Emptiness

 

“I can’t understand it,” Valerie says sobbing. “Why would he want to leave me? We said it was forever. He’s breaking his promise! It’s not fair!! This should have been the best time of our lives. Approaching retirement, soon able to travel wherever we wanted. And now I’m just going to be alone.”

“Valerie, is Dave really choosing to leave you?” I ask gently.

“Of course he is. The doctor said there were several other chemo options he could try.”

I am more than familiar with the pain of losing a life partner, so I know to tread carefully in this most difficult of life experiences. “Can you understand Dave’s decision to stop further treatment?”

“No. Definitely not.”

“Do you have a living will, Valerie?”

“Yes, of course. I wouldn’t want to be kept alive if I was in a vegetative state, or if my mind was totally gone. But that’s not where Dave’s at.”

“Where is Dave at? What’s his quality of life? How does he spend his days?”

“He’s in bed a lot. He’s always tired. He sleeps. I know it’s partly from the lung cancer and partly the pain medication. But we still have conversations. We still sleep in the same bed. Sometimes we watch TV together. He coughs all the time, sometimes says he can’t catch his breath. Tells me he has a lot of empathy for Covid patients but he also says…” Valerie breaks off, puts her head in her hands and sobs.

When she composes herself she continues, “He says at least they have vaccines for Covid now and new medications and that at least Covid patients have the chance to get better and live normal lives. He no longer has hope. But I have hope. He could try some of these other drugs, these other regimens.”

“It sounds as though Dave is very tired, Valerie.”

She sobs again. “You think I should let him go?”

“Sounds like he’s saying he’s had enough.”

She sobs. “I’m so scared. I’m going to miss him so much. I’m not saying our marriage
was perfect, no marriage is perfect I know that. But we’ve been together for over 30 years. I don’t know what it’s like to live alone. I’ve never lived alone. I lived with my parents then roommates and then Dave. I just see myself locked in that house rotting away.”

“Rotting away? That’s a very graphic image. What makes you think you’ll rot away?”

“I don’t know. I guess like old food in the refrigerator that is left and forgotten about and just rots away. Like no one would know whether I’m alive or dead.”

“I don’t in any way doubt that you’re describing your feelings, but it’s surprising to me that you picture yourself so desolately. Before your husband’s illness you seemed to have a very active social life, to be involved with lots of people, in lots of different ways.”

“All meaningless. And besides, it was my husband who was the social one. Left on my own I just rot.” Pause “There’s that word again, rot.”

“Do you feel as though you’re rotten, Valerie? Rotten as in bad?”

“No, I don’t think I’m bad.” Pause. “I just think I’m not much of anything. Kind of a blob. My husband brought life into our home. Left to my own devices I’m afraid I’ll be swallowed by the emptiness.”

“I know depression can put a pall over everything, but this sounds like something more, like you’re literally afraid of disappearing into the void.”

“That’s it exactly. No Dave, no me, just an empty blob.”

Feeling more and more of Valerie’s despair, I ask, “And you felt that way as a child as well and as a young adult, like in college?”

“Well, there were my parents to tell me what I was supposed to do and then, as I said, I had roommates and sort of followed along with the crowd.”

“It sounds, Valerie, as though you’ve spent your life following along with whomever you’ve been with. And now, with Dave’s decision to stop treatment, you’re confronted with the terrifying feeling of not knowing who you are apart from him, and perhaps of never knowing who you were.”

“I’m terrified. I think you’re absolutely right and that makes me need Dave even more. Do you think I can persuade him to continue treatment until you and I can work this out? Until you can fix me?”

“Right this minute you may feel that you need Dave more, but nothing has actually changed. We definitely do need to work on your feeling more your own sense of self, but whether Dave will stay around until we accomplish that I can’t say.”

“I’m not sure I can survive. I want to survive but I’m not sure I can.”

“You just said something very important. You said you want to survive. That’s you, Valerie, knowing what you want.”

Welcome Back

Annette smiles wanly when I open the waiting room door, walks slowly into my office, and lowers herself gently into her usual chair.

“Welcome back,” she says with little enthusiasm.

“Thank you,” I reply, surprised by Annette’s distance and reserve. Although this was the Annette who began therapy with me many years ago, our close enduring relationship had allowed her to deal with her childhood sexual abuse and to transform into a warm, open, engaged woman. Now forty-five, she worked as a para-legal and had a full, satisfying life. Although she never married, she had several long-term relationships and a network of close friends. She was usually especially glad to see me after my return from vacation, eager to catch me up on her life.

After a brief silence I ask, “What’s wrong, Annette?”

“I have some really bad news,” she says, her voice barely audible. “I have metastatic colon cancer.”

My eyes widen, tears immediately filling them. “Oh Annette,” I say. “I’m so, so sorry. When did you find out?” I was only gone two weeks I think to myself, aware that I feel guilty I wasn’t here for her.

