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Dr. Chan: What is it like to have a spouse that was working a full-time job transition into being a medical student? How do you keep the lines of communication open when there is frustration, and why is it important to put your spouse first? What type of opinions do you offer your spouse when deciding what type of residency to pursue? Today on Talking Admissions and Med Student Life, I interview Zach, spouse of a recent graduate here at the University of Utah School of Medicine.

Announcer: Helping you prepare for one of the most rewarding careers in the world, this is Talking Admissions and Med Student Life, with your host, the Dean of Admissions at the University of Utah School of Medicine, Dr. Benjamin Chan.

Dr. Chan: All right. Well, we've got another edition of Talking Admissions and Med Student Life. I have a fantastic guest today. Zach, how are you doing?

Zach: Great.

Dr. Chan: Now, Zach is married to a current fourth-year student. We're going to hear your perspective.

Zach: Awesome.

Dr. Chan: All right. So let's start back in the beginning. Tenley, when she started thinking about medical school, were you guys together at that point or . . .

Zach: We were not.

Dr. Chan: Okay.

Zach: So she decided she wanted to go to medical school when she was an undergrad and she applied, unfortunately did not get in the first time, did another application for the second year and also did not get in. I believe at that point in her life, she evaluated maybe her strengths and her weaknesses in her application and decided to take a year off and strengthen her application. That's where I came into the picture as I met her and we met during that time.

Dr. Chan: How'd you two meet?

Zach: We met online.

Dr. Chan: Okay. Do you feel comfortable sharing the website?

Zach: Yeah, we're good.

Dr. Chan: Because I know Tinder is very popular with the students here.

Zach: Yeah, this was before Tinder.

Dr. Chan: This was pre-Tinder.

Zach: This was pre-Tinder. This was not the old-fashioned way, but through websites, but before apps.

Dr. Chan: Before apps. All right. Is this in California or Utah? Where is this at?

Zach: We met in Utah.

Dr. Chen: Okay.

Zach: Tenley went to undergrad in California, and then we were both from Utah, so we met here in Utah. We were both just working full-time at the time.

Dr. Chan: How soon in the relationship did she kind of mention like she was applying to med school? Was that like right off the bat?

Zach: I don't . . . I remember it being one of the initial conversations about my feelings towards medical school or towards her pursuing a graduate degree of some sort. I said, "You know what? I am here for you, let's do the application." She asked, "Are you serious about going with me somewhere?" I said, "Yes, if you got in and we're planning on getting married or engaged or wherever we are in our relationship, as long as we're not deciding not to be together, I would be there to support you." So that, I felt like she told me that, and I gave her the go-ahead. That kind of won her over I guess that I supported her.

Dr. Chan: It sealed the deal. She was on the fence with you.

Zach: Just the support that someone would support her through the attempt to do her dreams.

Dr. Chan: I've met a lot of medical student applicants. This is why I enjoy doing the podcast just to explore this. I think, like you said, explore dreams. Sometimes I think there are certain applicants and sometimes women, usually women, who feel like you just said, like they want someone to support them, because historically medicine has been very male-dominated and male-oriented. So I don't know if those discussions ever came up like that or how she felt towards the process in general.

Zach: The discussion came more along the lines of previous people that she had interacted with.

Dr. Chan: Or dated.

Zach: Or dated, maybe not being as supportive of, was more stereotypical gender roles in the sense of a female should be in the home and maybe not pursue a degree. Then I kind of said, "No, let's try it and then we'll see where life takes us." At that point, we were still just getting our applications together. So I didn't know where it was going to go at that point.

Dr. Chan: Do either you or her come from a history of medicine, a family in medicine?

Zach: No. Her family is a history of lawyers, and my family is a history of just retail. My dad owned a business.

Dr. Chan: All right. So she's applying to med school. You're supporting her dream. Where were you when she told you she got in? Do you remember that day? I assume that was a great day?

Zach: She was in a parking lot with her mom in a car, and I was driving home from work. And she was crying on the phone, and she said, "Zach, I got in." It was a happy day, an emotional day. Up to that point, we had sat down at computers and looked at schools. For me, it wasn't as much doing that, it was just there to support. But the fact that she was accepted for her dream and that she was able to pursue it. I don't know, just that happiness that comes with getting something that you've always wanted and really wanted.

Dr. Chan: That's a beautiful moment. It's a touching moment. I love how you said she really strengthened the application, because if I recall correctly, she got into other schools, multiple schools.

Zach: Yeah, she had multiple.

Dr. Chan: So she went from zero to . . . yeah. So again, going back, how did you guys come to the decision to come here? What was kind of the discussion like?

Zach: So we basically made a pro-con list of each school. We made a pro-con list. Utah is the only one in state. So we had an in-state option, and we had an out-of-state option and what moving would look like, what cost of tuition would look like, what the school's program looked like. Ultimately, I told her, I said, "You need to be happy. You're going to school, so you need to be happy with the decision, and I can be happy wherever we go."

So we looked at the curriculum at the other schools and how it was taught and the ranks of the other schools. And ultimately, we came up with the decision to stay at Utah, and we lived here, so that made that part a little easier. We didn't have to move. She really enjoyed her time here. Now she's a couple weeks away from finishing up.

Dr. Chan: We'll get to that. That's kind of the big moment. I feel like the process of going through the pros and cons would also repeat itself in a few years.

