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.”

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.”    

Counting the Years

Slim, youthful-looking Marjorie is trying to break her habit of reading obituaries. 

“I’ve read them for more years than I can remember. And now that I’ll be turning 65 in a couple of weeks – I hate saying that but unfortunately it’s all too true - I keep focusing on how old people are when they die, trying to figure out how much time I have left. I remember when I turned 50. I knew that more than half my life was over. Maybe that’s when I started counting the years. There are lots of people who die in their 80s or even older, but there are people who die in their 70s too. That could mean I have less than ten years to live! That scares me, really scares me. I tell myself I should just stop reading those damn obituaries, but I’m not sure I can.”

“What are you afraid would happen if you stopped?” I ask.

“Nothing. Nothing would happen.”

Silence.

“I guess it’s like then I wouldn’t know,” she says.

“Wouldn’t know?” I echo.

“Wouldn’t know who died. Or when. Or how old they were. Or what they died of.”

“And that would mean what to you, Marjorie?”

She knits her brow and sighs in exasperation. “I just wouldn’t know,” she says emphatically. “I don’t like not knowing.”

“’I don’t like not knowing.’ That’s an interesting statement. Does not knowing makes you feel powerless, out of control? After all, what we can least know is when and how we’re going to die.”

“Just listening to you say that scared me. It’s like my heart fluttered. I always wanted to know.”

“And if you didn’t?”

“You know the first thing that popped into my head? My mother would die. I know that’s ridiculous, but that’s how I felt as a kid. My mother was sickly, although it wasn’t ever clear what was wrong with her. It was all hush, hush. Don’t upset your mother; don’t bother your mother; be good to your mother. From as early as I can remember I was scared that something would happen to her, that she’d die and it would be my fault. I think she had some kind of neurological disease. By the time I was in high school she was in a wheelchair. She died while I was away at college.”

“So your fears about dying started very early and your not knowing felt dangerous. You didn’t know what was wrong with your mother so you couldn’t protect her.” I suspect Marjorie was also angry with her mother for needing caretaking rather than providing it, but I leave that thought unsaid.  

“So you think that’s when my fears about death started?”

“I think that’s when your fears about being out of control started, including your fears about death.” Here again I say nothing about my thought that Marjorie was also fearful of being out of control of her own anger.

“I was thinking about the office next door to you,” she says. “I think it’s a doctor’s office. They’re lots of patients in walkers and wheelchairs, lots of them with aides. I don’t like it.”

I don’t like it either, I think. Recently I too have been dismayed by having the inevitability of the aging process impinge daily on my working space. I’ve also been surprised by my feelings. Both my husband – 21 years my senior - and my mother deteriorated greatly in the last years of their lives. Although it greatly pained me to watch that deterioration, it didn’t affect me in the same way. It felt as though the aging process was about them, not me. But six years have gone by. Although I don’t count the years I have left, I am increasingly aware that I am no longer young. But unlike Marjorie’s experience, my mother lived until almost 99 with a positive, rosy disposition until the end. I may not like the daily reminder, but it isn’t as frightening as it is for my patient. 

“I suspect it makes you anxious,” I say.

“Yes it does,” she replies. “But that must be true for everyone.”

“Well,” I say, “No one likes the idea of being old and infirm and helpless, but it carries extra meaning for you. It reminds you of the helplessness of both your mother and yourself. After all, you were the child. You were in need of caretaking too. You didn’t have a mother who could take care of you and that left you feeling all the more alone and scared.”

“And you think that’s why I’m afraid of dying?” Marjorie asks skeptically. 

“I think that’s one of the reasons you’re afraid of getting old and of dying. But there’s never just one reason for anything. We have to keep exploring and trying to understand.”

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.