Pretending

 “I did it!” Charlotte says, gleefully.

“Congratulations,” I say enthusiastically, “And welcome back.”

“I’m not talking about going by myself to Italy.”

“Oh! What did you mean?” 

“I did go by myself to Italy. It was hard. And all you’ve heard about Italian men, don’t believe a word of it. No one gave me a second glance. Oh course, why look at a middle-aged woman when you have all these gorgeous young, half-dressed I might add, girls running around. But seriously, don’t you remember what we talked about our last session?”

“I thought I did but… Oh, Charlotte, you really didn’t…”

She smiles broadly nodding at me.

“You pretended you were sick,” I state matter-of-factly.

“Correct! You see, not even you can remember me unless I do something daring, outrageous.”

“Of course I remember you. I didn’t remember that you were considering presenting yourself as someone who was ill, but I remember …”

“It doesn’t matter. I figured out how to get the attention I wanted. The more outrageous I made the story the more attention I got. It’s amazing how solicitous flight attendants can be when you tell them you’re dying of cancer or that you just had a chemo treatment.”

“And is that whose attention you wanted?”  

“Anyone is better than no one, but no, that’s not whose attention I wanted. But it was fun trying out different stories and seeing what provoked the most sympathy or what made people the most uncomfortable.”

“What did make people the most uncomfortable?”

“If they thought I was going to throw up all over them. That was a good one, especially on a plane with the person sitting next to me.”

“Sounds like you took a lot of pleasure making people uncomfortable.”

“Yes, I did. Felt like I was getting back at all the people who’ve made me uncomfortable, people who look at me like I’m ugly or don’t look at me at all, as if I don’t exist.

“What do you feel as you tell me all this?”

“First word that came to me? Triumphant!”

“And since you’ve been home?”

“It’s back to the same boring life. Biller in an ophthalmologist’s office. Real exciting. A great place to not be seen.” Pause. “But I am thinking about bringing my little pretense back home. Maybe in grocery stores or gas stations – I can go someplace I don’t usually shop. I’ve even considered taking it to work. Who’s to say I couldn’t start telling my co-workers I haven’t been feeling well, that I’ve gone to the doctor, that I have some kind of cancer, etc., etc.”

“Charlotte, when you first started talking today I felt annoyed with you, annoyed for the people you were duping and angry that you felt you had to stoop to subterfuge to get people to pay attention to you. But as you’ve kept talking, I find myself feeling sadder and sadder. And I suspect you also feel both angry and sad. You’re such a bright, insightful person. You could do so much more with your life.”

“Except that I’m ugly.”

“I know you feel ugly, and this is something you and I constantly disagree about, but you don’t have to be the most beautiful woman in the room to have friends, to have lovers, to have a job that fulfills you.”

“You mean billing doesn’t fulfill me?” she asks sarcastically.

I sigh. “I know your mother didn’t value you. I know you feel your older sisters were prettier and smarter than you. And given all that, it is still possible to have a meaningful life.” Pause. “You’ve always talked about writing. You certainly demonstrated that you can be creative with your storytelling about yourself. Put the stories down on paper instead of acting them out.” Pause. “I’m sorry. I’m preaching. I know I can’t decide your life for you.”  

“I’m 55 years old. Don’t you think it’s too late for me? How do I change now?”

“You went to Italy.”

“And my most fun was spinning a death fantasy about myself.”

“What was your fantasy about what the trip would be like before you left?”

Charlotte drops her head. “I thought I’d meet the love of my life. I know, that’s stupid, ridiculous. I feel like an idiot even saying it.”

“It’s not stupid, Charlotte, it’s a wish. But maybe it would have been good if we had talked more about your imaginings about the trip before you went so that you could have anticipated several scenarios, thought of the good things that might have happened, as well as the disappointing things. And I know that although many people like it, traveling alone can be very hard.”

Charlotte starts to cry. “It was very hard.”

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.”

Endless Despair

 “I don’t understand,” Amber wails over the phone. “I was doing fine. I had a good day. I took my dog for a long walk. And then with one phone call I’m a wreck. I can’t stop crying. I feel as though I want to beat my head against the wall,” she says sobbing.

“Can you tell me what happened during the phone call?”

“Nothing! I mean nothing that would lead me to feel awful. I don’t understand. Why doesn’t it stop? Why do I always, always feel so awful?”

Having seen Amber for several years, I realize nothing I say at this point is likely to be of help. Still, I reply, “You don’t always feel awful. You were just telling me you were having a really good day.”

“But it always comes back! Why does it always come back?”