“Just yesterday. I guess I’m still in shock. I wasn’t feeling well, had some bloating, discomfort. I wasn’t hungry which, as you know, is unusual for me. I thought maybe it was just my usual stomach stuff, but I went to my GI doctor. He examined me and suggested a colonoscopy and a CAT Scan. I was too happy about that. And then the diagnosis, cancer. They want to start chemo. I don’t know. I don’t know what my chances are and if I’m going to die anyway, I’d rather not prolong the agony.”

I’m overwhelmed by sadness, sad for this woman who fought so hard in her therapy to get through the pain of her past, only to now be forced to confront a dire illness and the possibility of death. My own losses flash in front of me as well, my husband to metastatic prostate cancer, numerous friends to pancreatic cancer, liver cancer, breast cancer. The list seems unending.

“I’m sorry, Annette,” I say. “I know I’m not being helpful to you.”

There again is her wan smile. “No, you are. I can see how much you’re affected by my news. That means a lot to me. I know you care for me. I know I’m not just one in a long line of patients.”

“We’ve worked together a time long, Annette. Of course I care about you. And I’ll help you through this however best I can.”

“Will you support whatever decision I make about whether or not to get chemo?”

“I will, but there’s a “but” to that statement. I want you to be sure you’ve explored all your options and know what the doctors think of your chances.”

“I am going to see an oncologist.”

“Good. I’m glad. And I also think you need to give yourself some time. You just found this out yesterday. It’s overwhelming. It’s overwhelming to me, it must be more than overwhelming for you.”

“You’re the first person I told.”

“You didn’t call any of your friends?” I ask, surprised.

“No. I knew I’d see you today. I was afraid if I told anyone I’d totally fall apart. I called in sick to work. I couldn’t bear telling everyone there and I didn’t know if I could fake it. They know I haven’t been feeling well.”

“Do you feel you can tell your friends now?”

“I don’t know. I’ll see.”

“Annette, does this feel like part of the abuse all over again? Like an unwanted, foreign thing invading your body?”

“Oh my God, I hadn’t thought of that! But it’s true. I mean I know it’s not the same thing, but it does kind of feel that way. How did you think of that?”

“I guess because today you’re more like the self I knew when we first started seeing each other – removed, defended, isolating. I know it could be shock, but for you I thought it might be more. And it’s not only the cancer itself, but all the tests you had to take and will continue to have to take. So we’ll need to be sure that your decision about treatment isn’t contaminated by your desire to avoid what might feel like more abuse.”

“You’re right. I wouldn’t want that bastard to destroy me in the end.”

“I wouldn’t want that either. Go see the oncologist, tell some of your friends and hopefully you’ll have  time to decide what to do.”

“See you Thursday.”

“See you Thursday,” I repeat, aware of the now increasing importance of time. 

Secrets

Tall, thin, with neatly coifed grey hair, Estelle Harrison, fidgets in the chair, looking decidedly uncomfortable. “I’ve never done this before. I’m almost 80 years old. I can’t believe I’m coming to a psychologist. But I have to talk to someone. My husband has lung cancer and he won’t let me tell anyone. Another secret. I’ve been the keeper of secrets my entire life.”

“Why is your husband’s cancer a secret?” I ask, thinking how unimaginable it would have been for me to keep my late husband’s cancer secret, how more impossible it all would have been without the support of friends and family. 

“He feels ashamed of being sick, like it’s a weakness.”

“So you’ve told no one?”

“Our daughters know. They call. But they have their own lives. And truthfully,” she says sighing, “I’m not sure how much they’d care anyway. Dave wasn’t a very good father. In fact, he was a terrible father. He used to beat them. That was another secret I kept. He’d take down their pants and beat them with a belt.”

For a reason I cannot completely explain, I think, “Did he get off on it?” What I ask is, “How old were they?”

“I can’t remember how old they were when he started. Young. Too young.”

“Until …?” I ask.

“They both left the house pretty early, so I’d say until they were seventeen. Actually after Maureen left – she’s the oldest – Liz got it worse.”   

Finding this difficult to listen to, I say nothing. My mother didn’t protect me from my father’s rages, but he wasn’t beating me and his rage wasn’t fueled by a perverse sexual desire as seems to be true for Dave Harrison.  

As if reading my thoughts, Mrs. Harrison says, “You think I’m terrible don’t you?”

“I don’t think you’re terrible, but I’m not sure why you didn’t try to intervene, to protect your daughters.”

“I was afraid he’d get physical with me too.”

“And did he?”

“He slapped me across the face a couple of time.”

I am again silent.

“You younger generation, you all think I should have left him. But it wasn’t so easy back then. I was a housewife. I had no way to support myself. I wouldn’t have known what to do,” she says starting to cry.

Feeling more compassion, I say, “It sounds like your daughters are angry with you for staying, for not protecting them. That must make it harder for them to be available to you; that must make you feel all the more alone.”

She nods her head, still crying.

“This might seem like a foolish question, but why haven’t you told whomever you want about your husband’s illness, regardless of what he wants?”

She looks at me, startled. “I can’t do that. It’s his illness. If he doesn’t want me to tell, I just can’t.”

I feel myself getting angry at Mrs. Harrison’s passivity. Is that reasonable? Or is my anger at my mother seeping into this therapy session? Or, yet another possibility, am I feeling Mrs. Harrison’s own anger? 

