Tuesday, May 28, 2013

Forever Together

Theirs was a storybook romance. Living in separate cities, their relationship began on the telephone: long conversations about her first two disastrous marriages, uncertain that she’d ever want a new man in her life; his pain about caring for two wives and having them both die. He quoted poetry to her. She told him about her life as a psychoanalyst. A nurse and administrator by profession, he had read all of Freud. He studied philosophy and spoke German. By the time he flew down for them to meet for the first time, they were already in love. He wanted more. She was frightened. He persevered. In time she realized how supportive he was of her professional life, of her connection to her women friends. He wanted to add to her life, not take her over.

This love story is neither about me nor any of my patients. It is about my very good friend Emily and her new man, Paul. When Emily first met Paul she told me he looked like George, my deceased husband with whom I too had a storybook relationship. When I met Paul for the first time, I didn’t think he looked that much like George – except for the same strikingly blue eyes – but I thought he was a lot like George, eager to proclaim his admiration, love and devotion for Emily to anyone who would listen.

So, after much trepidation on her part, a year ago Paul moved into Emily’s house. Emily basked in Paul’s love, her radiance and happiness obvious to all. And Paul couldn’t stop talking about his good fortune. It was a joy to be with them, a joy to see them glow in each other’s presence. After more trepidation and uncertainty, Emily agreed to marry Paul. Their wedding date was set for the last Saturday in June.

In April we spent four days together at a psychoanalytic meeting in Boston with another friend and colleague, Donna, continuing to celebrate their most wonderful connection. Not too long after returning home, Paul was hospitalized. Pneumonia. Not a big deal I thought, I know lots of people who’ve been hospitalized with pneumonia, many much older than Paul. There was some concern about his arrhythmia, but nothing to be alarmed about. Time passed. Emily told me Paul had been admitted to ICU. I was shocked. What happened? His pneumonia was unstable. What did that mean? They didn’t know what was causing it. His breathing wasn’t improving despite four different intravenous antibiotics. I started to feel sick. 

More time passed. Then Emily called to tell me Paul was on a ventilator, that they’d put him in a medically induced coma and had found blood in his lungs. The cardiologist told Emily he might die. The pulmonologist said to wait and see. I called all our friends. We cried together. It was so impossible to comprehend. We mourned for Emily, for Paul.

And so began the vigil, the up and down of his condition, the roller coaster ride of being buoyed by apparently good news, only to be followed by the sickening drop of more negative information. I knew about this roller coaster ride. I’d lived it with George for sixteen months. Images flashed before me – his agonizing pain from metastatic prostate cancer, his heart attack after his first chemotherapy treatment, the cardiologist suggesting I call his children, his determination to survive, his subdural hematoma resulting from a fall, his becoming jaundiced, his final giving up – “It’s enough already.” But as awful as it had been, as awful as it still was, I had George for twenty-nine years. Emily had Paul for only two! It was incomprehensible. It couldn’t be!      

But like their storybook romance, this story has a happy ending. The bleeding in Paul’s lungs was being caused by his blood thinning medication. They took him off, but the drug remained in his body for almost a week. And so the vigil continued, but the hope increased. Finally Emily called and left a message – Paul was off the ventilator, his lungs were improving, he could speak. I burst into tears, tears of relief, of pure joy. I called. Emily put Paul on the phone. He couldn’t speak well, but he could speak! I cried again.

And so, on June 29, 2013 Emily and Paul will be married on Hollywood Beach. And we will all rejoice in their extra-special relationship and good fortune and we will all remember how fragile life is.    

Tuesday, May 21, 2013

A Difficult Patient

Why did I ever agree to see Paula? I didn’t have good feelings about her from the very beginning. She barely smiled as I greeted her in the waiting room, seemed to eye me warily, and held herself rigidly erect. My first impression was that she might be schizoid, someone who distances and keeps herself apart from others to protect herself from feeling her own vulnerability. She’s thirty-five, tall, a bit overweight, with short black hair cropped close to her face. She described herself as a computer nerd.

Today is only our fourth session, but it is not proceeding well. She sits across from me with a smirk on her face, her arms folded in front of her, staring fixedly at me.

“Paula,” I begin, too uncomfortable to let the silence continue, “It seems as though we’re back in the place we’ve been the last two sessions. I feel as though you’re daring me to say something brilliant and until I do you’re not saying anything.”

“That’s pretty good,” she says, her smirk increasing.

I want to slap her. “Do you want me to be angry with you?” I ask.

She shrugs.

