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.
I’m returning to Alyce, the first patient in my book and the subject of an earlier blog. For those of you who have not yet been introduced to her, Alyce was a young woman I treated much earlier in my career. We had an intense, tumultuous relationship filled with both hate and love. It was one of the most successful treatments of my career and one I am particularly proud of.
When I found Alyce many years later to ask her permission to include her in my book, I discovered that she had been in two horrible accidents, had a brain injury that had affected her mind, her speech and her ability to walk. I was devastated, for both Alyce and for the young therapist I once was.
As I wrote in my earlier blog, “Alyce represented the time of my life I most cherished: the time before my husband’s illness, the time before I left the home I loved, and most importantly the time before my husband’s death. Life was now painfully different for both of us, although I in no way equated them. Alyce’s losses were tragic, mine, although terribly painful, were an expected part of life.”
I spoke to Alyce the other day, a day she returned from having twenty injections in her back, buttocks and legs, to attempt to reduce her searing pain. She told me she had to go see her neurologist, concerned that her back was degenerating further and that she might lose still more mobility. She also told me that her 17 year-old daughter, the person she loved more than anyone else in life, had mostly cut herself off from her and that even their brief contacts were filled with cruelty and rage.
I feel myself sinking. How is it possible that anyone could continue to survive one loss after another, one tragedy after another?
“You sound sad,” my previous patient says to me.
“Well, yes,” I reply. “You’ve had to cope with so much in your life. How could I not feel sad for you, for all you’ve had to endure?”
“Hey, I’m alive!” Alyce replies, her voice strong and bright, her indomitable spirit shining through.
I feel myself brighten along with her.
She continues. “I’ve asked myself if I’m sort of manic these days, but I don’t think so. I don’t know what’s come over me, but I can just take every day as it comes and I’m still here. Nothing has killed me yet. I love my daughter more than any person in the whole world. I would do anything for her. I would die for her! But I can’t change who she is and right now she’s an angry teen-ager. I remember being an angry teen-ager. I bet you remember, too,” she says laughing. “I’m here for her and when she needs me I’ll still be here. And in the meantime I just have to go on living, putting one put in front of the other – well, sort of – I don’t do that so well - but you know what I mean. I have to keep myself alive and enjoy every day for what it is.”
What do you say to this kind of spirit? What response is there? Is part of this denial? Perhaps mania, as she herself suggests. It doesn’t matter. Her determination, her willingness to keep pushing, to keep smiling, to find the good in her life is nothing short of miraculous.
“Lots of good things have happened in my life,” she continues. “Lots of people who care about me have come back into my life, starting with you. You were my first mother. You grew me up.”
Does Alyce cry during parts of our conversation? Yes, she does. She’s not unaware of the bleakness of her situation. But her grit remains. “They wanted to move me out of this apartment. I told them no way. I told them I’ve moved six times in the last two years! I’m not moving again. I’ll worry about it when I totally run out of money.” Her voice cracks. “I don’t have any money. That’s a big worry. But something will happen, something will turn up.”
Am I really worried about how I’ll get my car back from the repair shop? Does it matter if I can’t get my voice mail messages from my cell phone? Does it matter if I lose a few hours of sleep so that I can finish my blog? Or what tragedy would befall if I didn’t get the blog done after all?
Surviving life well. We can all take lessons from Alyce.
Those of you who read my book will meet Alyce, the young woman whose five-year treatment was one of the most tumultuous of my career, filled with both rage and love. You will also meet me as I was at that time of my life, a relatively young clinician, married to the love of my life, living in an idyllic setting in the home my husband had remodeled.
I was immediately drawn to Alyce, hooked by her underlying fragility covered by a defensive and defiant toughness. Within two weeks of beginning treatment, Alyce decompensated into a florid psychosis. I saw her two and then three and sometimes four times a week. In addition, she often called me between sessions, sometimes pleading that I make her better, sometimes railing against my incompetence.
Even after she improved Alyce, who was an adopted child, maintained the belief that I was her biological mother.
“Why don’t you just admit it!” she would rage. “Why are you rejecting me again? Why did you reject me the first time? I hate you! I hate you! I hate you!!!”
Or she’d try a gentler approach. “Please just tell me you’re my mother. I won’t tell anyone. I understand. You don’t want anyone to know. I won’t tell. I promise. Just tell me you’re my mother.”
My reaction to these exhortations varied, both internally and verbally. There were times I wanted to yell, “Enough already, you know I’m not you’re mother.” At other times I wanted to take her in my arms and tell her that everything would be all right; that she didn’t need me to be her mother, that I would protect and take care of her as if she were my child.
Alyce and I worked very hard. She struggled with the reality of my not being her biological mother, of my having a life outside of her, of my going on vacations. But through it all Alyce definitely knew that I cared deeply about her. She blossomed.
Even after Alyce left treatment we remained in occasional contact for many years. I knew that she had married and had a child. I knew she had two Master’s degrees, one in psychology and one in writing. Eventually we lost touch.
When I decided to write my book, Love and Loss In Life and In Treatment, I knew that I wanted to write about Alyce. I wrote two chapters and then went searching for Alyce to ask her permission to use her material. Although she is partially disguised, I felt there was too much information about her to publish without her consent.
I emailed her, looked her up on Facebook, wrote to the last address I had for her. Nothing. No response. I tried again. Then, one night, there was a long message on my machine that I could barely decipher. A halting, drawn out, barely understandable voice said, “Li…n…da,… This is Al…yce.”
Although I couldn’t make out all that she said, I gathered that she had two accidents: the first some years ago which resulted in a long undiagnosed neck injury, the second a more recent car accident. The car accident resulted in a brain injury causing her speech problems, an inability to walk, difficulty in concentrating, and the need for twenty-four hour care. The message ended. I sobbed. My beautiful, accomplished Alyce! After all she had struggled through, this horrible tragedy befell her. I, who always tell patients life isn’t fair, wanted to rail against the unfairness of life.
Sometime later I realized that I wasn’t crying only for Alyce, but also for myself. Alyce represented the time of my life I most cherished: the time before my husband’s illness, the time before I left the home I loved, and most importantly the time before my husband’s death. Life was now painfully different for both of us, although I in no way equated them. Alyce’s losses were tragic, mine, although terribly painful, were an expected part of life.
I finally spoke with Alice, a painful conversation both because of my difficulty understanding her and the details of her injury and her life. Yet I could still hear Alyce’s grit and determination. She wasn’t giving up. She was suing the insurance company. She was in physical therapy, speech therapy, occupational therapy and psychotherapy.
I have continued to follow the ups and downs of Alyce’s life. She lost the insurance case. She could no longer afford an aide. She was moved to a group home. Her daughter could no longer live with her and went to live with her father from whom Alyce was divorced. She rarely came to visit. And still Alyce persevered. Her speech improved. Her mind improved. She went back on the internet. She became more interested in life.
After poor medical attention Alyce was hospitalized and almost placed in a nursing home. Instead, she now lives in her own apartment. There are many things she requires but cannot afford. And still she perseveres, determined to survive, determined to improve, determined to be present for her daughter. She is, after all, my beautiful, accomplished Alyce!