Zach: Yeah, right.

Dr. Chan: It's funny how life works in a cycle like that.

Zach: Right.

Dr. Chan: So did your employment, I mean did your career factor into the discussions? Because I think in every relationship there's always kind of this negotiation, push-pull kind of compromise. How did that factor in when you were talking about med school choice?

Zach: So we talked about like what I wanted to do with my life and where I was going and if I was comfortable being a potentially stay-at-home father if we decided to have children at that point, if I was okay with that or what we would do, where our life would take us, kind of some of those long-term ideas that you hypothetically talk about.

At that point, when we applied, I had a different job. Then Tenley didn't like my job. I worked in retail. So she found me a new job. I worked in school. I work in academics at the University of Utah. So it was just, I don't know, something that we did for the time. I told myself I'd figure something out when we get to the next chapter of our lives.

Dr. Chan: Okay. So it sounds like you got to know Tenley outside of school, right? She was going through the application process.

Zach: Yes.

Dr. Chan: You were married by the time school started?

Zach: Yes.

Dr. Chan: All right. How was the transition when she went from kind of someone who was working and doing all these activities to being a full-time student? How did that look like on your end? Was it a big kind of change when all of a sudden she started to have to study all the time?

Zach: So, before school started, Tenley had a full-time job. So going into school she told me that she was going to treat school like a full-time job. So even though here at the University of Utah classes are set up where they're kind of blocked in a portion of the day, depending on the time of day and the year and such, but we would treat it like an 8:00 to 5:00 job. Since I worked here at the University of Utah, we'd drive together, which was awesome because you get to spend some time together. We'd drop her off at 8:00, and when I got off at 5:00, I would pick her up. That's kind of how it would.

So day to day, that didn't change as much. Then when tests started coming, that's when things started changing. I think some big things going into that is communication. So don't hold something back. Just be open to talk about anything with your spouse, anything you're going through, your frustrations, how things can change. Don't just come in saying you're frustrated. Come in with some suggestions, possibly like, "Hey, how could we change this?"

There's going to be some days where, you know, I recall Saturdays coming and she's getting up and going to study and she either left and went somewhere to study or she studied at home and I made her breakfast and took her a plate to where she was sitting and then she would eat and study. And then I would grab the plate and take it back to the kitchen and wash it and do my own thing, and I would make her lunch and kind of do that same thing all day. She just sat there and studied. You just have to be flexible and not be so rigid in understanding that your schedule might change and you can't be as rigid in your schedule. Be flexible, but also be willing to enjoy the times together.

So if you have just that moment to go to the grocery store together to buy some groceries or if you have to go by yourself, that's kind of what you have to do to support your spouse. But just enjoying the small times together, and I think you'll understand, and if you don't understand what that is, you'll understand and appreciate the small times. And it's great, the hour you get to spend together or the time you get to sit down and watch TV together. You go through that the first years and throughout medical school. You've got to just learn to enjoy the time you get to spend together.

Dr. Chan: There's an image of medical school before it starts. Obviously, the two of you talked about she would start studying more and probably not have as much time, kind of you referenced to do things with you. Did it meet your expectations, or was it like, "Oh, wow, this is a lot more studying than I thought?" Do you understand what I'm saying?

Zach: Yeah. I guess I projected it in my head to be a lot of studying. So then when it wasn't studying, I wasn't disappointed. That's just how I set it up in my head.

We got some advice from one of our neighbors who he is a surgeon. His wife said, "Try to take some time together. Even if you're busy every night of the week, try to take one night to spend a couple of hours together. If that's going out to dinner, if that's making a dinner together, do some activity together, because that will just help break up the studying a little bit but also just so you guys can have quality time together."

I think that's something we really tried to do throughout the first couple years was just to try to plan that time together, even if it was going to someone else's. We both have family here in Utah. So if it was even going to a family member's house together or something, just making sure we tried once a week to spend some time together. It is a daunting task to study, and it can be stressful. I think, as a spouse, you have to realize that maybe not to just throw your thoughts away or anything, but try to put them first and reduce the stressors in their life.

So figure out what your spouse's stressors are. If they appreciate a clean house or a vacuumed front room or any little thing, just try to do those for them so then it takes that little stress out of their life so they can focus on their schoolwork.

Dr. Chan: I love what you said, Zach, because I think medical school is inherently stressful. There's many, many experiences we go through in life that are very, very stressful. It sounds like you and Tenley, you did a great job in managing that stress. As a spouse, you kind of see the other side of it and kind of the roller coasters of tests and test scores coming back and those kinds of experiences.

Zach: I'm not saying like what we did was perfect. It doesn't alleviate the bad days. It doesn't take away the stressful times. It just helps to minimize them, to be there, and then the communication I think makes it open to be there for each other, so when you're having a bad day, you can just let someone vent about a test being hard or not understanding how to study for it or just talking through scenarios with them.

Dr. Chan: Would you help her study? Would you get involved in flashcards and quiz her? I talk to some couples, and they kind of build more time together. They kind of use the other person kind of as a sounding board or things like that.

Zach: I was used more as a fake patient later on.

Dr. Chan: Pretend you have chest pain right now, Zach.

Zach: For studying purposes, Tenley liked to just do her own thing. She liked to kind of be shut off, I guess, just kind of be in her own little space. That's her way of studying. But I was there. If I needed to be there, she knew I would help her with something, but we didn't really do it that way together.

