Dear Prudence: Medical Residency & Relationship

[minoanmiss]

Q. Roiled in residency: My boyfriend is about six months into his first year of a medical residency program. He works 80-hour weeks and is constantly emotionally abused by his supervisors. This is par for the course in his specific program and, though he would like to make changes when he becomes a supervisor, he has little to no power to effect change now. The problem is this: He cannot, or will not, engage in any deep conversations when we spend time together. He’s so tired and emotionally fried that all we discuss is his day, some events in the news, and updates on our respective families. So many of the conversations I want to have are “off-limits”: hopes/fears/dreams/worries about our future together, trips I’d like to plan after COVID, anything that could remotely cause conflict.

I’m sick of having to manage his emotions and walk on eggshells. He has 10 days of vacation time for the whole year and can’t really use it because he’ll get in trouble with his team. He has a day off once every week or so, and he spends it catching up on sleep and playing video games to “unwind.” Even when he was in med school, he still made me and our relationship a priority. I feel like I don’t know this man anymore. I suggested counseling but the same issue comes up—he doesn’t have the bandwidth to discuss anything beyond our immediate day-to-day life. I’m at my wits’ end. What should I do?

A: It feels a little lazy to say this, but if you’re at your wits’ end, if he’s not willing to go to counseling with you, and nothing’s changed despite repeated attempts on your part, I think you should probably break up with him. Yes, even if you used to have a better relationship in med school, even if you think he’s a generally good person, even if you understand why he’s so fried all the time. It’s reasonable to believe this dynamic is going to continue for years, it’s reasonable to decide you don’t want to be in a relationship where such a dynamic is present, and it’s reasonable to walk away even if you know he’s not personally responsible for the overwork and mistreatment of medical residents generally. This relationship isn’t working for you, and this relationship isn’t changing; I think what you were hoping for is that I could offer a suggestion that would finally convince your boyfriend to take your frustrations seriously and do what you’ve been asking him to do. I don’t have such a suggestion! I just think you should leave wits’ end, even if it means you can’t take your boyfriend with you.

Comments

[minoanmiss]

Sorry for posting three in a row, but I couldn't stop thinking about this one. This is quite reasonable advice. But.

The residency is sucking the mind out of the boyfriend, and the residency has an end date. For a problem with an end date, I can see the argument that one put up with the guaranteed-temporary issue. That said, that argument would be a lot stronger if boyfriend seemed to have any awareness that his residency is eating his mind and leaving nothing for his relationship with his girlfriend.

I'm not sure if it would help to inform him that this combination of neglect and demanded caretaking is what the girlfriend is experiencing. Whether or not he internalizes that, either to say "let's work on it now" or "Please bear with me, I promise to make this up to you when I finish this residency" vs saying "what problem? I need to play a video game," would probably say a lot about whether it's worth it for her to stay or to go.

[castiron]

The residency has an end date, but is the end date in six months or 4.5 years? If it were six months, I'd say wait it out and see if he's willing to seek counselling after things have let up. But if BF is going to be doing these physically and emotionally exhausting 80-hour weeks for several years and doesn't recognize that it's ruining his relationship, yep, go.

[rmc28]

Yes, I was looking through the letter for an end date and didn't find one. I think there's a huge difference between "I will have time to talk about this in March" and "go away I need to play a game".

[julian]

Yeah. If it's "I know this sucks, but I just can't have this discussion right now," as opposed to, "I just can't, now go make me a sandwich," that does matter.

[jadelennox]

leaving aside the question of the end date, I do really appreciate the framing of the response: it doesn't matter if it's nobody's fault, it doesn't matter if it sucks for him, you have the right to decide what you want in your life and that's not uncool. So often advice answers Want there to be a bad guy.

[melannen]

I can't tell from the letter if there is "demanded caretaking". She says "manage his emotions and walk on eggshells" but it seems like all that means in the rest of the letter is he doesn't want to be expected to do things he doesn't have the bandwidth to do right now - she doesn't mention anything he seems to expect from her, except to accommodate the fact that he's fried.

The boyfriend having awareness of how his girlfriend is reacting is unfortunately contingent on him having something left for his relationship with his girlfriend, and he doesn't.

LW, your boyfriend doesn't have time or energy for you while he's a resident. That is a true fact that you can't change. You get to decide if you want to not have a boyfriend because you broke up, or you want to have an absentee boyfriend until the residency's over. But those are your choices. If he was in a coma or prison, would you stick with him for a bit? That's about where you are, I'm afraid.

[likeaduck]

Ooof, a medical emergency or being incarcerated is not the boyfriend's choice, or indicative of his priorities, though.

[minoanmiss]

That's true. OTOH, I don't think there's another way to become a doctor in the US than to undertake a horrible residency, so it's not really a free choice. But this was what I was thinking of when I was musing on whether it might be worth it to put up with the situation for a finite time. It still might not be worth it, of course.

