Conventional models of stress and coping are highly individualistic and give little attention to circumstances and involvement with others. A more contextual perspective on wives of patients who had suffered myocardial infarctions was adopted in this study. Wives' distress was related to the character of the infarction, but initial contact with medical personnel and marital quality each had independent contributions. Other analyses related wives' distress to their and the patients' coping. Wives' protective buffering of patients had a positive relationship with their own distress, even though Smith & Coyne (1988) have shown it contributes to patients' self-efficacy. Results suggest the need to acknowledge the limitations on adaptation imposed by health and the health care system. Also, initial conditions set a trajectory for later adaptation and there may be tradeoffs between preserving one's own well-being and contributing to a partner's efficacy.