“Part of the problem for you is that when you feel awful, the feeling takes you over completely and you can’t remember that you felt really good yesterday or the day before.”

“But why does it always come back?”

“What’s the ‘it’ that always comes back?”

“The bad feelings. They always come back.”

“You know, that’s a really good question. Why do your bad feelings always come back? Like today, you said you didn’t think the phone call should have triggered your bad feelings, but it did. And perhaps I should ask what specifically you mean by bad feelings.”

“Sad feelings. Depression. Feeling everything’s pointless.”

“Okay. So why do your sad, depressed feelings always come back?”

“I don’t know!”

“Well, what did happen on the phone call?”

“My boss told me I did a really good job on the marketing project. She had a few minor corrections, but basically complimented me on a job well done.”

“And you felt how about that?”

“While I was on the phone with her I felt good, pleased. But then, I don’t know. It just washed over me and I felt like shit.”

“What washed over you?”

“Despair. Like what does it matter anyway. It’s just a stupid marketing job, for some stupid liquor company that’s just going to turn people into alcoholics.”

“Whose voice is that, Amber?”

“It’s mine.”

“Yes, but isn’t it also someone else’s voice? You’ve certainly told me that your mother was always critical of you, always telling you what a failure you were, how you couldn’t do anything right.”

She sighs. “Yup. That’s my mother.”

“So when you were talking to your boss you could take in your her voice, you could take in the compliment. But when you got off the phone, your mother’s voice returned with a vengeance.”

“I guess so.” Pause. “But why?”

“What are your thoughts?”

“I certainly heard her voice a lot longer. It’s louder, telling me how stupid I was and that I’d never amount to anything. And she still does. Why did I go into marketing? Why couldn’t at least have been a teacher? Why aren’t I married? Why am I such a bad daughter, etc., etc.”

“Yes, her voice is louder. And I also wonder if you’re invested in staying attached to your mother’s negative voice.”

“Why?”

“If you move away from your mother’s voice, maybe it’s like moving away from her, leaving her behind. And she is, after all, the only mother you ever had.”

Amber starts sobbing. “I can’t leave her. I can’t. I’d feel way too guilty.”

“Plus, if you take in more positive voices and leave your mother behind, you’d also have to mourn never having the mother you wanted or deserved, not as a child and not as an adult.”

Amber continues sobbing. “I can’t! I can’t! You can’t make me! Oh my God, I’m being swallowed up by those bad feelings again!”

“No, Amber, I can’t make you. I neither could nor would force you to do anything. But I think you can see how terrifying the thought is for you, the thought of moving away from your mother, of mourning who she isn’t and wasn’t.”

More sobbing. “But maybe she’s right. Maybe I am bad and stupid and incompetent, maybe that’s why she couldn’t be nice to me.”

Softly I say, “I understand that it feels safer to take the badness inside you, to take it away from your mother, so that as long as it’s inside you you can hold onto the hope that if only you were different she would treat you differently, would love you more.”

“Wouldn’t she?”

“Only you can answer that, Amber, but from what you’ve said, it sounds as though your mother was rejecting of you from the moment you were born, for her own reasons, stemming from her own problems, but extraordinarily destructive and painful for you.”

“I can’t. I just can’t.”

“I understand. You can only do what you can do. And we’ll keep working, working at a pace that you can tolerate, that isn’t unbearable to you.”

I Feel Okay

 

“I realized the oddest thing this week,” Anne begins, her voice fairly upbeat as she speaks into the telephone. “I’ve been feeling okay.”

“That’s terrific, Anne,” I say excitedly.

“Yeah, I’ve been talking to you for how many years? And this is probably the first time I’ve ever said I feel okay. I can’t figure out why. Nothing has changed. I’m stuck indoors like everyone else. Our Covid numbers are spiking, I’m as terrified as ever of getting the virus and yet I’m okay.”

Anne is correct. I have been speaking with her for a number of years and this is probably the first time she has not described herself as depressed, anxious and isolated. We began working in person when she relocated to Florida to take care of her aging and always demanding mother, a long and arduous process that called upon all the strength Anne could muster and all the support I could give. After her mother died, Anne returned to New York, saying it felt like home, although she had neither friends nor career to return to. She did, however, now have sufficient money to live comfortably whether or not she could find a career path commensurate with her intelligence and education, leaving behind her unsuccessful attempts in retail or restaurants.

“What are your thoughts?” I ask.

“I don’t know. I’ve done the same thing these past several weeks as I’ve done for months, or even years, and I feel strangely content. No despair, no pressure. Of course I haven’t had any pressure for a while, not since my Mom died.”

