Today's podcast is special because this is not only for you as premeds, but also for your significant other. Share this podcast with your loved one who is going through this process with you. This will help both of you.
Sarah Epstein is a Marriage and Family Therapist and her husband is a second-year emergency medicine resident. They started dating when he was starting to study for the MCAT.
Sarah is the author of Love in the Time of Medical School. We talk about how you can keep your relationships strong. In her book, she talks about helping keep relationships going through the stressful time of being a premed, being a medical student, and being a physician.
Get a chance to win one of five copies of Sarah's book Love in the Time of Medical School. Simply go to www.facebook.com/sarahepsteininsights. Like the page. Then leave a comment on this page regarding what's your biggest concern about juggling medical school and your relationship. From these comments, we will be picking five winners at random.
If you're interested in grabbing a copy of the book, check it out on Amazon. Sarah marked it down to a special price at $4.99 just for this podcast.
[02:18] Going Through the Process as a Significant Other
Sarah explains that those that are significant others of others have a lot of challenges that a couple faces together and that the significant other deals with on their own.
Giving you a little background, Sarah is finishing up her training as a Marriage and Family Therapist in Philly. She started writing the book three years ago when her husband was a third year medical student. He was on his surgery rotation, which felt like the pinnacle of all the challenges.
He was working 15 hours a day and she didn't know what to expect. She thought there was so much she wished she had known going into this process – in terms of what she can expect, how to understand what medical school looks like, what kinds of relationship issues would come out each year. So she started putting all this together. She started writing her own experiences. She started conducting research about physician couples. And she started interviewing other significant others of medical students. She wanted to get a sense for what other people's experiences have been like.
[04:38] Becoming a Significant Other
Sarah started dating her husband Brian when he was a Senior. They went to the same university. A month after they started dating, he started studying for the MCAT. In hindsight, she thought it wasn't the smartest decision. But she got to see the whole journey – taking the MCAT and applying to medical school through now. Brian is currently a second year emergency medicine resident in Philadelphia.
Being supportive, asking a lot of questions, and finding interesting ways to spend time together when he was studying a lot became the key for them. They had to find ways to just be in the same room or spend time together where they could take study breaks. They started to think of it as something they could face together. It was that team mentality. He was doing all the work, but she was cheering him on. Marking his progress studying made her feel like this is something they were going at together.
[07:05] Good Communication and an Attitude of Postponement
Sarah and her husband talked a lot. And over the course of the medical school, that was one of the fundamental keys to making it through each step. Unlike other processes of training, every year is something different. There's a new schedule, new goals to reach. So they talked through what it means for him to do well on the MCAT. She also tells him her concerns about getting to spend time together. She wants to feel validated by him that it's still important that they get to spend time together. And having that dialogue and re-negotiating over the last seven years, over and over again what their relationship is going to look like.
Sometimes it also meant that this is his priority for right now and they can wait to celebrate an event/occasion after the MCAT, or after the applications are turned in, or whatever. But it has to be balanced with having an attitude of postponement. They want to balance having that sense of the big picture but not putting everything on hold.
[09:40] How Much Say Do You Have in the Decision-Making Process?
For Sarah, how much emphasis she has as the significant other contributing to the decision making process for the student is an important question. Depending on where your relationship is, it's going to impact what kind of say or input you have.
At the time Brian was applying to medical school, they decided that their relationship was not far enough that she would have a say in where he applied. He basically made the decision based on his scores, grades, and where he's going to apply. So she played a supportive role. When he had his acceptances, she helped him decide what made the most sense for him, and infusing thoughts about what would make sense for them.
Sarah recommends to think about where is your relationship at the time that they apply. Also, have that conversation with your partner about whether you should have a say. If you're already married or in a very committed relationship, this could look different.
Whether your relationship is ready or not, you're going to have to make some big decisions around who gets to say which medical school. Who gets to say where they go and what they do? And if you've only been dating for a few months, that could feel out of sync with where your relationship is. And this is the first taste for the partners of people in medicine that medicine really does call the shots sometimes.
