Bad health news, rethinking everything

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bostondan
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Bad health news, rethinking everything

Post by bostondan » Sat Jan 09, 2016 2:53 pm

Sorry in advance if this post ends up reading like an emotional LiveJournal post, but I wasn't sure where else to post and I've always valued the Boglehead community. This site literally changed my entire approach to life after I started earning an income, so I owe a lot to all of you. I'll give a little background on why I am rethinking everything.

I'm currently a 30 year old physician working as a hospitalist. My wife and I just found out that we have a baby on the way. I did a year as a chief resident and was planning to apply for cardiology fellowship in July after one year of working as a hospitalist. I have attended prestigious training programs and should not have any difficulty if I go forward with applying for cardiology.

We just got some very bad news about my mother's health. She has a type of cancer that likely has a poor prognosis. We are absolutely not willing to give up hope though. She has never had a single health issue before this. She never smoked, barely drank, and lived a fairly conservative life. She has had every age-appropriate screening test, and looks about 50 instead of 65.

On top of that, my father, who was a cardiologist at another nearby prestigious academic center, also passed away from a freak cancer a few years ago. He was 60 years old at the time. He similarly was in extremely good health when his cancer came out of absolutely nowhere. It was a type of cancer with fewer than 200 cases world-wide per year. She and my father had an amazing marriage. It was a real tragedy.

Prior to these two cases, every single one of my relatives has lived until 95 or older. One grandmother is currently 100 years old. Nobody had ever had cancer, heart disease, diabetes, or really anything other than mild hypertension.

Anyways, I'm feeling extremely overwhelmed. I don't want to just work for 35 years and then die. Hopefully these cancers are not genetic and don't represent something that will happen to me, but it is pretty scary to think about. I feel like with my current trajectory, I'll end up working 7 days a week and having 16 hour days. It seems hard to avoid. As many of you likely know, it's hard to work in the Harvard system and work part-time and still excel, or to turn down too many things. At least it feels that way to be currently.

When the inevitable depressing thing happens, I'll inherit approximately $3 million. My sister will inherit the same. Could end up being a bunch more than this, but I don't feel like thinking too much about it. I think there is life insurance and some pension payout, but it makes me feel awful inside to think about it for more than a brief second.

Perhaps I'm just feeling emotional, but here are some things I would like to hear from the Bogleheads community:

1. Do any of you work with your spouse? My wife is a lawyer. We have a wonderful marriage and I'd love to be able to work with her. She feels the same way. We can't think of any practical way to do this.
2. How would you approach this feeling of being overwhelmed by how much I work currently? Would you consider a career switch? Drop out of academia and work part-time in the community where it might be more accepted?
3. What are some careers that a doctor could do that would allow significant flexibility? If the terrible things above happen, and I inherit $3 million+ at this age, I feel like I won't really have to worry about saving and income. The ability to have financial freedom would be a bittersweet gift from my amazing parents.

Other thoughts? Sorry, I feel like this turned into a therapy visit...
“There may be times when we are powerless to prevent injustice, but there must never be a time when we fail to protest.” - Elie Wiesel

Daryl
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Re: Bad health news, rethinking everything

Post by Daryl » Sat Jan 09, 2016 3:05 pm

First - Congratulations to you and your wife on the upcoming addition to your family!

Second - I'm so sorry for the loss of your dad at such a young age, and your mom's recent diagnosis. While my parents will never have the types of careers you discussed above, they have been very frugal. Each time I visit I try to get them to switch to "2 ply" toilet paper, but to my dad, that feels like flushing money down the drain! As a result, like you, my brothers and I could receive what to us would be a sizable inheritance. That isn't my money. That money belongs to my parents and I hope they will live a long time and enjoy their retirement. I wish the same for your mom!

StoneyCWI
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Re: Bad health news, rethinking everything

Post by StoneyCWI » Sat Jan 09, 2016 3:10 pm

Live your life and use your abilities to create a better world for others. You have skills as Doctor...use them to help others. your wife has skills as Attorney...She can use them in similar way.

My wife suffered a heart attack, blocked artery, this year. I got her to hospital in time and the Heart MD's there saved her life and gave me back one of the most precious things I have.

You have a skill...your wife has a skill...use them to help others and change peoples lives for the better.

Life has no guarantees. We live it and respond/react to what is placed before us. Just because cancer hit your family, does not mean it will hit you or if it does there are new findings every day that could change that for the better.

I have been where you are and made a life change that in the end bettered me and the world. I used the skills I was given in one field to change things in another.

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4nursebee
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Re: Bad health news, rethinking everything

Post by 4nursebee » Sat Jan 09, 2016 3:20 pm

I think it is too emotional of a time to make new and different decisions, consider coasting or going forth with what plans you have had until you get some more time and distance under your belt. Sure it is overwhelming, but you are a doc and have handled great pressures many times before.

Hospitalists offer one some decent time off where I work, 7x12hrs in a row, then 7 off. Not bad. One could always keep at that.

Dont count on the money.
I work with my spouse. Many can't.
4nursebee

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jhfenton
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Re: Bad health news, rethinking everything

Post by jhfenton » Sat Jan 09, 2016 3:25 pm

I am so sorry for everything that you're going through. I can sympathize a little bit.

My mother passed away almost 10 years at only 58 from pilomatrix carcinoma (hair follicle cancer) that spread from a lump in her arm to her entire body in just a few weeks. It was such a freak cancer that it was hard to decide what it meant to suddenly have that in your family history.

