Making Marriage work in Medicine — an epic reflection
19 years and counting.
Kylie and I are standing on the grand precipice of being married for twenty years.
Twenty years of marriage has special significance to Kylie and me not simply because of this being a significant milestone but because interestingly it is related to our journey together in medicine for one main reason — let me tell you why.
In late 2003 as we were preparing to get married in Perth on January 3rd 2004 and organising this from Sydney, I faced my first barrier exams in my second year of Medical School at the University of Sydney.
At that time too, I was completing research in Endocrinology for my honours and also working part-time.
To say it was hectic was an understatement.
My mind was everywhere but on the one thing that mattered most at the time — getting through my exams. Whilst I sailed through the written exam, I failed the practical.
And because I failed, Kylie and I needed to return to Sydney two days after we were married. This is because I was offered a lifeline in the form of a supplementary exam.
However, if I failed this too, I would have to repeat my second year again, the stakes were thus high.
I went on to pass that supplementary exam but I failed it initially for a variety of reasons. The central reason was that I had taken on too much and wasn’t able to give my best to what mattered the most at the time — passing medical school.
Little did I know that this same unlearnt lesson would come back to haunt me both as a registrar and as a newly Fellowed GP when I would successfully burn myself out twice by taking on too much work and not intentionally caring for myself a number of years later.
Needless to say, as a consequence of failing this exam, Kylie and I could only spend one beautiful night of marital bliss together, our wedding night before we returned to the realities of exams and life in Sydney.
We never got to experience a proper honeymoon and time away to ride the high of being a newly married couple (which I have been told is face-meltingly divine!).
And because of this, I made a promise to my new bride in 2004 that we would spend our twentieth wedding anniversary in Bora Bora or in the Maldives in an overwater Bungalow. I figured that by then that I would have enough time and money saved for this luxurious promise!
And so as we approach twenty years I cannot help but reflect on what Kylie and I have been through along my medical journey and on the nuances of building a beautiful marriage whilst training and working as a doctor with a non-medical spouse.
Scroll ahead if you would like my five thoughts about making marriages work in medicine.
Why medical marriages are unique — Dr. Ramachenderan’s notes
Medical marriages are unique for a number of reasons, here are a few reasons why.
Mo money, mo problems
You will likely have more money than most to play, save, invest and waste.
Whilst this is a wonderful reward for your hard work, it also brings with it a few interesting and potentially problematic issues.
The perils of lifestyle creep and keeping up with the Joneses is perhaps the clearest outward challenge.
However, a common inward struggle is defining what “enough” looks like. And this can lead to the potential of continual marriage money arguments.
Disagreements like these usually start with two people with different financial expectations, and differing inbuilt money stories. This can lead to insecurities about having enough money and whether to build wealth or live it up like Kanye now.
Side note — Entertainers and Professional Athletes earn money in a stratosphere not known to medical professionals. And to think we can live like this is unwise and foolish.
And compounding all of this is the simple and stark realisation of “if I cannot work, I do not get paid” (unless you become a medical influencer!).
All of these issues have the wide potential to either leave a trail of debt, increase the risk of divorce and create dilemmas for your family.
However, if we are intentional, and inclusive and turn towards each other in how we discuss our finances, we have the potential to build extraordinary wealth, make lasting memories and leave a legacy of generosity.
Emotional fatigue is real
You will have a spouse who will experience the full range of human emotion on daily basis and somehow need to be the conduit and displacement agent of this depleting energy.
It is challenging to resuscitate a child and come home to your own. It is difficult to be shouted at, threatened and manipulated and leave this at work, pull it together and come home to eat dinner together as a family. It’s an unexplainable experience to give your all to help resuscitate and treat a sick patient who is trying their very hardest to die and come home and unwind with your spouse and children or even on your own try to calm your nerves and racing thoughts.
It’s tough to make a mistake at work and not think about it all the time and feel like a failure and question your calling whilst your family life is happening all around you. It’s devastating to hear that a patient of yours has committed suicide and hold it together whilst reading your children a story at night. It’s heartbreaking to see and treat an endless stream of patients, carry their stress and then realise that you have no energy for yourself to continue.
I personally find it challenging to hold the distress and suffering of my dying patients and remain at an even keel when Kylie and the boys need me. I have to balance the seemingly trivial (but supremely important to my family) with the end-of-life realities facing my patients.
