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Holding the Knife for the First Time

As an intern in ob-gyn, one of the things you look forward to the most is getting to be the surgeon while an attending is your assistant for a cesarean delivery.  In some residency programs this doesn’t happen until your second year of training.

Most of the time you are honing skills on uneventful vaginal deliveries.  You are learning about labor progression, shoulder dystocia, inserting cervical ripening agents and performing “scut” work around the labor ward.

However, one a day an attending notices the work you have been putting in.  He also notes the great rapport you have with this particular patient.  He asks you if you would like to perform her necessary surgery and you say “yes!” before he has finished asking.  You put on the surgical gown and knee high scrub boots about 30 minutes too early in anticipation.

You nervously sneak away for a few minutes to review the steps in your mind for the surgery.  You have scrubbed into dozens of c-sections as a medical student, but that involved holding the suction and retractors.  This was much different- you would be holding the knife for the first time.  You feel ready, and have been practicing your surgical knots and know the steps.

After you talk with the patient and help her onto the operating table, you begin the prep work.  You check the fetal heartbeat one last time and then cleanse her abdomen with a solution to help prevent infection.  Next, you cover her body with a drape that has a large hole in the middle designed to allow access to just the pregnant abdomen.  The drape extends upward and you can no longer see her face behind the drape.  You now understand why this is a good thing.

The drape helps you mentally separate from the attachment you have with the patient.

Before the drape went up, you were sensing and feeling your patient’s expected anxiety about having a surgical procedure.  You were also feeling the excitement from both she and her husband about the fact that their baby was about to be born.  The drape moves your focus to only the task at hand.  You stop thinking about the emotions involved with this person, and instead direct all of your attention to safely performing this surgery.

You confidently call out “scalpel” for the first time and the scrub tech hands you the instrument.  Your hand is shaking just slightly as you press it against the skin.  However, you notice the tremor disappears as you carefully and deliberately make the large incision on her abdomen.   You have started and the steps of the surgery proceed like second nature.

When you make the incision on the uterus you are particularly careful.  All you can think is “don’t cut the baby”.  The fetal head is firmly pressed against the uterine wall which is particularly thin after a long, stalled labor.  You cut through the thin uterine muscle layer by layer until you see the scalp of the baby.  At this point you gently slide your hand over the baby’s head and deep into the pelvis.  You have never done this part before, but the attending calmly guides you to keep your wrist straight and pull the baby’s head through the incision.

It takes more strength than you anticipated as the head was socked deep in the pelvis of a laboring patient, but you do it successfully and the baby is screaming immediately on delivery.  You look down and excitedly announce “It’s a girl!” to the parents waiting anxiously behind the drape.  For the first time since the surgery started, you allow your emotions back in.  A rush of adrenaline runs through you as you relish and acknowledge the gravity of the moment of this baby’s birth.

Finishing the surgery, you sew the uterus and fascia carefully back together.  You notice the scrub tech impatiently looking at the clock and you are acutely aware it takes you more time than most seasoned surgeons since this is only your first case.  However, your attending doesn’t seem to mind your meticulous fashion so you proceed without worry.  Finally, you sew the skin to complete the case.  Your attending physician says “nice job” and shakes your hand firmly.

You don’t think there could be a better feeling than performing your first case solo…..

Until, you get to walk an intern through their own “first case” and experience the growth, excitement and gratitude through their eyes.

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A Humbling Night at Taco Bell

This is a true story from my otherwise uneventful Monday night.

I was driving my 4 year old daughter home from swim lessons and planned to stop at Taco Bell, her current favorite, for dinner afterwards.

After I parked, I realized I forgot my wallet at home but luckily I did have my cell phone.  No problem, I thought. I have “apple pay” on my phone and could use that to pay for dinner as my credit card was uploaded.

