E. was my first patient today. She handed me a piece of paper: "Fax this letter to my child's school for me".
E had enrolled the child in school A, went the first day, didn't like it, pulled the child out, enrolled the child back in the school she had attended the year before, or school B. However, she didn't notify school A of the change. Her rationale was that since school A administrators did not pay my patient enough attention when she showed up with her child on the first day, she would exact her revenge by not notifying them of the withdrawal. Naturally, school A had been calling her every day to find out where this child was, and finally threatened to call the authorities if she did not provide proof of enrollment somewhere else.
So here she was today in my office, offended and annoyed by school A's unreasonable request, but willing to give in and send the letter. She had obtained the letter of attendance from school B where the child currently is, and that's how she came to hand it to me this morning, a gesture accompanied by a 'fax this to School A for me'. No question mark, no please, no thank you.
I wondered why she didn't ask the person who wrote her the letter to also fax it to school A and she answered 'I didn't want to bother them'.
Next!
S. was patient #2. S. came with her home attendant, as she does every week. S. is demented and the home attendant helps me understand what is or is not going on in S.'s life, since S. herself is often confused. Besides the fact that it is not possible to do any kind of psychotherapy with someone this impaired, sitting with her for a session is a sad, disheartening experience. She has no memory and no short-term memory in particular, so we'll talk about something and shortly after she'll want to talk about it all over again, having forgotten all about the first talk. For example, she'll say 'My daughter hasn't visited me in years'. She'll look really distraught and I'll help her remember that yes, her daughter does visit her twice a week, and S. will smile, reassured. Then five minutes later she'll say 'My daughter hasn't visited me in years' and so on.
It's like watching Memento, which gave me panic attacks even as a movie.
And every week is a bit different, since dementia apparently has its ups and downs, good days and bad. Today S. complained that she was tired and could not remember my name, which was frightening to her. "What's happening to me?" she wanted to know.
Before I could intervene in any way, the home attendant decided to cut the tension by telling me that there was another lady in the waiting room that also couldn't remember my name! How funny! The other lady was apparently mumbling to herself 'what's her name? miguelina? magdalena? mariaclara?...' The home attendant thought it was a hoot that nobody seemed to remember who I am today, and S said: "I remember your name now! You're Ribaldina!". Which I'm not sure it's even a name, let alone mine. But S. felt better.
My third patient's first words to me were: you are dressed like a Mexican. I happened to be wearing a long summer skirt from India, with pieces of mirror and lots of colorful embroidery. Third Patient stared at it with a look of disapproval.
Oh, but the lady with dementia? She said one wise thing. We were discussing how she has been forgetting to eat, and she giggled -inappropriately- and said "I may forget to eat but I'm hungry when I'm angry!"
To which I absolutely, most definitely can relate.
Friday, September 24, 2010
Monday, September 20, 2010
Home sick
Today I am home sick. I woke up this morning with a sore-throat so bad that it was a real effort to talk. So I called the office and spoke to the person in charge about coverage and about which of my patients should be called first and what they should be told about my absence.
This is probably the second sick day I have taken since the beginning of the year, and I know I must have sounded pretty under the weather on the phone, raspy voice and all. However, all the person at the other end of the line managed to say was 'I guess I'll see you tomorrow' and then we hung up. I was inordinately upset by the exchange, to the point that, finding myself home alone, I burst into tears.
This was not a completely unexpected reaction as I am not quite at my best, emotionally speaking, when I'm ill. I tend to feel bereft and vulnerable and left to take care of myself while being completely unprepared to do so. None of which is true, and all of which is residual from a childhood of covert neglect and lack of, well, love. I have processed my feelings of abandonment and anger and the very deep sadness that stems from knowing, as a child, that I was not cherished, and that when I was ill I was more of a nuisance than usual.
That said, sometimes when I'm feeling sick and my defences are down, the adult in me gives way to a 5 year old girl, who is feeling unwell and has no clue what to do. It's not fun. It's also funny that after so much analytic work on myself and after having so nicely shelved my past and having recovered from it, a simple bad sore throat can still bring on this intense longing for someone to bring me soup and crackers and comic books, someone to make sure I'm tucked in nicely and comfy on the couch. That is what I wanted when I was a child when instead I got spoonfuls of codeine-laced cough-syrup thrust down my throat to make me drowsy. Neglect negates your existence, and triggers fears of annihilation. When I feel the way I did earlier today, much of the work I have to do is to soothe this little kid in me who is panic-stricken.