But yep, this is a doctor’s life.
And emotional and physical fatigue can take its toll on us if we are not careful and intentional about our own individual self-care.
The impact of mistakes ripples further than you know
Medicine is not perfect and as a result, adverse events and mistakes do occur.
And when a clinical mistake is made, it does not simply exist in the physical realm, it affects your whole being. It is whole-person problem. It affects your mood and emotions, depletes your energy and it may consistently play on your mind and erode your physical energy.
Medical mistakes can be devastating and career-ending if it is not handled well.
A stable home life and a wise and understanding spouse are all protective and guiding factors.
But this takes time to build into a marriage.
It is recognising that your medical spouse has had a tough day dealing with issues that you will not understand and that they may not be able to disclose.
It’s responding to them with love and not taking it personally when they seem detached and distant — this happens often in our marriage.
Your clinical performance is directly related to the quality of your marriage
Although doctors are masters of compartmentalization, this clear facade will eventually erode. Trust me, I am a doctor.
The success and the trajectory of a medical career rise and fall are both tied to the quality of your marriage.
If your marriage is falling apart, a person can only compartmentalize their life for so long before it starts to erode their mental state and impact the quality of their clinical work.
A doctor with deep relationship woes is not functioning at their best no matter what they say.
On the other hand, a beautiful marriage can be the strength of a doctor’s life — this is how I feel and the reality of my personal journey.
The support and wisdom of their spouse can be a catalyst of deep personal growth and an important cushion for the blows sustained at work.
However, most importantly, having a partner to share the joys and success of medical life is especially sweet and deepens the quality of your relationship and enjoyment of life.
The challenge of maintaining good mental health
The impact of stress on doctors on mental health is can be enormous and should not be underestimated. This impact inevitably spills into the inner and outer world of marriage.
Anxiety over treatment decisions, premorbid psychological distress, patient expectations, making mistakes, the “buck stopping with you”, hospital politics and government intervention, private vs public medicine and race to the bottom with bulk-billing, the highly litigious environment, social media and defamation and not to mention the lure and impact of sex, drugs and alcohol are all common stressors that doctors face in their careers.
And if we do not intentionally consider and managed these stresses appropriately through self-care (professional supervision, emotional self-care, counselling, debriefing) these can become significant factors that WILL affect your closest and most prized relationship, your marriage.
This is why being intentional about your self-care as a doctor and building circles of protection around your marriage is foundational to protecting what is sacred, intimate and God-ordained.
The long road to being a grown-up doctor — the impact of medical training
Medical training is arduous and partnering with a doctor can sometimes look like you are giving your life away, settling for their dream instead of yours.
Medical training is a requirement for specialist registration and so whilst it incurs a personal impact, it certainly is not personally directed at any individual.
This is directed by the systems organised by our Specialty Colleges. And it may require you to move to another city, state or country to become certified, accredited and followed. This is our reality and what is required by the College for you to be unconditionally registered and find work as a specialist.
And this is the journey that all doctors need to take in order to follow their calling. We may need to move (several times) and we will certainly need to spend time outside of work studying and working slightly longer hours — this is medical training in 2023.
The impact on marriage is that this time does come out of your recreational, family and self-care budget, so priorities need to be discussed and arranged before rather than reacted to in a moment of crisis.
It is so clear to me that this can potentially be the root cause of many relationship issues and strains in a medical marriage.
As a spouse who has worked for long stretches of time and spent hours studying, it all came down to attending to Kylie’s needs.
What I learnt through those training years was that my wife was my number one priority over my exams and work schedule.
This was much easier said than done, but here is what it looked like for us:
(1) Checking in regularly — talking/texting/writing notes to each other
(2) Involving myself in her life and serving her — attending to what she needed from me (it was never much, but it was something — picking the boys up from school, usually putting the boys to bed, washing the dishes, taking out the rubbish, vacuuming, going to the shops…..I did what I could to serve her.
(3) Scheduling time for intimacy and time alone together — date night which was usually couch time usually because we were looking after little kids.
(4) Connecting each day — Using Kylie’s love language to connect with her each day
(5) Making sure Kylie was able to pursue her dreams too — We talked always about what we both wanted and it has changed in the different seasons of our lives.
