Monday, December 16, 2013

Expectation Management

In anesthesia, some of the most difficult cases to do are sedation cases, ones we call “monitored anesthesia care” or “MAC.” This isn’t because of challenging physiology or surgical considerations, but because the patient is awake. When the patient goes completely off to sleep, under general anesthesia, the focus can be on pharmacology, physiology, and pathology.          

Once the patient is “awake,” the focus changes. (“Awake” is used in quotes because the anesthesia provider considers the patient awake, even if the combination of medications given for sedation make the patient unable to remember their time in the operating room.)  In these cases, it becomes about the patient’s experience: ensuring that they are comfortable, warm, not nervous, anxious, or in pain.

In order to achieve a good experience for the patient, it is very important to do expectation management. If the patient thinks that they are going to hear nothing, see nothing, and remember nothing during their sedation case, no matter how smoothly the procedure goes, the patient will be upset with the outcome. That’s why I always am very clear about what are realistic expectations are. Patients can experience the exact same thing: the one that knows what to expect, and has a realistic picture, will always be happier.

That’s what I’m trying to do in my own life.  Expectation management.

I'm hoping that creating realistic expectations for myself will make me happier.

It’s hard. I carry about this image of myself. An unrealistic one, but a consistent one.

My house can be perfect, clean, organized, and beautiful. My children will be happy, well behaved, involved in activities, enjoying plenty of quality time with me.  My job will be fulfilling, and I can advance and excel professionally and academically. My meals will all be homemade, healthy, well balanced, filled with organic, local, and varied ingredients. My marriage will be fairy tale, romantic, perfectly balanced, and always supportive. My free time will be plentiful.  I will exercise regularly.  I will read widely. I will be involved in my community.  I will blog, do art projects, write letters, call my family regularly, be a good friend, develop new talents, be politically active.

Basically, that I can be perfect, can do everything and anything. I know it’s not realistic, but for some bizarre reason, I keep thinking that if I try hard enough, I can be that elusive, mythical Super Mom. That all I have to do is try hard enough, wake up early enough, drink enough coffee, stay up late enough...

Okay, I know that I can’t really. I already know that I can’t do everything, and even if I could, I couldn’t do it perfectly. But the knowledge that perfection is unattainable doesn’t ever seem to stop me from trying.

I’ve been packing more and more into each day, trying to make sure we have homemade meals together as a family, that I keep my house clean, that I’m doing a good job at work. Each day, it seems like I’m able to succeed less and less of the image in my head, that even as the daily to-do lists grow longer, I’m able to do less of them. The harder I work, the less happy I’m becoming.

I’m trying to do everything my working male colleagues are doing: maintain full time hours, be a good educator, stay on top of new developments in my field. I’m also trying to do everything a stay at home mom does: homemade meals, enriching activities, tidy home.

And suddenly, I can’t do any of it.

So I’m going back to expectation management. Sometimes, my house will be dirty. There will be laundry that gets worn before it makes it out of the dryer. The table will be covered in enough crumbs that sweeping it off makes more sense than wiping it off. The family room floor will be an unnavigable wilderness of Legos and Hotwheel cars. Sometimes, dinner won’t be handmade. There will be delivery pizza and frozen meals and failed crockpot adventures. Sometimes, I won’t want to spend time with my children.  There will be times I tuck them in bed early, and watch a show off the DVR with a bowl of ice cream.  Sometimes, I won’t be the best doctor I can be, so I’ll call in sick so that I can focus on things at home.

Sometimes, I’m not going to be perfect. And I’ve got to learn to be okay with that.


  1. It's definitely okay not to be perfect. And I understand that feeling of trying to succeed at everything only to wind up feeling like I'm failing at everything. It's a hard place to be, but you'll come through it. Because you ARE awesome.

  2. You have wonderfully defined what I have been pondering on for a while to be content with my expectations and staying within reality! It's so easy to be hard on ourselves and I wish it were easier to accept ourselves. We're all beautifully flawed and doing our best to keep it together. :) I'm always amazed at how much you do.