But then 22 months ago, I, a fit, healthy 43-year-old 2:51 marathon runner was diagnosed out of the blue with kidney cancer (7.5 cm RCC). It cost me my left kidney, but I recovered well and 8 months later ran a 2:56 marathon.

And I'm still trying to decide what it all means. For a few months, I had a hard time focusing on any long-term goals. It was just too scary to contemplate. But that eventually got better. And now that my 3-month, 9-month, and 21-month scans have come back clean, I can think about the future without any discomfort for at least 50 weeks per year. (The time around the annual scans is always going to be nerve-wracking.)

On the work front, I can certainly sympathize. I am an attorney, but I work for a corporation, so my hours are quite reasonable. If I had had a job two years ago that demanded a lot of my time, I doubt that I could have handled it after my scare. There was definitely a fresh sense that life was short, and that I while I should still plan for the future I should make sure to enjoy the present as well, because the future isn't guaranteed. I make sure not to skimp on things that will really make us happy, and I've done a few crazy things in the last two years that I would never have considered doing before my scare.

I wish all the best to your family.

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prudent
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Re: Bad health news, rethinking everything

Post by prudent » Sat Jan 09, 2016 3:29 pm

Sending best wishes for your mom's recovery.

Regarding your specific questions.
1. One way you might be able to work together is in the personal injury legal field. That said, I don't know if it's a good idea to work with your spouse. I suspect that's something that is better in theory than in practice (no pun intended).

2 and 3. Being overworked and overwhelmed is a terrible way to live. 7 day weeks with 16-hour days - I don't know how anyone can do that without suffering physically and mentally, not to mention the impact on family. If you financially have the freedom to explore other fields without having to focus on income, why not do that? But try to evaluate how much of the "overwhelmed" is job-related vs. the other factors to make sure you're looking at things in a balanced fashion. I have read about doctors who go to practice family medicine in small towns that have no local doctor. I imagine only the financially independent could afford to do that, but imagine the satisfaction and how grateful those residents would be.

Wishing you the best in working out your career path!

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neurosphere
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Re: Bad health news, rethinking everything

Post by neurosphere » Sat Jan 09, 2016 3:39 pm

Very sorry to hear about your mother.

I had a similar experience a few years ago, with a rapid death from cancer in one parent and a new diagnosis of cancer with uncertain prognosis in another. My medical specialty is pediatric neurology/epilepsy. I decided that spending time with my and my wife's remaining family, and with each other, was more important than my career. Primarily because medicine tends to be fairly rigid from a scheduling perspective, whereas family and health problems are not predictable.

I chose to finally pursue a second career as a financial planner and tax preparer (which I had been doing on a hobby basis for years). The financial planning career was supposed to be "out", and my wife and I were prepared for my salary to decrease to under $75,000 (hourly planning is a very very tough way to make a living). I work from home, on a schedule that I set, and can be more responsive to my immediate and extended family, because I can time projects/clients/workload around other issues when they come up. There are few financial planning emergencies, and my financial planning pager does not go off at night and wake my wife and me up! In addition, I can do the financial planning and tax prep from any location in the country with my laptop and a secure internet connection. So I can travel to see my parents or my wife's parents when they need health related help and/or when there is some other event/holiday, yet still work when I need to.

The point is, I also didn't want to work "35 years and just die".

But during the process of setting up my firm, I was able to find a part-time medical job which fit my needs and personality.

I definitely altered my academic career pathway. I turned down a research grant at an "ivy" league university, and instead accepted a primarily clinical job at a less renowned University hospital. My division chief called it "throwing away my career". But I've never been happier with BOTH of my jobs, despite the lower/uncertain pay. The extra free time (and flexible time) is very much worth it.

So now I work part time (10 days a month) in a combination of inpatient and outpatient work for a hospital. And BOTH financial AND MDs jobs are overwhelmingly satisfying because I no longer have to make hard "work vs. family" decisions.

Just like you, I was overwhelmed, and briefly considered leaving medicine altogether. It doesn't help that morale in medicine seems to be so low right now.I was lucky to find a great position in medicine which matches my personality. Plus, because it's part time, it's easier to tolerate the frustrating stuff. So I way say, absolutely, look around for a part time MD job. They are definitely out there.

I don't really know what other types of jobs you can do with your training. There are many MDs on this board who might have some idea. But I feel it's totally natural not to let yourself get caught up in that "work til I die" mentality. You may have to re-evaluate your spending/budget. I'm try to balance my personal and work life as if I could die any day. However, for financial planning purposes, I still assume my wife and I are going to live to at least 95. Taking a voluntary pay-cut certainly alters the math when it come to retirement planning.

The question of working with your spouse is a tricky one, and one which no one can likely help you with. It depends to much on you, your spouse, and the nature of your work. I know several spouses which work together closely, and it's great for them. I've seen other cases however, where it added strain to the marriage.

I'm sorry I don't have much specific advice, other than this post to remind you that your situation and thoughts are not unique. You needn't feel trapped by your "past". A medical career can often make one feel as if you are on a conveyor belt. Step on in medical school, and just follow along through residency, fellowship and academic job. But step off that conveyor, and you'll have a chance to look around and find many alternate paths, even is some paths may have you going backwards a bit before you go forward again.

Good luck.

Neurosphere
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littlebird
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Re: Bad health news, rethinking everything

Post by littlebird » Sat Jan 09, 2016 3:39 pm

I agree with the poster who advised not to make any hurried decisions. You're grieving. But something to think about that a lawyer and a doc can collaborate on (besides the baby), especially since money is not going to be a problem: a medical ethics practice. One or both can also have a side gig with this.

protagonist
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Re: Bad health news, rethinking everything

Post by protagonist » Sat Jan 09, 2016 4:01 pm

I'm a retired MA physician.