I am not pleased. We sit in silence. Five minutes goes by. She uncrosses and crosses her arms, her legs. She says nothing. I flash on Kathryn the schizoid patient I wrote about in my book, one of my more unsuccessful treatments. But Kathryn was horribly anxious. She would never have been able to sit through this silence. She would have just gotten up and left. OK, does that mean I’m feeling Paula’s anxiety for her, that I need to help Paula take back her own feelings? I decide to give it a shot.

“I wonder, Paula, how you feel in this silence, whether it makes you at all anxious or whether I’m the only one in the room who’s feeling the anxiety?”

She raises an eyebrow at me. “You were doing better the first time around.”

I am ready to kill her. And then I remember another patient I wrote about and my reaction to him when he demanded that I be brilliant. He wanted me to be brilliant just as his father demanded that he be brilliant and just as my father demanded the same from me. And that demand always resulted in both my patient and I being frozen with anxiety. So my earlier patient was doing to me the same thing that had been done to him. He was acting out his childhood experience except now he was in the role of his father and I was the frightened child.    

I think about Paula and am a bit baffled. In our first session she described her father as a middle-level manager who didn’t seem particularly bright or demanding. What did she say about her mother? Not much actually. I guess I had the impression she was a housewife, but now I wonder. 

“Paula, I find myself wondering about your mother. What did she do?”

Paula’s smirk fades immediately. She glares at me. “You get a gold star,” she says sarcastically. “My mother was a Pulitzer Prize winning journalist who wrote novels on the side. She edited all my papers all through school. They were never good enough. I actually wanted to write. I became a computer technician instead.”

Sadness fills the room.

“I’m really sorry, Paula. I can feel how painful that was for you, never feeling good enough, never being able to freely express what you wanted to say.”

“Don’t get carried away. Just because you figured it out doesn’t mean you get a free ride.”

Although I can feel myself bristle, I remain determined to stay with the sadness. “So it’s easier for you to be a harsh taskmaster like your mother, than to feel the pain you felt as a not-good-enough little girl.”

I think I see Paula’s eyes fill with tears. But she draws herself back into her rigid self and closes down. 

This will be a very long treatment. All I can do is hope that my newfound understanding will help sustain me through the difficult times ahead.   

Tuesday, May 14, 2013


Andrea again calls me from home.

“I’m sorry,” she says, her voice hardly above a whisper. “I know I said I’d try to come today but I can’t. I can hardly get myself out of bed. I can’t leave the house. I keep calling in sick to work. I hope I don’t get fired. I just can’t function. I’m so scared,” she adds crying. 

Those of you who follow my blog will have met Andrea a few weeks ago, the woman who had been sexually abused by her father and felt herself more endangered after the Boston Marathon bombings. And now there’s the case in Cleveland, the shocking imprisonment for over ten years of three young women who were finally able to escape. 

“It’s all right, Andrea,” I say gently. “I understand. You know I always say that you can only do what you can do. We’ll do whatever we need to do to help you through this.”

“I don’t think I will get through this. I’m back there. I’m back in that horrible house. I keep seeing those disgusting green walls. And the closet. I’m locked in that closet. I feel like huddling in a corner, folded over on  myself, just like I was as a child, hoping that he’d leave me alone, but not wanting to be left in that closet for hours or days at a time. So did I wish he’d come back? That’s disgusting. I’m disgusting.”

“I bet you don’t think those three women are disgusting, Andrea.”

“No, of course not, they’re heroes. I don’t know how they endured for all those years. And that child! That child has never seen the outside world. That seems impossible to take in!”

“Notice how caring and compassionate you are towards those women and the child,” I say. “I wish you were able to have even a tiny bit of that compassion for yourself.” 

“It’s not the same.”

“In what way isn’t it the same, Andrea?” 

“They were imprisoned. They had no choice. I could have told. Why didn’t I tell?’ she asks plaintively, crying. “Why didn’t I run away?”

Although Andrea and I have covered this ground many times, her self-loathing and need to blame herself remains very difficult to change. To emotionally accept that she was an abused, helpless, dependent child without any options, is to accept her total vulnerability. And as awful as the guilt and self-hatred is, it is preferable to feeling completely powerless.

“You were a child, Andrea. And he was your father. There was no place for you to go. These women are adults now and they all went back to the embrace of their families. I’m not minimizing the horror of their story in any way. But I don’t want you to minimize the horror of yours either. You were as helpless and powerless as they were.”

“But that doesn’t make me feel better!” Andrea wails. 

