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When You Start To Grow Apart: Challenges of a Medical Marriage

10-24 hour shifts. Call days. Night float. Step prep. Away rotations. The nature of medical training involves long and sometimes stressful days. On a typical day, your spouse might leave for work as the sun is rising (or setting!) and will be gone all day in their medical world. You’re not sure what they do all day. Sure, you know they’re studying, attending lecture, at the clinic, in the OR, etc, but you aren’t privy to the nuances of the day. Left to yourself, you live most of your time in another world, without your partner.

Depending on how busy your spouse is, you may not hear from them until they return home (or break from their studying), which could be just before going to bed. You may be able to send a few texts here and there, but nothing deep and meaningful. The texts are “maintenance mode” – just a way of saying, “Hi. I’m still here. I’m thinking of you and I love you.” You might get in about an hour of face-to-face time before heading to bed to start it all again tomorrow.

The “separate world” reality of medical families creates a normal separateness that is ripe for disconnection. If you both aren’t purposeful and diligent about coming together in some way each day, the disconnection will slowly grow. Sometimes challenges are obvious – you’re clearly in a disagreement and have an issue to work through. Other times, your relationship feels okay until you wake up one day and realize that you have grown apart; sometimes so far apart that it feels like you’re different people. Do I even know my spouse anymore? Do they even care about me? This realization feels very scary. You see this moment as a glimpse into the future and panic sets in. Is this what my life is going to be like? Then, that bigger pang of fear: I don’t like how things are right now and I don’t want my life to be like this. So what then?

What happens when we feel this fear? Often, we either begin to panic and pull away more by creating a new wall that we think will protect ourselves, or we start to tighten our grasp by trying to control everything, including our spouse. We want more connection and intimacy with our partner, but unfortunately neither of these responses will actually bring us closer to that.

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In those moments where you feel like you’ve drifted apart, remember first that as quickly as you may have drifted apart, you can quickly come back together. Yes, you do have to put in the work, but your relationship just needs a little tender loving care. There are many things you can do to reverse course and reconnect. Here are some ideas:

Do you trust your spouse? Honestly, do you? If not, why?

This question might be loaded and possibly painful, but it’s important to address it. Trust is vital in a loving relationship, but trust is also a tricky thing. According to psychologists, trust is developed with time, understanding, reliability, and sacrifice. Each time you spend time together, come through for your partner, feel compassion for their situation, and sacrifice something for the benefit of your relationship (such as accepting and apologizing when you were wrong or acted harshly), trust is built. The “separate worlds” reality of medical families will test this trust, and in order to have a happy, healthy marriage, couples need to make sure to continually build and strengthen their trust in each other.

For some guidance on this topic, and healthy marriage habits in general, check out the book, “Seven Principles For Making Marriage Work.”

Being Kind and Respectful, Even When You Don’t Feel Like It
At times in this journey, you will feel angry, frustrated, and scared. You’ll wonder how you got yourself into this mess, and the scarier thought, you’ll wonder if your marriage is going to make it. Can we survive this? In those moments you both are on edge, but try not to push each other farther away. Acting mean and saying hurtful things might feel good in the moment, but it comes at a price and can cause lasting damage in your relationship. How can you build trust when you feel attacked or insulted? This is not to say that you just accept the situation or behavior that is causing discord; it’s saying that you try to work from a baseline of respect in order to address the problems without creating further hurt and disconnection.

A good guide for communicating from a place of respect even when you feel hurt or angry is the book, “Crucial Conversations: Tools For Talking When The Stakes Are High.”

Imagine Each Other’s Situation
One of the greatest reconnection tools is purely trying to understand each other’s perspectives by imagining what it must be like for them and how it might feel, whether we agree with it or not. Can you make an agreement to not make judgements about each other’s feelings, work, how you spend your time, or what you feel is challenging during your day? You both experience highs and lows and even though the specifics may look different, validate each other in your experiences. If your spouse says that things are hard and they’re struggling, believe them and comfort them, no need to prove it. Ask for the same in return.

Marriage takes continuous investments of time and love. When life gets busy and our attention is too focused away from each other, the imbalance will show up as disconnection. As medical couples, we have little control over the demands of medical training, so we have to look for other ways to give to our relationship and reaffirm our commitment to our spouses, even when time and energy is limited.

Try some daily check-ins. What actions can you both agree to that will be reasonable and help you feel more connected? Something as simple as a long hug first thing in the morning; texts, pictures, or videos from your day; talking about “highs” and “lows” at the end of the day, etc. Brainstorm together and see what works for your relationship.

Communicate! Try your best to verbalize when you’re feeling distance and ask when you can have a date or devoted time together. Try to communicate this before any resentment builds and have both of you acknowledge the importance of making some more time for your relationship in those harder moments.

If you find yourself in a particularly hard situation where your relationship feels in jeopardy, remember that you can do something about it. Medical training seems set in stone, a specific path to be followed. However, in dire circumstances, there are options. Sick days are available, as well as leaves of absence. Your spouse’s program wants them to succeed, so if they have a truly serious situation with themselves or at home, it’s possible to take some time off from training.

Have A Good Laugh
When was the last time you both laughed together? Or were silly together? When you feel so frustrated with your partner, is there a way to make a joke out of something to lighten the mood? Making a joke when you’re angry and upset might seem impossible, but it’s actually a technique (sourced from “Seven Principles For Making Marriage Work”) that can break through the invisible wall and help you both soften, which creates an opportunity to reconnect. Talk with your spouse about how the next time you are in a disagreement, you both are going to try to do something silly to break the tension, something like, “Oh, yeah? Well this is what I think! *blows raspberry*” Don’t knock it until you’ve tried it!

Please remember when you feel far apart and disconnected from your spouse that your relationship just needs a little tender loving care. Find the time – make the time – for it. There is hope, and there is opportunity.

Lastly, please seek out professional help if you feel like your relationship is in true danger or you feel paralyzed with too much hurt or hopelessness. Yes, medical schedules are busy, but you can find time. You must find the time. Find a trained counselor either through the program (often there is some kind of employee assistance program or medical student counseling office offering free counseling services), out in the community, or through a house of worship. You would actually be surprised with how common it is to attend marriage counseling, and probably have numerous friends that go, even though they don’t talk about it.

A healthy, happy marriage requires hard work. Add in medical training and possibly children, and you’ve got a challenging situation that requires some type of support. Do what you need to do for yourself and your marriage. Many wishes for coming together with your spouse to brave the winds together!