Tuesday, April 29, 2014

Before Death Does Us Part

“I don’t know what Pete wants from me,” Jackie says in her high-pitched voice, dissatisfaction oozing from every word. “I’ve already seen him through his surgery and now there’ll be chemo. And I’ll be there, picking up the pieces, as always.”

“You sound so angry, Jackie,” I say, stating the obvious.

“Look, he smoked for 30 years. Yes, he finally quit but, guess what, his years of being an ass came back to bite him. And guess what again, just when we get the kids launched – that’s the word these days, isn’t it? – he goes and gets lung cancer. So he’ll probably die and I’ll be left on my own to go looking for a new man at this not so young stage of my life.” 

I squirm in my seat, rubbing the thumb nail on my left hand. Jackie continues.

“I’m still being the good wife. I make his meals, I serve him, I clean up, same as always. I look at him sitting there just staring into space. But, yes, all I feel is anger.” 

And all I feel is sadness. Images of my husband’s illness and death flash through my mind – doing “laps” around our living room with his walker for exercise, determined to stay with me as long as possible; his final days, loudly proclaiming, “I love you, Linda” before going into hospice. Our love never wavered. My love still doesn’t waver, six years after his death. But perhaps I’m feeling not only my sadness, but the sadness Jackie cannot allow herself to experience.

“No sadness, Jackie?” I ask.

“What, I can’t feel angry?”

Oops. I guess I followed my feelings instead of hers.

“Of course you can feel angry,” I say backtracking. “But I’m not sure I understand the intensity of your anger. Do you feel angry for the things Pete did in the past, or because he’s sick, or because he’s going to die or for some other reason?”

“Well, he wasn’t such a great husband, that’s for sure. He was a good provider, I’ll give him that. But once he got home all he wanted to do was to be catered to. Me and the kids didn’t matter. Just give him his dinner and let him relax and watch TV, no talking about anyone else’s day or, heaven forbid, any problems. And in the bedroom? Forget that. It was what he wanted and when he wanted it. That’s one advantage to his being sick and coughing all the time. I got to move into one of the kid’s bedrooms and he couldn’t give me too much grief about it.”

I shudder internally. Jackie’s hostility is almost too much for me to bear. “What about when you got married, Jackie? What did you love about Pete then?”

“That was a lifetime ago.”

“I understand, but what did you love about him?”

“Why?” Jackie asks, staring at me defiantly.

I blink, knit my brow and look back at her. I’m beginning to think that it wasn’t only my sadness I was feeling after all. “That doesn’t seem like such a strange question. Why are you asking me why?”  

“You don’t like me being angry. That’s what I think,” she says crossing her arms over her chest.

“Perhaps,” I admit. “And perhaps you don’t want to risk feeling sad.”

“Why should I?”

“Well, remember what you said about Pete’s cigarette smoking coming back to bite him in the ass? That’s what can happen with feelings too. If you only feel your sadness and not your anger, you could, for example, end up being depressed. If you feel only your anger, in addition to missing out on a lot of love and closeness in your life, at some point you could be overwhelmed by your sadness or perhaps get physically sick, for example.”

“Sounds like a lot of psychobabble to me.”

“You know, Jackie, it seems like it’s not only Pete you want to stay angry at. It seems like you want to stay angry with me too.”

“I think you just can’t take my anger.”

“How about if I mull over that possibility and you consider whether you’re keeping your sadness at bay so you don’t have to deal with how scared and vulnerable you feel. Maybe we’ll be able to meet somewhere in the middle.”  

Tuesday, April 15, 2014

The Caretaker

“My grandfather died last week,” Melinda says as she settles herself into the chair.

“Oh, I’m so sorry. I know how important he was to you.”

“Yes, it’s hard. I know he was 95 and failing, but I loved him so much. He was always there for me. And I always knew he loved me.”

As she talks, childhood images of my own grandfather pass through my mind: his joy at baking my birthday cakes; our walking for what seemed like miles to find my wished-for record, “I’m a Lonely Little Petunia in an Onion Patch;” his traveling roundtrip by subway almost every weekend to pick me up in Brooklyn and bring me back to my grandparent’s apartment in the Bronx; the twinkle in his blue, blue eyes whenever he saw me. He’s been dead for over 40 years, but he lives with me still.

“His funeral was Sunday. My sisters came in which was good, but there just aren’t many people left. He used to have so many friends, but they’re all gone. And my uncles have been dead for years. Some of my friends came, but having so few people made it feel even sadder, emptier. My parents, of course, and Ron and the kids, but when we got home everyone left.”

“Everyone left?” I ask surprised. 

“Yeah. The kids wanted to go be with their friends and my sisters are staying at my parents and Ron went to play basketball.”   

