I met my husband my second day on campus at Northwestern University, 1991. He started one year ahead of me; I met him in the bookstore. He was an established  molecular biology major, having years of laboratory research experience behind him already. I, too, decided to major in biology, but with a concentration in physiology. The micro and the macro–that may describe us in a nutshell: Both awed by the mysterious and yet completely logical ways of the body—the ultimate integrated system—but from opposite ends of the spectrum. We trained at the University of Chicago, that mecca of hard core basic science. Research and discovery of the fundamental mechanisms of disease—much of it at the molecular level—still thrills him, and leaves me positively lethargic. Show me how people transform health through relationships and beliefs, how the mind and body are connected in ways we cannot measure—that seizes my attention.

Today my husband specializes in orthopaedic tumors and joint replacement, and I do primary care. Much of his professional world consists of binary decision making: operate or not, the experiment proved the hypothesis or not. I like exploring multiple solutions for a particular problem, withholding judgment, and trying one approach at a time. Personally, he likes to be alone; I love people, the more the better! He makes decisions based largely on data and devoid of emotions, whereas I root my decision trees firmly in how I feel about the issue at hand. I seek color, texture, and meaning in everything around me; his needs are pragmatic, functional, and stoic.

And yet, what seems contrasting and opposed turns out to be, in every sense of the word, complementary. For the most part, we both balance objective and empathic information when making decisions. But when my emotions run high and objective data look fuzzy, he points out the practical implications of my choices. When he faces decisions that impact relationships, I help him identify core values that lead him to settle on one side of an issue with confidence. When both people in a relationship are free to be fully themselves, without fear of judgment or ridicule, their differences, and respective strengths, hold each other up.

The most interesting conversations we have about work revolve around teaching.  As a surgeon, his primary charge is to prepare his trainees to be technically excellent in the operating room, to carry out patient care decisions with confidence and resolve. Nobody wants a wishy-washy surgeon. My teaching focuses on fostering empathy, role modeling excellent listening skills, and showing students that no matter what specialty they choose, their patients will always need to feel seen, heard, understood, and cared for. In primary care, the old saying, “They won’t care how much you know until they know how much you care,” has explicit meaning. I like to think that because of me, my husband models more mindful interpersonal skills for his residents and students. And because of him, I try always to incorporate evidence and concrete, goal-oriented rationale in my decision making. We influence each other for the better.

The long-standing tension between surgeons and non-surgeons remains a fact of life in medicine today.  Stereotypes peg internists as ruminating and indecisive, and orthopaedists as dull-witted, mallet-wielding carpenters. This territorial, oppositional culture can be insidious and damaging.  How can we do best by our patients if we cannot get along ourselves?  In our ‘mixed’ marriage, I see us bridging this gap.  I hope it translates to better patient care. For ourselves, at least, it makes for interesting dinner conversation and a shared love for our work. And we would not have it any other way. Footnote: I first published this post on the American Holistic Medical Association blog in 2012.

I had not seen jaundice that bad in years.  He was Caucasian, in his fifties, about five feet, ten inches tall, 150 pounds, maybe less.  He wore straight leg jeans and a thick leather bomber jacket zipped all the way up, and his face was noticeably yellow, even from 100 feet away.  We walked toward each other along a busy sidewalk, on an overcast spring day.  I immediately scanned down to his hands, looking for a hospital patient ID bracelet.  “Why is such a sick man walking around on the street?  Which hospital did he just escape from?” I thought.  I saw no ID band, and his hands were not yellow, though they did look slightly thick—maybe swelling from liver disease?  He walked at a normal pace, no listing or shuffling.  Aside from his yellow face and apparent thinness, he actually did not appear ill.  As I got closer, I noticed that he wore Top Gun, Tom Cruise-style sunglasses, with lenses the shade of a perfect urine specimen.  His skin color was normal.

Would a non-medical person have immediately assumed he was an escaped liver patient, wandering the streets under the influence of hepatotoxic encephalopathy?    “How fascinating,” as Ben Zander would say, that I jumped to these conclusions, having only glimpsed this man from a distance.  What if I had turned an early corner and not gotten a closer look?  In the space of a minute or so, I perceived something shockingly abnormal, and with just a little more observation, reconciled it as only mildly out of the ordinary (I think not a lot of people wear pee-colored glasses).

