Confirmation Bias in Marriage

There's a saying in residency: “You see what you look for. You look for what you know.”

I remember as first-years we had to come up with interesting cases to present for weekly grand rounds given for the entire body of ophthalmologic faculty, a nerve-wracking experience. We had to figure out how the knobs on a slit lamp worked while simultaneously finding something interesting to world experts, then get grilled on-stage about differentials and management. Every single week. That’s Hopkins for you. Anyway, during early morning rounds we’d pool together what cases we could find to see what passed muster for our chief resident. He was someone we looked up to as a demigod: tall and attractive, impeccably dressed, freakishly intelligent with intimidatingly high standards, but somewhat socially awkward. Terse, blunt, the opposite of nurturing or effusive. He had a way of talking without saying a word, and as we’d go through the one or two cases we could find, he’d purse his lips dismissively and ever-so-slightly shake his head.

There was always one resident in my class who’d have a list of eight or nine cases each week. We’d each be desperately trying to dig out one case, and he’d pull this long list out of his white coat pocket. Some of them were ridiculous, but more often than not he’d have one or two worth presenting. I was always dumbfounded: we worked in the same clinics; how did he end up getting all the interesting patients? Until I realized: he read. All the time. I mean, I would read about a diagnosis here or there, but he was reading thoroughly through entire ophthalmological texts. He didn’t get all the interesting patients; he just knew what to look for. Things that probably passed right under my nose.

It’s a bit like confirmation bias: we see what we expect to see, which then confirms what we expect. Some of the cases were ridiculous because he saw what he wanted to see rather than what was contextually likely, but a lot of the cases were true pick-ups of interesting findings that others would have overlooked. The point being, what we think or know shapes how and therefore what we see. To some extent, we see what we want to see.

This is especially true of marriage. In marriage you see the strange juxtaposition of someone’s most unfiltered strengths and weaknesses. No one knows better than a wife how her husband is self-sacrificial, hard-working or the like: she also knows better than anyone how he leaves his socks on the floor, or farts, or whatever. When you focus on the good things, you don’t notice the bad things as much, and sometimes they even become oddly endearing. When you think about the bad things, they seem to be everywhere.

If you think, he never knows what to do with the kids, you’ll see him getting the wrong milk cups out or putting mismatching clothes on them. If you think, he’s so untidy, you’ll notice all the times he doesn’t immediately put something back the way you would have. If you think, why does he have to zone out so much? you’ll start seeing all the times he checks something on his phone or watches shows. But if you think, he cares about us so much, you’ll notice the way he sets out breakfast bowls the night before to save you time in the morning. If you think, he serves without complaining, you’ll notice how he always drives, or changes diapers without being asked. If you think, he’s so generous, you’ll see how he never criticizes what you buy for yourself.

In a discussion about her book The Surprising Secrets of Highly Happy Marriages, Shaunti Feldhahn once spoke about how couples who are happy do one simple thing: they think the best of each other. If a husband is late for an anniversary dinner date, for example, the wife could be sitting there thinking: he’s always late. He doesn’t care about us. He always works too much. Or she could be thinking, he’s doing his best. He must believe that whatever is keeping him at work is important for both of us—and that makes her respond differently to him when he finally shows up.

On the flip side, psychologist John Gottman microanalyzed videotapes of couples talking, documenting tone of voice, facial expressions, and body movement. He found that the greatest predictor of divorce was the expression of contempt. Contempt is the end product of steadily seeing the worst in your spouse: eventually they become someone subhuman. Someone you treat in ways you wouldn’t treat a stranger on the street. As Gottman says, “it’s trying to put that person on a lower plane than you.”

I’m not suggesting turning a blind eye to real issues we need to talk and work through, but I think it’s true that who Dave becomes is often a product of the dialogue I carry on in my own head. And how I see him affects so much of who he literally becomes, since words and perceptions have so much creative power in marriage. Am I conscious of what I’m thinking? Of what I’m noticing about him and any judgments I make? What have I seen about him today for which I’m grateful? This all could apply just as easily to the kids. But that could be a whole other post.

Of Medicine and Motherhood

Raising young children is like the residency of parenthood. I was reminiscing on my medical training experience, only to realize it’s not all unlike what I’m experiencing now. The similarities are intriguingly numerous once you think about it: the chronic sleep deprivation that comes from being awake at all hours of the night and trying to catch up on sleep at all hours of the day. The heart-sinking feeling when you get paged just after dozing off in the call room, not unlike the feeling when the baby starts crying right after you’ve settled into bed.

The unpredictability of your schedule: getting an admission just before your shift ends that wrecks dinner plans; the inevitable blow-out diaper or tantrum just before we’re ready to leave the house. The resultant difficulty of finding deep community, of trying to get to know people or attend events whilst navigating call schedules or bedtimes or being quarantined inside with sick kids. The temporally consuming nature of both, to the exclusion of all else if you’re not careful.