“How did you feel about Ron leaving, about being alone?”

“That’s just how Ron is. He can’t sit with his feelings. He loved Pop too and he can’t just sit around and be with his feelings. He has to keep moving. He has ADHD. I get it.”

“But how did you feel about his leaving?” I persist. I “get it” too, but having known profound loss myself, I cannot imagine being without kind, loving people after the death of a loved one.  Am I being overly sensitive? Am I imposing my experience and values onto my patient? Regardless, I feel angry with Ron and wonder if I am feeling Melinda’s anger as well as my own.

“That’s Ron. Would I have preferred if he was able to cuddle with me on the couch? Sure. But if he sat there playing with his phone, that would have driven me crazy. Better that he not be there. It’s like a month or so ago when Haley had her appendectomy, and he couldn’t sit in the waiting room. I told him to go.”

I remember Melinda and I discussing that incident and my being equally incredulous – and angry - that a parent wouldn’t have needed to be present during a daughter’s surgery. There again I found it hard to believe my patient’s apparent equanimity. 

Now I think about my anger and say, “Melinda, do you notice that when I ask you how you feel, you tell me how you understand why Ron is doing whatever he may be doing. I think it’s great that you’re able to be compassionate towards your husband, but that doesn’t tell us what you’re feeling.”

She sits thoughtfully. “That’s what I always do, isn’t it? I focus on Ron or the kids or whoever else, rather than on me. I always thought it was because I was such a caretaker, but maybe I’m just avoiding what I feel.”

“And what do you feel?”

“Sad. I feel sad. Here I just lost Pop and my own husband can’t even be there for me.”

“Sounds like there’s some anger there as well.”

“Yes, there is. But mostly it’s sadness. We’ve talked about this before. I’m the third girl, the unwanted child, everyone too busy for me, except for Pop - and Grandma. And then I pick a man who’s there and not there. I mean I know Ron loves me and he’s there for me sort of, but he has his own problems, and that limits what he can give me.”

“You’re starting to move back towards focusing on Ron. What happens if you stay with your own feelings?”

Her eyes tear. “It’s way too painful,” she says quietly.

“You’re carrying around lots of pain, from the past as well as the present. I know it hurts, but it is important that we look at it and that you try to stay focused on you. Otherwise you’re treating yourself the same way you’ve been treated, not giving yourself and your feelings enough importance.”

“Wow! That’s true. What I feel matters. I’ll work on it.”  

Tuesday, April 8, 2014

Together Always

“I came to see you because I thought you would understand,” Mara begins. “When my father insisted I see a therapist I did a lot of research. I was looking for someone who understood loss. I didn’t read your whole book, but I read enough to know you believe it’s important to stay connected to the person who died, that it can provide comfort. My father just doesn’t get it. As he would say he’s ‘moved on,’ and that I need to too.”

Thoughts and questions swirl through my mind: Who died? Mara seems so young. How old is she? She’s the first person who’s come to see me because of my book. I wonder if she’ll be anything like the other young woman who started treatment with me many years ago after reading a book I co-authored. That woman was fragile, defensive, and crying out for love. 

Mara continues. “That’s all well and good for him. He can get another wife. I can’t get another mother. I know it’s been a long time since she died. But it’s not like I’ve stopped living. I did well in high school. I’m doing fine in college. The letters don’t interfere with my life.”

“The letters?” I ask.

“I’ve written my mother a letter every day since she died.”

“And when did she die?”

“Nine years ago, when I was twelve.”

Uh oh, I think. What I say is, “That must have been very hard.” 

Mara’s eyes fill with tears. Her eyes are big and brown and bring to mind a deer which, in turn, makes me think of another young woman I saw many years ago who covered her terror with rage. Whenever I saw her I thought of a deer caught in the headlights.

“It was terrible. She died of breast cancer. She seemed to be getting better. And then she was suddenly dead,” Mara says shaking her head. “I cried for days and days. For weeks, really. I couldn’t go to school because I couldn’t stop crying, I mean like continually. I don’t know how I got the idea to write her letters, but I did. I wrote to her every day. And I still do. It helped me stop crying.”

“What do you do with the letters, Mara?”

“I keep them. I have boxes and boxes of them. Some are pretty short, others are longer. Sometimes I tell her about my day or a problem I’m having. But I end them all the same way. I tell her we’ll always be together.”

My stomach tightens. It wasn’t only Mara’s youth that made me think of those two other young women. Mara is another fragile doe, holding onto her deceased mother as a drowning person clutches a life vest. 

“Can you tell me about your relationship with your mother, Mara? I ask.

She smiles, nodding. “We had a wonderful relationship. She loved me so much. She stopped working when I was born. She’d walk me to school, read me bedtime stories, kiss and hug me all the time. She was the perfect Mom.” She pauses. “Until she got sick.”