I have known many colleagues who have worked within the Harvard system. If it is fair to generalize based on my own experience, overall they seem less happy than most physicians I have known. Unless they are among the ranks of the elite and famous, they tend to be underpaid and I think often overworked.

Many of them stay within the system because of the perceived value of the credential. But in medicine, the credential really doesn't mean all that much.

If you are inheriting $3M at age 30 you are set for life. Assuming you have no problem living within your means you can pretty much do what you want to do....work or not work at whatever you want, whatever makes you happy.

Though doctors tend to be over-achievers with an intense work ethic, it is not difficult to carve out a career for yourself that can be both professionally satisfying and not horribly stressful, on your own terms. It just takes creativity, and lack of fear of the less predictable. The $3M inheritance should go a long way as a buffer against the less predictable.

Best of luck to you and your family. I'm sorry about your parents.

letsgobobby
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Re: Bad health news, rethinking everything

Post by letsgobobby » Sat Jan 09, 2016 4:14 pm

Similar situation. I'm 42, parents each just diagnosed with stage 4 cancers. Similar estate size. I'm also a physician. To top it off, I now have my own serious and progressive health problems.

I may just go part time this year or next. Certainly Harvard does not sound compatible with your priorities. My sister works at a quarternary center as an academic and has immense flexibility. Maybe you can find a different place to work.

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ClevrChico
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Re: Bad health news, rethinking everything

Post by ClevrChico » Sat Jan 09, 2016 4:51 pm

My thoughts are with you and your family.

My dad had just won the "healthy living contest" at his employer due to his healthy lifestyle, only to be diagnosed with advanced cancer months later. It was a tough year.

1. Do any of you work with your spouse? My wife is a lawyer. We have a wonderful marriage and I'd love to be able to work with her. She feels the same way. We can't think of any practical way to do this.

Yes, but at a megacorp in a different building. I can't imagine being around any person 24/7 without being grumpy.

2. How would you approach this feeling of being overwhelmed by how much I work currently? Would you consider a career switch? Drop out of academia and work part-time in the community where it might be more accepted?

Losing my dad before he had a chance to retire, did change my goals. I stick to 40 hours weeks and plan to retire early if things go well. I work with people that say "just one more year" over and over, and I feel they're pushing their luck.

SamB
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Re: Bad health news, rethinking everything

Post by SamB » Sat Jan 09, 2016 4:55 pm

Apparently you are not an oncologist, but I would start with Thomas Seyfried (Boston College) and go from there. What do you have to lose? You might be able to tilt the odds in your favor over your life span. Apparently, your ancestors did just that. It could be that you really do not have all of these financial considerations that you bring up. But, one thing is for sure, you cannot follow the crowd.

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bostondan
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Re: Bad health news, rethinking everything

Post by bostondan » Sat Jan 09, 2016 5:07 pm

Thanks to everyone for the extremely thoughtful replies. I'll definitely wait a while before doing anything drastic. Luckily my boss is very nice and will let me cut back to half-time while I help my mother through this current situation.

My income was $200k this past year, wife's was $40k, and we managed to save $113k. I also finished paying off my car this past week, and our condo property tax is decreasing this month (Boston residential exemption kicks in). We have a baby on the way, which will obviously add expenses, but it seems like I can take the half-time pay cut without causing any dramatic issues in our finances. We aren't intentionally frugal, but we are the type of people who don't need a ton of fancy stuff to enjoy ourselves.

One thing that interests me is the idea of doing part-time primary care, or having a more limited patient panel. I do love seeing patients, but I hate feeling rushed from one to the next. It makes me feel like a factory worker when I'm rushed, not a doctor creating a true therapeutic relationship with my parents.
“There may be times when we are powerless to prevent injustice, but there must never be a time when we fail to protest.” - Elie Wiesel

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Watty
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Re: Bad health news, rethinking everything

Post by Watty » Sat Jan 09, 2016 5:21 pm

bostondan wrote: Prior to these two cases, every single one of my relatives has lived until 95 or older. One grandmother is currently 100 years old. Nobody had ever had cancer, heart disease, diabetes, or really anything other than mild hypertension.

Anyways, I'm feeling extremely overwhelmed. I don't want to just work for 35 years and then die.


Welcome to the club.

I had sort of the same feeling when I talked to someone that went to my ten year class reunion when people were in their late 20's. I was part of a large graduating class but there was already a handful of people that had already died, mostly in things like car accidents.

I think a lot of people start realizing that they are not immortal when they are about your age.

Finding out about any specific genetic issues is important but having so many long lived relatives is likely as much due to luck and lifestyle as having good genetics. Their lifestyle was likely different than your current demanding and somewhat sedentary lifestyle.
bostondan wrote:I feel like with my current trajectory, I'll end up working 7 days a week and having 16 hour days.
With a new baby on the way you would also be facing some of the same dilemmas about your life vs work balance.

A quote by Kurt Vonnegut
Joseph Heller, an important and funny writer
now dead,and I were at a party given by a billionaire on Shelter Island.

I said, “Joe, how does it make you feel
to know that our host only yesterday
may have made more money
than your novel ‘Catch-22’
has earned in its entire history?”
And Joe said, “I’ve got something he can never have.”
And I said, “What on earth could that be, Joe?”
And Joe said, “The knowledge that I’ve got enough.”
Even without the potential inheritance you are more than likely on track to have "enough". I am not in the medical field but I would assume that if you wanted to you could go to work for someplace like an HMO and have fairly regular hours and still have more than ample income for a very good lifestyle. I have had several friends that were doctors at HMOs and they seemed to manage to have a well balanced life.