The wacky diets: coffee and granola bars and pilfered graham crackers and peanut butter in residency. Now it’s peas, packets of squeezable apple sauce, goldfish, string cheese. Not eating out much and sometimes not eating in much either—finishing the kids’ leftovers while standing over the sink is routine—which is perhaps why I keep losing weight.

Even the dress and accessorizing: gone are dry clean-only items, smart little purses, heels and makeup. In residency it was scrubs and clogs and white coats that accumulated patient notes, extra scripts, lenses and drops. Now it’s jeans and pajamas and diaper bags that accumulate extra socks and chew toys. Both reflecting the unending grunt work: paperwork and dressing changes and bedside consults as a resident; now, diapering and feeding and outfit changes (whoever invented onesies with buttons has obviously never tried to button up a squirming infant). In both cases, dealing with bodily fluids.

And so, it’s like I moved from one residency to another. I was just finishing the last of my medical residency years when I embarked upon what would become four kids in six years. In a way, it feels like we never got a break. I sometimes daydream about what life would be like if we had nine-to-five jobs with no kids: the fantasies usually involve a perfectly-decorated abode, pets (either an Abyssinian cat or a great dane), cultivated hobbies like oil painting and world traveling, and, between my working full-time instead of part-time and having no diapers or college funds to pay for, a hecka lot more disposable income.

But of course, catching the break isn’t the point. The point isn’t imagined comfort but forged meaning. Clearly in these seasons there is risk of burn-out, isolation, and depleted relational margins. But perhaps because we are so pushed in meeting daily demands, we are more aware than usual of how we are doing, with God and with each other. The stressors expose our inner condition and relational status, and in coming together to live the residencies of life with purpose, we become stronger. There’s really no room for narcissism or torpitude in this world of compulsory daily service. It’s a transformative period, probably in ways that only time will tell.

Primary Parent

“Most two-career families sooner or later find that one person falls into the role of lead parent. To be sure, Anne-Marie was actively involved with our boys, taking responsibility for specific chunks of their lives… But none of this is lead parenting. Lead parenting is being on the front lines of everyday life.” – Andrew Moravcsik

The reality is, there is always a primary parent. Dave and I started off extremely equitably; there were long stretches in residency when he did nearly all of the childcare during my demanding rotations. I remember once, Ellie’s daycare closed due to a blizzard. I was in the OR about to scrub in on my next case. Dave was in the ICU about to place a central line. He called out and I kept working.

But over the past six years, I’ve slowly taken on more of the everyday childcare duties. I felt more strongly about being home for the kids, so the transition happened naturally. With the addition of each kid, I worked a little less, and the demands of parenting increased a little more. Simultaneously, Dave’s career has taken off, and like they say, success begets success. The grants and speaking requests and committee invitations multiplied, leading to greater travel. He started studying for a doctorate. He was gone more; I was home more.

So I’ve been learning more and more what it’s like to be the primary parent.

It’s hard. It’s much harder being at home in some ways than being at work. I mean, it’s hard to even talk about why. If I have a hard work day, I can say “there was this refractive error after surgery” or “this patient was upset about this”—a hard day at home would be something like “well I was nursing Esme and praying she would finally sleep since I needed to get dinner cooked and she was so grumpy I had to hold her all afternoon but Elijah and Eric were downstairs bickering again and Elijah started screeching so loud Esme was being distracted and I was thinking why can’t they stop fighting for one moment!”

So yes, it’s unpredictable, and isolating, and unlike Dave’s job, it never ends. I think there’s also a cultural double standard, that women should be the ones staying home with the kids. If I go out with four kids alone, people say almost apologetically, “you’ve got your hands full,” like “I feel so bad for you; how did you get yourself into this?” If Dave goes out alone with four kids, he gets all this “you’re so amazing! Look what a great person you are! They’re all so cute!” Sometimes the double standard makes it harder to feel appreciated, and rarely do I feel understood in the context of the toll it has taken in my career. People who see me with the kids just assume I don’t work or never worked.

The rewards of being the primary parent are simultaneously less tangible and more meaningful. I call it my “every diaper counts” theory of parenting. Every thing I do for them matters. It matters in living out who I am for them, in teaching them, in showing them I love them. Let’s face it: parenting young children involves mostly tasks you could pay anyone to do. I didn’t go to school for twelve years to pour milk and draw Darth Vader and wipe poop. But all of that matters, and these years when they are uninhibited in their openness and attachment won’t last forever, and I have to believe what I do now counts. Everything, the big and the small. Like they say, with kids, quality time doesn’t come without quantity of time.

If I could given myself advice, I would say: guard against resentment towards the non-primary parent. Don’t get upset if he can’t read your mind about how things are done at home; communicate better about parenting issues and daily details so you can be together in it as deeply and smoothly as possible. Remember to schedule regular time away from home for yourself. Remember to be in community with other primary parents. Remember the good moments and write about them.

Reading Comprehension

Lately I’ve been realizing: being able to read is not the same as being able to understand what you read. Being able to understand what you read is not the same as being able to express that well, verbally or in writing.

