Insensible Losses

crispydoc Uncategorized Leave a Comment

I was introduced to the concept of “insensible losses” in medical school.  Briefly, excess fluids lost from the human body are difficult to measure via the lungs, skin and GI tract, but can take a significant toll on the state of hydration.  Conditions that stress the body and increase metabolic rate (burns, fever, a pint of Ben and Jerry’s in the lactose intolerant) result in increased insensible losses.  Reading an endearing blog post on Marriage in Retirement by Darrow Kirkpatrick led me to believe that relationships, too, have their version of insensible losses.  From his post: Long ago, somebody told me that each member of a successful partnership has to give more than 50%. That’s because of losses due to “friction.”

I was reflecting on this idea as I finished a 2 week stretch of every-other-day shifts, with a third being overnight shifts.  The wife and I were both feeling depleted.  She’d been taking the munchkins solo; arranging playdates and reviewing homework; and working her side hustle along with a weekly clinical day shift.  It was the 1980s television wrestling matches of my childhood, only my wife did not have me available to tag team and jump into the ring when she was taking a beating.

I’d been busy at work, at times staying a couple of hours after each shift to complete my charts on the more difficult days.  On my most recent overnight shift, 15 minutes before my replacement arrived the paramedics brought a patient with a catastrophic intracranial bleed from a ruptured aneurysm.  Our excellent ED team of nurses and techs switched into flow mode, establishing IV access, preparing intubation drugs and clearing the CT scanner while I spoke to the distraught husband.  It was a rough end to a busy shift.  Bearing witness to this kind of life-changing event for another would usually remind me to be grateful.  Instead, I felt depleted.

This was a rare schedule for us.  I’d offered to help several colleagues cover gaps while they left on spring break and maternity leave.  This abutted our own trip to visit my in-laws.  When we were away, we were together but never alone.  When we were at home, we were apart.  The lack of unstructured time was rough: there was no time to be exclusively with one another nor to be available for one another.  When everyone is knocked down, there’s no one to lean on.

About my wife: she is a master logistician and an extrovert fighting an uphill battle against our odd calendar.  Because emergency medicine has such an irregular schedule, I work every other weekend (my wife works per diem, so she has far more scheduling control and works only weekday shifts).  Some of my “off” weekends are spent recuperating from night shifts.  Hence, the Venn diagram of our free time has little overlap with that of our friends’ free time. We consequently sit down months in advance to set up social events with friends, reserve sitters, arrange trips to visit family, and plan vacations to recover from those trips.  I like to say we have loads of flexibility but zero spontaneity.  The net result of our planning time off for maximum social interaction means we have few date nights for just the two of us.

While out running errands, I bumped into a local friend during this stretch, who took a moment to lend a sympathetic ear.  My friend, secure in his second marriage and on good terms with his ex-, shared a cautionary tale from his first marriage.  He and his ex- spent so much time putting the kids first that they did not carve out adequate time for one another.  Their relationship neglected, they grew apart.  He now enshrined date night with his new wife as an untouchable event.

At the end of our two week rough patch, my wife and I sat down and tried to pinpoint what we might learn from this experience to avoid repeating it.  We could plan our social calendar with deliberate gaps for just the two of us to spend time together.  We could employ what we’ve come to call the dump-and-run strategy, where we hand off the kids to their grandparents and take off for a couple of days when we take trips to visit our parents. 

We also looked at options for making work less of an imposition by potentially cutting back on our shifts.  This was also a big change in how we approached our FI/RE goals.  Previously, my plan had been a “speed is the best anesthetic” approach to cranking out back-to-back years of shifts, maximizing our savings rate, and then dropping out of medicine altogether in pursuit of my second act once we’d reached our FI number. 

We realized that by cutting back early, we could make our careers sustainable for longer and savor the interstitial moments that renew us.  Those times I tend to dread heading into work are the ones where I’ve just had a ton of prior shifts.  Spreading out fewer shifts more evenly seems like a better long-term plan.

Now we are heading into autumn with a plan to potentially reduce my shift load per my group’s policy, and while that means our FI number is a bit further out of reach than it would be otherwise, it also means my time off will be more abundant and higher utility than it has been historically.  I anticipate the gain in presence at home and the sustainability of my work life will more than offset the extra time to reach our number.

What are your biggest insensible losses?  How do you minimize their impact?

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