Happiness in this World

Reflections of a Buddhist physician

The Danger Of Having Unrealistic Expectations

How what we expect determines what we experience.

My wife and I vividly remember the anesthesiologist's statement: "You may feel a little pressure." She spoke the word gently, as if to imply that's how it would feel, and we believed her. Epidural blocks, she explained, don't numb the sacral nerve roots that deliver sensation from the pelvic floor so my wife would likely feel something as she entered the last stage of labor and our son began passing through her birth canal. But we were both reassured. A mild bit of pressure seemed no threat to our hope of having the same experience my sister-in-law had with her first child: she'd had to be told when to push at the final moments because she couldn't feel anything at all.

My wife's block had incompletely numbed her left side, however. Where my sister-in-law couldn't move either of her legs, my wife could have stood alone on her left one. But, again, we were reassured as the pitocin-induced contractions the monitor told us she was having remained for her a distant, almost imperceptible cramping.

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After 36 hours of peaceful—almost boring—labor, though, she began to feel some real discomfort on her left side. Over the following hour it built to the point where we were both starting to feel a little panicked about it. The anesthesiologist was called back into our room. She adjusted the position of the epidural catheter and dialed up the dose as high as she could. My wife's pain continued to worsen, however. "There's nothing else I can do," the anesthesiologist finally said apologetically.

The last five hours of my wife's labor were a nightmare. She was in agony. When she finally wrapped her mind around the idea that this was just how it was going to be, she buckled down and literally talked herself through it. I was utterly traumatized standing at her bedside without leaving once for the entire time, unable to do a single thing to help her.

A DOCTOR'S MISTAKE

Though she was certainly well intentioned, our anesthesiologist made a crucial error: she only described the best possible outcome of the epidural block, not the worst, and in doing so failed to prepare us for what actually happened. As a result, the entire experienced was transformed. Though the physical sensations my wife felt would have been no different had she been better prepared for them, her (and my) experience of them would have been far easier to endure had we been properly warned (even though I'm an internist, I had little knowledge of the detailed workings of epidural blocks). Because neither of us were expecting her to feel the degree of pain she did as a result of the anesthesiologist's statement, we worried something might actually have been wrong, which transformed the pain's significance from inevitable but ultimately joyful into something almost wholly frightening.

I've watched many physicians make this same mistake in other ways, thinking their honest and full description of a test or procedure will create undue alarm or scare their patients off from having it and so stop short of full disclosure. But in my experience, patients are far more upset (as we were) to be caught off guard and unprepared for something unpleasant. When explaining colonoscopies to patients, for example, I always make sure to describe just how unpleasant most people find the preparation. When I send people for nerve conduction studies I tell them outright that they're painful. Interestingly, most later report the pain wasn't as bad as they thought it would be.

You could certainly argue in taking this approach I'm causing my patients more suffering in anticipation of an unpleasant experience, but most tell me they're more grateful for having been warned. In my view, experiences like my wife's and mine are far worse.

DISCONNECTS BETWEEN EXPECTATIONS AND EXPERIENCE

I would argue further that the reason many of my forewarned patients report to me the experience wasn't as bad as they expected was precisely because I warned them it would be bad. Though I've used a medical example here, the impact of any disconnect between our expectations and our experience is felt in almost all contexts. Our expectations of our experiences dramatically color not just how we experience waiting for them but the experiences themselves. Four scenarios exist regarding expectations and experiences. We can have:

  1. Low expectations and a poor experience, where our low expectations can mute the disappointment or even the discomfort we feel at actually having a poor experience.
  2. Low expectations but a good experience, leading to a pleasant surprise.
  3. High expectations and good experience, in which we get to enjoy not only the anticipation of looking forward to something fabulous but an experience that actually lives up to our expectations and therefore feels thoroughly satisfying.
  4. High expectations but a poor experience, in which we often emerge bitterly disappointed or even traumatized.

THE BEST STRATEGY

The "gain" at which we set our expectations tends to be more a matter of habit and disposition than conscious intention for most of us. Some of us expect little, perhaps as a way to defend against disappointment, accepting the cost of a muted or absent anticipatory sense of joy. Others of us can't help having high expectations, basking consistently in the glow of anticipation but often paying a different price: the painful disappointment that comes when experiences fail to live up to those high expectations. Even worse, sometimes having unrealistically high expectations prevent us from being able to enjoy our experiences at all.

I honestly don't think one strategy is better than another but rather that different strategies are better suited for different types of people. If you observe yourself to be continually disappointed by experiences you feel you should be able to enjoy, you may do better by consciously lowering your expectations somewhat. Likewise, if your expectations remain so consistently low you never think things will work out for you, you may find yourself plagued by a gloomy pessimism that blocks you from savoring a truly enjoyable part of life—the anticipation of good things—and you might work on allowing yourself to expect just a little more.

Though we all may have a built-in set point at which we unconsciously tend to set our expectations, that doesn't prevent us from consciously grabbing the reins and adjusting them up or down to suit our needs. Certainly it would be ideal if our expectations always perfectly matched our experiences, but as the quality of many experiences is hard to predict, we might do better to adjust our expectation of how much we think we'll enjoy or dislike an experience based more on how we know those expectations will affect us than on how accurate we may think they'll turn out to be.

My own personal preference is to know up front as much as I can about both good and bad experiences coming my way. For me—and, I've observed, for many others—not knowing what's coming when anticipating something bad creates even more anxiety than having full knowledge of how bad what's coming will be. Knowing the limits of the "badness" I'll be facing enables me to focus on preparing for it rather than on managing my imagination's tendency to inflate it beyond all rational proportion. For me at least, the devil I don't know is far worse than the devil I do.

Though soon after the anesthesiologist left our room for the last time my wife and I had both become resigned to having a different experience than we'd expected, after our son was born (perfectly healthy) we received another surprise: my wife's left-sided pain actually became worse, located now not low in her pelvis where her uterus was appropriately contracting down to staunch any bleeding, but rather high up in the left upper quadrant of her abdomen where it had absolutely no business being. When I glanced worriedly at our obstetrician she only shrugged in confusion. The anesthesiologist was called back in one last time, gave my wife a narcotic, and the pain finally faded away, never to return. To this day, however, my wife regards the last five hours of her labor as one of the worst experiences of her life. The only thing that saved the day was that it was followed immediately by one of the best.

 

If you enjoyed this post, please feel free to explore Dr. Lickerman's home page, Happiness in this World.

Alex Lickerman, M.D., is a general internist and former Director of Primary Care at the University of Chicago and has been a practicing Buddhist since 1989.

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