I'm not saying that you should do something like that but just that even without a potential inheritance you should likely treat the finances as a very secondary factor in your life choices.
bostondan wrote:Sorry, I feel like this turned into a therapy visit...
No need to be sorry, but if were talking to a patient that had a lot going on in their life that felt overwhelming and stressful you would likely recommend professional counseling. You might consider doing that to get some help in prioritizing your decisions and coping the the situation.

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mlebuf
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Re: Bad health news, rethinking everything

Post by mlebuf » Sat Jan 09, 2016 8:03 pm

Hi bostondan,

First, I am terribly sorry for your loss of such a great dad so early in life and your mom’s illness. Life never comes with a warranty. For better and for worse, we have to play the hand of cards life deals us.

Your feeling overwhelmed is completely understandable. However, in almost every crisis lies opportunity. In your particular case, I believe the good that could come from the current situation is your opportunity to evaluate and make adjustments early in your adult life. Those adjustments have the potential to make life more fulfilling, less stressful and happier for you and your family.

The famous Serenity Prayer asks the Almighty to give us power to change the things we can change, serenity to accept the things we cannot and wisdom to know the difference. I suggest you begin by making a list of things you can control and then consider some possible changes.

The people who write the horoscope pages don't know any more about what the future holds than the rest of us. However they do know that a happy life revolves around 3 key aspects: Money, health and relationships. Get those three things in good order and you are on your way to a great life. Another bit of wisdom I believe is that in order to be happy we need 3 things: Something to do, someone to love and something to live for.

Inasmuch as your financial situation is in good order, changes in your career seem to be the most fertile field for considering other options. You mention the possibility of working with your wife who is an attorney. I have a friend who is a retired attorney. He had a successful career defending physicians who were slapped with malpractice lawsuits. Perhaps this is a field where you could work together, given your respective backgrounds. For the record, I’m neither a doc nor a lawyer.

I discovered the following 3 quotes almost 40 years ago when I was in my mid-thirties. Time has convinced me that they contain great wisdom:

1. “There is only one success –– to be able to spend your own life in your own way.”
– Christopher Morley

Don’t spend your life doing what others deem as successful or prestigious. It’s your life. Take charge of it and do what is meaningful to you. If others deem it successful and prestigious, so much the better, but your opinion is the only one that counts.

2. “In order for people to be happy in their work, these three things are necessary: They must be fit for it. They must not do too much of it. And they must have a sense of success in it.”
– John Ruskin

That quote reminds me of another one: “All work and no play makes Jack a dull boy and Jill a wealthy widow.” You are the doc and know far more about medicine than I. However, from what little I’ve read and observed, stress from overwork can be a killer.

3. “Nothing is really work unless you would rather be doing something else.”
– James Barrie

There are infinitely many opportunities out there for you to do meaningful, satisfying work that won’t leave you exhausted. You only need to find one.

Sometime back I read this article written by a Hospice nurse who spent time with patients in their final days. She recorded her thoughts it the book, “The Top 5 Regrets of the Dying.” The 5 regrets are summarized in this article and provide some keys to a happier life: http://www.huffingtonpost.com/2013/08/0 ... 40593.html

Here’s wishing your mom a full and complete recovery, and a very long, happy life for you and your wife. May you both live to have wonderful conversations with your great grandchildren.
Best wishes, | Michael | | Invest your time actively and your money passively.

SleepKing
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Re: Bad health news, rethinking everything

Post by SleepKing » Sat Jan 09, 2016 9:08 pm

Dear Bostondan,

So Sorry for the news on your family. Like other, perhaps taking more time to reflect on the decision is most appropriate.

Personally, if i had that windfall i would actively search for a job that met my lifestyle and family needs. As you stated, a 3 year cards fellowship, more for interventional/eps/advanced inaging, etc... Is brutal...especially if you may never practice to the full training.

Have your ever consided approach area medical schools about structuring a position based on verry limited clinica/call duties, and focused on medical student education? You could do tremendously fulfilling, though very lifestyle friendly, instructions during second, third, and fourth year curriculum. Be creative and think outside the box! You, like most of us physicians, obviosuly love the science and service e behind medicine, just dont want the brutal lifestyle when there are so many other aspects of your life warranting attention.

Regards,
Sleepy

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in_reality
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Re: Bad health news, rethinking everything

Post by in_reality » Sat Jan 09, 2016 9:40 pm

bostondan wrote: I'm currently a 30 year old physician working as a hospitalist. My wife and I just found out that we have a baby on the way. I did a year as a chief resident and was planning to apply for cardiology fellowship in July after one year of working as a hospitalist. I have attended prestigious training programs and should not have any difficulty if I go forward with applying for cardiology.

2. How would you approach this feeling of being overwhelmed by how much I work currently? Would you consider a career switch? Drop out of academia and work part-time in the community where it might be more accepted?
Congratulations on your baby!

I respect your ability to help people and hope you make the best use of the gift that you have worked hard to cultivate. I encourage you to make the best use of your talent possible!!!!

madpunster
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Re: Bad health news, rethinking everything

Post by madpunster » Sat Jan 09, 2016 11:52 pm

Dear BostonDan:

Congratulations on your new baby. Sorry to hear about your parents.

As medical people well versed with the fragility of life, I must admit that when misfortune darkens our family doors, it is no less a visceral punch in the gut. Many who have been touched in this way have been working in the same groove for decades, and can't see any other path. In this vein, I offer you two ideas which might help.