“Except for the pressure you put on yourself.”

“That’s true.” Pause. “I still feel I should figure out what to do with the rest of my life. I should be looking at various career possibilities, seeing what piques my interest. But I guess I know what the reality is with Covid. New York is decimated. There are thousands and thousands of people unemployed, stores are boarded up. No one is going to hire a 52 year old woman who has probably never held a job for more than a year. I also feel I should go back to my painting. I was pretty good at it. Why don’t I spend my very excessive amount of free time painting again? I should. But I don’t.”

“So you’re still putting pressure on yourself.”

“Yes” Pause. “And I do still hear your voice telling me I should be spending more time with people. But of course everyone is told not to spend time with people these days. But I know you’d still be telling me I should at least reach out to my sort-of friends by phone.”

“You still feel pressure from both yourself and me, but you feel different, calmer, less despairing.”

“Yes.”

“And you don’t feel isolated?”

“Everyone feels isolated.

“Maybe that’s comforting.”

“What’s comforting?”

“That everyone feels isolated.”

“That’s a good point. I don’t have to feel like such a freak.” Pause. “Yeah, that’s right. Usually this time of year would be the worst. Thanksgiving in November, Christmas and New Year’s in December. Everyone running around buying food and presents and looking forward to seeing family and friends. And then there’s me. Sitting at home stuffing myself with junk food and wondering if I should kill myself. But not this year, this year everyone’s in the same boat as me. I know they still have these ridiculous TV commercials with people sitting around a big table together or drinking themselves sick at parties, but now they look exactly like that – ridiculous. No one should be doing that this year. Everyone should be doing exactly what I’m doing, sitting home alone, no one else there. Yes, it’s a tremendous relief. That’s exactly why I feel okay.”

“Where do I fit in?” I ask.

“You’re my one exception. You’re here. But of course you’re not here. You’re thousands of miles away.”

“And that means what for you?”

“Actually makes me feel a little sad. But not too much, because I know even if you were next door we’d be meeting just as we are now, on the telephone. Yes, that makes me feel better immediately. So I guess that’s another thing Covid has done for me – made me feel less like a freak and made our distance feel less significance. No wonder I feel better.”

Anne may feel better, but I’m left feeling sad, both for the sadness she likely feels underneath her “better,” as well as for the isolation she wears as a protective shield, unable to breach the chasm between herself and others. Covid will eventually end and unless we are able to breach that chasm she will return to feeling like a freak, the forever outsider longing to be part of the lives she only imagines.  

Tag words: Psychotherapy, mental health, patient-therapist relationship, projective identification, isolation, sadness, despair, aloneness, Covid19.

And Then There Were None

Mary Collins, a 49 year old woman who looks at least 10 tens older, sits across from me, tears streaming down her face, unable to speak. Although I have never seen or spoken to this woman before – her husband made the appointment - I feel the intensity of her pain and find myself similarly at a loss for words. Finally I decide on the most basic of human responses.

“I’m so, so sorry for your loss. I can only imagine the depth of your suffering.”

Mrs. Collins shakes her head again and again, her straight brown hair falling forward over her face. “I can’t …,” she says, continuing to shake her head.

I wait.

“I can’t stand it. I can’t!” she says more loudly. “I can’t stand the pain. I have nothing left, nothing to live for.” Pause. “I know you’re going to say it will get better. My husband says that all the time. But this? How can this get better?”

“Can you tell me about your son, Mrs. Collins?”

“Mary,” she says, still shaking her head.

“Mary, can you tell me about your son?”

“Billy. He was a good boy. A little wild as a kid, but what boy isn’t? He always wanted to be a policeman. I don’t know why.” A blank, distracted look comes across her face. She repeats, “I don’t know why. I don’t know why. I don’t know why.”

“You don’t know why he shot himself?” I ask.

Wailing she beats her fists into her thighs. “Why? Why? Why?”

Without thinking I get up from my chair, kneel in front of her and take hold of her hands. “Hurting yourself won’t bring your son back,” I say softly.

She stops hitting herself and sobs.

After a few moments I return to my chair.

She hides her head in her hands and continues sobbing.

“He didn’t want a divorce. Til death do us part. That’s what he wanted. That’s what he saw in our family. But she, she didn’t want to be married to a policeman, although she knew that’s what he was when she married him.” Pause. “And maybe it was more the boys for Billy, two little boys. Tore Billy to pieces.”  

She pauses. I think about what she said and wonder what her words will trigger for her. I watch the awareness go across her face.