Dr. Chan: Did you develop relationships with other spouses or male significant others or female significant others in the class? I know like there's something called the Medical Student Alliance where there's kind of like a support network that's kind of built in. But just my perception that tends to be a lot of women in that and not as many men, and I'm just curious what your experience was.

Zach: Yeah. Getting into med school, they came across saying, "Hey, we have these different groups that you can join." They were very female dominated as spouses, so I didn't join them. Tenley had a group of female students . . .

Dr. Chan: Classmates.

Zach: . . . classmates, peers, that we started doing stuff together. We'd all get together with our spouses. So her medical student friends, her classmates became my friends, and then we started doing stuff with their spouses, never to the point that we would just do like a guy's trip or anything like that. A group of us ran a Ragnar together. So that was a few spouses and a few medical students. That was fun and something to do in the summer, something to do in the first two years when you're less busy. But that was something fun that we did do as a group.

Dr. Chan: Okay. Awesome. As Tenley transitioned into her third year, where she has like clinical rotations and going to the hospital and her hours start being more variable depending what clinical rotation she was on, how did that change? Is that something you welcomed? Or was it better to have all the studying?

Zach: I think, for Tenley, it was something she wanted. By the time you're done with two years of class work, you're ready for a little bit of a change, to take what you've learned in the classroom and apply it to everyday life. So I think for her, it was a good change. So, for me, it made . . . you have to build on what you done in the first two years as a couple, because your time separated gets, sorry, your time together is less. She's busier. Your rotations change. So, for us, it came back to that communication and a shared . . . We did a shared calendar on our phones so that we could put in each other's schedules and so we knew where we were.

And at this point, when Tenley started third year, we also had a child by this time. So that added another wrinkle into our lives. So just communicating and being where you needed to know. It sometimes became a daily discussion of what are we doing tomorrow and what's your schedule, what's my schedule, who's doing what. Also, I think it goes back to those basic things that we talked about doing in the first year, being there and supportive. Making lunches, I guess, is another thing that's huge. You do it through all medical school.

Prepare lunches the night before would be my best thing. It just takes away the stress in the morning to having to make the lunch while you're getting ready to go, run to class if you're late, or just making a meal for them and having some leftovers. We became a big freezer meal family. We would make like a lasagna or something, and the leftovers we would cut up and put into freezer meals. So that makes it an easily grab and go for a lunch.

Dr. Chan: That's awesome. There's a lot to unpack there.

Zach: Yeah, sorry.

Dr. Chan: No, no, this is great, Zach. I love this. It sounds like as time moved on, things got more complex in certain ways.

Zach: Right.

Dr. Chan: We were talking before I turned on the pod, but it sounds like Tenley decided to pursue a master's and you also pursued a master's. Zach: Yes.

Dr. Chan: Walk us through that. What were those discussions like? Who got their master's first? Is this some bizarre one-upmanship within your marriage?

Zach: No. Tenley during her first year of medical school, I'm going to get it wrong, so you can correct me, but they have to do an experience. Tenley chose to do an experience in Ghana. She went to Africa and did some research. That really solidified, I think, her understanding or wanting to do something in public health. So after her second year, she took a year off and did a master's in public health.

At this point, I was thinking about doing a master's too, because working in the line of work that I do in higher education administration, I was at a point where I needed an advanced degree to move on in my life. I knew residency was coming down the pipeline in a couple years. At this point, I was thinking I'll have five years' experience in this field. If I were to get a master's, that would just build my r�sum�, that if we had to move for residency, that I would have a solid r�sum� to be able to get a job somewhere else. So I applied to grad school that year and did not get in. Like you said, she did the master's.

Dr. Chan: So the original goal was to be on your master's together at the same time.

Zach: About the same time. My goal was to just graduate with my master's by the time she was done with medical school was my ultimate, just my goal. So I knew that if I applied the year that I did, so she is now in what would have been her third year of medical school, but she took the year off to do a master's. She has three years left, and I have three years to try to get a two-year degree in. So I'll apply once, see if I get in. If I don't, I'll have one more chance to get in. So that kind of was the decision of going and doing the graduate school.

Dr. Chan: And then deciding to have a kid.

Zach: And then we decided to have a child, and we did.

Dr. Chan: This was during her third year?

Zach: This is here third year. Yeah.

Dr. Chan: Okay, so during rotations.

Zach: No sorry. During her third year of her master's. We had the child while she was doing her master's degree.

Dr. Chan: So that must have been nice insofar that the schedule probably was not as demanding on her.

Zach: Right.

Dr. Chan: I'm not trying speak down to a master's of public health program, but in my experience, usually the coursework is not as demanding as medical school.

Zach: That's correct. At the same time, though, our son was born in the spring semester. She had a week off, and then she went back to classes the next week. So demanding in the way that she needed to get her coursework done. So I imagine it being similar to medical school in the sense that you still need to get your coursework done. So it's not like we were able to take a long-term leave, but definitely the demand wasn't as high on your time during that time.

Dr. Chan: Yeah. So your son is born, and everyone is pursuing different degrees and she's progressing, Third year, you mentioned at the very beginning, Zach, being a stay-at-home dad. Did that discussion ever continue to grow, or was that just kind of an idea at the beginning?

