There are close to 200 cans of tuna in the cabinet of my apartment in Madison, Wisconsin. This is not a preference. I do not like tuna. I eat it because it is 79 cents a can on sale. It needs no refrigerator, and it becomes a sandwich in 90 seconds, which is roughly the time medical school allots for lunch.
Jeremiah Swanson
My daughters think the cabinet is funny. My wife thinks it is disgusting. I think it is necessary, because the tuna pays for a decision I made the summer I started medical school.
The decision was that my family does not move. We live an hour outside Madison. When I matriculated, my oldest was starting her senior year. She had research, activities, and a life she built herself, and I was not going to be the reason she started over. My younger two would have transferred mid-freshman year and mid-junior year. My program, WARM, only keeps me in Madison a year and a half anyway. So, I rent a small apartment, stay in the city during the week, eat tuna, and drive home on the weekends. Paying for housing twice is expensive. Uprooting three kids is more expensive, just not in dollars.
For most of my life, money was something that happened to me.
I grew up in Iowa County, Wisconsin, in a three-bedroom house that regularly held 10 or more people, relatives and sometimes people from town with nowhere else to sleep. I got my first job at 12, sharpening blades before and after school. The rest of my hours belonged to my father. We tore down old buildings and sold the materials, hauled scrap steel to the junk yard, and sanded commercial equipment for weeks with no protective gear 5-7 days a week. I was supposed to be homeschooled for part of seventh grade and all of eighth. I touched the books once, the day I opened the box.
So, I dropped out of high school. I had never heard of an AP class. I assumed GPA was a college thing. At 17, I moved to Arkansas, lived in my oldest sister’s garage, and worked as an HVAC assistant while earning my GED. As far as I could tell, my options were farmhand, construction, alcoholism, or the military.
I picked the military. It was the first institution that ever handed me a plan.
It ended with the vehicle I was driving torn in two. I came to days later with a military chaplain at my bedside praying the Rosary, which is not a sound you want to wake up to before your 25th birthday. I had fractured my C2, my greater trochanter, and both legs in multiple places. Because of the cervical break, they kept me awake for surgery. I asked the surgeon whether I could watch the monitors. He laughed and said yes. I spent my own operation fascinated.
Years of therapy later, I sat on the living room floor watching my daughters play, thinking, now what. The answer turned out to be that monitor.
Here is the part The White Coat Investor is responsible for.
For the last two years of my undergraduate degree, I commuted to UW-Parkside, an hour and fifteen minutes each way. Same decision as before. I was not moving my family for two years of school. That is 2 1/2 hours a day in a car. I filled it with the WCI podcast, every episode, in order.
I was 38 with essentially nothing to my name, listening to attending physicians describe themselves as behind. I could have taken that badly. Instead, I took notes. What I learned is that the numbers are learnable. Student loans are a tool with terms printed on them. Compound interest works the same for a guy with a GED as for anyone else. And the difference between a good financial decision and a bad one is almost always whether you knew what the thing cost before you agreed to it.
That last part became my research.
I now study healthcare price transparency at the University of Wisconsin School of Medicine and Public Health, working inside the machine-readable files that hospitals and insurers are required to publish, matching negotiated rates against neighborhood deprivation indices to see who is charged what and where. What I have found is less tidy: the prices are technically public but practically unreadable. The spread between two places offering the same service is wide enough that no honest person would call it a market.
I understood that problem long before I had the vocabulary for it. As a kid, we loaded the truck with scrap steel and hauled it to the junkyard, where you weigh the truck full, unload it, and weigh it again. The difference is what you brought. Then you walk inside, and they tell you what they are paying per ton that day. You find out the price after the metal is already off your truck. There is no posted rate, no second opinion, and no loading it back up and driving home. That is also how a hospital bill works. Most patients in this country are standing at that scale.
I max my loans to the cost of attendance. I am not proud of the balance, but I know exactly what it is, what it accrues, and what repayment will look like. That is more than I could have said about anything I signed before I was 36. That is not financial success. It is financial literacy, and it came first.
Here is what I would tell another student.
Your commute is the cheapest classroom you will ever own. Two and a half hours a day for two years is nearly 1,000 hours. Fill it with something that compounds.
Pick the one line in your budget that is not for cutting; then cut everything around it. Mine is my family staying put. The food, the apartment, and the car with 280,000 miles: all of it bends around that line. None of it feels like sacrifice, because I know what it is buying. My daughters get to keep their schools, their friends, their activities, and the life they built. I get a tuna sandwich. That is a trade I will make every time.
Read what things cost before you sign. Loans, leases, procedures, scrap steel. That is the entire skill, and almost nobody teaches it—not to patients and not to physicians.
Grit is not a substitute for arithmetic, and arithmetic is not a substitute for grit. I have needed both, in that order, and I am not finished needing either.
At 12, I sharpened blades before school so someone else’s mower would cut. My daughters have never had to do that, and they never will. That is the return I am actually calculating.
The tuna is fine. The tuna was never the point. The point is that, for the first time in my life, I know what everything costs. And more importantly, I know what some things are worth.
Father of three daughters. Husband. Veteran. Medical student.