Remarks
Sage Advice from a
“Dutch Uncle”
There are things I wish an older medical
colleague had taught me.
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If I had known when I began my medical
career what I know now, I would have made a lot fewer mistakes
in my personal life. New physicians can learn now from my
mistakes.
Marriage
No marriage relationship is easy to work
out over time. With mindfulness of our life partner’s
needs, a good sense of humor, and integrity, contentment and
joy are possible in our marriages. It does take effort however,
and plenty of patience and creativity. If your marriage is not
working, seek marital consultation or therapy. If your spouse
refuses to participate, seek a divorce lawyer and don’t
smolder in your unhappiness. Inform your spouse of your
feelings and plans during every step of this process. My
difficult advice on this matter: After a divorce it is
best to wait a year or two before entering another serious
relationship. This allows one to carefully assess one’s
own role in the divorce and not just demonize the EX. If you
have children, this time can be used to be available to your
kids during the painful adjustment. Seek therapy if you need
it. Before entering a new relationship, spend time getting to
know the new person and her family before making commitments.
This will give the next marriage a better foundation.
Infidelity is exciting, but
not cool.
Several years ago after a
Wednesday round of golf with three surgeons, our foursome was
sitting in the locker room having drinks. One surgeon was
sharing with us how much he and his wife enjoyed a relaxing and
romantic week in Bermuda. Another surgeon interrupted him
saying:
“Bermuda sounds
great, but why go with your wife and not your
girlfriend?”
The interrupter continued
to pester the Bermuda advocate about this. The young surgeon
finally said to his more senior partner:
“My wife IS my
girlfriend!”
Many busy and successful
men I have known from clinical work and via social
acquaintances drift into a pattern of infidelity. They
partition their life into several compartments. In one domain
they act as a worker/wage-earner, in another they behave as a
proud father to their children. In yet another zone, they
perform as a dutiful husband. And in still another compartment,
they have a secret erotic life with a mistress. The sadness and
pain in the philanderer surgeon’s marriage and family was
clear to me a year after the episode above. He came to me for
help with marital and family therapy.
Time
One key issue is time. If you are single,
time with significant others is still important, and hopefully
you will find a life partner. People who have life partners
live longer and have better physical and mental health than
those who do not. Our work as physicians is very time-bound and
time-determined. The schedule of patient contacts rules most of
our day. We get paid by the hour if we work in a private
practice. Even if we work for a salary at a heath center, a VA
hospital, or other institution, the time demands are also
present. Our work is emotionally draining. When we get home at
five or six pm, (usually it gets later if we let it), we are
emotionally drained. Our spouse is also tired from homemaking
or their work outside the home. (I believe that taking care of
several children for eight to nine hours is much more draining
than any physician’s work day!)
A vigorous thirty-minute
walk together before or after supper is ideal. Jogging,
swimming, or bicycling is less effective for associated couple
communication during the activity. Gardening together, while
less aerobically beneficial, can allow for communication and
winding down emotionally. Ripping out a weed can sublimate
those pent-up hostilities. It is certainly worth paying a baby
sitter for this time together.
In 1985, Daniel Goleman
reviewed the research literature on marital happiness and
contentment in a New York Times article. Contentment correlated
strongly with whether a couple had twenty to thirty minutes to
talk meaningfully together daily. He found that couples
developed a unique language or emotional shorthand that evolved
in a special way in their relationship. There was no
correlation with IQ, presence of psychopathology, or level of
sexual satisfaction.
In 1988, O’Leary and
Malone followed 292 white, suburban, middle class couples from
New York from six weeks before marriage until three years into
their marriages. Their findings, summarized in The Houston
Post, were similar to Goldman’s earlier findings.
O’Leary and Malone found that after 2.5 years, 25 percent
of the marriages were in distress. Key triggers for distress
were verbal fights about money, sex and in-laws. Key positive
factors were good daily communication and verbal and nonverbal
signs of affection.
I have noticed that it is
good to share friends you make at work with your spouse. If you
begin to share more about your life with a coworker than you do
with your spouse, it can lead naturally to falling in love with
that person. If the coworker and her spouse are good people,
you would want to share time with them as couples.
Our patients form a special
pedestal of idealization for us. It is often very flattering
and affirming to our narcissism. But, it should not be taken
too seriously. Our patients put us on a pedestal to try to
compensate for the fear and pain they feel. Our spouse or life
partner often feels she cannot compete with the special time
our patients receive from us every day. It takes conscious
effort to counteract this “spell of wonderfulness”
that we can allow our patients to provide for us, sometimes to
the subtle exclusion of our spouse.