Weeks later, a headline appeared on my Facebook feed: “Dad’s reply to school on kids’ absence is best response ever.”  The school principal had sent a letter to the family informing them that absences for family vacation were unexcused.  The father replied with a page-long justification of the high educational value of their trip.  Like many, I congratulated the father on his response, feeling righteous and indignant on his behalf.  My sister posted a subsequent article on my page, pointing out that the principal’s letter was merely informational and a formality, not a personal indictment of his choice of vacation timing, and that the father’s public shaming of the principal was both uncalled for and petty.

I feel embarrassed for holding him up like I did.  I don’t condone public shaming, what was I thinking?  I believe now that the headline attracted me for a reason.  Maybe I myself feel defensive around my own children’s school absences for family vacations.  I think I was preconditioned to take the dad’s side, to take the principal’s letter personally, as my medical training led me to see that man’s yellow face as evidence of end-stage liver disease.  Now I am the one wearing pee-colored glasses.

When I first read the father’s response, I wondered about the principal’s purpose in sending her letter.  But I did not take the next step to answer my own question.  Had I read it again, as I did after my sister’s post, I might have realized sooner that it was simply an informational form letter, and did not at all deserve the father’s negative public retort.  How was I able to correct my initial conclusions about the man on the street, and not about the principal?  My observations of the man were objectively inconsistent—apparently jaundiced face but normal colored hands and not otherwise ill-appearing—and I have no personal feelings about people with jaundice.  I do, apparently, have feelings about receiving notices from school about my decisions regarding my children.  My judgment of the principal’s letter came from that emotional place, and impaired my ability to see objectively.

These two very different situations remind me to monitor and manage my biases–inspect the tint of my glasses–early and often.

One bright, spring Saturday morning in clinic, I met a pleasant middle-aged woman with a cold.  She was new to me, but I recognized her right away—educated professional, mother of two, loving wife, keeper of all schedules and task lists—the command center of her complex world.  Her symptoms had followed the typical arc of a viral upper respiratory infection—fatigue, sore throat, nasal congestion, headache, fever, cough—and it was the green snot that brought her in on day 5.  My physical exam revealed no signs of strep throat or pneumonia…

The relaxed calm I had felt heretofore began to unravel as I contemplated telling this woman, suffering at the peak of acute illness, that I would not prescribe an antibiotic.  In an instant I heard familiar scripts in my head:  She did not have time to be sick; she needed something to kill this infection right away.  She was about to travel and did not want to feel this badly on the plane.  Her regular doctor always gave her an antibiotic for this before.  The snot is green, that means it’s bacterial (it doesn’t)!  My mind’s eye saw hers widen with disappointment, then anger, her posture turn aggressive.  My inner conflict escalated quickly:  Sacrifice the rapport I had just established in the name of antibiotic stewardship, or give in to the misguided pleas of a wrung out fellow working mom, and contribute personally to the scourge of antibiotic overuse and resistance?

Maybe it was the sunny weather that day, or the initial connection I had felt when we talked.  Amid the flurry of mounting anxiety, I had a flash of clarity:  What if I just asked her what she needed?

“What are you looking for from me today?” I queried.

“I just want to make sure I don’t need antibiotics.”

Imagine the absolute and complete relief of realizing that my swelling dread was, in fact, unfounded and unnecessary.  She needed reassurance, and probably formal permission to leave the air traffic control tower and go take a nap.  I cheerily listed all of my self-care recommendations, including a firm admonishment that she take care of herself ahead of all others for at least the next 24 hours, doctor’s orders!  The visit ended happily for us both.

“What are you looking for?”  Such a simple question, and key to understanding one another, as well as ourselves.  I was looking for connection, authority, relationship, and affirmation.  I wanted her to like me, and to trust that I knew my stuff.  And more than once before, I had given my best advice in this situation, only to be rejected as a power-tripping antibiotic extremist.  I had one eye out for an ambush.

What if we ask ourselves more often, both as patients and physicians, “What am I looking for?”  Could we identify biases and fears more readily, and then challenge them?  Would it make asking for and getting what we need a little easier?  What do you think?