Zach: That's still a discussion to this day. You have to weigh all the options of your life, and so for us, it's continuing that conversation of dreams, where we want to be, what's best for our family, what's best for us not just for the family but financially for the family. So, for me, I guess it's still an open discussion about being a stay-at-home dad. Right now, I still am working. I still have a job. Luckily, we have a great support system here in Utah with having both of our families. My dad is retired, so he runs what he calls his Grandpa Daycare. He just watches his nieces and nephews when people need it.

Dr. Chan: And teaches them lessons of life.

Zach: He does.

Dr. Chan: And a little grandpa wisdom, little pearls and nuggets he probably drops on them.

Zach: So we were fortunate enough to have that support system. Tenley's mom is a teacher. So she's off in the summer. So we're very fortunate to have a lot of support around us to help us in that endeavor, because I don't know if we went away to school, the path that we're currently on would be that same path.

Dr. Chan: So if I were to ask you and Tenley -- Tenley's not right here. I didn't say that in the beginning. Tenley's not in the room. She's here in spirit though -- what kind of doctor she was going to be before med school, what would she have said? Then walk us through either how that was confirmed or how that changed towards the end of med school?

Zach: I'm recalling her answer that she'd tell others when she first started. It was, "I'm going to experience medical school and have an open opinion and not have a definite thought." I think that stayed true. I remember her coming through first and second year and getting a lecture and saying, "Man, that's awesome, Zach. I want that." If you're starting medical school, I think something fun to do, that I wish I would've done, is every time your spouse tells you that they like something or that they changed their mind, write that down in a notebook.

Dr. Chan: Yes. Use it against them down the road as a weapon. I married too, Zach. I know how it works.

Zach: Just to see how often it changes and how the process is.

Dr. Chan: Yeah.

Zach: So, before she went to medical school, she did benchtop research. I think she knew she was kind of done with that and she wanted to do clinical research. So, after that first year, when she did the research in Ghana, I think that solidified that she wanted to do a research aspect. So it was kind of finding everything that she loved about different things and settling on the direction she wanted to go. At one point, she loved surgery, and I think, as we've talked about, third year you go through your rotations. There were some rotations that she loved and some rotations that she said, "You know what? This is okay. I could do this, but I don't love it. I don't see myself doing this for the rest of my life."

So I think it slowly narrowed it down to a couple. Then we would talk it out and talk about (a) the lifestyle of that kind of doctor, also what that job looks like for her. Does she want to be doing the same thing every day all day? So she made her decision, and then going into her fourth year, the end of third year, beginning of fourth year, she just really was debating between two.

Dr. Chan: Before we talk about those two though, Zach, did you start forming a strong opinion? You as a spouse, even though, for example, Tenley loves surgery, the hours tend to be much worse than other rotations, and people tend to be very tired. You know what I'm saying? I don't know if you started picking up things on your end saying, "Even though you say you like X, Y, or Z, I'm a little nervous from my vantage point, because I'm seeing you at home and you seem stressed or you're very, very tired and I don't see you in the mornings." Did you start forming opinions about the different fields?

Zach: I didn't have necessarily an opinion about an exact field. My opinion was more of I want you to be happy. So you choose what you're going to be happy with. I think that frustrated her a little bit, because I didn't give her my full opinion. But then when she would talk about certain things, I would just try to remember in the back of my head, point out the good and bad, the pros and cons that she had said about the rotation and say, "Hey, remember, this is what you said before. I just don't know if you remember it," just to take it all into consideration. I would say she had an inkling, to be honest, to look back once she went to Ghana and did her research paper, of a potential direction she wanted to go.

Dr. Chan: Okay.

Zach: But hadn't made that a solid. So it was more about confirming if that was the direction she wanted to go. There were some changes through third year, and we can talk about that, because that came down to the final two of kind of what did she want to do.

Dr. Chan: So what were the final two?

Zach: So she really liked surgery. She loved surgery.

Dr. Chan: General surgery.

Zach: General surgery. She liked her surgery rotations, I guess I should say, because I don't know where all the rotations were. She just really enjoyed those. But she also enjoyed her OB/GYN rotations and the various gyn-onc, sorry, the gynecology oncology rotation, the fetal maternal medicine. So it came down to those two. That's where we kind of I think really talked more about pros and cons and the lifestyle of a surgeon. You're a surgeon and . . .

Dr. Chan: A lot of call. A lot of early mornings.

Zach: A lot of call. You're in surgery.

Dr. Chan: Hours and hours on your feet.

Zach: The other parts of being a doctor that she really enjoyed, you didn't get those as a surgeon. She wanted to be able to do some research. She wanted to be able to have some bedside care. She wanted to be able to do surgery, and there's a fourth one and I can't think of it right now. All of those encompassed in the OB/GYN. So she's able to do research if she wanted. She does some surgery in delivery. Then she has that patient care in a clinic. So it was kind of the all encompassing for her.

Now, are the hours going to be great? Are they going to be that doctor, like what I perceive as a dermatologist or a family practice physician that has more of a set hour, set schedule? No, it's not going to be that way. That's kind of what we signed up for, and that's what I signed up for going into this was I know the lifestyle of a doctor. Fortunately, I have friends that are doctors. So I understand how hectic the life can be and just to be their support, so for me that was actually another good thing going into it. One of my friends is a physician, and his wife is a physician as well. Just being there and the stages of medical school he would say, "Hey, at this point this might be a stressor, so just a heads up, you could just be there for her." So that was helpful too.