My daughter and I waited in line as a large family in front of us completed their order.  The cashier was patiently compiling their customized order with a soft smile.  I noticed multiple tattoos on her arms as she was working the register, and wondered about the stories behind them. When it was our turn, I asked the cashier if they accepted apple pay as I didn’t have my wallet with me.  She wasn’t sure, but thought she had seen someone use it before and suggested we try.  So, after giving the order for myself and my daughter, we tried to pay.

However, it didn’t work.

Immediately, I felt very awkward and now had no way to pay for our dinner.  In my pockets I had about a dollar’s worth of change I found in the car.  The cashier noticed me checking my pockets.

Not a big deal, we would just go home to eat dinner.

I told my daughter, “sorry, we’ll have to come back another time”.  Immediately, the cashier jumped in and said she couldn’t let us leave without our dinner.

“I’ll pay for it”, she told me.

“No, no, absolutely not” I replied.  Then my 4 year old piped in with “what’s going on Mommy, I want to eat here”.  Before I could say anything else or leave the restaurant, the cashier was literally running to get her wallet and paid for our dinner with her credit card as she would not take “no” for an answer.

“I’ve been there too” she replied.  “You know, left my wallet at home”.

However, I am quite certain that’s not what she meant.  I thanked her profusely and felt strangely awful for accepting her money yet also completely humbled at her generosity.  I told her I would return to pay her back, but she just asked me to pay it forward.  At this point I didn’t know what to say to a woman who doesn’t know me or my situation, but just sees a mother and a daughter and wants to help.

I asked for her name- it is Christie- and she wrote it on the receipt for me.  My bill was $9.29.  As we sat quietly eating dinner, I was lost in thought.  I wondered how much minimum wage was.  I was also embarrassed by the fact that I didn’t know.  (I looked it up- ironically, it’s $9.25).

I thought about how quickly and selflessly the cashier paid for our dinner despite the fact it very well may have cost her an hour’s worth of work.

Her act of kindness stayed with me all night.  I couldn’t shake how profoundly this was affecting me.  I kept thinking how it must feel for mothers who truly don’t have the money to pay for a meal must feel.  Helpless?

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I thought about victims of domestic violence.  I have actually had discussions with patients and talked with them about developing a plan to leave an abusive partner.  They are often afraid to leave an abusive situation out of fear for how they will care for their families on their own.  In my ob-gyn practice, it was a standard question for new patients at their annual exam, “do you feel safe at home”? Unfortunately, pregnant women are at an increased risk for domestic abuse and I have seen this with more than one of my patients.

In the past, I have discussed with patients some practical measures such as hiding away a small amount of money so that they would have a way to care for themselves and children when first escaping the situation.  Often, these women have zero resources of their own.  I was wondering if this caring cashier thought perhaps I may have been in a similar situation.

The truth of the matter is that I have never been in this terrible situation, and can’t possibly understand what it is like for these women.

That night, I was wearing pretty typical clothes for a Monday night swim lesson- nice pair of jeans and a t shirt.  My daughter was in a cute matching Minnie mouse outfit. Definitely not the definition of needy but also not clearly one of wealth.

This cashier didn’t stop to question or judge our situation.

My plan is to go back next Monday night after swim lessons.  I have an envelope with Christie’s name on it that will pay her back many times over.  I also plan to talk with her manager about the kind of person they are lucky to have working the cashier. Most importantly, I want to tell Christie that her small gesture impacted me profoundly.   With stories of hate, mass shootings, and natural disasters filling our news lately, her kindness showed me that love and compassion for strangers is still present.

And, needless to say, I will also “just pay it forward” as she requested.

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Investing in the Stock Market? I Never Learned About This in Medical School!

How Can I Start Investing if I Don’t Even Know What the Terms Mean?

People have different opinions on how, when, and what to invest in.  A good rule of thumb is to SAVE (emergency fund and college funds for kids), PAY OFF DEBT, and INVEST all at the same time.  This means you do not have to wait until all debt is gone to start investing (you will have missed the potential for large profits during this time through compounding).  Most can consolidate medical student loan debt at reasonable rates.