I've run into a few colleagues who do serial fellowships. Often they are military, and get fellowships at great places since they bring their own salary. You might get your choice of fellowships this way, and could even structure fellowships the way you like, pure EP here, pure U/S there, medical informatics, specialized training overseas, research, legal consulting etc. You might step off the standard high achieving academic treadmill and cultivate a very special portfolio of skills. You might even find yourself being courted with blank check support, schedules, staff etc by places you aspire to currently.

My old fellowship director used to tell us a story about EP Richardson, the celebrated MGH neuropathologist. Apparently the salary at Man's Best Hospital was abysmal in his day (as it may be now). He came from means, and when a fellow or resident complained about not being able to make ends meet, he said, "Well, give him my salary". The absence of day to day worry over money gave him the freedom to really focus on medicine.

A digression, hope this link works - if not google EP Richardson - it should be the first link.
https://www.google.com/url?sa=t&rct=j&q ... 6Q&cad=rja

You have a very special set of skills, and the means to do exceptional things.
Good luck!

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obgyn65
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Re: Bad health news, rethinking everything

Post by obgyn65 » Sun Jan 10, 2016 1:36 am

Sorry to read your post, OP. Not much too add to the replies above. Just to say that, like you, I became aware of my own mortality early. I retired this year, age 50, now traveling and managing my foundation. Good luck.
"The two most important days in someone's life are the day that they are born and the day they discover why." -John Maxwell

22doubledeuce22
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Re: Bad health news, rethinking everything

Post by 22doubledeuce22 » Sun Jan 10, 2016 1:58 am

Greetings Op. While not a medical person myself, I lost my mother 6 years ago in a similar fashion. We had our first child on the way as she was diagnosed with Stage 4 Small Cell Cancer. I waited until after her death 18 months later - 17 of them great, absolutely great for a cancer patient, to look at what her life expectancy was.
It was only 6 months or so.
I've heard that people, to an extent, wait to die. I can promise you my mom hung on to see and hold her first grandchild.

While you already know this, it's easy to overlook this detail about cancer patients. It can go from pretty well, to 24 hour round the clock hospice care in the blink of an eye in some cases, as it did for us. It's so easy to lose sight of this and take for granted what you have left.

As far as yourself, you're beyond your years to be thinking long term and that's great. Some of the best advice I have ever heard was:
1. Think of where you want to be in "x" years and work back to present day. In other words, think future to present. It will make sense of many things. Thinking like this has literally revolutionized my approach to life and my goals.
2. Retirement is not your last day of work, when you get a cake and say goodbye. It's when you have the resources to quit any moment you wish. Of course, you can still chose to work, but it's the point when you can stop working if you chose.

Have you considered plans for raising your child?

I've been fortunate to raise our kids for the last 6 years while running my business in the wee hours and whenever time has allowed me to do so. The difference in our kids, compared to those raised by daycares of any type (from great to poor) is pronounced. I can watch a kid for a few minutes and tell if they've spent a lot of time in a daycare. You only get one chance to give your kids your absolute best and set them up for a great future. Of course, you or your spouse have got to really want to do this for it to have the best outcome - I can also tell when a parent is in this role and hates it.

But what's more:

When the child comes home and your mother is going through treatment, be preemptively aware - this will be a very stressful time in your life. It's a challenging adjustment. I went through this as my mother was dying and my only sibling was working to loot what little of the estate was there to be had. Make sure to take care of yourself in this phase and don't be afraid to lean on your support network when needed.

Also, I wouldn't feel shame for discussing a potential inheritance - it's simply a fact of your situation. I think as parents, we all want our kids to have it better than we have. It sounds like your parents wanted this for their kids too. While I wouldn't make plans for it until it is in hand, whenever that may occur, it could be a key to unlocking a great life.

I hope the best for you and your family.

wxl31
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Re: Bad health news, rethinking everything

Post by wxl31 » Sun Jan 10, 2016 2:57 am

bostondan wrote: 1. Do any of you work with your spouse? My wife is a lawyer. We have a wonderful marriage and I'd love to be able to work with her. She feels the same way. We can't think of any practical way to do this.
Believe me, having a newborn will be most rewarding way you'll be able to work with your spouse. If you want to work together more with your spouse, work less at the hospital and more at home (spouse will have to agree too).
bostondan wrote: 2. How would you approach this feeling of being overwhelmed by how much I work currently? Would you consider a career switch? Drop out of academia and work part-time in the community where it might be more accepted?
Went through prestigious training similar to you. Coming out of training, all the institution could offer me was a 1 year contract that would have been a paycut from fellowship. Fortunately, was also offered several jobs in clinical practice paying 3x as much. Reluctantly turned my back on academia (because that was all I had known) but in retrospect, it was one of the best decisions I was forced to make. Direct patient care, not constant stressing about grants/research, more time, more income, option to retire early and pursue other interests. At the expense of what? Prestige? I'd do it again.
bostondan wrote: 3. What are some careers that a doctor could do that would allow significant flexibility? If the terrible things above happen, and I inherit $3 million+ at this age, I feel like I won't really have to worry about saving and income. The ability to have financial freedom would be a bittersweet gift from my amazing parents.
Instead of looking outside the field, why not work part-time? May not work well in a high-powered academic program like MGH but trust me, it is common, it works often and it works well outside of the ivory towers.
neurosphere wrote: My division chief called it "throwing away my career".
My division chief said something to the effect of "if you go into private practice, it'll be very hard for you to ever get back into academia". He was absolutely right, but not in the way he meant it.