Patients tend to think that we are perfect people living perfect lives. And it should be that way, so therapists can be the famous blank slate and patients can project what they need onto it.
It is through this wonderful, fascinating process that in my current practice working with the elderly I end up being the mother figure to 80 year olds who, much like me today, still wait for that soft kiss on the forehead that tells them that yes, they are loved and yes, they will be okay.
Not anything a 5 year old kid would be able to provide.
Not today.
This is probably the second sick day I have taken since the beginning of the year, and I know I must have sounded pretty under the weather on the phone, raspy voice and all. However, all the person at the other end of the line managed to say was 'I guess I'll see you tomorrow' and then we hung up. I was inordinately upset by the exchange, to the point that, finding myself home alone, I burst into tears.
This was not a completely unexpected reaction as I am not quite at my best, emotionally speaking, when I'm ill. I tend to feel bereft and vulnerable and left to take care of myself while being completely unprepared to do so. None of which is true, and all of which is residual from a childhood of covert neglect and lack of, well, love. I have processed my feelings of abandonment and anger and the very deep sadness that stems from knowing, as a child, that I was not cherished, and that when I was ill I was more of a nuisance than usual.
That said, sometimes when I'm feeling sick and my defences are down, the adult in me gives way to a 5 year old girl, who is feeling unwell and has no clue what to do. It's not fun. It's also funny that after so much analytic work on myself and after having so nicely shelved my past and having recovered from it, a simple bad sore throat can still bring on this intense longing for someone to bring me soup and crackers and comic books, someone to make sure I'm tucked in nicely and comfy on the couch. That is what I wanted when I was a child when instead I got spoonfuls of codeine-laced cough-syrup thrust down my throat to make me drowsy. Neglect negates your existence, and triggers fears of annihilation. When I feel the way I did earlier today, much of the work I have to do is to soothe this little kid in me who is panic-stricken.
Patients tend to think that we are perfect people living perfect lives. And it should be that way, so therapists can be the famous blank slate and patients can project what they need onto it.
It is through this wonderful, fascinating process that in my current practice working with the elderly I end up being the mother figure to 80 year olds who, much like me today, still wait for that soft kiss on the forehead that tells them that yes, they are loved and yes, they will be okay.
Not anything a 5 year old kid would be able to provide.
Not today.
Thursday, September 16, 2010
Today
This morning I woke up feeling out of sorts, a mix of bereft, vulnerable and angry. The last thing I wanted to do was going to work. In fact, I really, truly, very strongly wanted to stay in bed. When I twisted my ankle on my way to the subway I decided to take it as a sign that I should turn around and go back home. But I didn't. It's hard to take a day off when there are a bunch of people who depend on you being there for them. Twisted ankle and incredibly sad mood and all the other little things that make me human and that they will never know about, I hobbled to work.
And this was my day:
My first patient did not show, and did not call. She does this all the time. See previous blog on 'how to drive your therapist crazy'. I did not call her. Instead, I went to the cafeteria and got breakfast. Two egg-whites, swiss cheese, turkey bacon on whole-wheat toast. I inhaled it at my desk.
My second patient talked about her physical therapy and how she had forgotten to do her shoulder stretches this morning. She explained that she needs to do ten stretches every day, and showed me how. She tried a couple of times and then realized she might as well get her exercise in. "one, two, three...". I watched her in astonishment "four, five...". She stopped stretching and said "how many did I do?"
"I don't know, I wasn't counting"
"You weren't?"
My third patient discussed her plan to buy her son a birthday gift. The son is a 20 year old good-for-nothing drug dealer who only calls his mother to demand money, which she does not really have. She's been known to sell or pawn her jewelry to find money for her son. 'He's my baby', she'll say. And I understand. Really, I do. But my understanding doesn't help her when she has no money left for rent, because she gave it all to her baby. So this time she looks really happy and tells me that she has decided to buy the son a new coat and to save herself some money she will go to this store that sells stolen merchandise. Aren't I proud of her, she wants to know.
I feel suddenly very, very tired. I want nothing more than to close my eyes and fall asleep.