Our medical marriage — the good, bad and the beautiful
I hate to admit it but I am easily distracted, usually by work and the selfish superficial complexities that consume my thoughts.
However, over time Kylie and I have worked on a communication style that allows us both to feel heard.
We connect best usually for a few minutes at the start of the day when are having our morning brief and at night during our couch time.
And quite honestly, work distractions can be quite consuming.
I’ll be distracted either by the enormity of what my day holds or dealing with the after-effects of work that I am still processing — breaking bad news, being on-call or whatever horrific injury, accident, deteriorating and devastating pathology I might be still thinking about.
And more so these days, it’s hospital politics, the challenge of COVID-19 and the people issues that I am increasingly needing to manage now as a senior doctor.
But despite this, and the busy and all-consuming season of raising our three wonderful boys our marriage thrives.
Kylie is more beautiful to me than the day I married her — I believe that is what real marriage should be!
We’ve grown closer to each other, and more connected to each other’s needs, each year that our marriage rolls on.
Quite honestly, Kylie replenishes me with her presence.
I look forward to seeing her each day.
Our marriage is playful and even the tensest moments are bathed with a clear understanding of our dedication to each other — till death do us part.
We are each other’s biggest fans but also wise counsel and the largest corrective force in each other’s lives.
And to achieve this in amongst the organised chaos of my medical life, a few things have remained a constant.
We have daily practices and routines and standards for our marriage that we’ve set for ourselves and learnt through many late-late-night discussions (which we don’t have anymore), spirited arguments and openly talking and sharing about our marriage.
But our marriage hasn’t always been so wonderful…..
Not long after starting my first registrar position and a few months after our first son Samuel was born, Kylie and I were fighting consistently.
It wasn’t pleasant and our marriage was less than replenishing for either of us.
There were plenty of moments of desperation and at times and I wondered if we’d eventually separate — it was that bad.
This was 5 years into my post-graduate training and our seventh year being marriage. I was a young emergency registrar in a busy department and my work was depleting me. My priorities were disordered and I had nothing left for anyone, let alone my wife.
Kylie and I were not connecting with each and thus we weren’t communicating.
We’d turned away from each other and were not listening to each other’s needs.
She was tired and lonely and caring for our first son Samuel who was a toddler and I was tired too and looking for meaning in my work and trying desperately to replenish myself and fight the insidious burnout that was enveloping me.
“Why don’t you go to a marriage counsellor” was a suggestion from a close medical friend.
I didn’t want to go to a marriage counsellor for a variety of reasons (mainly pride and about our business no longer being private) but this one move was the catalyst for change in our relationship.
Marriage counselling worked for us.
It helped to break down the walls that we’d put up and it helped us to start communicating and most importantly, connecting again.
It only took a few sessions before we’d opened up a dialogue and we started to look for points of connection at home.
I started to see where Kylie was coming from and the challenges she faced each day.
She missed me and wanted nothing more than my time, touch and presence.
It’s strange but that was what I wanted too!
However, underneath the fog of hurt, the unresolved arguments and the snappiness that had built up, this was extremely hard to see.
I was thoroughly impressed that our counsellor sliced through to the root of our issues and offered us clear advice and actionable solutions.
She was objective and held us both within a clean space of accountability, but I guess that’s what professionals do!
I acknowledge also that Kylie and I were receptive clients, ready to do anything to be better and save our relationship.
This was the point of change in our medical marriage.
- Kylie and I reordered our priorities and got rid of the tiredness script and started making time for each other and ourselves — we set our agenda straight.
- We built self-care time in our marriage which has become central to my longevity as a clinician.
- We made time to talk each night, time to date one another and most exciting of all, scheduled regular intimate time together.
- And for my part, I started to clean up my act. I got real about my relationship with God and I also found a mentor. My mentor was a few years older than me and had been married for decades and raised wonderful adult children. I focussed on my behaviour and contribution to our marriage and instantly saw areas that I needed to change.
- We started turning towards each other much more rather than turning away
And the more we repeated these simple actions, the stronger our connection became.
It was simple, romantic, elegant and beautiful.
And this experience taught me an important lesson that has become central to how I approach our marriage and has served me well ever since.
Look for points of connection
I look for points of connection to Kylie’s heart and do my best to connect with these each day.
