Originally posted Jul 3, 2014 by on KimBlackham.com

It’s July…Happy New Year!

I know, most people celebrate New Years in January, but for some of us, July 1st is the start of the “new year.”

See, I’m married to a doctor and my husband has been in training for the past 11 years…with two more to go. Four years of medical school, five years of general surgery residency, two additional years of research and starting July 1st of this year, two years of surgical oncology fellowship. Each of these “milestones” or transitions occurred in July.

This July is a big deal for us.

When we were in medical school, he initially thought he wanted to do ophthalmology or radiology, but as he progressed through his different rotations, it became increasingly obvious that neither of those were a good fit for him. He loved surgery. He tried to love a different specialty, but his passion as a physician was really in the operating room. We knew the road to become a surgeon was really hard so we began looking for ways that our family could make it work. Everybody I talked to – literally EVERYBODY – said that a general surgery residency was the worst thing that ever happened to their marriage and they wished they had never taken that path.


Now Aaron and I had a great marriage, but I was not naïve enough to believe that we were somehow immune to the challenges that these other couples had faced.

Surgery residency is marked with 80-120 hour work weeks – consistently, for five years. Some of the general surgery residency programs in the country have prided themselves that “no marriage has ever survived their program.” (As though that is really something to be proud of….)

How were we ever going to make this work? Our family was the most important thing to both of us, but honestly, I couldn’t see a way to navigate those years.

This July marked the end of those five (turned seven) years that I was terrified would destroy my marriage. We made it. And we didn’t just survive the process, we actually thrived during those years.

But thriving was a choice. A deliberate, daily choice.

Now that I am on the other end, I have many people ask me what tips I have for surviving residency. Forgive the personal nature of this post. I really wish there had been someone to tell me these things seven years ago. For that reason, I’m sharing with you the 10 lessons I have learned in hopes that there is someone out there who will find it helpful. I recognize that not all medical relationships are where the husband is the resident and the wife is home raising small children. Often both partners are residents -which presents a totally different layer of complexity, or the resident partner is female. I have used the pronouns to reflect my experience, not to be stereotypical.

1. Believe that medical marriages work—even if the chosen path is surgery.

Surviving residency with your marriage intact is possible! I wish someone had told me that. Okay, people did tell me that, but only people who didn’t really know. “Oh, it will be fine. Just think about how great it will be when he is finished. Five years isn’t that long.” When those comments were stacked up with the ones from those who had lived it, the “It was the worst thing we ever did for our marriage,” and “It’s not worth it” won out. The truth is (from someone who really has lived through it), it really can work and you really can come through with a great marriage!

I honestly would not change the path we have taken. I am so glad that my husband gets to spend each day doing what he loves. That does not have to come at the expense of your relationship. I promise.

2. Medical marriages, like military marriages, have unique challenges that are specific to this profession. Don’t expect other people to understand. They can’t.

Don’t expect your family or your friends in other professions to understand what a struggle surviving residency really is. Understanding someone else’s experience is really difficult unless you have lived it. You and I will never fully understand what their situations are like either.

For many years, I tried really hard to get certain people to grasp what my husband’s life was like. I wanted them to understand who he really was and why he wasn’t around. I knew his number one priority was me and the kids, yet I was always showing up alone to the kids’ activities or to church. It bothered me that others would have expectations of him and then be disappointed when it was impossible for him to meet those expectations. The truth is, most people hear 80-120 hours a week and assume you are exaggerating. No one can possibly work 3 full time jobs – right? Even if they accepted that number, they couldn’t wrap their head around what that translated to in terms of when he was home – i.e. almost never. I had to accept that most people would not understand his schedule or the demands that were placed on him. Most people would not understand that I was a pseudo-single mom. I had to accept that it wasn’t their job to understand and it wasn’t my job to make them.

3. Time together is worth more than anything. Guard it, protect it, and buy it when possible.

Because people did not understand Aaron’s schedule, surviving residency meant we had to become very protective of the time he was home. When he walked in the door, I always hung up the phone. If he was going to be home, I made every effort to have us there – without friends around. When he had vacation time, we would carefully consider if and with whom we would be willing to share that time. Most of the time, we were not willing to share his vacations – even with extended family. That was really hard for family to understand, but when we were with extended family, our kids were off playing with cousins and aunts and uncles and were still not spending time with their dad. When we would come back home from the vacation, they still felt like they had not seen him.

Those precious weeks off were a lifeline for us. They were the time to reconnect and recharge so we could make it through the next several months. My number one priority was to get my family through residency intact. It wasn’t to make it to every family reunion, go out to eat with different friends each month, or even make sure we had lots of social gatherings at our home – although all of those things matter to us. They would have all been obsolete if our marriage and family relationships were not solid. Because of that, we had to set careful boundaries and again, be okay with the fact that most people would not understand.