Dr. Chan: Awesome. All right. So she's picked OB/GYN. She's feeling good about it. What was your strategy when you started sending our residency applications? Did you guys kind of focus more geographically, or was there something that Tenley was looking for in a program specifically? How did that process start?

Zach: So the whole process I would start before she had narrowed down. We would just have in our discussions of where do we not want to live in the United States.

Dr. Chan: Ruling out certain parts of the country.

Zach: Yeah, just ruling out geographical areas, not necessarily programs at this point.

Dr. Chan: Is this based on weather or proximity to Utah, or good, available food?

Zach: All of the above.

Dr. Chan: Cuisine?

Zach: All of the above. Weather. I have a fear of snakes, maybe that factored into a place.

Dr. Chan: You're Googling where snake populations are the largest.

Zach: Yeah, right. That's, I guess, where we narrowed down our first list. Then once she had figured out what residency she wanted to pursue, she looked up a whole list. We went through and looked at test scores. So we sat side by side both on a computer, and we looked up test scores and what kind of application materials each of these schools needed, and we set out a spreadsheet just to detail it all out. We didn't necessarily exclude schools that were in those geographical areas, because if there was a school in an area that we didn't love, we may have applied for it. We would talk about it. So we set down the list and I said, "You need to feel good about your list." So she narrowed it down, and then . . .

Dr. Chan: Did she do any away rotations to kind of check these places out?

Zach: She did not. That's partly because we have our son, and that was going to be a burden that way to take care of that. So she did not do an away rotation. I think looking back, I think that's a great opportunity to do if it's available to you. But we did not do that.

Dr. Chan: And I get the sense, was she looking at more academic programs? It sounds like if her . . . she has an interest in research and maybe global health.

Zach: Academics, how much, so at this point, it's more like what they do for the family, how like family oriented are they. We looked at what the step two score was, what scores they accept, what their range is so that we get into that applying to, as I was told, they're called reach schools and then your safe schools, just kind of making a good grouping, I guess you could say, of those and then places you want to live and then the amount of schools you want to go to. I know she reached out not just for me, but to other professionals within the school and got their opinion on . . . laid out everything.

Dr. Chan: Kind of like the network behind the scenes. Like what do you guys think about this program? What's the reputation?

Zach: And then also where should I apply? Do you think this is a good school? Do think it's a bad school? Just any questions she had, she made sure she reached out.

Dr. Chan: So she's trying to aggregate all this data, all this information into this Excel spreadsheet.

Zach: To try to determine how many and where we apply.

Dr. Chan: So how many did you apply to? What was the final number, ballpark?

Zach: I don't remember, 30 to 40 I think is where we ended up.

Dr. Chan: And then the interview offers started rolling in.

Zach: Yeah. Those are like mini acceptance to med school days. You get a letter and you get accepted.

Dr. Chan: Now, with OB/GYN, because I know in some specialties, is what I'm asking, the interview spots are so rare or so hard to come by that you need to jump on it immediately. Sometimes they conscript the spouse to have access to kind of the email accounts. You need to respond immediately to get your top pick.

Zach: I did not . . . I was not involved in any of that. So one thing we did on the Excel spreadsheet is most places will tell you what their interview dates are.

Dr. Chan: Okay.

Zach: So they'll say, usually for OB/GYN, it was like once or month over the next four months, and they'd have interview dates. So we knew that this school might have this date, and that's something you have to think is if you get two schools on the same day that's offering you a date, which one do you want to go to? Also, there is ways of saying, "Unfortunately, I can't make it that day," because you have another offer. Most schools will come to you with two days or ask you what your best availability is. So just managing all those calendar days within that and then jumping on them. So when she was not on a rotation, we had emails pushing to her phone immediately so that she could respond to them and get back to those things. There were some that it was a matter of minutes.

Dr. Chan: Like minutes. The top ones are like that.

Zach: You have to call on and get there.

Dr. Chan: So it sounds like she did that. She was able to navigate that even on rotations.

Zach: Yeah. So, for her, that was something she was able to do. That's something I never even thought of having the spouse work on, but if that's something that you want to do in your relationship, I just say open the lines of communication to what it is and realize that you have to travel. There was a lot of . . . I knew the airport here in Utah like the back of my hand after a couple of weeks of picking her up. I could probably drive there in my sleep because you just go so often. I know some people, if they're fortunate enough, they try to do back to back interviews. So they try to fly out to, let's say, Texas and then they fly to another interview in another state and then back to Utah.

Dr. Chan: Yeah, try to stay in kind of the same state, as opposed to crisscrossing the country.

Zach: Yeah. Unfortunately for us, it was more flying in and out of Utah and then back and forth. There was one day where she flew in and then that night, she flew out to another interview as well. That was because the scheduling of the interviews came at different times.

Dr. Chan: Did you guys start turning down interviews?

Zach: We did not. We accepted all the interviews that we were given or that she was given.

Dr. Chan: Ballpark a dozen?

Zach: Yeah. We talked about this "we" thing. It's really her, and I'm just here to support. It's her interview.

Dr. Chan: That's my next question, Zach. Did you go to any of these?

Zach: I went to one. I was fortunate enough to go to one. That was partly because in the middle of all this medical school time frame, I switched jobs. So I didn't have the vacation built up at my new employment to go and it costs. Flights cost money. We did take one trip out back East.