The foundation and work of a medical marriage — look for points of connection
Quite simply, I’ve learnt about how I can make Kylie feel safe and secure, loved and cherished and adored and served through a few simple daily actions.
It all starts with an attitude that seeks to connect with her heart each day despite what is happening in my world.
I look for points of connection.
Every woman and man has their own language of love.
This is a way that they experience love from their spouse.
And my number one job each day is to connect to Kylie’s heart each day by speaking her love language each day.
Dr Gary Chapman wrote a breakthrough relationship-changing book entitled “The Five Love Languages” which wonderfully described how every person experiences love, and these are not always the same!
The love languages are:
- Acts of service — For these people, actions speak louder than words
- Receiving gifts — For some people receiving a heartfelt gift makes them feel loved!
- Quality time — For some people, spending unbroken and undivided time is how they experience love
- Words of affirmation — For some, words convey love and affirm them
- Physical touch — To these people, nothing conveys love more than physical touch and embrace
Reference: Learn the Five Love Languages
Kylie, experiences love through physical touch, time spent together and acts of service.
She loves a hug both in the morning and night, a neck and back rub when I can and time spent together on our couch.
And because she knows my schedule intimately, we plan monthly dates well in advance and any help I can offer with the boys is always welcomed.
But as spouses of doctors know, our smooth scheduled bubbles of time can be interrupted by unpredictable emergencies and complex patients.
Our schedules have to be intentional but also flexible.
It however can never be one-sided and never operate with a credit and debit system of “owing” time to one another.
This is because when we then move to a transactional and works based-marriage that is founded on points scored, points lost, time owed and time lost — we both lose.
The transactional model isn’t a marriage. That type of marraige is a game with winners and losers.
*Pro tip, there are always two losers (and the “winner in marriage” is kidding themselves)*
At 19 years, despite the testing and turmoil in my work and the changing seasons of our lives, I will always seek to connect to Kylie’s heart.
Be it my touch or words, or serving her the best I can, we aren’t playing games anymore. This is real and high-stakes. This is our marriage and it matters beyond any other earthly priority.
This is our medical marriage in 2022.
Five thoughts about making marriages work in medicine
I am an advocate for long, beautiful, death-do-you-apart marriages.
This is because the single most important relationship in my life is my marriage and connection with my wife Kylie.
And as such, I have written a few thoughts about how to make medical marriages work.
Thought 1# Repair it now and do not sweep it away
Medical marriages and every other type of marriage will fall apart if there is no repair.
When you push important sticking points and issues away and when you sweep away points of conflict — that fight this morning, the snappiness that came out of nowhere or the sadness or low mood you are experiencing.
When you sweep these little but important exchanges away, it always gathers, builds up and surfaces when you least expect it.
Marriages usually end when the unspoken becomes a burden too great to carry any longer.
Medical marriages are notorious for looking good on the outside but falling apart and disintegrating behind closed doors.
Intentionally looking good to cover the mess inside is an outward sign of sweeping it away.
And we do this for a variety of reasons but mainly because we may not have the language to engage and ask our spouse about what is going on and what we can both do to deal with our issues.
It could also be a sense of insecurity and the fear of what others may say or think about the real truth of our marriage and good-looking life.
Can I encourage you that repairing what is broken and hurt is the key to a long-lasting marriage?
“Repair in marriage refers to any statement or action, silly or otherwise that prevents the negativity from escalating out of control.
Repair attempts are the secret weapon of emotionally intelligent couples”.
(Read this article on repair on the “Secret Weapon of Emotionally Intelligent Couples).
Did you read that?
“Repair attempts are the secret weapon of emotionally intelligent couples”.
When anyone talks about “working on their marriage”, it is almost always about repairing and building a communication style and attitude that seeks to repair rather than sweep away and hope for the best.
According to Dr John Gottman in his brilliant book Seven principles of making marriage work,
“The success and failure of a couple’s repair attempts are one of the primary factors in whether their marriage flourishes or flounders.
And again, what determines the success of their repair attempts is the strength of their marital friendship”
This is an excellent segue into my next point.
Thought 2# Aim to be best friends and lovers, not administration partners with benefits
The greatest generator of passion, excitement and being replenished by each other in your marriage will be the friendship with your spouse.