However, in order to do all 3 of the above, you might have to cut back on spending and most likely live below your means. If you use the example of living off half your salary, or on the salary of one person (if married and both are working), you can do all 3.  However, the point of this article is not to preach about how you decide to manage your money but how to actually invest.

What even makes up the Stock Market?  What do these numbers mean?

If you pick up the Wall Street Journal, watch CNBC, or look to any source for information about the stock market you will find three things mentioned when tracking how things are going.  What if you don’t even know what these terms/numbers represent?

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S & P 500: Tracks the price of 500 large US stocks (account for more than 70% of total value of the market despite tens of thousands of stocks).  This is a broad representative index of large US stocks.

Dow Jones Industrial Average “the Dow”: Tracks 30 companies in US that are thought to represent the diversity of the economy of the US.  The stocks included change over time.

NASDAQ: This is an index focused on technology stocks

Why do you care about these indexes and why do they talk about them on the news every day?  It gives you a general idea overall how the stock market is doing (percentage gains or losses).  You can also compare your stock market investments to these indexes based on the types of stock you invest in.  If you own facebook (FB) or Google (GOOG) you may be interested in the NASDAQ numbers.

Mutual fund:

Contains many securities (stocks, bonds, etc) in one “investment portfolio” and is actively managed for you.

– automatically provides you with diversification (and therefore decreased risk) by owning many different stocks

– no time investment is needed for you to research stocks, determine which stocks to buy- but you should spend some time researching the actual mutual fund

-small fee associated (these fees have come down quite a bit in recent years and some mutual funds can have very low costs)

-may be a minimum amount necessary to invest

You can pull up your brokerage account website, select “mutual fund”, choose to invest in a diversified mutual fund yourself and call it a day.  Alternatively, you can have a financial advisor do it for you as well.  Just remember, you will not only be paying the fee for the mutual fund management but if you have an advisor you will also be paying a fee to them as well.   I’m not saying having an advisor is a bad thing- for some people really feeling overwhelmed, a good advisor can really get you on the right track.  However, I also think if you are motivated with just a little time commitment you can put money into a mutual fund and invest on your own too.

How do I pick a mutual fund?

You can google some top mutual funds; take a look at the performance over 10 years (including recent data too) and the fees with each.  Pick one.  If you are paralyzed by indecision, it may be worth your time to get an advisor.

Find a good finance app to help you look at these charts quickly and for brief summaries of the important info you need.

Download one today (they are free)- I use yahoo finance; Charles schwab, and cnbc.  You may need to try a few to find one that works well for you.

One particular mutual fund over different time frames (Vanguard 500 index Fund):

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3 months

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1 year

IMG_162910 years

Mutual funds (namely index funds comprised of stocks) are often more likely to mirror the overall stock market trend than an individual stock given its diversification.  Luckily, the overall trend in the market is typically UP.  Your mutual fund will not guarantee the typical 8% yearly return of the stock market, but may be closer than if you bought an individual stock.

Remember, I am not a financial advisor.  I have no crystal ball.  I don’t know which mutual fund will do better than another.  However, I do know that people who have invested long term in the stock market have done well and will continue to do well.  You can decrease your risk with diversification (owning more than one stock as in a mutual fund).  There is minimal time commitment (which is a plus for busy physicians).  You can build wealth if you invest in the stock market early in your career and leave the money alone.  Put the money in and let it grow for you over the years- no need to check back too frequently or you will just make yourself panic when the stock market dips down occasionally, as it always does.  Even if we hit a Bear market or serious downturn in the coming years, it will be important to keep invested as the market will eventually recover.

By this point, seasoned investors will be rolling their eyes at me for the basic nature of this post.  On the other hand, I am certain some readers will be feeling overwhelmed with information overload on pretty boring and dry topics.  It’s not as exciting as learning a medical procedure, as gratifying as building a lasting relationship with a patient, or as rewarding as delivering a baby.  However, you owe it to yourself and your family to develop a basic understanding of finances.  It’s not selfish to invest and maximize your potential earnings.  Doing so will provide you a future with more control over your life (when to retire), be able to handle an emergency (unexpected health bills, loss of job), and have the ability to give more generously through charity and donations.