“No! Not both of them! God couldn’t be so cruel. How could he take both my boys? Blown to bits by one of those IEDs. Who cares about that godforsaken place? Why do we keep sending these children to Afghanistan? It’s all so senseless, senseless.”

“I imagine Billy was pretty broken up by his brother’s death.”

“Sure was. And angry. Like me, angry. Ron was his baby brother. Billy kept saying he should have gone first. And now they’re both gone. And I have nothing.”

“Can you say who you’re angry at Mary?”

“Everyone.”

“Can you be more specific?”

“God. The government. The universe. Sue. I’m definitely mad at Sue. That’s Billy’s wife.”

I suspect she’s also angry with Billy for killing himself, but know it’s way too early to broach that topic. “Are you going to maintain contact with Sue? I imagine you’ll need to in order to see your grandchildren.”

She shrugs. “Who knows what she’ll do.”

“You saw each other at the funeral?”

She nods. “But I didn’t know what was going on that day. I don’t think she brought the boys, although I think I saw them later at the house.” Knitting her brow, she pauses. “I don’t know. What difference does it make anyway? Nothing matters anymore.”

“Do your grandsons matter?”

“I guess.” Pause. “Yes, they matter. They carry part of Billy.” Pause. “They’re the only grandchildren I’ll ever have.”

I can see Mary’s despair and rage begin to build, her hands in fists.

“Remember,” I say quickly, “Hurting yourself won’t bring your sons back.”

“But it’s easier. The physical is easier, easier than thinking, easier than remembering.”

“I do understand, Mary. But I don’t want you to hurt yourself. And I’m sure your husband doesn’t want you to hurt yourself either. I know the pain often feels intolerable, but you can survive it. As awful as it is, you can survive it.”

Mary sobs.

“And we can talk about your pain, Mary, your pain and your anger. I know that won’t bring your sons back either, but talking does help. And maybe us talking together will make it easier to bear the pain.”

Misery

Beth smiles wanly at me as I open the waiting room door. I anticipate a long, dreary session.

“I’m still miserable,” she says, sitting down, immediately confirming my worst fears. I do understand that Beth has good reason to be miserable. Her husband divorced her after 20 years of marriage, leaving her with two teenagers, three dogs and a six bedroom house. It’s a lot to deal with. And we’ve been dealing with her misery for almost two years.

“Of course I had another problem this week. The kitchen sink started leaking. I freaked out. I went running around to my neighbors to ask if they knew a plumber. Luckily one of them did.”

Knowing I am about to make a futile statement, I say, “So that’s something that worked out well.”

“Not really. It took me days to reach the plumber and then more days before he could come. And in the meantime the kids and I had to eat out which certainly doesn’t help my budget.” She sighs. “It’s all so complicated. I don’t know why life has to be so difficult.”

I wonder how many times I have said things such as, ‘life can be difficult and you’ve certainly had a difficult time, but life can bring lots of joy as well.’  I remain silent.

“Well …?” she says.

My stomach tightens. I feel as though she is commanding me to respond.

“What is it that you want from me right now?” I ask. I hear my choice of words, the tone of my voice and realize that Beth is making me feel as she feels – burdened, put upon, ineffectual, despairing. Ineffectual. That’s an interesting word to flit through my mind. Perhaps that’s what Beth feels. Now alone, she feels unable to competently contend with life.

“I need you to reassure me, to tell me that it will all work out okay.”

“Would you believe me?”

Beth opens her mouth to speak and then stops. After a pause she says, “Well if you said it, it might reassure me.”   

This time I don’t hear Beth’s words as a command to speak, but rather a wish that I take care of her. “I understand that you want reassurance, but you often hear that reassurance as empty words.”

“But I don’t know what to do. I have all these responsibilities. The kids. They’re certainly becoming more than a handful. How am I supposed to handle two teenagers by myself?” She takes a breath. “And what if I get sick? That’s all I’d need. How could I take care of all the things I need to take care of if I got sick? Who would take care of me?”

“I definitely hear how overwhelmed you feel, Beth. Like there are all these things that happen on a day to day basis and then there are all the things that might happen. How are you going to cope?”

“Exactly.”

“But I wonder, Beth, if it would be more helpful to you if you were able to see your own strength, if you were able to realize that you’re far more capable than you think you are.”

“But I’m not!”

“Do you really feel as though you’re not a competent, capable adult or are you afraid to let yourself know you’re a competent, capable adult?”

“They always said I wasn’t.”

“Who’s they?”

