then there’s the culture. The institutional ethos of so many senior doctors is, “Well, when I went through it, it was so much harder, so you should have to go through it, too.” Doctors in training are junior members of the team, dues-paying underlings on the lowest rungs of the totem pole well into their mid-thirties, and that’s if they take no time off between college and medical school.

Then there’s the stress. I remember in the newsroom, the refrain we often used to calm ourselves when it got really hectic was: “We’re reporting news here, not saving lives.” But Dave could never fall back on that refrain because, well, he was tasked with saving lives. If I made a mistake at my stressful job in the newsroom, a typo slipped through onto live television. If Dave made a mistake at his job in the hospital, a life hung in the balance. That kind of pressure cannot help but weigh on you day in, day out.

Physically, Dave held up a lot better than I would have in his place. He would roll out of bed fifteen minutes before he had to leave for the hospital. He usually got no breakfast or lunch; dinner was often cold leftovers after I was fast asleep. He fueled his body with energy drinks and coffee. He was perennially dehydrated (which was sort of a good thing—he would not have had time to run to the bathroom on many days, anyway). Chronic sleep-deprivation was the norm. I remember one day when Dave woke up with the shakes and a fever of 103.9 and he still insisted on going into work. I remember thinking: What about this situation is OK? I often wondered why doctors are expected to take care of everyone else’s well-being, yet they are not ever allowed to think of their own. It felt, at times, not only nonsensical but unconscionable.

A phrase that I once heard has stuck with me: Medicine makes a most demanding mistress. That is what it feels like so much of the time. When you are married to a doctor, you are sharing your spouse. Your time together is not your own. The pager goes off at all times—holidays, weekends, the middle of the night. You thought you could go home to see family for Christmas? Ha! You thought you could celebrate your anniversary? Rookie mistake! Oh, and that wedding you wanted to go to—the one in which your wife’s sister is getting married? Yeah, well, it depends on whether we have a case that day. There’s a reason why the divorce rate among doctors is so high. It’s so much more than a job. As the late Dr. Paul Kalanithi wrote, “You can’t see [medicine] as a job, because if it’s a job, it’s one of the worst jobs there is.”

It’s got to be a vocation, a calling, the work for which you are willing to sacrifice so much else. Dave believed that if he could only make it to the other side of this grueling training, his work as a surgeon would always be something in which he could feel a deep sense of purpose and fulfillment—he was giving someone not just a new hip or a new shoulder, but a renewed ability to live life to the fullest.

But the years of training are trying.

All of those years, I could not help but look at my life and see the ways in which Dave and I were being, well, ripped off. How I was being short-changed as his wife. There were long hours logged at home alone. My friends could enjoy their weekends, could bring their spouses to weddings, could exchange Christmas presents on Christmas morning. Even on the few Christmases when Dave was home, he was not really able to enjoy it, being so tired or still fielding emails or pages or the threat of being called in at a second’s notice. True, some of the other nonmedical professionals I knew worked as hard when they were on a specific project or account or case, but eventually the case ended, and usually brought with it sizable financial compensation. The stock market closes on holidays, legal cases eventually get resolved, schools close for the summer—but people never stop needing doctors.

I did not always excel in acknowledging how difficult it was for Dave. I am human and I wanted my husband around. I thought that having moved to his hometown for him awarded me some appreciation. He told me over and over again that I was his priority, but it often did not feel that way. And I often reminded him that that was the case.

And the stress and the lack of sleep got to him. How could it not? Being that perennially tired and overworked will take a toll on any personality. One midwinter night in his second year, Dave’s car died at the hospital, after many long hours of being parked in the well-below-freezing temperatures while he remained inside, working a never-ending series of cases. Dave called me, his voice tired and stressed, telling me I needed to drive my car over to the hospital so he could jump-start his car. I was in my pajamas ready to get in bed, so this was not a call I was thrilled to get. I pulled on my snow boots, threw my heaviest down coat on over my pajamas, and headed out. When I got to the hospital, we hooked up the jumper cables. Dave’s car sputtered to life, and my car promptly died. Dave and I were cold and tired and frustrated, and neither one of us was in a good mood. I remember thinking just how un-fun it all was.

