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Jet Lag and Residency: Long Distance Relationships in Medicine

When I started looking at where I wanted to spend my residency during the fourth year of medical school, I considered numerous factors, as every student does. Many of them are quite similar: location, quality or style of learning, fellowship options, benefits, personality fit, etc. However, not everyone is at the same place in life when they are matching. Some people are moving their families across the country. Others are trying to couples match with another partner in medicine. My story was a little bit different.

I remember on match day, I was standing in the back of the crowd with my parents, my brother, and my boyfriend, who happens to also be in medicine. I opened my email at the time and read out my match. I was happy, and so were my parents. I looked up at my boyfriend, and he smiled at me. With sad eyes. Because we knew what my match choice had meant. I was going to live 13 hours away from where we stood at that moment. 858. That’s the number of miles in between our houses.

I chose to leave my home state. I knew my best fit was at a different program. We had talked about this prior to the match multiple times, and he had encouraged me to leave and to focus on my career. He had never been anything less than supportive of that choice. In that moment, though, it was a weird feeling to be so happy and yet still a little bit hurt at the same time, especially over something I knew was going to happen and had chosen.

The truth of the matter is that we had initially agreed that we were going to break up when I matched. I remember calling him the Monday after match day, upset. He asked me what was going on and I told him that I was upset that our relationship had to end. He said, so matter of factly, that obviously, we were going to do long distance. “Oh,” I said. I laugh now, thinking about how logical his response was to something that was causing me emotional stress. He said that it didn’t make sense to end our relationship, and that we would make long distance work because it was important. That sentence alone has held so much weight for us.

The time from match day to July 1 moves incredibly fast. We spent time trying to prepare ourselves, even reading books about how to make a long distance relationship work. We got advice from others, including one of his best friends, another resident doing long distance. People assume that it would be easy to be in a long-distance relationship during residency because you are both busy. In reality, that is often the challenge itself. Your schedules are both incredibly busy and somewhat inflexible and unpredictable. Even so, it is not an uncommon thing. For residents, about a third of them will be separated geographically from their partner at some point in their training. I would be a PGY-1 in emergency medicine, and he would be a PGY-3 in orthopedic surgery. Our schedules could not be more different.

Over the past year, I’ve been thinking about what I would say to someone else considering starting on the path we have been on. We are, by no means, professionals at it. We still have our difficulties. Even now, trying to consider fellowship and future job options, there are a lot of obstacles. I’ve gathered my thoughts regarding this into five larger categories of advice on long distance relationships, specifically in medicine. I hope this can be a helpful guide to those who may be going through something similar.

1. Manage your expectations–of yourself, and of your partner.

  • Being in a long distance relationship is financially difficult, especially on a resident salary. You have to budget for it. Driving, for us, is often not feasible, so I have to budget for flights and dog sitting. I also have to budget time, because there are no direct flights between our cities. When you are taking a $400 flight every month or every other month, that can be a big chunk of your salary to put aside. You have to talk about realistic expectations of when you will see each other. Our goal is every 4-6 weeks. As an aside, we both did get a travel credit card to build up points and miles, which has helped with the expense.

  • Your expectations of your partner will change. You can no longer expect to hear every detail about their day the way you might if they came home and lived in the same place as you. It is an emotional struggle to not see your partner when seemingly every other resident gets to see theirs every day, come home after a rough day to theirs, and bring them to residency events.

  • You will get angry at the situation. Try not to take it out on your partner. Life makes love look hard, as Taylor Swift says. Love is simple, when it comes down to it. It’s about choice.

2. Schedule your relationship.

  • Make an effort or it won’t happen. It helps to know the other person’s schedule. For example, my boyfriend added me to an e-mail list so that I would get copies of the call schedule they have. I have a way to share my shift schedule with him as well. We sometimes attempt to schedule things together (ie, long days on the same days, nights at the same time, hard rotations at the same time). You have to be fully cognisant of putting in effort to talk to and see the other person, or it simply will not be possible.

  • Date nights–We schedule them. It’s not possible every week or on every rotation, but we do make time for it. It can be as simple as watching a tv show on netflix teleparty, or as fun as going to a Mexican restaurant to get a margarita at the same time. It’s about making the effort to foster connection, even from a distance.

  • Schedule the next time you will see each other. Our goal is to not leave from a time seeing one other without knowing when the next time will be. We have to request time off pretty far in advance, and even sometimes that doesn’t work out. There will be last minute changes and required events added. It’s difficult not to take it personally sometimes, but sometimes going with the flow is all that you can do, because you have so little control over your work life in residency.