The other extreme from the
special pedestal is the “pit of devaluation,” when
patients direct their anger, disappointment and sadness at us
as if we were the cause of their pain and illness. It takes
conscious effort to not take this devaluation experience home
with us. Don’t withdraw from your family to protect them
from this stored-up stuff left over from the office or
hospital. Or, don’t be like the person who is blistered
with hostile criticism by the boss, only to come home to yell
at the family and kick the dog. Remember the philandering
surgeon—and this poem!
“What of MARRIAGE, master?
And he answered saying:
You were born together, and together you
shall be forevermore.
You shall be together when the white
wings of death scatter your days.
Ay, you shall be together even in the
silent memory of God.
BUT let there be spaces in your
togetherness,
And let the winds of the heavens dance
between you.
Love one another, but make not a bond of
love:
Let it rather be a moving sea between the
shores of your souls.
Fill each other’s cup but drink not
from one cup.
Give one another of your bread but eat
not from the same loaf.
Sing and dance together and be joyous,
but let each one of you be alone,
Even as the strings of a lute are alone
Though they quiver with the same music.
(Kahlil Gibran, The Prophet, 1923)
Bringing work home
Before my divorce after ten years of
marriage, I used to rationalize to myself: “Peter,
you don’t want to bring your work home.” I
unilaterally chose to not discuss anything about my workday
with my first wife. Yet, many things I experienced each day
were poignant, fascinating, and interesting. But, I thought,
confidentiality had to be sacred. Today I say hogwash to that
assumption. My first wife felt left out. I had to turn to
colleagues for discussion of important life and death
experiences in my professional life. My suggestion is to
discuss this issue with your life partner. If your partner is
willing to respect the sacred commitment to patients’
privacy, and you can talk about the events without a lot of
identifying detail, I say feel free to ventilate and share. My
second wife of thirty years is also a physician, so we fairly
frequently have collegial discussions about clinical
situations. We ventilate, even cry together at times about the
soul-saddening events we witness. This sharing can deepen our
marital relationship and help reduce the propensity for
burnout.
Children
My tendency in parenting was always to be
over-protective, so I have always found the Existential meaning
behind the following lines from Kahlil Gibran to be helpful in
my parenting efforts:
“Your children are
not your children.
They are the sons and
daughters of Life’s
Longing for itself.
They come through you but
not from you,
And though they are with
you yet they
Belong not to you.
You may give them your love
but not
Your thoughts,
For they have their own
thoughts.
You may house their bodies
but not
Their souls,
For their souls dwell in
the house of
Tomorrow, which you may
visit,
Not even in your dreams.
You may strive to be like
them, but seek
Not to make them like you.
For life goes not backward
nor tarries
With yesterday.
You are the bows from which
your children
As living arrows are sent
forth...........
Let your bending in the
archer`s hand
Be for gladness;
For even as He loves the
arrow that flies,
So He loves also the bow
that is stable.” (Gibran, 1923)
I thought of this poem countless times
during my struggles and efforts to be a parent to my three
children.
The element of time also
affects our children. I made great efforts to spend as much
time as possible with my children. I found that doing ordinary
tasks together, like raking leaves, taking walks, pulling
weeds, or watching TV together was best. Elaborate, expensive
vacations to interesting places are nice, but pillow fights and
floor wrestling are OK too. Reading stories to kids or making
them up at bedtime or at campfires is good. When TV shows hit
heavy topics it is important to talk about violence, death,
love, etc. I tried to let them see my playful side. This was
not easy for a serious intellectual like me. I tried to let
them see my mistakes. The dignified acknowledgement of a
mistake or offering an apology is as valuable for our kids to
witness as our financial or professional triumphs. Do enjoyable
things with your children. Let them have choices and be
prepared to listen and talk at times when you are least ready
for it. Like driving home late from an event when you are
hungry or tired. There is something inherently beneficial about
conversations with kids that occur while driving, hiking, or
walking. Kids don’t feel stared-at or under pressure
because both of you have to watch where you are going as you
talk.
I was once treating the
wife of a child psychiatrist. He worked nine or ten hours per
day and Saturday mornings till noon. His wife described an
amazing event. Their ten-year-old son knew that his dad worked
without a secretary on Saturday mornings. The resourceful lad
rode his bike the six blocks to his dad’s office at 10:30
on a Saturday morning. He put his own name in the schedule book
for the last therapy appointment at 11 am. When the doctor came
out after his last patient, there was his own son. This event
got a message through to our colleague that his wife and I had
not been able to get across at many joint therapy sessions.
Peter A. Olsson, MD is a psychiatrist and
psychoanalyst who supervises the psychotherapy of psychiatry
residents at Dartmouth Medical School. He has written Malignant
Pied Pipers of Our Time and Poems Behind A Psychiatrist’s
Couch.
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