“I understand that Andrea. I understand that hating yourself, thinking you could have done something, anything, in many ways feels better than experiencing your total helpless. But, and this is an important but, you’re no longer that helpless child. You’re a competent, capable adult. It doesn’t mean bad things can’t happen, but today you have many more options than you had as a child.”

“But why didn’t I tell?”

“Because you were afraid, because you were ashamed, because you didn’t know what would happen if you told.” Suddenly I have a thought. “I wonder Andrea, if in addition to these women’s story making you more frightened, whether it also made you even madder at yourself for not figuring out a way to tell. Here you see how supportive and welcoming and thrilled complete strangers are of these women and I wonder if that made you almost envious, like you’re still in hiding and no one ever got to applaud you.”

Andrea mumbles something on the other end of the phone.

“I’m sorry, Andrea, I didn’t hear you.”

“I said you’re right. I found myself almost wishing I were those women. And then I got furious at myself for that thought. Disgusting! How could I want to be them? What’s wrong with me? I must be sick, sick, sick.”   

“I think it makes complete sense, Andrea. So maybe you should try to stop beating up on you. And maybe, just maybe that might help you to feel less scared, like the person you’re really scared of these days is you.”

Tuesday, May 7, 2013

Surviving Life Well

I’m returning to Alyce, the first patient in my book and the subject of an earlier blog. For those of you who have not yet been introduced to her, Alyce was a young woman I treated much earlier in my career. We had an intense, tumultuous relationship filled with both hate and love. It was one of the most successful treatments of my career and one I am particularly proud of. 

When I found Alyce many years later to ask her permission to include her in my book, I discovered that she had been in two horrible accidents, had a brain injury that had affected her mind, her speech and her ability to walk. I was devastated, for both Alyce and for the young therapist I once was. 

As I wrote in my earlier blog, “Alyce represented the time of my life I most cherished: the time before my husband’s illness, the time before I left the home I loved, and most importantly the time before my husband’s death. Life was now painfully different for both of us, although I in no way equated them. Alyce’s losses were tragic, mine, although terribly painful, were an expected part of life.”  

I spoke to Alyce the other day, a day she returned from having twenty injections in her back, buttocks and legs, to attempt to reduce her searing pain. She told me she had to go see her neurologist, concerned that her back was degenerating further and that she might lose still more mobility. She also told me that her 17 year-old daughter, the person she loved more than anyone else in life, had mostly cut herself off from her and that even their brief contacts were filled with cruelty and rage.

I feel myself sinking. How is it possible that anyone could continue to survive one loss after another, one tragedy after another?

“You sound sad,” my previous patient says to me.

“Well, yes,” I reply. “You’ve had to cope with so much in your life. How could I not feel sad for you, for all you’ve had to endure?”

“Hey, I’m alive!” Alyce replies, her voice strong and bright, her indomitable spirit shining through.

I feel myself brighten along with her.

She continues. “I’ve asked myself if I’m sort of manic these days, but I don’t think so. I don’t know what’s come over me, but I can just take every day as it comes and I’m still here. Nothing has killed me yet. I love my daughter more than any person in the whole world. I would do anything for her. I would die for her! But I can’t change who she is and right now she’s an angry teen-ager. I remember being an angry teen-ager. I bet you remember, too,” she says laughing. “I’m here for her and when she needs me I’ll still be here. And in the meantime I just have to go on living, putting one put in front of the other – well, sort of – I don’t do that so well - but you know what I mean. I have to keep myself alive and enjoy every day for what it is.”

What do you say to this kind of spirit? What response is there? Is part of this denial? Perhaps mania, as she herself suggests. It doesn’t matter. Her determination, her willingness to keep pushing, to keep smiling, to find the good in her life is nothing short of miraculous. 

“Lots of good things have happened in my life,” she continues. “Lots of people who care about me have come back into my life, starting with you. You were my first mother. You grew me up.”

Does Alyce cry during parts of our conversation? Yes, she does. She’s not unaware of the bleakness of her situation. But her grit remains. “They wanted to move me out of this apartment. I told them no way. I told them I’ve moved six times in the last two years! I’m not moving again. I’ll worry about it when I totally run out of money.” Her voice cracks. “I don’t have any money. That’s a big worry. But something will happen, something will turn up.”     

Am I really worried about how I’ll get my car back from the repair shop? Does it matter if I can’t get my voice mail messages from my cell phone? Does it matter if I lose a few hours of sleep so that I can finish my blog? Or what tragedy would befall if I didn’t get the blog done after all?

Surviving life well. We can all take lessons from Alyce.