Doctor as rescuer
My husband has been pressuring me to take on coverage of a nursing home 60 miles from here for an internist who is pregnant and will soon be on maternity leave. He tells me the nurses are fed up with the doctor's irritability. He seemed awfully disappointed that I said no.
The urgency behind this request puzzles me; after all, he is the one who consults at that nursing home, not me. I don't know any of these people, the internist included. It isn't clear that the doctor even needs a replacement (she has at least one partner), and the doctor's irritability is likely to be temporary. But my husband has responded emotionally to the nurses' emotions in this situation. He wants to bail them out. He imagines the stress the internist may be under. He wants to bail her out, too. He projects his own anxieties about money onto me; he wants to bail me out, too.
Perhaps all doctors need to rescue others. I suppose at first I was that way, too. I quickly learned, though, that adults are rarely helpless victims (aside from acts of random violence or natural disaster), and bailing them out doesn't provide any lasting benefit.
When I first went into practice in a rural community health center, so many patients, young women especially, brought their problems to me. I heard about violent husbands and unruly children and dying parents and bad work environments and illness and symptoms and a whole slew of issues. At first I felt incredibly burdened by these problems. What could I do to fix their marriage or their job? What pill would make their violent husband go away?
Finally, I learned to respond with: "What do you think you need to do about this?" Most of the time the patient had good ideas, and was just looking for someone neutral to talk things over with. I could bolster their problem solving skills and even teach some additional skills, but no longer felt burdened with the job of finding the answers for them. I use that technique for medical problems too, especially stuff like obesity and tobacco use and stress management. "What do you want to work on first?" helps the patient focus on a smaller part of the problem and find goals that are manageable.
So, what is my husband's deal? He wants to rescue the nursing home staff, he wants to rescue the internist attending, and he wants to rescue me. None of us have asked to be rescued. And what does he get out of the rescuing? Well, he gets to be a hero, with grateful, helpless people, especially women, thanking him profusely for making their terrible problems go away.
No doubt rescuing others is the basic motivation for most people in the helping professions. I wonder, though, if the rescuer is the one who deep down needs to be rescued. My husband was the middle child in his family. His independent, self sufficient older brother probably resented him tagging along. And once his younger sister developed medical problems at a young age, the family focus turned to her. I suspect that the helpful, conscientious middle child disappeared off the family radar.
My husband admits that he has always wanted to cure his sister. What he doesn't talk about is how curing her would have turned the family focus onto him; who wouldn't want eternal gratitude? Over and over he tries to rescue people - his sister, his relatives, his first wife, who is an expert at being a victim; patients; me, I suppose. Who else? Then he collapses at the end of the day from all the responsibility that rescuing implies. There is never enough gratitude and admiration to counter all that responsibility.
So what do I do? I dig in my heels and resist his rescuing by proxy urges, and encourage him to get more information before assuming that the parties in question need to be rescued. And then I need to remind myself that his urgency may indicate his own need for appreciation and attention. It may feel like a bottomless well of need for appreciation and attention, but ultimately it is a need we all share.
And then, if my model of working with patients applies, it may be my job to help him refocus, to suggest other ways that the problems can be addressed. As his wife, I do have responsibility to give him attention and appreciation. The trickier part is to figure out where my responsibilities begin and end. It is awfully easy to be the guilty wife, and believe it is my responsibility to prevent him from suffering. The guilty doctor in me feels the same. Thank goodness for that little voice of sanity that helps me see that my own boundaries need protecting, too. Without boundaries, we all turn into victims.
The urgency behind this request puzzles me; after all, he is the one who consults at that nursing home, not me. I don't know any of these people, the internist included. It isn't clear that the doctor even needs a replacement (she has at least one partner), and the doctor's irritability is likely to be temporary. But my husband has responded emotionally to the nurses' emotions in this situation. He wants to bail them out. He imagines the stress the internist may be under. He wants to bail her out, too. He projects his own anxieties about money onto me; he wants to bail me out, too.
Perhaps all doctors need to rescue others. I suppose at first I was that way, too. I quickly learned, though, that adults are rarely helpless victims (aside from acts of random violence or natural disaster), and bailing them out doesn't provide any lasting benefit.
When I first went into practice in a rural community health center, so many patients, young women especially, brought their problems to me. I heard about violent husbands and unruly children and dying parents and bad work environments and illness and symptoms and a whole slew of issues. At first I felt incredibly burdened by these problems. What could I do to fix their marriage or their job? What pill would make their violent husband go away?
Finally, I learned to respond with: "What do you think you need to do about this?" Most of the time the patient had good ideas, and was just looking for someone neutral to talk things over with. I could bolster their problem solving skills and even teach some additional skills, but no longer felt burdened with the job of finding the answers for them. I use that technique for medical problems too, especially stuff like obesity and tobacco use and stress management. "What do you want to work on first?" helps the patient focus on a smaller part of the problem and find goals that are manageable.
So, what is my husband's deal? He wants to rescue the nursing home staff, he wants to rescue the internist attending, and he wants to rescue me. None of us have asked to be rescued. And what does he get out of the rescuing? Well, he gets to be a hero, with grateful, helpless people, especially women, thanking him profusely for making their terrible problems go away.
No doubt rescuing others is the basic motivation for most people in the helping professions. I wonder, though, if the rescuer is the one who deep down needs to be rescued. My husband was the middle child in his family. His independent, self sufficient older brother probably resented him tagging along. And once his younger sister developed medical problems at a young age, the family focus turned to her. I suspect that the helpful, conscientious middle child disappeared off the family radar.
My husband admits that he has always wanted to cure his sister. What he doesn't talk about is how curing her would have turned the family focus onto him; who wouldn't want eternal gratitude? Over and over he tries to rescue people - his sister, his relatives, his first wife, who is an expert at being a victim; patients; me, I suppose. Who else? Then he collapses at the end of the day from all the responsibility that rescuing implies. There is never enough gratitude and admiration to counter all that responsibility.
So what do I do? I dig in my heels and resist his rescuing by proxy urges, and encourage him to get more information before assuming that the parties in question need to be rescued. And then I need to remind myself that his urgency may indicate his own need for appreciation and attention. It may feel like a bottomless well of need for appreciation and attention, but ultimately it is a need we all share.
And then, if my model of working with patients applies, it may be my job to help him refocus, to suggest other ways that the problems can be addressed. As his wife, I do have responsibility to give him attention and appreciation. The trickier part is to figure out where my responsibilities begin and end. It is awfully easy to be the guilty wife, and believe it is my responsibility to prevent him from suffering. The guilty doctor in me feels the same. Thank goodness for that little voice of sanity that helps me see that my own boundaries need protecting, too. Without boundaries, we all turn into victims.
posted by HS at 8/09/2006 11:00:00 AM
1 Comments:
You know what's weird? Just a couple days ago I was trying to figure out whether supporting my husband in a certain situation was truly support or rather enablement. I decided to distance myself and pretend I wasn't his wife. From that vantage point, it became clear that in this instance, he would benefit from support.
Sounds like you've known this technique for a long time, and that you know your boundaries better than a lot of people.
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