In the same soft-spoken manner that she uses to counsel patients and families facing end-of-life decisions, social worker Elana Gonzalez presents a fact of her own future.
"Two-hundred seventy-three dollars and sixty-one cents a month for 30 years," she said, describing her student loan payment. "It is disgusting."
Ms. Gonzalez, 25, knows that she would never have been able to secure the job that she loves as a clinical crisis coordinator at UPMC Shadyside without having her bachelor's and master's degrees.
But for the generation that includes Ms. Gonzalez, those educational achievements have come at a price: Nearly two-thirds of graduates of four-year colleges have student loans.
And with college costs rising faster than inflation, the average cumulative debt for graduating seniors is approaching $20,000, more than double that of 14 years ago.
In ways large and small, those loans are changing the way that this generation lives. Even in the best of circumstances -- in which education does help land the job of the student's choice -- the monthly payments are often accompanied by dread, anxiety and uncertainty.
"It's hard to come to terms with; you're just going to pay it forever," said Ms. Gonzalez, who has about $52,000 in loans from her Chatham University undergraduate degree and University of Pittsburgh master's degree.
She worries about the fact that she and her husband basically have no savings -- he's also a social worker, and also has more than $50,000 in loans. She's been accepted into a Ph.D. program but put her admissions offer on hold, worried how she'll afford at least $18,000 more in loans, and whether the degree will pay off. And she worries how she and her husband eventually will be able to afford children.
She knows that she's one of the lucky ones: She and her husband bought a house in Plum this year, have secure jobs and can at least afford their loan payments. "Lots of my friends have more debt than I do and make $20,000," she said.
More than twice as many recent college graduates reported that their greatest fear was being unable to pay college debt than those who listed terrorism in a 2005 Partnership for Public Service survey.
"There is a psychological effect to carrying loans on your shoulders as you exit college," said Robert Shireman, executive director of the Project on Student Debt, a program of the nonprofit Institute for College Access and Success, based in Berkeley, Calif. "In today's generation, a lot more college students are graduating with debt and they have more debt."
A large debt load can affect the type of job that a student might be interested in. There's particular concern about willingness to go into low-paying teaching or public service careers, said Mr. Shireman, as well as whether students are willing to take the risks to become entrepreneurs.
Students are also much less likely to go on to graduate school when they need to borrow money as an undergraduate, he said.
For some students who fear that certain career choices will limit their ability to pay back their loans, the income-based repayment option in the College Cost Reduction and Access Act of 2007 should restore some piece of mind, he said. The income-based repayment option will limit monthly loan payments to a fixed percentage of a student's income and will forgive loans after 10 years for students working in certain public service jobs.
Students also should be encouraged by the trend started at some elite universities, such as Harvard, Princeton and Yale, which have eliminated loans or drastically decreased tuition for needy students. More than 30 public and private colleges have pledged to reduce or eliminate loans for some students, according to the Project on Student Debt.
Debby Rubin, an associate professor and director of the social work program at Chatham University, sees students who come in more career focused now than they used to.
"The student loans, the payment is what makes people feel pressured," she said. "What I see in general is fewer students feeling like it's OK to just find themselves for a few years after or stumble into what they're going to do."
Olivia Ryan, a 32-year-old law student at the University of Pittsburgh, had the kind of first-year grades that would have put her in contention for a six-figure job at a large law firm.
But Ms. Ryan has decided to pursue public interest law instead -- despite the fact that the salary might be less than half as much as at a large law firm, that she'll have between $50,000 and $60,000 in loans and that she's expecting her first child this spring.
"I'm a little terrified," she said. "I'm definitely worried about my financial forecast. When student loans hit, it should be pretty difficult. I can't say that my mind won't change, that I'll need to take a higher-paying job. I hope I can work everything out, but you never know."
Mr. Shireman's fear is that students like Ms. Ryan will wait until they are done paying their loans before they start saving for other aspects of their lives, such as retirement or buying a home.
"There are the family effects [of student loan debt]," he said. "There's the ability to buy a home, to afford to have children, to save for your own children's education, all of which can suffer because of your student loan situation."
Those effects have been prolonged in recent years because students who consolidated their loans in order to lock in record low interest rates often extended their time of repayment from 10 years up to as long as 30 years.
"Where people are paying much longer, the longer they're waiting to get to that psychological point where they're ready to start saving for other things," he said. "If I say 'I'm going to start setting up my kid's college account when I'm done paying my loans,' well, you might be still paying your loans when your kids are 18."
Danielle Terrell, a supervisor in medical support for outpatient specialty services at the VA Medical Center in Oakland, harbors no illusions of saving for college for her 13-year-old son.
"We'll be paying these back after our son graduates from college," she said. "My goal at this point is to correct our mistakes and be able to help our daughter, who is four."
She and her husband -- both of whom spent years in the military -- are living "penny to penny," she said, trying to pay their $500 per month student loan bill as well as $500 in day care for their younger daughter. She owes $10,000 in student loans; her husband, Brian, owes $36,000.
The family has no cable television, no cell phones, hasn't taken a vacation during their daughter's lifetime and puts 70 miles per day on a car with only liability insurance. They're looking at selling their house and moving from Jeannette to the East Allegheny School District, which is closer to their jobs and has full-day kindergarten.
The worst part of it, said Ms. Terrell, 31, is that the only way they see improving their financial situation is by getting master's degrees, which would only add more loan payments.
"A bachelor's degree doesn't have nearly the impact that it did 10 years ago, but they cost twice as much," she said.
Her husband will start a master's program in human resources and conflict resolution later this month, though he had thought about delaying it until after their daughter starts kindergarten next year.
Ms. Terrell has regrets -- she wishes she hadn't spent a semester at college straight out of high school when she wasn't ready and that she hadn't consolidated her loan at a high interest rate -- but ultimately, she doesn't see a way around taking out student loans.
For people whose parents can't afford to pay for college, the loans -- even high-interest private loans -- are a "necessary evil," said Timothy James, a 28-year-old sales engineer for Aegis Software.
Mr. James borrowed about $70,000 just to pay for his undergraduate degree, most of it in high-interest private loans, and went back for his MBA, in part just so he didn't have to deal with his undergrad payments.
Though he now has $115,000 in loans and pays well over $1,000 per month in loan payments, he's confident that he made the right decisions. He's making six figures and is married with a small townhouse in Cranberry and a 1-year-old son.
"I came from a poor neighborhood, my mother didn't have a lot of money," he said. "I feel very privileged in the fact that I was able to get a college education. A lot of people are not as lucky as I was."
While Jackie Walker is proud to have paid off her $30,000 in loans from her master's degree in special education in six years, she wouldn't have gotten the degree if she could do it over again.
To pay off the loans, she ate a lot of boxed macaroni and cheese, gave up competing in dog shows and had to move to Arizona to find a full-time job.
When her mother became ill and eventually died, she moved back to the Pittsburgh area to be closer to family. She hasn't been able to find a full-time teaching job here, though, and is working as a teaching assistant.
Brian Kahle, a Downtown lawyer who has about $80,000 in total loans, also isn't sure the graduate degree was worth it. He went straight from an undergraduate degree at Grove City College to a law degree from Duquesne, but his salary didn't match his expectations. Mr. Kahle doesn't own a home and has sold his motorcycle and given up skiing and other hobbies to make his $600-per-month loan payment.
"Hindsight being 20/20, I would have taken some time off to make sure I wanted to undertake that time commitment," he said. "Everyone says you'll make more later on, but you can't be sure."
Anya Sostek can be reached at firstname.lastname@example.org or 412-263-1308.