So often within the busy years of medical training, establishing a new practice whilst raising little ones, marriage can feel more like an administrative relationship with benefits than a romantic friendship.
And it’s not hard to see why when there are bills to pay, holidays to organise, financials to get sorted, kids to raise, practices to run, research and clinical administration to check off and self-care to squeeze in.
These are all important but not as much as the one thing that brought you together in the first place — cultivating your friendship, the joy of being together and losing time playing with one another.
This is possible in the busy season, but only with intention.
Trust me, I’m a doctor.
In the busy sleep-deprived years of raising our children when we had 3 boys under the age of 7, Kylie and I prioritised connection and time with each other.
It wasn’t elegant or Instagram-worthy but it happened.
Day in, week out, months flowed into years of compounded connection.
And this built an unshakeable foundation of “nothing matters more than you and I and then the rest of the stuff”.
Kylie and I actively cancel events and commitments so that we can spend “slow time” together.
The one thing that I know is that after this season of raising children is over, it’ll be Kylie and me as parents from afar but best friends and lovers until death parts us.
I’ve written about this before in an article entitled “Best Friend”.
Your friendship is everything, cultivate and protect it each day.
Do not let anyone else or any other competing priority break the covenantal bond you made with each other.
Thought 3# Make your points of connection the daily bread of your marriage
The clearest path to cultivating a marriage that grows deeper in love for one another is connecting to one another hearts every day.
This attempt at connection is best focused on how your spouse experiences love.
And it doesn’t need to be fancy but it needs to happen.
I experience love through touch, words of affirmation and time spent together.
Kylie’s learnt this and writes notes to me often.
She’s the first to encourage me and let me know when I’ve done something well.
We schedule regular lunch dates and time alone away from the boys.
We’ve learnt to hug and kiss each other every morning and the “kiss on leaving and arriving home” has been our staple for nearly two decades.
We never celebrate Valentine’s day or need to resort to grand gestures.
This is because we deposit connections every day and it has compounded significantly over time.
The other important aspect of making a connection is receiving your spouse’s “bid” for the connection.
Too often through the busyness of life and preoccupation with the most urgent, we may fail to see our spouse’s bid for connection.
John Gottman suggests increasing the ratio of positive connections to negative interactions within a marriage enlarges a couple’s emotional bank account — read more here.
Thought 4# Build circles of protection around your marriage
In 2022, the one thing that saddens me the most is the “mature marriages” that break up and the growing number of “grey divorces” that are occurring.
This is because I often find myself thinking about these people and their marriage asking “what went wrong here? It seemed so good,”.
But more so, it leads me to reflect on my own relationship.
Not long after Kylie and I started to get our marriage back on track as young registrar, I became focused on protecting what we had started to rebuild.
I never wanted to find myself in a situation where my marriage vows were at risk of being compromised or continuing along a path that was drawing me further and further away from Kylie.
I called this “building circles of protection around my marriage” and I became intentional about my behaviour, what type of media I consumed and the types of people I hung around.
I’m talking about adultery here. Having an affair. Breaking the covenant and promise of marriage.
But see, the affair or the cheating isn’t the worst part, it is only the beginning of the disaster.
I’ve written about this before, in which I asked my audience to picture their lives in short camera moments after the affair became public. To consider the effect and far-reaching ripples of your decision not simply on your wife or husband but on your children, your parents and family, your colleagues and friends and the cloud of shame, regret, sorrow and sadness that you’ve brought to those around you.
Build circles of protection around your marriage.
Avoid temptation, and run from it!
Do not flirt with sexual immorality or even consider it with your eyes, mind or heart.
As our Pastor Phil said on this subject, the best defence against adultery is a strong intentional offence — build a great, beautiful and face-meltingly passionate marriage.
Building layers of protection around your marriage results in you never finding yourself in a morally compromising situation.
It is drawing a line way before it becomes an issue around your relationships, your internet and social media use, how and who you spend your time with and how you conduct yourself when you are alone.
A married man never ends up naked with a woman who isn’t his wife by accident.
Sex isn’t crossing the line because the line was crossed several moments before.
Here are a few suggestions about how you can build circles of protection around your marriage updated from my article:
1) Live an open-book life
Live a life of uncompromising integrity which starts with this maxim, “who I am in public is who I am in private”.