SGM
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Re: Bad he Lalth news, rethinking everything

Post by SGM » Sun Jan 10, 2016 4:49 am

Go to Amazon.com and use the keywords=first+do+no+harm++Australia

Read First Do No Harm Being a Resilient Doctor in the 21st Century by Leanne Rowe and Michael Kidd.

Inframan4712
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Re: Bad health news, rethinking everything

Post by Inframan4712 » Sun Jan 10, 2016 7:18 am

Sent you a private message

TMCD75
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Re: Bad health news, rethinking everything

Post by TMCD75 » Sun Jan 10, 2016 9:30 am

I lost my mother a little over 2 years ago at 62, she had cancer. It was awful to watch a beautiful, successful person go through such a living nightmare. That changed my view on everything, you and I aren't guaranteed tomorrow...I geared way down.

Four months ago I lost dad at the age of 66 from cancer. I'm only 40 but have started to think 65 is it for me given mom and dad's early passings. I work hard, I'm a blue collar guy with no fancy degrees. My knees hurt, my back is stiffer than a 2×4 and I'm self employed in construction.

You have lots of options though. If you are expecting that kind of windfall from your parent's estate, you do what you want to do. Once your baby is here, you'll REALLY feel different about working 7 days a week, trust me on that.

You're obviously bright, take inventory of things and don't over do it. Doctor's get burned out early it seems, then they become a frigging robot, everybody in the outside world knows this. Maybe you should work with your wife, my wife and I have been working side by side for 11 years.

Good luck, congrats on your baby and I pray for your mom.

IlliniDave
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Re: Bad health news, rethinking everything

Post by IlliniDave » Sun Jan 10, 2016 10:48 am

bostondan wrote: ...

Perhaps I'm just feeling emotional, but here are some things I would like to hear from the Bogleheads community:

1. Do any of you work with your spouse? My wife is a lawyer. We have a wonderful marriage and I'd love to be able to work with her. She feels the same way. We can't think of any practical way to do this.
2. How would you approach this feeling of being overwhelmed by how much I work currently? Would you consider a career switch? Drop out of academia and work part-time in the community where it might be more accepted?
3. What are some careers that a doctor could do that would allow significant flexibility? If the terrible things above happen, and I inherit $3 million+ at this age, I feel like I won't really have to worry about saving and income. The ability to have financial freedom would be a bittersweet gift from my amazing parents.

Other thoughts? Sorry, I feel like this turned into a therapy visit...
Sorry to hear of your situation. I know quite a bit of how your feeling. For the past 20 or so months my mother has been battling against cancer that has progressed to stage 4 and a terminal diagnosis. Two weeks before Christmas my sister was diagnosed with cancer at "at least" stage 2. Her outlook is better than Mom's on paper, but cancer is never a certain thing.

The primary question you have to answer is, apart from your mother, are you happy with the path your life is on? Do you have clear ideas what you want to do when you are no longer working? What I'm getting at is asking whether there is something specific in your life that you feel that continuing to practice is preventing you from doing, and is that something more important to you than practicing? I spent many years with a vague notion that there was something for me at the end of the rainbow in retirement, but I had no idea what. I ran into some circumstances over the last 8 years that prompted me to really think of what I could do after my professional life. Once I had a vision I was able to cast aside doubts that kept me locked into old habits when "retirement" was a only nebulous concept that was supposedly better than "working until I died".

It's never too early to think ahead about what you want for your future. Once you and your spouse have a vision take the steps to get you there. If your profession is extremely fulfilling there is nothing wrong with having a long career.

I am not an MD so I have nothing to offer on that front. It does sound like you might be overworking yourself, which should prompt you to ask yourself how important it is to "get ahead" (that should be part of what you are thinking about in terms of a lifelong plan).

All that is back burner stuff, of course, while you comfort and support your mother during her illness. In the longer-term, choose a path that feels right to you.
Don't do something. Just stand there!

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Re: Bad health news, rethinking everything

Post by Stormbringer » Sun Jan 10, 2016 11:28 am

bostondan wrote:I don't want to just work for 35 years and then die....I feel like with my current trajectory, I'll end up working 7 days a week and having 16 hour days.
I think you should consider the wisdom of the old saying that "if you love what you do, you'll never work a day in your life." If you are working like that and not thoroughly enjoying it (and some do), then you have a problem. I think that is completely independent of the issue with your mother.

A satisfying life is a journey to be enjoyed, not a destination in the far-off future that you may or may not ever live to see.
"Compound interest is the most powerful force in the universe." - Albert Einstein

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Re: Bad health news, rethinking everything

Post by Herekittykitty » Sun Jan 10, 2016 11:33 am

This is not the time to make career changing decisions. I would delay those decisions and keep my options open as long as I could. Your father was struck down at the relatively young age of 60 having lived a healthy life and your mother, also having lived a healthy life, has a diagnosis you say likely has a poor prognosis. It appears that all the information may not be in about your mother's situation yet or if so, has not yet been fully processed. In addition there is the upcoming birth of a baby, which will hopefully be a joyous occasion but even when births turn out the best, this is still a significant change for you and your wife that will take energy to accommodate.

You are a practicing physician. You have career aspirations (cardiology) and are successfully moving toward them. In the meantime you are working as a hospitalist (internal medicine I assume) and your employer is working with you, allowing a half time schedule (whatever "half time" means as a hospitalist!).

You have not indicated whether you know whether your parents' diagnoses will in any way change your risk for the same or similar. We do know of course that life is finite, that there is plenty we can do to increase our probability of good health outcomes, but that adverse events can occur even in the best lived lives.