“When was that, Mara?”

“I was seven.”

“So she was sick for two years.”

“Yeah,” Mara says. Her doe eyes look downward. “It was really hard for her. She had to have a mastectomy and then chemo and radiation. It was awful.”

“You must have been really scared then. And pretty lonely too.”

“Yeah, I was really scared. I’m not sure I got it completely. I mean I knew she was really sick …”

“Did you worry about her dying?”

“I guess.”

“Did you spend time with your Mom when she was sick?”

“Depends. Sometimes I’d crawl into bed with her and it would be like always. She’d stroke my hair and tell me everything would be OK. She’d tell me we’d be together always.” She pauses. “Other times, other times she’d just want to be left alone.”

The room fills with sadness. I feel sad for Mara’s loss and for my losses as well. Mara was a dependent child when she lost the person she was closest to in the world. Is there also anger at her mother’s desertion? No doubt. But she is nowhere near ready to deal with that.  

Yes, I do believe that mourning is a process of taking in images and memories of the deceased which then provide a sense of connection with the person who is no more. But there’s more going on here for Mara. She is trying to keep her mother alive, compelled to make good on the promise that they be together always. 

 I suspect this will be a long, intense, and painful treatment. 

Tuesday, April 1, 2014

My Blog

Many of my friends, colleagues and readers have expressed an interest in my blogs: how and why I write them, where I get my ideas, how I maintain confidentiality, how I feel about having to turn out weekly material, and so on. So I decided that I would write a blog about my blogs and, hopefully, many of these questions will be answered. 

When I first started blogging I was tremendously intimidated, not by the writing itself, but by the idea of tackling social media. To say the least, this was not my area of expertise. My foray into this arena was due to the prodding of Alia, the public relations person I hired after the publication of my book, Love and Loss in Life and in Treatment. She thought it would get my name “out there” and, hopefully, help promote my book. Has it? I have no idea. My guess is, not much. But I’m still blogging. And I still hear Alia’s admonition to write shorter, clearer, simpler, in a way that will engage readers.  

I get mostly positive feedback on my blogs and, of course, that in itself is gratifying. But I suspect there’s another reason I keep blogging, a reason related to my need for someone to hear me, to listen to me now that my husband is no longer present in that role. He’s been deceased for over six years now. My ever constant supportive and appreciative audience is no more. So I blog instead, to a more anonymous audience who can’t of course replace all his love and warmth. Still, I’m drawn to my computer every Friday. 

Yes, I write on Fridays, every Friday. That’s when I wrote my book; that’s when I write my blogs. Friends know not to call me on Fridays. I don’t answer the phone. I don’t find that discipline difficult. I love to write and even if I’m having a not-so-productive day, I stay at my computer. Sometimes having to produce weekly blogs can feel burdensome and I do occasionally give myself a vacation break. Basically, however, as I said, I appreciate having an audience.

Sometimes I’m asked how I can reveal so much about my patients in such an open a forum. I want to again offer the reassurance that I never violate my patients’ confidentiality. Most of the patients presented in my blogs are composites of various patients I have seen over the years; sometimes they are entirely fictionalized, springing seemingly unbidden from somewhere in my unconscious; very occasionally they are patients - still disguised - who have given me permission to write about them. 

Some readers will then question how my blogs can have any clinical relevance if the patients presented are composites or fictional. My answer is that I always try to remain true to the patient or concept that I am attempting to portray. I also hope that my 40 plus years of clinical experience adds weight to my ability to paint an authentic clinical picture.

Others ask how I can be so self-revealing in my blogs, since present, past or future patients can potentially learn so much about me. I struggled with this question when I wrote Love and Loss which intertwines memoir with clinical material. I couldn’t write that book, the book that memorializes my husband and our relationship, without providing autobiographical material. It was a risk I chose to take and, as far as I can tell, it has had minimal consequences. Most patients seem not to know about my book – or my blog. Of those who do, some have chosen to read it, others have not. Those who read it have told me either that they felt enriched by getting to know me on another level or have seemed relatively unaffected by the content.

I have read and written about self-disclosure a good deal during the course of my career and have come to the conclusion that patients can fantasize as much about what they know about their therapist, as what they don’t know. For example, patients who know that I’m a widow have as much of a subjective spin on that fact, as those who don’t know. They can create whatever transference scenario that fits their own internal dynamics. I know I have colleagues who will disagree and say that I’m rationalizing my self-disclosure. Perhaps they are correct. I can only say that my experience has been that my self-disclosure has often deepened the treatment, as opposed to derailing it.

Please ask whatever further questions you might have about my blogs and I will attempt to answer them. Perhaps in another blog.