[12:20] How to Frame Your Conversation
Especially if you think you're not really a good communicator, Sarah suggests the tone and the way you frame the conversation is really important. Premed students are very protective over their ownership of the process. They've worked exceptionally hard to get to where they are. So they feel like they really own it. And that's acceptable and appropriate if the relationships is not at a certain point. So talk in terms of yourself and say something like “I feel like I need to prioritize what I need during this application process. But I would love your help to look at the options.” or “Are you also feeling this nervousness around the application process? Let's sit down and talk about it.”
So be gentle about it. Don't make it about you. Avoid talking in “I” statements and talking about how hard you've worked. Say you're excited and you want your partner to be involved in helping you research schools but maybe you want the ultimate decision over what that means. But then tell them you're so excited about their feedback about what seems like a good fit. In a way, try to include the person by asking them what their thoughts are.
[14:44] Making It Work While Being Long-Distance
For Sarah, this is one of the hardest parts especially for the significant other. Because medical school is rigid. You're going to be somewhere for four years. You can be very lucky to get in all and feel like you have options.
Sarah and Brian were actually long distance during his first year of medical school because Sarah was in Thailand. So they didn't only do long distance, they were twelve hours apart. And when she got back, Sarah moved to Miami not knowing anyone. She didn't have a network there. They went to school in Boston and she's originally from Dallas. So she picked up and moved to a place where she knows no one to see if they could make it work. And it was really hard for her, for a number of reasons. What does it mean for her that she's moving for her boyfriend's career? Does this mean she's prioritizing his career training over her own? So it was a hard decision for her. A lot of things have to come into play. But they've done the long distance thing and then she moved for him.
Everything was practically new for them. And one of the things that really helped them was before she moved to Thailand, she visited Miami and she saw his apartment. They walked around the medical school. So being able to picture it made her connect to his world. She was able to picture what he was doing and who he was spending time with. She admits it's going to feel a little alien to some extent, for someone who's not in medical school, to hear about the experience.
While first year med school was exceptionally busy, Sarah says it's fairly easy to understand and grasp what your partner is doing. The hardest part for them was Brian not being able to conceive what her life was like in Thailand. She was living in a fishing village and teaching Thai children their abc's. And being unable to come visit her to get a sense for her world was difficult.
They also had to grapple with the fact that before they were long distance, they could pick up and talk to each other whenever. It didn't require a lot of forethought. But then suddenly they can't talk between the hours of 12 and 7 because someone's asleep. And he's got this incredibly busy schedule and so did she. So consciously making times for them to Skype with each other was vital. They had to prioritize it, even if they were both tired or it was first thing in the morning. He had to miss an event or something like that. They had to put enough face time. And things changed considerably. He came to Thailand over winter break and Sarah claims it saved their relationship.
[19:10] Making It Work Living Together
Sarah describes the first year of living in Miami was harder on her than Bryan. At least they had set expectations when they were apart. They created routines to make sure they were talking to each other. But when she moved to Miami with a new job and in a new apartment, he had his friends, his routine, his support system. And he had an exceptionally busy schedule. The second year was difficult since Bryan had to start studying for Step 1. Once again, they had to re-negotiate what their time together would look like. Whether it meant sitting in the same room while they're each doing their thing. And finding other ways to feel connected. They had to foster smaller ways to connect when they couldn't be together. Basically, Sarah ended up being the third wheel to medical school.
What Bryan did for his part to make things work were a few things which Sarah considered as really vital. Brian was good at keeping her aware of what his schedule would look like. He made her feel she knows where he's going to be and staying in touch when he had to study longer than he thought. Or he had to go to an extra lab.
Knowledge makes you feel a little bit more in control because at least if he couldn't see me, I could plan for later. Especially in Brian's third or fourth year when he was doing something different every month with a different schedule and different expectation, it was important for them.
Additionally small gestures became a lot more important like taking the time to take a study break and go out for coffee. Or they'd take on little tasks around the house. They'd take time to notice those breaks in the schedule. Sarah describes medical school as being very busy but there are points in the schedule that are less busy than other points. This could either be right after an exam, when the new material hasn't piled up yet, or before you start an intense study period. Or save up some time in bank. So when those difficult study periods come along or someone's working a 15-hour day on surgery, they'd start texting each other more. He would leave her post-it notes around the house telling her he missed her. Sarah says it was that knowledge that he was thinking of her and their relationship even when he couldn't invest in it at that moment.
