I am married to a surgeon and do understand your comment about not coming first. I struggled with this early in our marriage when I realized that I couldn't come first. But the reality is that my husband doesn't choose to put his patients first, he has to. If he has to make a decision whether to save a patients life or attend our child's soccer game, he knows what the right decision is, and so do I. It is difficult at the time, but when you look back, you can understand. I know that in my husband's heart, I do come first.
Once I came to terms with this, things became easier. I have watched his heart break when he had to leave me with a dying pet because he had a surgery scheduled. He wanted to be with me, but the reality is that he couldn't be with me. And I now understand that. My acceptance has helped my children understand.
I am married to a surgeon and do understand your comment about not coming first. I struggled with this early in our marriage when I realized that I couldn't come first. But the reality is that my husband doesn't choose to put his patients first, he has to. If he has to make a decision whether to save a patients life or attend our child's soccer game, he knows what the right decision is, and so do I. It is difficult at the time, but when you look back, you can understand. I know that in my husband's heart, I do come first.
Once I came to terms with this, things became easier. I have watched his heart break when he had to leave me with a dying pet because he had a surgery scheduled. He wanted to be with me, but the reality is that he couldn't be with me. And I now understand that. My acceptance has helped my children understand.
My husband calls it taking care of business. We would all like to make our loved ones the absolute center of our universe, but most of us don't have that luxury...we have to earn money, fulfill requirements and jobs, and satisfy our own needs that do not mesh perfectly with our loved ones. Hopefully, we can take turns 'taking hits' in our careers, and sort out our priorities so that we can blend and share our lives.
I think it is harder if you don't feel like the priorities are ever shifted to your greatest needs or to farther your greatest desires...and maybe then you have to push for that, make it an absolute priority. Otherwise, you might feel you are more in a support or caregiver role and sacrificing yourself for the benefit of your partner.
I can say, that for me, I am frequently aware that my husband is getting the short end of the stick, and I acknowledge it and do my best to be certain that the time he does get is quality. And in my case, I am not saving (at least not directly) human lives, so the clear 'right' thing is a bit more murky. However, I sacrificed my aspirations for 3-4 years for his career and his needs...and in some ways that makes me feel ok and comfortable with trading that off.
We don't do date night...instead we each pick several things that are important to us each month, and those things are given highest priority. It doesn't matter if I don't want to go see the Blue Angels; if that is the top priority thing my husband wants to share with me, I will go with bells on and spirits high. If I want my husband to attend a trip to an island to do herd assesments, he asks what he needs to bring and asks if he can arrange a nice dinner on the way home. Sometimes our highest priority items are completly hobby or interest related...sometimes they are career related (I HATE corporate formal dinners, and yet, if it is a high expectation that I attend hubby's work party, I will.) For us, this concept works really well; it clarifies our expectations each month, prevents suprises and miscommunications (I THOUGHT you knew how important this was for me) and is what we work to build the rest of our life around. We also take time to talk about the most important things that can't be dropped (huge exams, service trips, award ceremonies) that the other person isn't a part of, but for whom our schedule and priorities will affect.
Another thing is to be incredibly clear. "I need one hour of your time this week. please let me know by tomorrow morning when we can sit down together and do this. " "I understand that you want to discuss this right now, but I can't focus on this and my other responsibilities. Can we discuss it over lunch on Wednesday?" I confess, it feels automated at times....and it means that we don't get a lot of instant gratifications on resolving issues, but we are becoming more patient...and it works well for us. Obviously, occasionally we do drop everything for each other, but we always understand that recovering the juggling act is difficult.
I don't have any real words of wisdom especially for anyone feeling marginalized. We can only really be at the center of our own lives as we share our life with others. Make yourself your own priority, communicate clearly, and ask for what you need in specific and concrete terms (rather than 'I need more attention' or 'I need to feel cherished') and see if your partner can work with you to achieve what you need. If not, the questions become tougher.
Oh, and from the other end...I did tell my husband at one point that it is a good thing we are married. If we weren't, and this was a relationship without a heavily defined commitment that is difficult to break, we probably would have split up during some of the more stressful moments because it would have been an easier, more convenient decision...but ease and convenience aren't always indicators of quality! The quality is well worth it, even if the quantity is less than either of us would have hoped!
so he could finish charting at the office) and compromise can sometimes be reached (he now has home computer access and finishes his charting after she is in bed so we can have our time together).
What the one lady said was right how it may feel so automatic when you ask for some time to discuss something and his answers are automatic "when would you like to talk about...can we talk about it after i finish this quiz section?" and I think I need to realize I'll never be first anymore (I was first in his life for a glorious year or so...it was spectacular...I felt like a princess and extremely loved). Does this mean I am settling? Settling to not be first? I suppose it is selfish to always want to be first in someone's life. He does try to make me feel special often but it's just different than our honeymoon phase. 