[likeaduck]

There isn't another way. But people aren't typically forced to be doctors. And doctors have *so much power* and so much of what's terrible about residency is bound up with consolidating and reifying that power that I have a hard time seeing the residents in the system as powerless within it, you know?

[melannen]

Oh I didn't mean to imply a moral dimension with those comparisons, sorry! Only that she needs to treat this as a situation where her boyfriend is physically incapable of boyfriending for a set time, and may be a different person when he comes back. Maybe military enlistment is a better comparison, except that Basic is probably less traumatic.

Though I would say that medical residency isn't entirely unlike a medical condition - the level of sleep deprivation forced on medical residents would be classified as serious mental impairment if there was a different cause. If it's hitting him badly he likely isn't capable of making the choices he would if he were ok and she needs to know that too. This isn't "he chose to be in a stressful job" this is "he's been forced by a deliberately abusive system into a place where he is, by design, being systematically destroyed physically and mentally."

[likeaduck]

IDK, I get that the system is abusive, but lots of people choose not to be doctors? Or doctors in especially abusive fields? Heck, part of the gendered aspect I gestured at in another comment is that lots of women choose not to be doctors or quit med school/residency/specific high-prestige-high-abuse fields because these demands conflict with their other priorities. Part of why people stay in the abusive system is powerlessness, but part of it is choosing the profession/prestige/whatever over their other priorities or responsibilities, and it's hard to weigh out exactly how much is each.

[shirou]

I hope he dumps her, especially if they are/were thinking about children. I cannot imagine co-parenting with LW.

[p_cocincinus]

I totally agree. It's been six months. I don't think Spouse and I had a conversation about anything more complex than daily logistics for at least two and possibly three years after Bug was born.

[melannen]

I don't know, on the one hand LW seems pretty self-centered here - but on the other hand, someone whose reaction to exhaustion and stress is to shut himself in a room and play video games and refuse to address relationship conflict or do any kind of planning is also not someone I'd be excited about co-parenting with. (This is not an insult to LW's bf, it's what I do and I am not excited about coparenting with myself either.)

[lassarina]

There are many reasons I do not want to parent and one of them is that my reaction to stress is to ball up and tell everyone to go away. Not for six months at a time, usually! But I know this about myself and know that, in combination with my anxiety, chronic illness, and other factors, it makes me a very poor choice for parenting.

[likeaduck]

That seems so strange to me? I mean, we have so little information in the letter about the rest of their relationship, but expecting a partner to be able to talk about the state of your relationship, conflicts that come up, and whether or not you are doing xyz that you might need time to plan even just once in six months...does not seem unreasonable? Wanting a partner to occasionally spend some of their non-work time with you seems fine to me? Like, people who are parenting together need to talk to each other, need to be able to find the bandwidth to discuss things and make decisions together even when they're exhausted, so I don't see why the LW's goals here are incompatible with that?

[shirou]

Everyone has needs, sure. Yet after only six months, LW is “at [her] wit’s end” because of how the unusual exhaustion and abuse her boyfriend is suffering affects her. I don’t see a single word in this letter expressing concern for how the abuse is affecting him—the victim.

[likeaduck]

Six months of not addressing any conflict, or not addressing the state or future of a relationship (depending on the stage the relationship is at--sounds like theirs might be in a stage where they're still figuring out if their long-term plans are compatible) is a really long time. And his work situation is abusive, sure, but that's not a reason to just put up with him not being available for the kind of relationship the LW thought they were in, if he can't have any conversations about how and when he expects it to be different.

There are whole gender pieces to this too: how much of this do you think is that he doesn't view emotionally investing in his relationship as important compared to his job/the prestige of this probably-not-coincidentally-abusive program? How much does he not see that investment or maintenance work as his responsibility?

[likeaduck]

CRISTINA YANG ICON NOT ACCIDENTAL

[shirou]

I'm not sure we're disagreeing? I don't think LW has some kind of moral obligation to put up with her boyfriend being emotionally unavailable. She can leave, and better she do so than continue demanding something he is in no position to provide.

What I said is that I would not want to co-parent with someone who can't handle six months of emotional unavailability. Parenting asks a lot more of you.

As for gender: LW says her boyfriend was emotionally invested until the residency, including during med school, suggesting he does see emotional investment as his responsibility—when he has anything left over to invest.

[likeaduck]

I mean, what you said was, "I hope he dumps her," which seems to suggest you think she's being unreasonable. And you seem to be generalising your desire not to co-parent with her to at least her boyfriend.

[conuly]

So I'm gonna take a veer in a different direction here and say this: While it's probably true that LW's boyfriend just, generally, sucks, the other part of this equation is the fact that the way we do medical residency is actually bad and, honestly, an abusive labor practice all around. There's no excuse for it, and I'm not at all surprised that BF turned into a rage zombie who cannot put his relationship first, because residencies are designed to ruin people.

[likeaduck]

TRUE. And yet, what can you do? The LW can't change it! The Lw can only respond to the boyfriend's actions and take them as indicative of his priorities and capacities within a bad (but chosen) situation.