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  My husband is an M4. As long as I've known him, he has wanted to pursue medicine. There are physicians in his family who have trained at brand-name programs. He went to a very competitive college for undergrad and graduated with high honors in a humanities field (while also completing his pre-med courses).
  
  

  
  His MCAT score was disappointing--enough to get him into medical school, but not in line with the background of academic excellence he and his family expected. His schooling has progressed normally. His USMLE Step 1 score was in the median range of US MD students. Just yesterday, he got his Step 2 score--he passed, but it was 5 points lower than his Step 1 score. He is so hard on himself, and I have a hard time not feeling angry at this whole process. I know how hard he has worked and that he has not done as well as he expects himself to do, and how the rest of the family expects him to do.

  When he has bad days (like yesterday) he isolates himself completely to "deal with it". As it happens, we have company right now. I work full-time, and yet last night as he was isolating himself, I was the only one doing anything with our guests--making dinner alone, entertaining them alone, and then cleaning up alone. He sat on the couch reading a journal the whole time.
  
  I was angry about this and, before bed, told him that I was mad that he left me to play host all by myself and embarrassed me in front of our company. He said that I had no idea what I was talking about, didn't understand what a big deal this test was, and said that maybe it's best that he's leaving next week for several months of away rotations, so that he can concentrate all alone on what he needs to get done.
  
  I'm hurt because I've sacrificed so much to support him in this process.... but I just don't know if I'm being unrealistic. At the root of my role in supporting him, is this just my place in our journey? To put on a smile, act like it doesn't bother me, and just do what I can to keep everything going? I just need help understanding how to help him through the disappointment without having unrealistic expectations that end up making me so resentful. I love him, and have no plans of not spending my life with him... but I'm just upset.
  
  
  So, to start with, and most importantly: It will never be your job to act like it doesn't bother you when he's unkind to you. Medicine is a worthy endeavor around which to create a life, but it is not a free pass to treat one's spouse poorly. You are not an indentured servant. If he wants to stay joyfully married to you, he needs to behave in ways that make that happen--and that includes putting aside his own hurt and disappointment when he has made a commitment to you that he needs to honor. Those guests weren't YOUR JOB, they were your shared commitment, and he dropped the ball. Frustration is absolutely legitimate.
  
  I understand the background you've given about his family of origin and the expectations and definitions of success that he has internalized. When you're from a family system that values prestige and social presentation as part of "success", anything that disrupts a smooth, flawless ascent to the pinnacle of the chosen field is disastrous.
  
  Your dh isn't a jerk or an adolescent, feeling sorry for himself that he didn't get what he wanted; he is a man who spent his entire life believing that he would achieve whatever he desired, as he thinks that his physician relatives had done before him, with enough work and willpower--and it is painful to realize that work and willpower are not always going to get the job done, or that maybe the job that needs doing isn't really what you thought it was. It's hurtful to feel ashamed, to feel not enough. He is feeling what he perceives as a deep failure and likely assuming that everyone around him sees him as a failure, too.
  
  The supportive-wife position here is a little bit delicate. He needs to feel deeply that you DO NOT see him as a failure, that you respect his accomplishments (even when he has a hard time respecting them), that you believe in the good he is doing and will do in the world with this work, that you see him as more than a test score. He needs to be reminded that academic excellence and performing excellently as a physician are not the same thing--and for every patient he'll ever talk with and touch, the clinical excellence is a vastly more powerful gift. He doesn't have to be the best multiple-choice test taker in America to be a good man, a good husband, and a good physician.
  
  At the same time, you do not have to lay down and take it in the name of "being supportive," when he behaves poorly. He is going to be hurt and embarrassed and disappointed and he is going to fail a lot (A LOT) in learning how to be a doctor. Patients will die despite his best treatment efforts. Disease will worsen. Residents and attendings will yell at him. He will forget things, and do things wrong, and miss things he should have gotten, and that is all absolutely normal. This process is painfully long for a reason: it takes an awful lot of failure to have exhausted how to do things wrong, enough that you know how to do them right.
  
  He will be hurt by this again and again. He doesn't get to take his pain out on you. So you can support him, and lift him up, and give him some space when that's reasonable and doesn't cost you something you can't bear to give up--as in the case last night, when he embarrassed and disrespected you by leaving you to flail through an obligation that you made together. But you are absolutely within your rights--and in my opinion, it will be the salvation of your marriage if you can find a calm & firm way to do this--to say, "I'm sorry you're hurting, but I am not a whipping post. Being nasty to me won't change THAT problem, it just makes a NEW problem." How to handle disappointment graciously, that will be his task to learn, and it's impossible to overstate what an important task that is. Your task is to love him through it without sacrificing your dignity and self-respect.
  
  It may help him as he absorbs this blow to really honestly assess what it is that he brings to the table as a residency candidate and, down the line, as a practicing physician. With his far-reaching mind, the odds are very good that he has an unusual gift at recognizing patterns and seeing a broader picture. He will have strength in translational work--applying scientific theory to live practice. His gifts in language and communication may give him an ENORMOUS leg up over his peers--the skillful scientists who become medical students and physicians are so very, very gifted intellectually, but sometimes struggle with having a heartfelt human conversation or being present with someone in difficult and scary times. A doctor who can chat, and who can tolerate discomfort, and who can meet a patient where he is--that doctor is worth his weight in gold.
  
  He *will be* successful. His success just may not look like his family's idea of success, exactly. That's good. There's no glory in walking down a path that someone else cleared for you; it's comfortable, but it's not always authentic. It's a truer power to recognize your OWN strength, and to make a life that utilizes your best self.
  
  
  Cristin has marched alongside her academic attending husband for 18 years, through medical school, eight years of residency + fellowship #1 + fellowship #2, four moves, four kids, and a crazy lot of laughs. You can submit questions confidentially to dearcristin@outlook.com.