My third patient has a concern and wants my clinical opinion. This is a rare occurrence and I am instantly very alert. He says that he has been hearing voices again, but only in the morning, when he's still asleep. He hears children's voices telling him that he is going to be ok. The voices disturb his sleep and he wakes up. They disappear once he's awake. I wonder if this may be a case of parasomnia, a type of hallucinations that happen in the phase between sleep and alertness, basically just before we wake up. They are benign and fairly common. I ask the patient how he feels about the voices, and he says that he finds them disturbing. Why? Because he thinks they are spirit voices. Apparently, he has been praying before bed, and his church frowns upon bed-time prayer because it opens the soul to the spirit world. I ask him if he thinks he can do something other than praying before bed, like maybe listen to the radio. He smiles and claps his hands and thanks me for my great idea.
I have a cup of soup for lunch.
My fourth patient talks about one of her sons who is wanted by the police for parole violation. There's a warrant out for his arrest. He recently called her to tell her that he is fine but she has no idea where he is, and he won't visit her. Which is just as well because the cops have taken to showing up at her door at 5am with a search warrant, looking for him. He hasn't been there in months, but they still search the house down to the bathroom cabinet where she keeps her anti-depressants. He is not a midget and it's unclear why they feel compelled to check her medicine-cabinet looking for him. Anyway. She wonders how it happened that all three of her children ended up being drug users. Her 43 year old daughter had 10 children, all of whom were toxicology positive at birth and have now been adopted by their foster families. My patient has no idea where any of her 10 grandchildren might be. Her daughter is living in a shelter and continues to do drugs. Her other son, who recently stopped doing drugs and is now on anti-psychotic medication, recently told my patient that his new girlfriend is pregnant with his child. She is 52. My patient laughs and laughs until she cries.
My fifth patient is angry because her landlord insists that she pay her rent. She feels that the landlord should not expect her to pay. It's unclear why. I try to explore this issue but we get nowhere. This has been going on for months. Mostly, what she says is that the landlord is Jewish and 'you know these Jews, all they want is money'. I want to yell at her.
Fast-forward to patient number seven, also called The Last Patient of the Day!
Yay.
So patient number seven comes in 20 minutes late and starts talking about how much she spent on her daughter's school supplies. She goes on to describe each purchase in detail. I learn the size and color of binders, the thickness of paper reams, the number of pencils acquired, and so on. What she does not tell me is the result of her gyn visit. As of last week, she thought she might be pregnant. At 46. By a man that she doesn't care for. Last week she cried desperately just thinking how she does not want a baby, how she would rather die than tell her teenage children that she is pregnant. She was so anxious that she had not slept in a week, just anticipating the doctor's appointment that would determine whether she was pregnant or not. She was too anxious to even take a home pregnancy test. But today she won't talk about it. And normally I wouldn't ask. It's not how psychotherapy works. The patients have center stage and can talk about whatever crosses their minds. It's a fairly basic rule. Except that I'm tired, and I have had a hard day, and I stop monitoring my impulses for a split second, long enough to hear myself say 'Did you see your gyn?'. Startled, my patient looks at me for a second, then giggles and says "Oh. Right. I'm not pregnant".
And then I came home.
And this was my day:
My first patient did not show, and did not call. She does this all the time. See previous blog on 'how to drive your therapist crazy'. I did not call her. Instead, I went to the cafeteria and got breakfast. Two egg-whites, swiss cheese, turkey bacon on whole-wheat toast. I inhaled it at my desk.
My second patient talked about her physical therapy and how she had forgotten to do her shoulder stretches this morning. She explained that she needs to do ten stretches every day, and showed me how. She tried a couple of times and then realized she might as well get her exercise in. "one, two, three...". I watched her in astonishment "four, five...". She stopped stretching and said "how many did I do?"
"I don't know, I wasn't counting"
"You weren't?"
My third patient discussed her plan to buy her son a birthday gift. The son is a 20 year old good-for-nothing drug dealer who only calls his mother to demand money, which she does not really have. She's been known to sell or pawn her jewelry to find money for her son. 'He's my baby', she'll say. And I understand. Really, I do. But my understanding doesn't help her when she has no money left for rent, because she gave it all to her baby. So this time she looks really happy and tells me that she has decided to buy the son a new coat and to save herself some money she will go to this store that sells stolen merchandise. Aren't I proud of her, she wants to know.
I feel suddenly very, very tired. I want nothing more than to close my eyes and fall asleep.
