Life and Death

Naomi looks weary and haggard. She looks as if she has spent countless nights in a hospital besides her 85 year old mother with stage IV ovarian cancer which is indeed the case.

“I had to come in and see you today. I had to steal an hour for myself. I’m not even sure the last time I took a shower. Good thing the girls are self-sufficient. Although my husband’s been great. No complaints there.” Pause. “But now there’s my brother. I don’t know if he thinks he’s the knight in shining armor, but he’s decided he’s going to save our mother. By prayer.  As long as I don’t ‘kill her’ in the meantime. Does he actually think I don’t want her to live? I’ve spent years of my life trying to keep her alive; years trying to make sure she had the best quality of life. But she’s dying. She doesn’t even know who we are any more. It’s enough. It’s enough already.”

Internally I flinch at my patient’s words: “It’s enough already.”  Those were the same words my late husband spoke when he decided that he had tried everything possible to halt the progression of his cancer and that he was ready to let go. I would, of course, respect his wishes, but the finality of the words took my breath away. Steeped in remembering, I struggle to bring myself back to Naomi’s current reality.

“Your mother never made her final wishes known?” I ask.

“No, she didn’t. Every time I tried to bring it up, she’d change the subject. She couldn’t tolerate dealing with the reality of her own death. Well, you know how my mother was, never wanting to deal with reality, her head always in the sand.”

“So now you and your brother disagree about what to do.”

“That’s putting it mildly.”

“And you’re angry.”

“Yes, I am. I’m almost too tired to be angry, but I am. I’m not sure when he got so high and mighty religious and it’s not like I’m talking about killing Mom, just withdrawing treatment and allowing her to go peacefully. You’d think his God would welcome that.”    

    

Did you and your brother ever see eye to eye?”

“As children we were very close. I was like his second mother. But then he moved away and I stayed put and I gave my parents grandchildren which he never did. I guess that made me the favored child.”

“So maybe he’s fighting for favored child status now?”

“A bit late, isn’t it?”

“Perhaps not psychologically.”

“Yeah, I know what you mean. So you think I should be more understanding of my brother?”

I flash on an incident that occurred when my beloved grandfather died and the samovar that had always been promised to me was taken by my uncle, the less-favored child. “Being more understanding doesn’t mean you’ll be any more comfortable with what your brother is doing. I guess I’m concerned that this battle with your brother is going to divert you from grieving for your mother.”

“That’s true. Right now I’m more involved with feeling angry with my brother than dealing with my mother’s death. And it’s only a question of time before she dies, regardless of what we do or don’t do.”

“So how do you feel about her death?”

“Sad. But it’s time. And I have no regrets. I’ve been a good daughter. There’s no unfinished business between Mom and me. Hmm. I wonder if that’s what’s missing between her and my brother. I wonder if he still has unfinished business.”

“That’s a good insight, Naomi.”    

“But I’m not sure he knows it. And I have no idea how I’d talk to him about it.” Pause. “But you know what I said about it only being a matter of time until she dies anyway. Maybe I should listen to myself. Maybe it doesn’t matter all that much what we do. Death will do what’s it’s going to do, regardless.”

“I’m impressed, Naomi. That’s certainly taking yourself out of the fight with your brother.”

“The only problem will be if she lingers too long and suffers.”

“Yes, that would be a problem.”

“But maybe I can just wait and see what happens and try to opt out of fighting with my brother.”

“Sounds like a good plan.”

I Lied

A tall, too-thin, young blonde woman looks up at me with beseeching eyes when I open my waiting room door. She does not return my smile. Slowly, tentatively she walks to my office and waits until I gesture for her to sit, which she does almost reluctantly, teetering at the edge of the chair.

Oh, oh, I think to myself. This young woman is in trouble and probably means trouble for me as well.

She looks down at the floor, pulling at her fingers. Anxiety fills the room.

“Bethany,” I begin, planning to ask what has brought her to therapy.

At the sound of her name, she flinches.

“That’s not my name,” she says, practically whispering.

For a moment I’m confused. Did I misremember the name she gave me on the phone?

“I lied,” she says.

“You lied about your name?” I ask, surprised. In all the years I’ve been doing therapy, I don’t think anyone has lied about her name.

She nods, still looking down at the floor.

I wait.

“My name’s Belinda,” she says.

Belinda I think to myself, an unusual name. Tall, thin, blonde. The pieces fall into place. “You’re Chelsea’s friend,” I say.

“You have to see me,” she says raising her head, her eyes now boring into mine. “I’ve seen lots of therapists over the years. I knew you wouldn’t see me if I told you I was Chelsea’s friend, so I lied. I planned to lie for a while, until we had a relationship going, but I was too afraid. I didn’t think I could pull it off.”

I’m swimming in conflicting thoughts and feelings, and suspect that my confusion mirrors Bethany’s – I mean Belinda’s. Why is Belinda so determined to see me? What does it mean about her 

relationship to Chelsea? Why did she choose subterfuge and then immediately abandon it?

“Why don’t you say something?” she asks.

“I guess because I’m feeling confused and uncertain what to say or do, much as I imagine you often feel yourself.”

Belinda’s face lights up. “Yes! That’s exactly how I feel. I knew you’d be the only one who could understand me.”

Immediate idealization always followed by falling off the pedestal. But it can never get that far. I need to extricate myself from this situation as soon as possible for, as Belinda correctly surmised, I cannot treat both Chelsea and Belinda. They are good friends, both disturbed young women with eating disorders. They’re also extremely competitive with each other. I can just imagine the jostling that would occur as each tried to win my favor. Way too complicated for me to ever consider.

“I assume, Belinda, that Chelsea doesn’t know you came to see me,” I say.

“You’re not going to see me,” Belinda says, tearing up.

“No, Belinda, I’m not going to see you, but I would like for us to understand why it was so important that you see Chelsea’s therapist. There are many good therapists I could refer you to, why did you want it to be me?”

“It has to be you!”

“Because?”

“Because of how much you’ve helped Chelsea.”

“That could be one reason you want to see me. Might there be others?”

Silent tears pour down Belinda’s cheeks. In the next second she’s beating her fist into her thigh, her face contorted with rage.

“Stop it!” I say. “Stop it and tell me what you’re feeling.”

“I always, always lose. I hate myself! I hate myself! I’m never good enough!”

“Belinda, I know almost nothing about you, but I do know that today you set yourself up to lose. You knew coming in that I wouldn’t see you when I’m already treating one of your best friends.”

“We could keep it a secret,” she says interrupting.

“You know I’m not going keep a secret from a patient. You wouldn’t want your therapist to keep a secret from you. Is there something that happened between you and Chelsea that made you suddenly decide you wanted to be my patient?”

She shakes her head no.

“Is there something that happened in your life?”

“My sister got engaged.”

“So you felt that your sister won over you and you thought maybe you could win over Chelsea.”

She nods. “But of course I couldn’t. I always lose.”

“But again, Chelsea, with me, you set yourself up to lose and I think that’s something important for you to understand. Can I give you the name and phone number of a therapist I think you’d work well with?”

“I don’t know.”

“Well, why don’t I give it to you and hopefully you’ll think about it and give her a call.”