Dr. Chan: Where'd you go?

Zach: Virginia. We made it a little vacation. So we took our son. It was all about her until the interview was over, and then we drove up to Washington, D.C. for a few days and then we came home. Those are great times, because sometimes you're not afforded those vacations during medical school. So it was time to kind of create a vacation.

Dr. Chan: Awesome. She's going out interviewing at all these places. I assume the Excel spreadsheet is just exploding with information left and right. I assume a lot of discussion between you and her as like this kid of proto-embryonic rank list starts taking shape?

Zach: Yes. As she went out, she took a notebook with her and then would write pros and cons. She didn't just think about the school. She thought about the area. She thought about me too and some of her pros and cons, like things that I would like about the cities and what maybe I wouldn't like about the cities.

Dr. Chan: I assume she was accurate, or did she sometimes read in too much? How worried was she about the snakes? I can see Tenley bringing up that question with these different programs, "Do you know what the snake population is?"

Zach: No, the snakes didn't come up. I'm a big sports fan. So if there was any sort of professional sports there, she would note that.

Dr. Chan: Okay. We're talking like basketball, football.

Zach: Basketball, football, NFL. So she just noted that. She noted the weather, what relocation would look like. Maybe the cost. She would ask residents things along the lines of, "Were you able to buy a house here? Do you rent? What type of things do you do?"

Dr. Chan: Schools for kids? Districts?

Zach: School districts.

Dr. Chan: A lot of residents have children. It's more and more common. I think like the residents, especially, I like what you said, if the residency was "family friendly." If they had a lot of married residents who have children, I think that would be kind of a great resource, for especially someone going into that residency.

Zach: Yeah. I look forward to that going forward into this residency is to look at what other people have done and they're doing as we move into phase here in a little bit. Right now, we've got a list. We've got interviews, and now we're creating that rank list. I know she really thought about it. Then finally, we went to lunch one day, and she had cut up every school into a little strip. She pulled it out in a little baggie.

Dr. Chan: Oh, I love it. I want the scene. Where is this?

Zach: We're sitting down at Zupas.

Dr. Chan: Zupas, oh great place. It's a hot tip for everyone out there. Zupas. Good karma at Zupas.

Zach: It's just a cafe with soup and sandwiches if you're not from Utah.

Dr. Chan: So the different schools . . .

Zach: Every school was listed on a piece of paper.

Dr. Chan: So they were all roughly equal then?

Zach: No. It was just like a little paper that said like University of Utah, whatever the other schools were. It was okay, let's put them out. Let's put them in a list.

Dr. Chan: Oh, I see. So you're physically moving them.

Zach: So we're physically moving them around and saying, "Do we like this?" Based off where she had been, there were some schools that she really, really liked, and there was obviously some schools that you're going to find that might not just be a good fit for you. We originally put those to the top and bottom. Then we sat and talked and ate, and then we talked about the pros and cons of why is this school in second place and this one is in the third place. Why is this one down in five? Should it be up at three? I thought you really liked this. She pulled her book out. We talked about all the pros and cons. So it wasn't like a short lunch.

Then we made the list. To save it, we took a picture of it just to keep the order. We did that a couple weeks before the rank lists were due.

Dr. Chan: The rank list were due.

Zach: So then we could think about it. So we'd talk about it, you know, every couple of nights, like, "Hey, are you feeling okay about it? What are you feeling?"; Then we'd talk, "Hey, you know what? You mentioned this school was really good. Why did you put it here instead of here on the list?" So we just still massaged it. Then once the ranks had to be submitted, I think a day or two before, we sat down and just kind of solidified the list. To be honest, I don't know if it changed much since our lunch meeting, but that was something that we sat down and worked on together.

Dr. Chan: It sounds like you had this big summit. You have all the information. I thought you were going to say that you put it in like a hat and just drew out randoms. Wow, that's gutsy. I love it. That's letting fate decide.

Zach: I think it does come to a point where there are a lot of schools that are like on equal ground. "Why do I put this school as six instead of five, when you feel like you're pretty equal?" I don't know, to me you have to go with your gut.

Dr. Chan: Your gut instinct. The problem is, and I don't see how you work around this in the way our system or society is set up. A lot of people are weighing different offers to medical school. A lot of people weigh different offers for residency programs. A lot of people weigh different offers for jobs or master's programs. You try to make the best decision you can with, I would argue, finite amount of information, because not until you actually set foot at that school, in that job, in that program, do you really know what it's like.

You can try to talk to as many people as you want. The internet is great for this. You get all this information. But it's really hard to make decisions. In hindsight, I went through med school, I know exactly what to look for now. But once you have that information, it's already in the rearview mirror.

Zach: Right.

Dr. Chan: You can try to share that with other people, but everyone's different needs. Everyone has different needs, desires, wants. It sounds like you two were very, very thorough and introspective and reflective through this.

Zach: I think what you have to do is when you're doing your list, you have to go with, like you said, your gut, but you have to understand that you're going off, like you said, the information you have now. If after match you find out more information, you're like, "I wish I could change it." You made the best decision with the information that you had at that point. That's what you have to know and go with and then just kind of trust the process, because after that, you've done everything you can and it's just waiting.