My third patient has a concern and wants my clinical opinion. This is a rare occurrence and I am instantly very alert. He says that he has been hearing voices again, but only in the morning, when he's still asleep. He hears children's voices telling him that he is going to be ok. The voices disturb his sleep and he wakes up. They disappear once he's awake. I wonder if this may be a case of parasomnia, a type of hallucinations that happen in the phase between sleep and alertness, basically just before we wake up. They are benign and fairly common. I ask the patient how he feels about the voices, and he says that he finds them disturbing. Why? Because he thinks they are spirit voices. Apparently, he has been praying before bed, and his church frowns upon bed-time prayer because it opens the soul to the spirit world. I ask him if he thinks he can do something other than praying before bed, like maybe listen to the radio. He smiles and claps his hands and thanks me for my great idea.
I have a cup of soup for lunch.
My fourth patient talks about one of her sons who is wanted by the police for parole violation. There's a warrant out for his arrest. He recently called her to tell her that he is fine but she has no idea where he is, and he won't visit her. Which is just as well because the cops have taken to showing up at her door at 5am with a search warrant, looking for him. He hasn't been there in months, but they still search the house down to the bathroom cabinet where she keeps her anti-depressants. He is not a midget and it's unclear why they feel compelled to check her medicine-cabinet looking for him. Anyway. She wonders how it happened that all three of her children ended up being drug users. Her 43 year old daughter had 10 children, all of whom were toxicology positive at birth and have now been adopted by their foster families. My patient has no idea where any of her 10 grandchildren might be. Her daughter is living in a shelter and continues to do drugs. Her other son, who recently stopped doing drugs and is now on anti-psychotic medication, recently told my patient that his new girlfriend is pregnant with his child. She is 52. My patient laughs and laughs until she cries.
My fifth patient is angry because her landlord insists that she pay her rent. She feels that the landlord should not expect her to pay. It's unclear why. I try to explore this issue but we get nowhere. This has been going on for months. Mostly, what she says is that the landlord is Jewish and 'you know these Jews, all they want is money'. I want to yell at her.
Fast-forward to patient number seven, also called The Last Patient of the Day!
Yay.
So patient number seven comes in 20 minutes late and starts talking about how much she spent on her daughter's school supplies. She goes on to describe each purchase in detail. I learn the size and color of binders, the thickness of paper reams, the number of pencils acquired, and so on. What she does not tell me is the result of her gyn visit. As of last week, she thought she might be pregnant. At 46. By a man that she doesn't care for. Last week she cried desperately just thinking how she does not want a baby, how she would rather die than tell her teenage children that she is pregnant. She was so anxious that she had not slept in a week, just anticipating the doctor's appointment that would determine whether she was pregnant or not. She was too anxious to even take a home pregnancy test. But today she won't talk about it. And normally I wouldn't ask. It's not how psychotherapy works. The patients have center stage and can talk about whatever crosses their minds. It's a fairly basic rule. Except that I'm tired, and I have had a hard day, and I stop monitoring my impulses for a split second, long enough to hear myself say 'Did you see your gyn?'. Startled, my patient looks at me for a second, then giggles and says "Oh. Right. I'm not pregnant".
And then I came home.
Tuesday, August 24, 2010
How to drive your therapist crazy in 10 easy steps
Psychotherapy, like all relationships, has its ups and down. So for those dull therapy moments when you find yourself getting bored with your own self, and wonder whether your therapist really loves you, or you just want to spice things up a bit, here's a quick and easy guide on how to do drive your therapist crazy.
I broke it down into points, though they are not steps in the common sense, and can be followed in any order. Also, you do not need to follow all of them. Chances are you will begin to see results after only 3 or 4, it all depends on you perseverance and focus.
I should add that this list has been compiled based mostly on my 9-5 clinic patients, who have a different view of psychotherapy than, say, your average private patient, and who generally think of me as their social worker rather than their psychotherapist.
HOW TO DRIVE YOUR THERAPIST CRAZY IN 10 EASY STEPS:
1. If you don't feel like keeping an appointment, remember not to call and cancel.
2. When your therapist calls YOU to find out whether you are still alive after you have missed three consecutive appointments, try not to answer the phone. Or, if you must answer, make sure to have a TV on in the background. It doesn't matter what channel it's on, as long as it's loud. If your therapist can still hear you, turn the volume up, or walk closer to the tv. Oh, and don't forget to mumble.
2a. A fun alternative to #2 is to answer the phone and pretend not to be home. "Who? Maria? Nooooooo. She's not here. What do you mean I sound like her! SHE IS NOT HERE!"