This is a time to take good care of yourself and your family including your mother, and to simultaneously maintain your medical career and keep in mind your dreams you may have held for many years, and to hold doors open, not shut. Your employer is letting you take some time by letting you reduce your hours. Perhaps the cardiology program will let you take some time too before starting if you need to - but there appears to be some time before that needs to be addressed. Maybe, for example, you would be able to make an arrangement with your current employer and also the cardiology fellowship to extend current employment by a year and delay entering fellowship by a year - I am by no means suggesting you do this because I don't know you or enough about your situation to make suggestions like this; I am just mentioning it by way of indicating one of many potential possibilities that could occur in the future especially if you don't shut doors now.

In medicine as in other pursuits, it is possible to shut a door such that it cannot be opened again. You can always make life changing/career changing decisions later. I am not suggesting you delay any such decisions forever. Just that now is likely not the time.

You are fortunate to have had and to have such an amazing family, an employer who is working with you now, and to have the ability and drive to have such a successful career/career path.

Condolences for the losses, and best wishes for you and your loved ones.
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Re: Bad health news, rethinking everything

Post by deikel » Sun Jan 10, 2016 9:36 pm

Rethinking ones current life and choices is never a waste of time and should not be called therapy, but just simple smart living.

What strikes me is that the death of the father did not trigger the same question than the potential same fate of the mother (although that's still not a given at all).

Working together as a husband wife team rarely works IMO and is also not always desirable, dinner table conversations might be fairly mute if both had seen all about the others day already anyway....in this specific case, it would depend on the wife's field of specialty - maybe medical claims and legal actions related to that ?

Plenty of work for an MD can be found that is less demanding than the clinic and since still early in the career a smart career choice now could enable such career - say medical clinic for the poor, medical work overseas, private practice with limited work, VA

But ultimately the question is: What was OP motivation to work in the chosen field prior and why did the news change that motivation ? And what does that say about the motivation to begin with.

If financial freedom is achieved a similar question would come up again - why work and what to do with ones life even if it were to end tomorrow....
Everything you read in this post is my personal opinion. If you disagree with this disclaimer, please un-read the text immediately and destroy any copy or remembrance of it.

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bostondan
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Re: Bad health news, rethinking everything

Post by bostondan » Mon Jan 11, 2016 7:51 am

Thank you for the continued insightful comments from everybody.
What strikes me is that the death of the father did not trigger the same question than the potential same fate of the mother (although that's still not a given at all).
It did actually trigger the same type of question. I was initially planning to pursue a career in a surgical subspecialty, but when my father died I decided to switch to a field that allowed a bit more flexibility (internal medicine). I could have chosen something like ophtho or dermatology I suppose, which have a decent lifestyle, but those didn't interest me as much. Given the extremely good health in all my relatives (and previously my parents), I still looked at what happened to him as a bit of a fluke though. With the same thing now happening to my mother, it is hitting me even harder.

I'll continue my current course for now, without making any sudden changes, but I'll be actively reevaluating what I want long term. I do love being a doctor, but I don't love it as much as I do spending time with my family and friends. That certainly doesn't mean they are incompatible, but I need to figure out the right balance.
“There may be times when we are powerless to prevent injustice, but there must never be a time when we fail to protest.” - Elie Wiesel

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TNL
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Re: Bad health news, rethinking everything

Post by TNL » Mon Jan 11, 2016 9:06 am

What type of law does your wife practice? Is she at the beginning of her career, or does she do public interest law? Just wondering because her salary seems low, unless she is at the beginning of her career or in nonprofit.

Many condolences to your family for the loss of your dad, your mom's illness, and congrats on your new baby.

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bostondan
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Re: Bad health news, rethinking everything

Post by bostondan » Mon Jan 11, 2016 9:28 am

What type of law does your wife practice? Is she at the beginning of her career, or does she do public interest law? Just wondering because her salary seems low, unless she is at the beginning of her career or in nonprofit.
She is an ADA (prosecutor). It's pretty bad how much they get paid compared to many other fields of law. However, I have learned that it is actually a small percentage of lawyers that make a lot of money, while the rest mostly make a much lower salary.

A study came out not too long ago discussing the issue of ADA and public defender salaries in Massachusetts. They showed that, accounting for cost of living, Massachusetts was the worst paid. They also showed that the state attorney was the lowest paid person in the court room: http://www.massbar.org/media/1494238/do ... ustice.pdf
“There may be times when we are powerless to prevent injustice, but there must never be a time when we fail to protest.” - Elie Wiesel

Miakis
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Re: Bad health news, rethinking everything

Post by Miakis » Mon Jan 11, 2016 9:30 am

Sorry about the bad news.

It seems like you're in a good position to plan for early retirement - so it may behoove you to check out a few of the early retirement blogs that are out there (Money Mustache, ERE).

I do know a physician who retired early and then built a business where he does medical malpractice consulting (on the claimant side).

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Re: Bad health news, rethinking everything

Post by Martello Shores » Mon Jan 11, 2016 9:39 am

Tough times: so sorry. Re genes and environment, both contribute, of course, as does chance.