Dave and I have always written back and forth to each other—hard copies of letters, little notes on a big day, emails, texts, and so on. My favorite aspect of Dave’s gift to me on holidays is usually the card, because he always takes the time to write a long and thoughtful note. I cannot tell you how often during those years of residency my notes from Dave had some variation of the following:

I am so sorry that this has been so hard for us…

It is especially when things are so difficult…

Thank you for staying…

This is so hard…

I am so sorry…

Dave considered quitting, on several occasions. They all do—that’s something I learned from every single other wife I spoke with. They all go through those valley moments when it just does not feel like it is worth it. But Dave stuck with it. Dave has never been a quitter.

But you know what else he’s not? A good bluffer. And that was another challenge he faced. A senior surgeon once told Dave that he needed to “work on his poker face.” Dave was far too earnest, far too quick to reveal when he did not understand or agree with something. Maybe it’s the politician’s blood in me, but I generally have an easier time navigating murky social situations. I can put on a good face and work within most interpersonal dynamics. Dave cannot. There is no guile in him. It’s both his best quality and at times his most crippling handicap. It’s a plus that he’s so honest and pure and genuine—one never wonders where Dave stands—but it can be a major handicap in a work environment filled with big personalities, opinions, and egos.

I remember one time in medical school, a few of the savvier students had started a trend of baking cookies for senior attendings. Dave thought this was an egregious and transparent display of kissing up. Dave is not much of a baker, so I offered to bake cookies that he could take into the hospital, but he flatly refused. We went to his parents’ home and told this story to his brother, Andy, who was also in medical school at the time. Andy smiled and shrugged. “I baked cupcakes and brought them in.”

“You did?” The disbelief was evident in Dave’s voice.

“Heck, yeah, I did!” Andy said proudly, no trace of regret in his tone. “You’ve got to play the game.”

This was a game that Dave did not know how to play very well. Dave’s just not an adept horn-tooter; he’s not a savvy self-promoter.

Writing, in large part, got me through those tough early years of residency when my husband was often gone or else home but tired or stressed or agonizing over something—a deadline, an upcoming surgical case, an unhappy higher-up, a research paper. I do not know how I would have coped if I had not had something to do at home that I loved so much. When I slipped into my writing groove, the hours flew by. I was incredibly productive those first few years of Dave’s residency. I finished The Traitor’s Wife and wrote The Accidental Empress and Sisi and several other manuscripts, along with scores of articles and blogs and guest pieces. Left at home with my imaginary characters, I was free from distractions, free to play and create and research and pour myself into not only writing but launching my career as a writer. I felt guilty at times that I loved my job so much and was able to do it at home in yoga pants while Dave was so miserable at the hospital.

When I ran out of steam and needed a break from writing, I would explore Chicago or go to yoga or meet up with girlfriends or my sisters-in-law or walk my dog. Penny, my daily companion, was another invaluable source of comfort during those years.

When Dave had long shifts or rotations at a hospital out of town, I would decamp to my in-laws’ place in the suburbs. I had gone from being surrounded by friends, near my parents, near my sister, near my family’s home, near my hometown where it was not possible to drive to the market without seeing ten people who had known me since childhood, to being seven hundred miles away from all of that, and with a husband who was often depressed or completely unavailable. And I struggled with that. But the Levys were so welcoming and loving that their place became a second home for me.

At that point Andy was the equivalent year to Dave in his own residency, and he was weathering many of the same challenges and frustrations. Andy and Dave would commiserate, and so would Erin and I.

I remember hearing that Avicii song, the dance hit with the lyrics “So wake me up when it’s all over. / When I’m wiser and I’m older.” I pulled out my phone and sent a text message to Erin. “I feel like this should be our theme song during residency. Just wake me up when it’s all over.”

If Dave was not going to quit—and believe me, I reminded him countless times that that was an option—then there was nothing we could do but keep moving forward. We just had to get through it, together, taking refuge in the belief that it would someday get better.