We also used our resources to “buy time” – as much as possible. There aren’t many professions that require the amount of hours away from home for such little compensation. (I paid my babysitter more than my husband made as a general surgery resident.) We made a decision early on that we were going to do whatever it took to “buy time.” This changed over the years, but some of the ways we incorporated this included me paying someone to take care of the yard so that my husband could be with the family when he was home, purposely moving into a newer home so that it would require less maintenance from him, and investing in good babysitters

4. out on a weekly date and get away alone together for as long as possible once a year.

Time alone together is crucial! When we started residency, we had two small children. By the time we were finished, seven years later, we had four. Making date nights and getaways a priority was hard, but absolutely essential! We went without a lot of things so we could afford to pay a babysitter and take a trip alone together once a year (See #3). We were fortunate to occasionally have grandparents come stay with the kids when we left, but that was not always feasible. I believe this is the second most important thing we did through residency to make it work (keep reading….my number one suggestion is coming up). That week alone would hold us over well for about six months and then we would feel we needed another one. That’s when we would begin planning and preparing for the next vacation. The anticipation would be enough to get us through the next set of hard months – knowing we had something to look forward to.

Be strategic in the kinds of getaways you take. Most likely both of you will be exhausted. My husband and I love to travel. We would have loved the sightseeing, museum going trips, but we knew that was not what we needed. Most of our vacations were just that – vacations. We tried to make them as easy as possible. Someplace where we could both get some extra sleep, wouldn’t have to work very hard to get what we needed, and could just be together. Cruises are a favorite for this reason. We would always request our own table at dinner and stay for as long as they would let us – just talking. You can always find a good deal on a cruise and in terms of what you get and what you pay, it was perfect for our meager income. The built in romance of a cruise adds to the whole point of getting away in the first place – to reconnect. Our intent was to leave everything behind and just be in love. For us, it always worked.

5. Take it in bite sized pieces and expect for things to be hard.

Most of my husband’s rotations would last for two months. Some rotations were brutal, others were more manageable. Surviving residency meant that I had to break it down and not see the whole seven years at once. During those more brutal rotations, I would continually tell myself, “You can do anything for a month. A month is only four weeks and you can do anything for a week.” All I had to do was make it to the next rotation and then I just had to make it to the next rotation. And then he would have a vacation week and we’d be okay again.

I also expected things to be hard. I know that sounds silly, but I really think that one of the reasons we made it through so well is that I knew exactly what I was signing up for. When I was in college, many of my friends thought that the idea of marrying a doctor was glamorous. When I married a pre-med student, I knew exactly what I was signing up for and that it was in no way glamorous. When we chose general surgery residency, I expected it to be hard. So when it turned out to be hard, I was prepared for that.

6. Choose to not be Resentful. Be Flexible and Understanding Instead

Aaron learned to not tell me when he thought he would be home, but instead, to tell me what he had left to do and about how long it would take him to get it done. I would then tack an extra hour and a half onto that for the unexpected emergency that would always come up and then plan on him around then.

I have a voicemail saved on my phone from my birthday this last year. He had scheduled things so that he was supposed to be home and take me out that night (should have followed tip #8). After seven years, I’ve gotten pretty good at receiving these kinds of phone calls, so when I heard him regretfully begin with, “Hi Honey.” A small smile formed on my lips as I thought how hard it must have been to call and tell me he had an emergency he had to attend to and how very sorry he was that he didn’t know when he would be home. A phone message that could have disappointed me and even made me angry, is saved on my phone because it is very endearing to me. When I listen to it, I really don’t hear that he was about to let me down, instead, I hear how sad it makes him to let me down. His message of, “I’m not going to make it” is filled with a tender acknowledgement of my feelings and regret that something out of his control may hurt me.

One day, early on in residency, it dawned on me that it was much harder to make those phone calls than it was to receive them. Regardless of how hard things were when he would call and tell me he wouldn’t be home, I would smile, remember how hard it must be to make that phone call and kindly respond that I understood and would see him soon. Had I gotten angry or hurt at something that was so totally out of his control, it would have spiraled us into disconnection. Years of that would have torn us apart.

Before residency started, I made a commitment that I would NEVER RESENT HIM. I accepted and joined in his goals and desires to be a surgeon. If I had said I wanted him to choose a different specialty, he would have. The truth was, we chose surgery residency. There was no way I could resent him for something that I chose.

I really believe this is our number one key to surviving residency.

I never once blamed him for being gone. There were times I was mad at the system for sure, but I was never angry at him. He had absolutely no control over it. Being angry at him would have destroyed our marriage and still wouldn’t have brought him home. (Incidentally, being angry at the system didn’t impact his work hours either – should have saved my energy.)