3. After you've missed several sessions, return to therapy driven by a firm refusal to discuss any psychological reasons for your absence, but be prepared to resume your conversation where you last left it, 5-6 weeks prior. Good opening sentences in this case might be: "That letter never came", or, "That letter arrived", or "Did you write me that letter?".
4. When you are presenting a complicated situation involving several people of the same sex, make sure to use pronouns only, as in 'He told him that if he ever did that again he would call him up and then he would know what he was talking about!'.
5. If you weigh over 300lbs and have multiple weight-related medical conditions so that your doctor and your therapist are on a first name basis with each other, make sure that whenever your therapist attempts to explore your relationship with food you answer: "I don't know why I'm fat. I never eat!". Ideally, you should try to have potato chip or cookie crumbs on your person when you say that.
6. Ask your therapist to make phone calls for you to settle your unpaid utility bills and make sure to say that this is because you do not feel like wasting the minutes on your pre-paid phone.
7. If your therapist insists that you make the calls yourself provided she/he lends you their own office phone, make sure to sneeze or cough into the receiver.
8. Take off your shoes to show your weird and potentially smelly foot fungus.
9. Ask for help obtaining obscure entitlements such as government-issued blocks of cheese. They do exist.
10. If your therapist has never heard of goverment cheese, or balks at your request to use his/her phone for your personal calls, or cracks open a window while you air out your smelly feet, make sure to look outraged and say "But aren't you a social worker?!"
I broke it down into points, though they are not steps in the common sense, and can be followed in any order. Also, you do not need to follow all of them. Chances are you will begin to see results after only 3 or 4, it all depends on you perseverance and focus.
I should add that this list has been compiled based mostly on my 9-5 clinic patients, who have a different view of psychotherapy than, say, your average private patient, and who generally think of me as their social worker rather than their psychotherapist.
HOW TO DRIVE YOUR THERAPIST CRAZY IN 10 EASY STEPS:
1. If you don't feel like keeping an appointment, remember not to call and cancel.
2. When your therapist calls YOU to find out whether you are still alive after you have missed three consecutive appointments, try not to answer the phone. Or, if you must answer, make sure to have a TV on in the background. It doesn't matter what channel it's on, as long as it's loud. If your therapist can still hear you, turn the volume up, or walk closer to the tv. Oh, and don't forget to mumble.
2a. A fun alternative to #2 is to answer the phone and pretend not to be home. "Who? Maria? Nooooooo. She's not here. What do you mean I sound like her! SHE IS NOT HERE!"
3. After you've missed several sessions, return to therapy driven by a firm refusal to discuss any psychological reasons for your absence, but be prepared to resume your conversation where you last left it, 5-6 weeks prior. Good opening sentences in this case might be: "That letter never came", or, "That letter arrived", or "Did you write me that letter?".
4. When you are presenting a complicated situation involving several people of the same sex, make sure to use pronouns only, as in 'He told him that if he ever did that again he would call him up and then he would know what he was talking about!'.
5. If you weigh over 300lbs and have multiple weight-related medical conditions so that your doctor and your therapist are on a first name basis with each other, make sure that whenever your therapist attempts to explore your relationship with food you answer: "I don't know why I'm fat. I never eat!". Ideally, you should try to have potato chip or cookie crumbs on your person when you say that.
6. Ask your therapist to make phone calls for you to settle your unpaid utility bills and make sure to say that this is because you do not feel like wasting the minutes on your pre-paid phone.
7. If your therapist insists that you make the calls yourself provided she/he lends you their own office phone, make sure to sneeze or cough into the receiver.
8. Take off your shoes to show your weird and potentially smelly foot fungus.
9. Ask for help obtaining obscure entitlements such as government-issued blocks of cheese. They do exist.
10. If your therapist has never heard of goverment cheese, or balks at your request to use his/her phone for your personal calls, or cracks open a window while you air out your smelly feet, make sure to look outraged and say "But aren't you a social worker?!"
Monday, August 23, 2010
WWFD?
Another patient decides to bring a child to her session. This is a grandmother and the child is 7 years old. She really wants me to meet this kid because, she explains with pride, he is her favorite grandson and she loves him more than she does his sister. And with that, the introductions are done.
He's a cute chubby kid in a blue Yankees shirt and purple crocs. On his grandmother's insistence he kisses me hello on the cheek, then sits down next to her, looks around the room and before I have a chance to offer him paper and crayons to draw, yells 'I love predators!'.