[23:08] Connecting with Other Significant Others and a Support System
Being in Miami, Sarah says she was able to hang out with groups and medical students and describes it as quite an experience in terms of feeling a sense of alienation. But sometimes at medical school, they'd have parties and then their partners would come. That would be how she would meet other SOs going through the same thing. Then they'd call on each other when one of their partners was on a tough rotation or when they're both studying at the same time. She also had one friend from college who's a partner with someone in Brian's class. So during study weekends, they'd hit each other up and plan a girls' weekend.
She recalls she was going to have wine with the partner of someone in Brian's class. She texted her and said her boyfriend was going to bed at eight. And she was setting his schedule to meet his so she asked if they could do wine at five. Sarah agreed of course because she gets it. Other people get that you're living this weird schedule and you're doing your best to match the medical school schedule so you get to to see them. So it makes a big difference to have other people who get that.
In terms of having a support system, Sarah says that anyone dating a medical student really needs to tap into an emotional support system. If you're a local and lucky enough to live in a place with a big network of friends, let your friends and family know this is the reality. And that you might need a night out when your partner is studying. Or you need to vent about this and what it's like to be dating someone in medical school. Find those specific people in your network. Not everyone is equally good to vent to. So have one or two people that you can all up and say you just need to talk for a few minutes. Find those people who get it. Moreover, Sarah is also a big fan of therapy as a support system.
[26:29] Hardest Times as a Couple
In terms of study periods, Sarah considers Step 1 as by far the hardest. She recalls after Step 1 was over, she was just talking to Bryan and broke down crying. Because there were so many thing she hadn't gotten to tell him. There were so many conversations they had to put on hold. And both people had to go into long-term thinking mode. You can't have those day-to-day times together.
Rotations are also difficult at the beginning in third year. First and second are difficult but predictable. But third year is incredibly unpredictable. Not only is your partner doing a different rotation every month, but they also have a different schedule. They have different attending physicians to make the experience easier or more difficult. They can't necessarily stick to schedule like if somebody needs to stay late or an emergency comes in.
That said, it was important for them to have the schedule in advance or have Brian talk to classmates about what this rotation was like, so they can prepare themselves. If he's working 15-hour days, then she's putting five social events for herself on the calendar. Then they're going to spend a bunch of time together before that starts. So this became a very important part of their preparation.
Obviously, surgery was really tough since he was working very long days. They had an unusually difficult time with his pediatrics rotation. All because they both expected it to be a very light rotation. But it turned out that it wasn't. So the feeling that they had prepared and then getting the rug pulled up from under them was difficult.
[29: 57] Common Complaints Among Significant Others
When Sarah got to talk to other significant others while she was writing her book, there were themes that came up again and again. The lack of time together was one of the biggest ones.
Another one is that sense of waiting. Almost everyone talked about how they would avoid feeling like they were waiting for their partner. Whether it's waiting for them to come home or for them to finish with their exam or waiting for them to finish with medical school. There is this feeling of powerlessness in the face of all of that waiting.
So you're kind of put into this passive role of just having to sit and watch your partner do these things that are taking up all this time. They also talk about the things they would do to make them feel like they weren't waiting. Like if their partner would finally be free, and if they had already made plans, they'd stick to those plans. Sarah explains you can't drop everything and relinquish your life to medical school.
Another theme that came up was that sense of loneliness. It could come up when you feel like your partner is just not available. And you feel like a medical school widow or orphan. One woman even described the feeling as being married to the shadow of the person. She felt she was married to the idea of this person because in reality, they were never there.
Also one of the other things that came up is navigating social circles that involved a ton of medical people. When a bunch of medical students or doctors or residents get in the same room, that becomes the topic of conversation. So dealing with the feelings around that was one of the things that all of them talked about.
Personally, even when I would get together with Allison, my wife, and her fellow neurology residents, they would niche down and talk about neurology stuff and I felt I was an outsider even though I was a physician myself.
