Marriage and Relationships: Advice(?) for future and current med students

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Relationship self-help/advice books, CDs, TV shows, etc. are a dime-a-dozen, and this post is NOT about “how to make relationships work while in medical school.” If I knew that secret, I would have written that book instead of this stupid blog and not have to take out any loans to go to school as I double park my Bentley in the faculty lot because I can. No, I can’t tell you how to make it work, but I can definitely tell you what to watch out for, what hasn’t worked for me, and give you a wider perspective on what is usually a hyper-myopic medschool life.

A few bullet points first, then I’ll expand on them:

• Medical school does not break people up in and of itself; it places strain (sometimes severe) on a relationship whereby a weak relationship can not endure it and a strong one can.
• There is far more to life than medical school, even (and sometimes especially) while in medical school.
• Medical school by definition is temporary. Try to make as few “permanent” decisions as possible (such as divorce, breaking up with a potential spouse, making irreparably bad financial decisions, etc.) using medical school as the driving reason.
• Your spouse/partner will never understand what you are going through. They can try and have the biggest heart about it, but you should save the true vitriolic dumping for those in your medical peer group who can understand and appreciate the context (and language) of your rant rather than set impossible expectations for your significant other who will probably always fall short. (all of this, of course, assumes your partner is not of the medical persuasion)

I especially want to expand on the last point: anybody on the “outside” will never fully understand what you’re going through. People who have gone to law school or a particularly rigorous graduate program may have a 1:1 comparison for the pre-clinical years when it’s almost all classroom, but especially when you get to your clerkships and you are dealing with sick people, real human suffering (or like here in Mexico, when we do have to deal with real patients to a limited extent our first two years), the analogy stops, because as we’re reminded all the time, this is about life and death, or at the very least, affecting people’s lives in a seriously direct way where any little mistake can have disastrous consequences. And that’s for EVERY patient you see, a situation you’re faced with multiple times a day, not just an occasional job hazard.

Everything I wrote above applies to me and my marriage too, except when it’s yourself, you lose judgment and sometimes emotions get the best of you. I am actually not a fighter; I’m a debater. I can calmly pick at arguments/points-of-view all from a perspective of logic, whereas Claudia, being raised with 8 siblings is quick to fight and lets her emotions get the best of her in a way that is frustrating for me. However, she’s able to let things go and slide off her back (for a lot of the same reasons) in a way that I can’t. So while she’s over everything, I’ll come up later and say, “Ok, I’m still having a problem with this…” to which she replies “are you still on that?!” This renders me feeling like I’m not being listened to while she feels like nothing ever gets put behind us. Neither of us is wrong, yet both of us could be more tolerant of the other’s needs.

This semester has been hellish, scholastically. Everyone’s grades are down, and students’ morale is even lower (more on that in the next post). If you’re by yourself, you don’t really have anyone else to turn to and you are necessarily more self-reliant. If you are with someone else, you naturally expect to reap one of the benefits of the relationship and want a soft place to fall when things are going tough. But what happens when you feel like you’re falling all the time and instead of the occasional complaint of “Man, what a shitty day” it’s turned into a daily litany of complaints as soon as you walk in the door? What happens when you’ve burned out your partner and that soft place to fall is the same concrete pavement it was had no one ever been there, except now, it’s complicated with them getting after you for being so negative? These are expected situations, people.

There are those who embark on relationships while in school (or came in with one) and have the attitude that they’re going to tough it out and hope for the best, and if it’s meant to be, it will work out in its own time, but priority is given to a fuller, more complete life outside the classroom/hospital, not waiting for a “right time” to satisfy the basic need of wanting to be with somebody. Another is popular among the early/mid-20s crowd, taking the opposite view of “I don’t have time for a relationship right now; I am going to completely focus on my studies.” I think that’s a luxury of youth, personally, or at the very least, a luxury of those who don’t feel that being with someone makes them a better, more complete person.