What am I supposed to say to that? What kind of predators, exactly? I make a non-committal sound that he appears to take as a sign of encouragement, and proceeds to list his favorite predators. To my relief, he means animals. To my dismay, the list is long. He moves from birds to fish to mammals, from extinct to fantasy to myth. That would be the Lockness Monster. Apparently, it is also a predator. And lives in Scotland. This leads him to the topics of pipe-playing and men wearing 'skirts'. The kid free-associates beautifully.
Meanwhile grandma, who is not very fluent in English, watches him adoringly and winks at me as if to say 'isn't he wonderful'. In fact, she does say it. She recognizes random animal names but reallly has no idea what he is talking about, and to be honest, neither do I.
Grandma makes an effort to provide some context: 'He likes that show with Mindy'. Only she says 'Ee likes dat chow'.
The kid stops his list long enough to say 'Who's Mindy?'
'Dat girl wid de chow wid all dee animals'
'That's Bindi, and I don't like her.'
Grandma says that Mindy is very cute. He rolls his eyes and moves on to different species of lizards and giant iguanas. We only have 35 minutes left and there are plenty of predators still unmentioned.
Grandma doesn't mind. 'I feel much less depressed now that he's staying with me', she whispers so as not to interrupt the child's list of snakes. 'He makes me so happy'.
'I like rattle-snakes!' says the kid.
Soon I will have to put a stop to this latest wave of kids joining my patients for their sessions. I know I have to. But my patient was so happy to show off her grandson....and he clearly needed someone to list his predators to.
What Would Freud Do?
He'd probably turn on the TV and watch Bindi.
He's a cute chubby kid in a blue Yankees shirt and purple crocs. On his grandmother's insistence he kisses me hello on the cheek, then sits down next to her, looks around the room and before I have a chance to offer him paper and crayons to draw, yells 'I love predators!'.
What am I supposed to say to that? What kind of predators, exactly? I make a non-committal sound that he appears to take as a sign of encouragement, and proceeds to list his favorite predators. To my relief, he means animals. To my dismay, the list is long. He moves from birds to fish to mammals, from extinct to fantasy to myth. That would be the Lockness Monster. Apparently, it is also a predator. And lives in Scotland. This leads him to the topics of pipe-playing and men wearing 'skirts'. The kid free-associates beautifully.
Meanwhile grandma, who is not very fluent in English, watches him adoringly and winks at me as if to say 'isn't he wonderful'. In fact, she does say it. She recognizes random animal names but reallly has no idea what he is talking about, and to be honest, neither do I.
Grandma makes an effort to provide some context: 'He likes that show with Mindy'. Only she says 'Ee likes dat chow'.
The kid stops his list long enough to say 'Who's Mindy?'
'Dat girl wid de chow wid all dee animals'
'That's Bindi, and I don't like her.'
Grandma says that Mindy is very cute. He rolls his eyes and moves on to different species of lizards and giant iguanas. We only have 35 minutes left and there are plenty of predators still unmentioned.
Grandma doesn't mind. 'I feel much less depressed now that he's staying with me', she whispers so as not to interrupt the child's list of snakes. 'He makes me so happy'.
'I like rattle-snakes!' says the kid.
Soon I will have to put a stop to this latest wave of kids joining my patients for their sessions. I know I have to. But my patient was so happy to show off her grandson....and he clearly needed someone to list his predators to.
What Would Freud Do?
He'd probably turn on the TV and watch Bindi.
Friday, August 13, 2010
The mummy's accomplice
My blind patient brings her 5 year old daughter to the session. She has no one to watch the child today.
The little girl complains that she is cold, and I lend her my extra-large pink pashmina. Her eyes light up.
While I listen to her mother, the kid proceeds to wrap herself in the shawl. It covers her head to toe. She wriggles around in it, adjusts it, and pretends to sleep. She then takes it off and wraps it around her head like a turban. She models it for me, moving her head this way and that and smiling like Carmen Miranda.
The mother talks on.
The girl takes the pashmina and bundles it up then holds it like a baby. She silently kisses it, then voila! unwraps it and tries to wave it like a flag. It's too long. She gives up and re-wraps herself in it, this time leaving an inch of room for her eyes to peek out. She looks around the room, then sticks her tongue out within the material. She pulls the pashmina off her face and pulls fuzz from her tongue with her fingers, then re-wraps herself, mummy style.