[32:53] Dealing with Alienation from Talking Jargon and Lack of Awareness
Sarah stresses the importance of having your partner be aware that that's a reality. If you're sitting with a group of medical students, a few different things that come up. In their household, they have a “no yucky stuff” rule because Sarah would faint just hearing the gross stuff. Her husband being an emergency medicine doctor, there are so many things she never hears about because she can't handle it. But he knows there are twenty other people in his life who are happy to hear about. But she will hear about other things.
Sarah's dad is the oldest of four boys and her grandfather was an anesthesiologist. The joke in the family was that all the girlfriends who came over dinner had to pass the test of sitting through his surgery stories. Her mom told her of one particular dinner when she was dating her dad. Her granddad was talking about intestines coming out of someone's body during a surgery and her grandma was serving spaghetti. So there's that lack of awareness that not everyone can handle that.
Sarah adds that most of them don't speak medical. They felt dumb because they didn't know the words. They didn't know what it meant when someone talked about blood pressure numbers and whatever they were learning that day. So it can be an incredibly alienating experience.
Sarah says after the first time this happens, you'll know it coming. So talk to your partner in advance and set up signal so they become aware of it too. You're going into it as a team so make your partner feel like they're not alone in that moment. You and your partner are in this together and not that they’re the med student and you're not. If it comes from your partner who changes the subject then great. Also, sometimes look at changing the conversation to another aspect of the topic.
For example, Sarah finds certain things about the hospital that are interesting like the relationships between attending physicians and the medical students and residents. So she's happy to ask about that. But that can be a way to pivot the conversation away from the technical details.
And when it comes to the yucky stuff, you have to come straightforward or have that signal with your partner so they can step in and say to them that you don't want to hear it.
[37:20] The Keys to Surviving and Thriving Relationships
Sarah says there are three keys that lead this kind of relationship to survive and thrive. First is communication. For a medical student couple, that means re-negotiating what the relationship is going to look like as medical school progresses. Communication around listening to each other's stress. Listen to it and validate that stress. Those may not be at the same degree. But having the other one validate it goes a really long way. Have those little gestures when things are tough. Re-negotiate the relationship. Validate each other's stress.
Second is intentionality. You can't just let it happen because it won't. Things will fall through the cracks. There's always more studying. There's always more to do at the hospital. So really be intentional and make sure you find time together.
The third key is flexibility, which Sarah admits as the hard one for her since she likes to have a plan and to know what's going on. So be able to relinquish a little bit of the control. Move plans around and find creative ways to spend time with each other.
[39:50] Dealing with Discouragement from Other People
Sarah has had people telling her that all doctors cheat on their spouses. She has also been asked if she's going to raise kids alone one day. Or people tell her she'd never have to work (as if her decision to work only has to do with finances and not her own ambitions). And these are things that can be hard to deal with. Sometimes random acquaintances make these comments about their assumptions. A little bit of it is judging your relationship to that person. Sarah suggests you have to pick your battles, because this will happen a lot. So she'd either brush it off or make a joke about it. It would be the best response to an acquaintance. But be more honest with people – and how it feels to hear comments like that – with people close to you. Tell them what it means to support you. Tell them it's hard and tell them what kind of support you need. That you need them to be there to listen to you. And that you can't be hearing things like what you're doing because it's not helpful.
You want to surround yourself with people who are going to be encouraging and supportive. It's okay to tell people what you need from them even if it's not their first instinct.
[42:20] The First Steps to Being Intentional
Sarah recommends having a check-in. Wherever you are in your relationship, those check-in's are really going to be important to see where your partner is at so you can improve things. It's possible that your partner who's not a medical student may be feeling stressed about what medicine is going to mean for your collective future, but they haven't felt entitled to talk about it because they're not the ones taking the exams. Or maybe the medical student is feeling overwhelmed or guilty that you had to move somewhere like what Brian felt.
So get some of those feelings out in the open about what you've been feeling about the process. Talk about how you can start supporting each other. What do you need? What do they need? How do you manage each step?
Also, cut yourself a little bit of slack as a couple as you're trying to figure out. You're working on it. And as long as you're working together on it as a team, you'll get there. You can get there.
Love in the Time of Medical School by Sarah Epstein
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