Tuesday, April 26, 2016

More Important Than Your Marriage, or Lessons from Old TV Shows

I've been re-watching The West Wing lately - my Netflix version of re-reading a favorite novel, which I also do frequently. In the episode Five Votes Down, early in the first season, Leo (the Chief of Staff to President Josiah Bartlet) forgets his anniversary and comes home at 2:00 AM in the midst of a crisis with Congress. The next day he sends his wife a pearl choker and plans a catered dinner, but it's too late. His wife has packed her bags and has a taxi waiting.
Jenny: I can't do this anymore. This is crazy. I don't want to live like this. I just can't.
Leo: I'm sorry about the anniversary. I just...
Jenny: It's not the anniversary. It's everything. It's the whole thing.
Leo: This is the most important thing I'll ever do, Jenny. I have to do it well.
Jenny: It's not more important than your marriage.
We all know what the right answer is here, don't we? We do. Leo knows, too - but instead he gives her the honest answer.
Leo: [emphatically] It is more important than my marriage right now. These few years, while I'm doing this, yes, it's more important than my marriage. 
Every time I watch it, this scene brings me to tears. This time, though, I watched it while I was doing the dishes at 10:30 at night on a day when I'd missed dinner with my family because I was at work until nearly 8:00 PM. That's not unprecedented; I'm lucky that it doesn't happen very often. One of the reasons we put off having kids was that I knew I would have a hard time leaving work at work during residency to be fully present for a small child. Sam was in graduate school at the same time and it was even more difficult for him. For many years, I was Jenny in that scene - I was afraid to ask Sam if his work was more important than our marriage. I was afraid he would say it was.

And now? Now I am almost always home for dinner, but I know I'm preoccupied with stress about work and thoughts about patients. I have to say "no" to my kid every third Saturday because I'm on call and I can't commit to whatever it is she wants me to do. There are a lot of mornings when I don't hear what's said to me because I'm in a fog from multiple overnight calls. Am I behaving as if my work is more important than my marriage? If I were answering honestly, how would I answer that question?

Overall, of course I would say my marriage is more important. Sam and Eve are the center of my life; I adore them and I want to be with them. I want them to be able to depend on me. In any one moment, though, I make choices that clearly put my work first, and those moments add up.

There's an episode of M*A*S*H in which the members of the 4077th invite their families to a party in NYC. Hawkeye assumes his dad won't leave, because he won't want to leave his patients. The elder Dr. Pierce writes back that of course he will go; "Yes, I'm attached to the patients I've brought into this world, but I'm more attached to the son I brought into this world." Hawkeye, brushing away tears, says "Funny, I always thought they came first."

I don't want my daughter to grow up thinking my patients come first. I want to show Sam and Eve now, in the moment, that they are important to me. And I want - I need - to keep the sense of myself that is only satisfied when I'm doing my work the way I know it needs to be done. Is my work more important than my marriage? No...and yes.


  1. Quite the conundrum. You write it well. :)

  2. I don't think working late or prioritizing work means you care about it more, it just means that at that particular point in time, work happens to be the more demanding mistress. It's just like when you have a high maintenance, but not very sick patient. They take more of your time, but it's not because you don't care about your other patients. Maybe you can't help feeling bad about this, but I don't think you have anything bad to feel about. You obviously DO spend abundant amounts of time with your family, and they seem to be doing well. The question is: are you happy with your balance?

  3. I think you can love your family and also be an example for dedication to your profession that will inspire and awe your child to emulate you. Having said that, I worry a lot too (don't we all) - beautifully written.

  4. Well said. I'm thinking of a recent anonymous KevinMD post: http://www.kevinmd.com/blog/2016/04/surgical-residency-hurt-the-people-that-mean-the-most-to-me.html, if you haven't seen it. A sad but inevitable part of our jobs.

  5. As the daughter of two doctors, growing up with missed activities, late dinners and occasional emergencies that would interrupt our family time, I can assure you that it hurt my parents way more than it hurt me. Now, as the mother of a wonderful, funny, precious little girl, I know it hurts me way more than it hurts her when work invades family time. I think you're children and spouse know how much they are loved.

    One thing that helped me as a kid--my parent's didn't commit to things and then back out. They were clear if they could or could not do something, or be somewhere, with me. And if they were on call and we might get interrupted, I knew that. So the expectations were laid out so clearly.

    Rather than thinking of work vs family, I am experimenting with thinking of prioritizing myself AND family--my work is for me. I like to work, it is interesting and fulfills me in ways that parenting and home life does not. There are a lot of things I would change--how much time I am required to work being the top one--and I will, once I have that freedom (read: graduate from residency). My family is loved and cared for, and for now my daughter is happy. If that changes, I'll reevaluate, but for now I feel OK with doing this work for me.

    Now if I had read this post when I'm post-call...you'd probably be hearing a much different story! Oh, the internal battles we fight.

    1. Yes, I absolutely agree that I work for me. For the satisfaction and the stimulation and, yes, for the money (which means I have security and independence and can stay in my marriage because I want to, not because I have to.) My dad was a doctor, too, and I don't think I minded his hours or the late/missed dinners. I know my mother did and I've discovered as an adult that my brother was very resentful as a kid. I also know my daughter is proud of me and respects my work and my accomplishments, and that I'm modeling something important for her. As you say, it's an internal struggle.

  6. The reasons you listed above are the exact reasons I left clinical medicine...I practiced for 8 years and when I was at home, I would be there but not be truly present. Even as a part-time ER doctor working 2-3 days a week, I missed so much of my children's lives when they were little because my mind was always thinking about my patients, the decisions I made, the charts I had piling up. Now as a nonclinical physician I can feel the difference in my relationship with my husband and kids, and so can they. I am able to be fully and completely present. I have no regrets, I don't miss my patients one bit.

    1. i feel the same way James and left the ER for the same reasons. I don't miss the patients at all (how could you?!). What are you doing as a non clinical job to find better balance?

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