  • Plan out your week–We plan when we are going to have our facetimes and phone calls. It can be difficult if I am on shift at a different time of day than him, or if he is on a 24 hour call shift, so we have to talk about it in advance and make it a priority. He loves talking on the phone, so I think that has helped us acknowledge the importance of it and make it happen. Communication about even small things matters so you can stay in tune with what’s happening in your partner’s life.

  • Consider time zone differences! Sometimes you want to stay up late talking, but consider that it is an hour later for that other person, and they have to wake up early and work, just like you do.

  • Tell your program leadership–sometimes they can help! My program leadership is supportive of us having personal lives outside of medicine. When I made my intern schedule, I told them that I was making it based off of the schedule my significant other already had so that we could have vacation at the same time, and they worked with me to make that happen. Every program is different, and some may be less flexible than others, but they can’t help you if they don’t know.

  • Plan (as well as possible) how long your time physically apart will be. It helps mentally to have an end date. Ours isn’t concrete yet. It will either be the end of residency or the end of fellowship. We will be matching into fellowships at different times, but doing them at the same time.

  • Maximize your time– When I request days off, I will often put when my flight is so that the schedulers can use that information. There have been times that I left work, went straight to the airport, flew out, got back, and drove straight back to work. If you want it bad enough, you’ll make it happen.

3. Learn how to love your partner from a distance.

  • How your partner receives love from a distance may not be the same way they receive love in person. It may take a different approach to make them feel loved. We’ve found a few ways that have worked for us so far. Honestly, our communication after starting a long-distance relationship has been better than it was when we lived in the same city. It forces you to be intentional with your conversation. We’ve grown a lot at this over the past year. We’ve learned to sense how and when the other needs reassurance.

  • Cards/Notes- We will leave each other notes, and mail each other cards and letters. It's a small, inexpensive way to show the other person that you are thinking about them and love them.

  • Occasional gifts–It’s fun to open a package from your significant other. We send each other small gifts when we are starting or ending a particularly difficulty rotation sometimes. He has sent me a Stanley cup to help me stay hydrated on shift. I have sent him boxes of snacks and little things to help him get through night float, including a Waffle House gift card, one of his favorite places to get food from.

  • We use question apps to improve our communication. It’s a small amount of effort each day, but it might be just the sentence your significant other needed to continue learning about their partner or to feel cared for throughout the day.

  • Keep important conversations important–don’t avoid them. It is easy to just not bring something up on a 30 minute phone call, when you don’t have to see the person. It is easy to push something off for a week. It’s not easy to have a difficult conversation over the phone. You have to, though. Your relationship will be better for it. We have never communicated better or felt stronger in our relationship than when we have been straight forward and real with each other.

4. Disconnect from medicine sometimes–and sometimes don’t!

  • Try not to talk about medicine or work. That’s really difficult sometimes for those of us in medicine, because we tend to move towards letting it take up a lot of our lives and our mental space. It’s nice to talk about other stuff sometimes and just to disconnect.

  • We do a lot of parallel activities, which is essentially doing something usually very boring at the same time as the other one. We do small things, like dishes, laundry, brushing our teeth, grocery shopping, at the same time. It seems like a small thing, but it’s actually one of the things I miss most about living in the same city–doing the small things together.

  • Sometimes, study together or work in silence. Sometimes, we don’t have the time to spend together. We will sit on the phone while we are both studying or working on research and not say a word to each other. It’s just nice to feel like the other person is there. It’s a great part of our relationship to support each other’s career so much and to be able to sit in silence sometimes.

5. Use this time for yourself.

  • It’s okay to put your career first for a while and you shouldn’t feel bad about that. There will be times when you feel regret and like this was a selfish choice. It’s okay to be selfish, too. I made the best choice for my career, and I love where I’m training. I wouldn’t change it for a moment. Distance is for such as short time when you think about the big picture, as my boyfriend always tells me.

  • You can fight loneliness by using the time for good for yourself and things you want to do. I’ve developed new hobbies and explored my new city on my own. It’s been nice to let myself be as independent as I want to be and pursue my own personal development. I can spend time with my friends and on those other things without feeling like I’m missing out on time with my partner–because he’s not here anyways, and we have scheduled time together.

Ultimately, long distance relationships are not an easy thing. Especially in medicine. Especially in residency. However, I think it can be worth it. You and your partner can make it your own, something completely unique to your relationship, and that’s totally okay. Not everyone will understand how or why you do it, and that’s okay too. It only has to make sense to you and your partner. In my opinion, it makes every moment we are together even sweeter and more meaningful. I’ve never cherished my partner and his support more. A long distance relationship in medicine can be such a fun and special partnership. One day, I hope we will look back at this time fondly and realize how much stronger it made us.

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