Dr. Chan: Philosophically, I sometimes have arguments, and you probably do this too, Zach. I think about, "What was my 30-year old self thinking? Why did I make that decision? When I was 30, I had this information. I was at this point in my life, and I made that decision. I can't doubt my 30-year old self." I think all of us should not try to live our life with regrets. Everyone has a little bit of regret in their life. You just have finite amount information.

Zach: Yeah.

Dr. Chan: You submit the list. How was it from that up until match week? Was it good? Were you feeling good? Was Tenley freaking out?

Zach: Feeling good but stressed. Really you're not waiting, and I didn't know this until this past year, you're not waiting for match day. You're waiting for the Monday before.

Dr. Chan: Yes. Was she ever worried that she wasn't going to match? You find out that Monday if you matched, not where you matched.

Zach: I think there's just a little bit of doubt that creeps in no matter what. So I think you're always going to have a little bit of doubt and that you're not going to match, that you're worried that something is going to happen. So that email comes and it's just kind of relief. So, at that point, it's now where. So you come to Friday.

Dr. Chan: So walk me through Friday. So the night before, are you guys sleeping?

Zach: You're dreaming about everything and the worst case scenarios and I'm dreaming. You don't sleep. I don't think Tenley really slept that week, to be honest, just stressed about where.

Dr. Chan: The big reveal.

Zach: Back to that whole pro-cons list. We came to Utah, obviously. We had Utah on our list. So you have your pro-cons, like do you stay, do you go. If we stay in Utah . . .

Dr. Chan: I assume you guys interviewed here.

Zach: Yeah.

Dr. Chan: Even if you're not interested, it's always good kind of politically just to interview at your home program. It's also a good backup option, because everything starts falling through. I'm sure Tenley and you had many discussions about this.

Zach: How life is going to happen. This is a buildup. You've been waiting for four years to match day, to residency, the next chapter. You don't know where you're going to go. You don't know where life is going to happen. You're opening that book and you're starting the next page. So you get there, and it's just this . . . you try to be helpful and nice to everyone and just, "Hey, we're excited." There's an excitement. It's a great day. It's an awesome day.

Dr. Chan: Who's there?

Zach: For most people, they bring close family. It's one of those days that it's a celebration. For Tenley, it was her immediate family and some of my immediate family were there.

Dr. Chan: And your son running around?

Zach: And our son running around.

Dr. Chan: Eating all the treats.

Zach: Yes.

Dr. Chan: A lot of sugar.

Zach: Everyone's there. Everyone has their own family, and they're excited and people are in different circumstances. They're going for different programs. One person I talked to, they had a blind match. They had interviewed for two different directions. So they didn't know where they were going until they . . . So there's this overall excitement, and you get the letter . . . they go get the letter.

Dr. Chan: So they have a bunch of speeches. They cut the ribbon. What does Tenley do? Does she go up, open it on her own, or she drag the envelope back to you guys? So how did she do it?

Zach: So we were standing in the back of the room. So she went up. They call everyone up to go get your letters. She goes and gets hers. She comes back to us. We end up going down the hall and kind of having like our own little area.

Dr. Chan: I like that. That's a good idea.

Zach: Instead of everyone around.

Dr. Chan: Instead of being in the masses. It's more intimate, more private.

Zach: You're kind of all in your own little cliques anyway with your families.

Dr. Chan: You're in your little bubble.

Zach: Anyway, so she opened it. We were all watching her, and she read it.

Dr. Chan: Were you reading over her shoulder? Or were you just watching her face?

Zach: No, I wasn't. I was taking some pictures.

Dr. Chan: The camera guy, all right.

Zach: There were multiple people with cameras. She opened it and read and then announced that we were going out of state. The flood of emotions that you've been waiting for, for years, in our case five years of where you're going to go, flood of emotions that your life is changing and what the implications of that are. So it's a happy and a sad day for us. For me it was, because it was a happy day that we know where we're going. We had this next adventure, and I signed up for this, but also that you're going to leave family. Just like any change in your life, there's going to be changes. You leave family. You're going to leave close friends. You're going to leave your job. That's just kind of the circle of life. There are these emotions of happiness and change.

Dr. Chan: So it sounds like it was a rush of both positive and negative emotions.

Zach: Yeah.

Dr. Chan: Was that by everyone, or just by you?

Zach: I would say to an extent I think there's emotions from everyone, happiness depending on just how you look at it, I guess. Happiness where you're going. Talking to other people, they got into their number one program or where they wanted to go or what they felt best for their family, if that means they're moving or if they're staying. It's an emotional day. It's happiness. It goes back to that day of opening your letter that you got in medical school. You're accepted somewhere in the next chapter of your life, and you know where you're going. So it's an emotional day. So we congratulated each other, and then we went out to lunch with everyone, the family.

Dr. Chan: Zach, when I hear you, I listen to you, I get the sense there was a lot of surprise.

Zach: Yeah.

Dr. Chan: It was kind of a shock.

Zach: I think we in our mind had built up where we were going to go. I think maybe not together, but maybe in my mind, I had made plans of what my future was going to look like, and those plans didn't happen in the way in which I thought they were going to, which is in its own way a coincidence, you could say, but there's a book called "Consider the Butterflies" and it talks about coincidences that happen in your life. I truly believe that everything for whatever reason happens for a reason. For whatever reason, we are doing what I didn't project in my mind, but it's going to be awesome.

Dr. Chan: Yeah. That's kind of life.