There are no secrets and nothing that I would be ashamed to come out into the light.
Think about your internet search history, the videos that you’ve consumed, and whom you meet without your wife present — this is a good start.
2) Find a mentor or friends with wonderful marriages
Find men who have solid marriages and hang around and learn from them.
Let these men be your guide and advisors in how to be a trustworthy and accountable spouse.
Your peer group influences the way you think and how you behave.
I’m proud and pleased with my circle of good men with decades of perfectly imperfect and wonderful marriages.
3) Acknowledge sexual temptation and draw strict boundaries in your life. Avoidance of any path that leads to compromising sexual behaviour is always the best option.
This is because sex is advertised and is on display everywhere.
Remember, an affair starts with your eyes and lust can grow into an unsatiable sexual urge if it isn’t stopped or avoided in the first place.
Watch where you place your eyes and know where they should go.
The false truth of “I don’t care where you get your appetite as long as you eat at home” is a lie and only believed by fools.
This is an example of a seemingly innocent pathway that leads to the destruction of your marriage.
4) Picture your life without her, the kids, the wonderful rhythm of life and everything you’ve built together.
This is devastating and self-inflicted unnecessary suffering.
Picture the best days of your life with your wife and children and understand that every time you move in the darkness or lust after another, this picture starts to erode.
And if you are not intentional about building circles of protection, one day it will implode and you will have nothing but regret, a broken home and an extremely ordinary and sad life.
Thought 5# Set your agenda and priorities first
Whatever we prioritise and set as our agenda is exactly where our attention lies and time goes.
If your marriage isn’t made a priority and remains a relationship of convenience that you take for granted, do not be surprised if it doesn’t survive.
Medical marriages are especially susceptible to wrongly placed priorities.
There is a myriad of seemingly more important priorities that can falsely blind the agenda of a medical marriage.
Training, study, fellowship exams, and research and I haven’t even mentioned the strain and stress of medical work yet! Not to mention, raising children, mortgages, investments, schooling and sports, in-laws, ageing parents, busy-body parents, your flagging fitness and tighter fitting pants, career progression, medical contribution, community involvement or simply stopping to smell the roses!
The most beautiful marriages that I have encountered are so because of their inherent simplicity.
Their priorities are simple and usually in this order —
(1) You and me till death parts us.
(2) Let’s love and raise these children to be wise, healthy and contributors to the world.
(3) Medicine is a calling but the connections to my wife, children and the things that bring me hope and meaning sit far above Medicine.
In the seasons of training or early to mid-career medicine, these are usually coupled with raising young children and or finding your rhythm and stability in the world.
There isn’t time for much more than work and study and playing with your kids.
But do not worry, seasons change.
Distraction is your enemy, believing that the good times from your single twenties, thirties and forties should keep on rolling.
This is where some men get unstuck and their crisis of “what used to be” drives their crazy and unexplainable behaviour.
Your marriage and your connection with one another should be the backbone and the foundation of your full life.
Everything, I mean everything is so much sweeter with solid and beautiful marriage.
A beautiful marriage is not perfect
When we live without clear and achievable standards for ourselves and our marriage, we live in the never-never and false promise of perfection.
Your spouse isn’t perfect and neither are you.
You are certainly going to mess up and fall short many times over.
But if you set standards and an agenda for your marriage, this will help drive your priorities and what you value and spend your time on.
Standards such as these are a good place to start —
Building circles of protection that you will not compromise
Setting priorities that favours time and connection with your spouse
Making a commitment to turn toward and repair what is broken and forgive what needs to be forgiven.
Making it your priority to look for points of connection with your spouse each day.
When I write about marriage, I am simply writing about my own story.
I’m not an expert on marriage but rather a growing expert on my marriage and allowing it to reach its eternal and godly potential.
The principles above are what Kylie and I live out each day.
We aren’t perfect and I know this doesn’t apply to everyone, but this is our story.
And these are words that I treasure and will look back on to recalibrate.
So, if these words speak to you, please share this article.
I believe in cultivating beautiful marriages and leaving a lasting legacy, especially in our profession of medicine.
Perfect marriages do not exist.
However beautifully boring and elegantly simple marriages are possible.
Thank you for reading and have an awesome year!
Enjoy your health and the wife or husband of your youth!
Dr. Jonathan Ramachenderan