Citing peer-reviewed literature, MD-authored website nutritionfacts.org has convinced me to eat many more legumes, fruits & vegetables, whole grains, nuts, etc. in bid for continuing my good health. I've reduced intake of animal products, but not as much as I should. (It's a journey. :wink: )

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TNL
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Re: Bad health news, rethinking everything

Post by TNL » Mon Jan 11, 2016 11:32 am

bostondan wrote:
What type of law does your wife practice? Is she at the beginning of her career, or does she do public interest law? Just wondering because her salary seems low, unless she is at the beginning of her career or in nonprofit.
She is an ADA (prosecutor). It's pretty bad how much they get paid compared to many other fields of law. However, I have learned that it is actually a small percentage of lawyers that make a lot of money, while the rest mostly make a much lower salary.

A study came out not too long ago discussing the issue of ADA and public defender salaries in Massachusetts. They showed that, accounting for cost of living, Massachusetts was the worst paid. They also showed that the state attorney was the lowest paid person in the court room: http://www.massbar.org/media/1494238/do ... ustice.pdf
I'm still thinking about some of the other questions that you posed, but if your wife were ever to switch to criminal defense, she would probably do quite well -- after getting the experience at the DA's office. There are very few criminal defense attorneys who are female, and where I live, they do quite well. It's not a job for everyone though. But you could help her manage her practice.

Also -- the divorce rate for female attorneys in a two career couple is very, very high. You might want to take that into account and plan accordingly when plotting our your own career path. The hours that you are talking about working do not sound conducive to family life at all.

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Re: Bad health news, rethinking everything

Post by letsgobobby » Mon Jan 11, 2016 11:42 am

It's worth finding out what specific gene mutations affected your parents. Not medical advice: but knowing whether you have inherited them will potentially affect your longevity planning, SWR, etc. Having an oncogene doesn't guarantee you'll develop cancer, but it's a matter of the odds. Knowing you have several is different than knowing you have one, etc. If your parents had heritable vs non heritable mutations, etc.

As I wrote, both my parents were diagnosed with stage 4 cancer this fall. My dad: non small cell lung cancer with only a single, typically non-heritable mutation. My mom: endometrial cancer, with negative everything at the time of her breast cancer diagnosis a year ago. No genetic abnormalities this time, so far. So nothing obviously heritable to me. So I can't obviously use their medical history to inform my financial planning.

That said, it certainly emphasizes that life is unpredictable. Both my parents lived extremely healthy lives, especially in the last 20 years. Fit, active, healthy weights, healthy diets, yada yada yada. No slow decline into various ailments, just BAM - stage 4 cancer out of the blue. No guarantees. No promises. Life is short. Live it now.

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Re: Bad health news, rethinking everything

Post by Qtman » Mon Jan 11, 2016 11:43 am

Dr. D, sorry to hear about your mother, went thru that recently myself. I think your post makes a very important point that rarely comes up on this forum - we never know how long we have, so frugality and planning, while very important, don't have to exclude other things that people may want to do, but don't want to spend the money.

If this scenario works out the way it seems likely, you will have soon the most critical job the world - raising a child. Having time with your new baby is wonderful.

Perhaps the financial flexibility you may have is to allow you to do things you only dreamed about; maybe help those who need medical help, with your knowledge perhaps starting some org that can help people with your medical knowledge.

Best wishes, God Speed.
Don’t wear yourself out trying to get rich; be wise enough to control yourself. | Wealth can vanish in the wink of an eye. It can seem to grow wings and fly away | like an eagle. - King Solomon

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Re: Bad health news, rethinking everything

Post by Dandy » Tue Jan 12, 2016 9:36 am

In this emotional time it is natural to go through this type of thinking. The combination of a new baby and the loss of a loved one makes you take a hard look at your own life. It probably is not the best time to finalize any decisions but to explore possibilities. It would seem though that with the prospects of significant wealth a change in direction is very possible. It will give you a chance to follow your heart/passion rather than a path created in a different mind set.

I would wait until things sort themselves out a bit before acting on major life changes. Good luck

mouses
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Re: Bad health news, rethinking everything

Post by mouses » Tue Jan 12, 2016 9:53 am

How about pushing back against the Harvard system, if you want to stay there. Maybe you will wind up out in the street, but you can afford that. You will also be doing a favor for other people, as there are no doubt other people with family or quality of life issues. I have always though the doctors work shifts designed to drive them into incompetence is a crazy system.

My internist works part time. She has a backup partner, and I would not rend my garments if I have to see the latter some times.

Rupert
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Re: Bad health news, rethinking everything

Post by Rupert » Tue Jan 12, 2016 9:56 am

These two books were recently recommended to me. You may find them helpful just now.

When Breath Becomes Air, by Paul Kalanithi, a profoundly moving, exquisitely observed memoir by a young neurosurgeon faced with a terminal cancer diagnosis who attempts to answer the question What makes a life worth living?,http://www.amazon.com/dp/081298840X/ref ... AA7I0XQ3M6

In Being Mortal, by Atul Gawande, bestselling author Atul Gawande tackles the hardest challenge of his profession: how medicine can not only improve life but also the process of its ending, http://www.amazon.com/dp/0805095152/ref ... VVSI2FG8EP

gilgamesh
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Re: Bad health news, rethinking everything

Post by gilgamesh » Tue Jan 12, 2016 11:09 am

If I were you, I will pick a specialty where you could work part time, in a non-insurance/boss controlled environment. Definitely wait till emotions settle down prior to nay major decision like this.

blackdeercap
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Re: Bad health news, rethinking everything

Post by blackdeercap » Tue Jan 12, 2016 7:10 pm

One of my best friends is a Dr and partner in a decent size medical group (30 doctors, ~200 total employees). His wife was fairly advanced at a big law firm, LW, when she decided to quit her job to be "general counsel" for the med group. Less money, but a lot more flexibility. They've worked this way for over 10 years now and all is well!

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