Zach: Things don't happen exactly every day how you want them.

Dr. Chan: So when I did the match process, I was still single. I had ranked a program in Arizona as my top choice. We exchanged the little love letters, the emails, like "Oh yeah." They kept on assuring me like that vague, pseudo-romantic language that, "Oh, we're going to rank you very high." So again, I went into match day going, "Oh, I'm in Arizona. It's close to Utah. It'll be close to family. It'll be down there. There's like tons of single people running around Arizona." Then I open up my match envelope, and it said Washington freaking D.C. My parents were there, and they said I looked like my brain had just been blown apart. I didn't talk for like two minutes, because I was just processing this because it was such a dramatic shift.

I didn't know anyone in D.C. It's on the East Coast. It's like hours and hours away. It took me a long time. I remember very clearly I went to the Barnes & Noble in Sugarhouse, and I went and bought a map of D.C. This is kind of before Google Maps and that whole thing. I said, "Okay, where the hell am I going to live?" I had not thought about this very carefully. In the end, Zach, it was the time of my life. I met my wife out there. I have some close friends I still stay in touch today. But like in the moment, it just felt overwhelming. It's like, what's happening? What is this?

Zach: Yeah. I think you have to go into match day with an open mind of anywhere on your match list is where you could go. I think for us we had determined, in our minds, where we had matched. Where we ended up was not where we had determined in our minds we had matched. So I think that's what caused the shock or the surprise the most.

Dr. Chan: Does it feel better now today than it did a few weeks ago?

Zach: Yeah, for sure. That day might be shocking, but as things happen, I think you just realize that that's what you're supposed to do. We went out. So we matched . . .

Dr. Chan: Yeah, where'd you match? We didn't even say it yet.

Zach: We matched at the University of Minnesota.

Dr. Chan: Minneapolis, Twin Cities.

Zach: Minneapolis. So we went out there this last weekend.

Dr. Chan: Not a lot of snakes, it's too cold.

Zach: No, not a lot of snakes. We found a place. So I think once those cards start to fall I guess or the dominoes start to fall of what you need to do to then get to that match day. After the match, there's the waiting game until you get your information from the school. That's life. I think you just jump on it and you just go with it. That's just where it's going to be. You can't change it. So you just go with it and enjoy it, and it's going to be a new experience. In the big picture, it's just the length of your residency. It can just be the length of your residency. You could move back. I just feel like you can go and create memories and have a good time. I've talked to other people and they say, "You know, when I was in residency," just like you mentioned, "it was a great time." They made the most of it. So I think that's a great opportunity to go make the most of it and see a new city and meet new people.

Dr. Chan: Zach, kind of like the Tao of me, the Tao of Dr. Chan, our lives are like 5,000-chapter books. We're only on like Chapter 257. There's so many more chapters to write. I totally understand. I totally feel what you're saying, but I can promise you, in a few years, it's going to be so awesome, because Tenley is going to be done with all this medical education stuff, and then you can start entertaining offers to be the attending physician wherever you want to be in this country.

One of the blessings and curses of our medical education system is that yeah, like you go to med school where you get in. You have to go through this match process. But there is so much freedom and autonomy at the backend, it's going to be beautiful. She can work as much as she wants. She can determine her own hours. She can work anywhere she wants to in this country.

Zach: Yeah and it's going to be great.

Dr. Chan: And you can always come back to Utah. Well, I ended up back in Utah.

Zach: I think that's just the next chapter. Right now, my chapter is just getting us moved to Minneapolis and that process. I think once you get to that process, it's about being supportive of your spouse, because depending on how they set up their fourth year depends on how much freedom and time they have to work towards the logistics of moving and the paperwork that needs to be done. You've just got to be there to be supportive in that situation. Tenley is starting up another rotation here soon, and so we'll go back to that life of I'll see her a couple days a week.

You have to understand too, during medical school, there's going to be some weeks that you might see each other two hours a week, especially if you're working. So for me, I left to work and by the time I got home, she had left to her overnight rotation, and the next morning, I might have seen her for 10 minutes by the time she got home before I had to leave. So just knowing that you love each other and that you're there to support each other in any way and if it's a small note, a token of appreciation, making their favorite meal, just anything to let each other know -- this is for the medical student and for their spouse -- to know each other and that you appreciate each other and that you're there for each other and that you're in it together is kind of my overall thought of how to be supportive throughout the whole process.

Dr. Chan: Zach, first of all, I want to thank you for coming on the podcast. I love talking to you. I love getting to know you. I'm also just very appreciative of you and Tenley. It's sounds like it's been a beautiful journey. It's been hard at times, but I'm just so excited for you guys, because it's a beautiful next chapter of your lives. I've been to Minnesota many times. There's tons of great stuff to do. It's a great place to raise kids. I can totally see you and Tenley ending up back in Utah down the road. Then you can become a Viking fan. In Salt Lake City, you can wear the purple.

Zach: It's going to be great. Yeah, it's just the next chapter. It's going to be fun to write, and we'll see where it goes and just be open and just try to be positive all the time. Like you said, it's not always going to be great days. There are bad days and there are hard days and there's hard weeks and hard months and hard rotations. Just being there to be a shoulder to cry on or a shoulder to be supportive in any way you can. Support means different things for different people, but however you support each other, just be there to support.

Dr. Chan: All right. Well, thank you so much, Zach.

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