Again, I am not endorsing any particular mutual fund.  Don’t make financial decisions from me, but your own research.  A mutual fund is a nice place to start, but if you are ready to try buying individual stocks stay tuned for the next article.

 

 

Investing

Getting into the Stock Market as a Physician? It’s not as Complicated as you Think.

As a young physician, I found that most of my colleagues were completely financially illiterate- myself included.  The simple fact is that we have dedicated our time and efforts to learning about medicine, not finances.  We also tend to find reading material on the subject dry and uninteresting.  However, with more and more physicians in debilitating debt from student loans, learning how to manage your finances has never been more important.

ANYONE can learn about investing (which I believe is the way to truly build real wealth in this country).  If you plan to save and retire off your income alone, you can do it but will need to continue working much longer than if you invest money from the very beginning in the stock market.  Make your money work for you.

I have found that there are several helpful financial websites out there for physicians such as White coat investor https://www.whitecoatinvestor.com/ and Physician on Fire https://www.physicianonfire.com/. I have referred many physicians to these sites.  However, in talking with my fellow physician friends (mostly women physicians), these websites are full of great information but can still feel overwhelming, especially when first starting out.

So, I will be starting a financial series and breaking it down from the beginning to help you get started.  No, I am not a financial advisor.  No, I am not backed by a financial institution.  I’m not really getting anything out of this other than maybe a few clicks to my website (but as other bloggers can attest, it barely adds up to anything).  Why am I doing this, then?  Well, I see a need.  I was in your position.  I have retired early thanks to wise investments and financial principles and now I have the time to help out those interested in the stock market but are afraid to jump in.  I do not claim to be an expert, but I don’t think you need to be in order to reach your financial goals (whatever they may be).   Hope you find it helpful.  We are starting with baby steps.

 

SET UP AN ACCOUNT FOR INVESTING

(This is separate from your 401K-make sure you have maxed that out first before investing in another account to receive the tax benefits of 401k).

You will need to pick a trading platform.  There are many companies for this.  They are all pretty similar and it ultimately doesn’t really matter which one you go with as long as you just start investing.  Back in the day, people used to use stock brokers and they would call on the telephone and urge you to invest in certain things.  Now, all you need is a computer and you can easily set up your account and start investing on your own.

I personally use Charles Schwab.  You could also pick Etrade, robinhood, Tdameritrade, etc.  Don’t get paralyzed by the choices, just pick one.

Here is the link to Charles Schwab to make it easy for you:

https://www.schwab.com/public/schwab/client_home

Click on “open an account

Type of account you want to open: “Brokerage”.

Then just follow prompts to open your account- will take less than 20 minutes.

You will need to transfer money into this account (you can link your bank account to make it easy or send in a check).  I recommend linking your account so that you can easily contribute in the future or set up automatic transfers each month.  Make it easy on yourself to keep investing!

 

Again, you can do this with any trading platform you wish- I happen to use this one, so I am sharing with you as I have found it easy to navigate, follow my stocks, and actively trade stocks.  I also like the interface of the app for my I phone.

Make it your goal to set up an investment account this week.

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Once your account is set up and money is transferred (make take a few days to have money accessible for you to invest), we will get started.

Expect my next post within the week.  It will go over the next step, which will be choosing what to invest in.  To delve into that further, we will have to get into some financial terminology but I plan to keep it simple, brief, and to the point.  We will talk about long term investing and mutual funds and how to do it.

Future Topics I plan to cover in the most basic way possible:

Investing- Mutual funds

Individual stocks

Saving for College: Setting up a 529 plan

Making a will/estate planning

I hope you follow along and share with any friends who may find this information useful as we work our way into investing.