“My parents, my sisters, my husband. Even my children. They say I’m a wreck, that I can’t do anything right, that I’m always running around in circles. And I am. I’ve been doing that my whole life.”

“So what would it feel like to be competent?”

“How do I know? I’ve never felt it.”

“Would you like to?”

“Of course!”

“Beth, can you think about that a bit more? I wonder two things: If feeling competent feels so foreign to you that it would be like you’re becoming another person and that in itself would feel pretty scary. And two, you’re not sure you want to be all grown up before you find someone who’ll take care of you.”

“My husband said he’d take care of me. But he never did. He just nagged at me for what I didn’t do right. Even my parents. I was the fifth girl. They’d had enough by that time. I was kind of an add-on.”

“I understand, Beth, that it’s very difficult to give up on wanting the love and caretaking you never had, but there’s no way to get that kind of caretaking as an adult. It doesn’t mean you can’t be loved and cherished, but you can’t go back to being the child and, in the end, it does feel much better to have confidence in your ability to take care of your adult self.”  

Until Death Do Us Part

Bob Samuels looks as though he would once have been a handsome man. Now his disheveled white hair, creased brown pants and too small plaid shirt, along with his sad eyes and almost shuffling gait, gives him the appearance of a man who has grown old before his time.

“I read your book,” he begins. “I thought maybe you could help me. You know about loss. But I worry that you don’t know about regret. You don’t mention it much.”

I immediately flash on some of the regrets I have regarding my husband’s treatment of prostate cancer and heart disease: Should we have chosen surgery rather than radiation? Why did no doctor ever tell us about the possible false negatives from chemical stress tests? Yes, I have regrets, but they don’t plague me. I accept that no one is infallible; no one can anticipate or control everything. I say nothing and wait for Mr. Samuels to continue.

“My wife died of ovarian cancer five years ago. She was diagnosed five years before that. In the beginning she put up a valiant fight, although I always wanted her to pursue more alternative treatments in addition to the chemo. I don’t mean anything way out there. Stuff like nutrition. I thought she should become a vegan, try juicing, stuff like that. But she couldn’t deal with it. And then in the end, when the cancer came back again and then again, she called it quits. Said she had enough. She stopped all treatment and just died. I wanted us to go to Europe and try some of the experimental treatments that aren’t available in the States. But she said she couldn’t, said she was done.”

I think about my husband’s words when he too decided to stop treatment: “It’s enough already.” He had fought for years to stay alive. But he reached his limit. Although I was grief stricken, I understood his decision.

“Sounds like you’re angry at your wife for giving up,” I say to Bob.

He startles. “No, no,” he says. “I could never be angry at her. I’m angry at myself for not being able to convince her, for not being able to make a good enough argument. I’m inadequate. I couldn’t make her see.”

“You couldn’t make her see what?” 

“That there was a chance. That there were still things we could do.”

I believe that Bob is angry at his wife for letting go. I also believe that he can’t let himself feel that anger, that he blames himself rather than her. And he can’t tolerate the helplessness we must all deal with in the face of death. But these interpretations are all too premature.

“It sounds as though you miss your wife tremendously,” I say instead.

He sobs. Reaching for the tissues he tries to control of himself. “I’m sorry,” he says, his voice breaking.

“There’s nothing to apologize for,” I reply.

“It’s five years. I shouldn’t be like this anymore. But I keep tormenting myself. What if I’d done X? What if I’d say Y? What if I was enough of a husband for her that she wanted to stay?”  

“You think if she loved you enough she would have fought harder?” I ask, wondering if his wife’s decision to stop treatment felt like a narcissistic injury to him.

He cocks his head and puts a finger to his lips, pondering my question. “I think I always loved my wife more than she loved me. I mean, she did love me, but I adored her. She was the only woman who really ever mattered to me. So do I think if she loved me more she would have continued to fight? Maybe I do. I don’t like to hear myself say that. It sounds so selfish, so much about me.”

“You know Bob, in the end, none of us can defeat death, no matter how much we might love or how much we might want to stay.”

“I know.”

“I wonder if you do. I mean I’m sure you know intellectually that we all die, but I wonder if on a gut level you feel that if only we do enough, if only we try harder, somehow we’ll be able to continue on.”

“I don’t know.”

“Bob, my sense is that we jumped right into this very painful, difficult topic because you’ve obviously been struggling with these feelings for quite some time. But I wonder if we could go back a bit so I can get some sense of you, of your life, of who you are.”

He takes a deep breath. “Where would you like me to start?”

“Wherever you’d like.”