It surprised me once when Ellie said her least favorite lesson at school that day was reading comprehension: that girl does nothing at home but sit around reading all day!

But I think reading, and reflecting on your reading—reading for meaning, not merely for fun—is an acquired skill. Probably one most of us do so automatically we’re not aware of how we do it. But research reveals that most children do not know how to check their understanding as they read. It has to be taught.

There are some basic tools that help with reading comprehension. One is acquiring good vocabulary. My favorite way of doing that with the kids is reading above their reading level and explaining words as we go. Another is teaching about genres and how they work: the elements of a story (plot, point of view, setting, theme, characters), poem (rhymed verse, free verse, literary devices like alliteration, metaphor, repetition), or non-fiction (headings, maps, index).

Then there are common reading comprehension strategies, to facilitate interaction with the text. Here is a summation of all the ones I found after some brief online research:

Connecting: what else does this remind you of? Is this like or unlike a past experience, other books?

Predicting: what do you think will happen next?

Visualizing: what picture do you have in your head as you read? Can you draw a picture after you finish reading, of how you felt, or a character or favorite scene?

Questioning: what questions do you have before, during, and after reading? What would you ask the author? What are you wondering about yourself, or about what you read?

Inferring: what do you think you can tell about something even though it wasn’t actually written? What clues can you get from the text, or from background you already know?

Fixing: if you don’t know, how do you figure out what it means? What can you tell from pictures or nearby parts?

Summarizing and retelling: how would you tell it to me in your own words? What is the main idea? What’s most important? How do you connect the main ideas? How do you put it all together into one main thing?

Critiquing: what did you like about what you read? What didn’t you like?

I try to insert questions like these as I read aloud to the kids—instead of just brainlessly flipping through each page, I pause and ask, what do you think will happen next? How do you think you’d be feeling if you were this person? Have you ever seen this happen before? What was your favorite part of the story? Etc.

My favorite moment with Ellie after we started doing this was when she said, “Mommy, I think one thing we can tell from this is that the girl is poor, even though it doesn’t say so.” We were reading my new favorite picture book, The Rag Coat by Lauren Mills, and it started a great conversation about what it means to be poor and rich, and what the main idea of the story had to do with her inference.

Here are two helpful links:

Scholastic handout on reading comprehension strategies

Reading comprehension for grades 1 and 2

Why Have Kids?

Wow, that’s a big question. And not one I actually thought about much before having kids. I just always wanted a big family; wasn’t much deeper than a gut feeling. My thoughts on this are in retrospect, though I think in some ways having kids gives you a deeper understanding of the reason for having them.

What our culture would say is: have kids because it makes you feel good, or look good, or gives you purpose, or saves your marriage, or lets you live out your dreams through them. Otherwise, they’re a major inconvenience.

What does the Bible say about this?

The first command God ever gave in the Bible is to have kids (Gen 1:28; later to Noah in Gen 9:7). It’s the sixth day of creation, God makes man, then the first four words he speaks to them are, “Be fruitful and multiply.” Other than that, I don’t think God overtly says anywhere else, “you must have kids!” And certainly not everyone in the Bible had kids. But I think it’s clear that somehow, having kids is part of God’s design for marriage, of God’s intent for us and how we are to reflect Him—the verse right before Gen 1:28 says we are created in his image. It’s not a leap to imagine how the fellowship God enjoys in the trinity, and relationship of God as father and son, are reflected in parenting.

Ultimately, the desire to have kids should come from an understanding of who God is, of his purpose and desire for us to reflect him in that way. And we should do this regarding children as a blessing (Psalm 127), a gift, not as a burden: our lives aren’t about us in the end, anyway. The moments of greatest beauty, joy, and transcendence come often in the most difficult times of laying aside ourselves, and parenting is one of the best examples of that. I mean, the cuteness is all great, but the real reward is my sanctification. No other situation in life calls for me to give of myself and put aside my own needs so completely or constantly.

I’m not saying everyone ought to have kids, and many can’t for good reason, but I think the point is to be submitted to God in your introspection. To examine your motives either way and ask yourself, God, is this glorifying to you, or are my motives selfish? Because if you don’t want kids for selfish reasons, you may be missing out on the greatest chance to live out Christ and become more like Christ you will ever have. And if you want kids for selfish reasons, that will all fall to pieces pretty soon once you actually have kids and realize how much you can’t do it on your own or for yourself.

If I had to describe what having kids is like, I’d say it’s like living in a broader realm of emotional and physical experience. The highs are higher; the lows are tougher. There is the altered travel and social lifestyle, the dealing with bodily emissions, the chores, the periods of savage exhaustion: but then there are the moments of heart-turning joy and sweetness. The look in their faces when you know they’ve understood something. The times you realize they are revealing something deep about yourself. Finding them dearer because you are caring for them, because of the lows. And there is no purer opportunity to share the gospel: to take these little beings, unfiltered in their sin and their wonder, and live out the gospel. That is a reward all on its own.