“Are you angry with your husband, Mrs. Harrison?” I ask.

“I can’t be angry at him. He’s sick.”

“You can still feel angry with him. You can feel angry for his mistreating you and your daughters. You can be angry that he won’t allow you to speak, to tell people who could be supportive of you.” Suddenly I wonder, “Does your husband know you came here today?”

“Oh no, I could never tell him that. He’d be furious at me for telling our secrets.”

I again feel annoyed. Now I wonder if I am feeling angry like her husband, angry that she is so passive, angry that she presents as a martyr just waiting to be beaten. Does she carry within her both the beaten child and the angry parent, with the angry parent projected outward so she doesn’t have to feel the rage herself?  Way too complicated for a first session but I do ask, “What about your own childhood, Mrs. Harrison? Were you beaten?”

“Oh no. I was the good one. My brother and sister got my mother’s rage, but I always did what she wanted and I never talked about what went on at home.”

“Just as you did with your husband. But were you angry with your mother?”

“I couldn’t be. I was too afraid I’d give her some sassy answer one day and then I’d get it too.”

“Sounds like you might have lots of angry stored up inside.”

She shrugs. “I guess.”

Unsurprisingly, another passive response.” 

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.”  

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. 

Cancer

As soon as I open my waiting room door, I can tell that Marsha isn’t doing well. Usually a warm, bubbly woman with a ready smile, today she seems sad, subdued.

“It’s been a bad week,” she says. “I’m not sure I even mentioned this to you before because Bruce was so sure it would be nothing and you know me, I’m more than happy to ignore things until they slap me in the face. Well, I got slapped in the face. Bruce has prostate cancer.”

Oh no, I think to myself, trying to keep my face impassive. My husband had prostate cancer. He died of prostate cancer. Memories flood me. When he first told me. When the radioactive seeds were implanted. When he started hormone injections. The years of the cancer being under control. Until it wasn’t.

“I’m not sure I understand all the details,” she says, “but I guess it’s past the stage of watchful waiting. So now we have to make all these decisions. I mean, I know they’re Bruce’s decisions, but obviously he wants my input. He’s only 58 years old. He’s scared of the surgery, the possibility of impotence or incontinence or both. I don’t much like the idea either. We’ve always had a great sex life. That’s been the glue through our ups and downs.”

58. A long time for the cancer to have to be kept under control. George was in his early 70s when he was first diagnosed. We didn’t want the surgery either. Not only for the reasons Marsha mentioned, but because George had recently had some heart difficulties and I was especially anxious about him having general anesthesia. It was a decision I often regretted. I remember my aunt saying, “Take it out! Take it out! Take it out!”

But this is not my decision. Neither my experience nor my bias should influence Marsha. I think about my book, Love and Loss. Marsha has never mentioned it, so I doubt she’s read it. If she had, she’d certainly know about my experience. Would if influence her? Perhaps. It’s one of the difficulties I considered before writing a book so filled with self-disclosures.

“You look sad,” Marsha says, bringing me out of my reverie.

Obviously my feelings are showing. “Yes,” I say. “I’m sad, sad that you and Bruce have to deal with this pain.”

It’s true. More accurately, it’s half true. I feel sad for Marsha and sad for me. Although I don’t need Marsha’s misfortune to remind me of George’s cancer and its progression, Bruce’s cancer does bring those memories and feelings to the fore once again.

Marsha begins to cry. “It’s so unfair. We’ve just gotten our kids off to college and all the problems we had with Lawrence. I never thought he’d straighten out. But he did. And there’s taking care of our parents who aren’t doing so great either. The sandwich generation! Except now we’re being eaten!”

This is the other side of Marsha. As she said, she’s usually able to ignore difficult things. But when they hit her in the head she’s blind-sided, her defenses fall away, and she’s left drowning in misery.

“It isn’t fair, Marsha. But life isn’t. We never know what will happen. You’re not someone who’s constantly worrying about all the terrible things that might happen and that’s good. But now you’re faced with a very scary, painful situation where it’s not at all clear what path you want to take and what the consequences of that path may be.”

“What would you do if it was your husband?”

Danger, I think to myself. “Well, first I think I’d talk to your doctors. Maybe more than one of them. Get their opinions. Find out what your options are. Weigh them.”

“But what would you do?”

Is Marsha unconsciously picking up that I do have an opinion? Am I stonewalling if I say nothing? Am I stepping outside the bounds of my therapist role if I say anything? Then I realize that prostate cancer is the only disease that would place me in this dilemma. With other cancers I wouldn’t have an opinion. I’m relieved. I feel clearer.

“Marsha, I wonder why you keep asking me for my opinion. I know you’re scared and maybe that makes you feel more in need of an authority figure to tell you what to do. But I’m not an authority here, I’m not an oncologist. I’m certainly here to listen to your pain, your fear, your indecision, but I can’t tell you what to do. I don’t know.”

And I realize that’s true. My husband’s cancer doesn’t make me an expert. I don’t know what Marsha should do. My experience is irrelevant.