I don’t wish I could be that way, specifically, but I do wish I could let more things slide off my back, more things not seem so dramatically important at that moment, like I could have the benefit of “sleeping on it,” without having to lose the time to do so. I wish I could compartmentalize my feelings in a box and just say, “I’ll deal with this later; I have a pharmacology exam on Monday I need to prep for.” As physicians, we have to necessarily have some kind of barrier with our patients, or we’ll burn out, get into legal trouble or both. I like to think of it (computer geek that I am) as a firewall, inspecting each “packet” of interpersonal data and determining if it’s kosher to discuss, reveal, touch, hug, give a cell phone number to a patient with a special case, etc. rather than an impenetrable wall that keeps a patient at a distance that is not always therapeutically necessary. I wish I could do the same for relationships, allowing some amount of feelings to leak through, to deal with, etc. but not have it flood the dam and render me incapable of concentrating.

I say “relationships” (plural) in the 1st person because I include friendships in this as well; it’s not all about burning out/fighting with your spouse, but you can tap out a friend too. It’s gets harder to manage your feelings with friends in class, because while you get the supreme benefit of someone knowing EXACTLY what you are going through without the need to explain or justify, they too are usually in the EXACT same predicament and can be the last person to turn to for emotional support. Imagine the conflict where your spouse/significant other doesn’t understand, you turn to a classmate who is emotionally unavailable or at the very least, you have to think about what problems you’re bringing to them the night before an exam (as you try to seek help calming yourself for the exact same reason), and you see where it gets complicated yet again. Of course, all this is made tons easier if, as I stated above, you can effectively compartmentalize and deal with things later (or you are a simpleton; either is good for this). It’s part discipline, yes, but it’s also a good part personality.

Well, this is getting away from the main purpose which was “advice,” but like I said in the beginning, I don’t have all that much. I have my own major problems, thank you very much. But in sharing some of the basics of what I’ve learned so far, perhaps it helps guide you in keeping you aware as you go along to not fall into obvious traps or realize sooner rather than later that something isn’t working for you. Be as self-reliant as you can, above all else. It’s not that you can’t count on others because they’re unreliable, but you really can’t count on others the way you’d think because of specific reasons that are not their fault. And while we’re all trying to be the best doctors we can be, remember that there’s a lot more to being a good doctor than memorizing textbooks or doing whatever it takes, bar none, to impress the holy hell out of the attending in a clinical rotation. I think a big part of my problem is that I go to school with so many people who haven’t figured that out yet; they either don’t get it at all, seeing such statements as evidence of my academic shortcomings, or they haven’t grown up enough to care or even think about such things. I’ll give them one thing: if I were freed up from myself to not think about just a fraction of the things I think about, I’d sure have a lot more time on my hands.

Maybe they were right all along…

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  By Jordan, October 14, 2006 @ 7:00 pm

  What do you do to make the physician think that a relationship would work? As a 20 yr. old nurse, I get the impression that more often than not the intern doesn’t take me seriously as possible relationship material when they find out my age (which is somewhat understandable since most are least 25, and I don’t think that I would take someone seriously who is 5 yrs. younger). I also feel that most don’t think they have time for a semi-serious relationship, so they make themselves unavailable unemotionally, OR they are emotionally available since they’re so stressed and need some comfort, however by the 2nd year they’re back on their feet and don’t need someone as much OR they think that only another doctor could understand what they’re going through and don’t think necessarily that someone else in the medical field could have an inkling as to what they’re going through since nurses do go through that themselves, but to a lesser degree.
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  By Jeremy, September 26, 2008 @ 1:22 pm

  This is a very good article. I liked your little comment about double-parking the Bentley. My fiance and I are both 32 years old. I am at a bit of a career crossroads and am considering med school because psychiatry seems the only way for me to advance in my mental health career that will both provide a solid income and allow me to continue face-to-face interactions with clients. Given our age and the desire to have children in our mid-30’s, what suggestions do you have to make it work? We would obviously become a one-income family for quite a while and she doesn’t make a whole lot. Family help is not an option.

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