7. Live life now

Studies have shown that those in the medical field who live life with the “When this is over, then we will….” mentality are unhappy in their relationships and in their job satisfaction. Medical training is a very long process. My husband will have been in school or training for 17 years since high school before he is actually able to practice his chosen specialty. 17 years! He will be almost 40, poor guy.

When I look at these two pictures, it is so apparent to me how long this process has been. If we had lived all of these years only thinking about when it was over, we would have missed out on a huge portion of our life together.

This idea is especially important for the physician spouse. Clayton M. Christensen addresses this idea in his New York Times best-selling book, “How will you Measure Your Life” (which I recommend, by the way). He explains that many professionals have the idea that if they invest in their careers early on – even at the sacrifice of their families, that they can later go back and reinvest in their family after their career has taken off. He explains that family relationships do not just wait around to be invested in when it is convenient and that those professionals who take this approach often find themselves with broken relationships and unfulfilling careers. It is possible to invest in both. It’s hard, but it is possible. Put your kids in music lessons, take your spouse on that trip you’ve been wanting to take, start running – whatever it is, find ways to live life now and not just wait until all the training is over. Sure the financial piece and the time constraints will factor in, but that doesn’t mean that everything has to be on hold. Certainly make the effort to spend time together and build relationships with those that matter most.

8. Ignore the Calendar and Set Your Own Holidays

People get sick on holidays, weekends, birthdays, Tuesdays – ok, every day. Admittedly, when Aaron was on trauma and taking care of victims of preventable accidents there were times I felt like the Disney superhero Mr. Incredible (remember, I have young kids) during the opening scene when he declared, “Can’t the world just stay saved!” I can’t tell you how many times I had that thought throughout his training. Can’t people just stay at home, in bed at 2 am and not shoot or stab each other and let my husband come home! Can’t the world just stay saved!

Sorry for the digression – where was I headed? Oh, right, holidays. So the reality is, the world is not going to stay saved and regardless of what specialty your spouse has chosen, there will be patients and patient’s families who need his help.


Because of that, I quickly learned that Christmas on December 25th is overrated. Santa Clause is just as happy to come a few days early and our kids never had a problem opening presents before all of their friends. Most years, my husband had to work all or most of the major holidays. I could either sit home feeling sorry for myself because he missed Thanksgiving dinner, or we could just eat it the next day. This is an easy one folks! Yet so many people have a hang up with it. If you are going to be married to a doctor, you will most likely have to accept that just because a little box on a calendar has a preprinted holiday listed, does not mean that has to dictate your level of expectation or disappointment. If your extended family has a problem celebrating on a different day, you can try to help them understand and then let them know you are sorry you will not be able to join them.

9. Support and Love Each Other. Talk about Your Needs

Surviving residency meant that we had to be super-efficient with the time that Aaron was around. There was no time for me to expect him to guess what I needed and for him to try and get it right.

Nor was there time for me to be mad he hadn’t been home – now that he finally was home. (Talk about counterproductive.)

Our communication needed to be clear and real. If I missed him, I needed to tell him and together come up with a plan for how we could spend more time together. If he felt disconnected from the family, I needed to know about it so we could take dinner to the hospital and eat with daddy more often or put the kids on FaceTime for the few minutes before they went to bed.

Strong relationships are not built on communication skills, they are built on vulnerability. Showing up and being real. Many people get hung up on the idea that if you have to ask for it, it doesn’t count. That’s an absolute lie. If you have to ask for it and your spouse delivers, it absolutely counts. There is no way your spouse is going to automatically know everything you need. This is especially true when lives are so busy. He is tired and stressed out too.

Set yourself up for success by sharing your deep and vulnerable feelings without the blame and criticism. Let him know when you are lonely and sad without attacking him and pointing out all the ways he is letting you down. Trust that he wants very much to please you and that he desperately needs to know he is good enough for you. Husband’s need to hear that.


Like every day.

And husbands, wives need to know that they matter more than anything.

**It will be much easier for her to be understanding and supportive if she does not question that she matters most and that when the day is over, you come home to her as quickly as you can.

10. Dream About and Envision the Future Together

This isn’t putting off life until training is over, but rather seeing a future where the two of you are together and in love. Frequently discuss plans and dreams together. Where do we want to be in ten years? Where should we vacation to celebrate when all this training is over? Where do we want to settle? What will our lives be like then?

Not only does this help you remember that it will in fact end, but it provides a blueprint for the long term quality of your relationship so you will remember how you need to treat each other today in order to get there.

I know this is hard. I know it can feel overwhelming and at times hopeless. I know there are days where you wonder if you can make it and you question if any of this is even worth it. Please borrow some of my hope that you can make it through this – not just be the skin of your teeth, but by actually thriving.

All of these posts have been from my point of view. Much of our success through residency came because of the decisions Aaron made as well.