The mother stops talking: "What are you doing?"
"Nuttin..."
From a slit in the wrapping, the cashmere mummy looks in my direction, then winks.
The little girl complains that she is cold, and I lend her my extra-large pink pashmina. Her eyes light up.
While I listen to her mother, the kid proceeds to wrap herself in the shawl. It covers her head to toe. She wriggles around in it, adjusts it, and pretends to sleep. She then takes it off and wraps it around her head like a turban. She models it for me, moving her head this way and that and smiling like Carmen Miranda.
The mother talks on.
The girl takes the pashmina and bundles it up then holds it like a baby. She silently kisses it, then voila! unwraps it and tries to wave it like a flag. It's too long. She gives up and re-wraps herself in it, this time leaving an inch of room for her eyes to peek out. She looks around the room, then sticks her tongue out within the material. She pulls the pashmina off her face and pulls fuzz from her tongue with her fingers, then re-wraps herself, mummy style.
The mother stops talking: "What are you doing?"
"Nuttin..."
From a slit in the wrapping, the cashmere mummy looks in my direction, then winks.
Monday, August 9, 2010
Juxtaposition
My 11 o'clock patient sits down with his usual rustle of plastic bags. He tells me that he has been feeling much more anxious since the weekend.
'I have been feeling a tightness in my head. I think maybe it's high blood pressure. Do you think it could be high blood pressure? I know you can't answer that, but I was just wondering. I'm just anxious. I'm afraid of being sick again.'
My cellphone rings. I forgot to turn it off. It's my mother. I send the call to voicemail.
'I went to the doctor's on Friday but he forgot to take my blood pressure. I wonder if I should go again.'
(My heart is pounding. My mother doesn't usually call me during the week. We just talked yesterday. She said that my uncle is in the hospital with pneumonia and he's not doing well. He's in the last stages of Alzheimer's.)
'I could go back to my doctor. Do you think I should go back? Though I have been taking my blood pressure medication. But my head feels tight. No it's not anxiety! I'm anxious because of it!'
(Could he have died? Why else would my mother call me on a Monday morning?)
'I heard that drinking water is good for high blood pressure. Have you heard that too? No? Well, I have. Though it's hard to drink too much water. I get bored of swallowing.'
(He no longer knows how to chew his food. They have started to feed him by IV because he cannot swallow.)
I take a sip of my coffee.
'I used to drink lots of coffee, you know. Always black though, never liked milk. But now I cut down, I only have a small cup in the morning, with my dry wheat toast. Food is just fuel for the body, not the other way round, right?'
(Oh, how he loved to eat! He used to call himself the human sink. You don't like that? I'll have it. Those leftovers? I'll finish them!)
My stomach lurches. I hold on to my coffee cup.
'So I spoke to my sister. She said that she's coming to see me on Saturday. I said 'ok' but only for a couple of hours, no more. I don't want to have her in my apartment all day long. She talks too much. I like my quiet. I like walking on the boardwalk, looking at the water, thinking. Exercise is good for the mind. Calms me down.'
(The last time we spoke he had just been diagnosed. He told me he wanted to come to NY to run the marathon. He was training, he said. He sounded so normal, so much like himself that I thought perhaps the doctors were wrong, perhaps it was just a misdiagnosis, a mistake that would clear itself out while my uncle, my funny, smart, loud-talking uncle would turn out to be fine.)
Something inside my head spins. It disorients me. I put down the coffee cup and grab the arms of my chair.
'I wish I could walk more, but I get tired easily now. Plus I don't want to overdo it. 30 minutes, tops. That's a good amount of exercise. Sometimes I just sit on the benches and read. I've been reading this book about the history of Japan. Incredible culture. Reading relaxes me, but only history books, or philosophy. Novels are tricky, they can give me nightmares.'
(He was planning a Japanese garden for the backyard. He had a complicated plan for a pond and a bridge and possibly some fish for the pond, maybe water lilies if the could live through the cold winters. Without wanting to, I see him hunched over his architect desk, drawing, drawing.)
It's only 11:20. I want to listen to my mother's voicemail. My patient's face goes out of focus, briefly. I blink twice.
'I think I have nightmares when I eat certain foods. I don't believe that dreams mean anything. Except perhaps for those dreams I had that were clearly warning me of things to come. I'm gifted that way. Always have been.'
(Didn't I dream that someone I loved was dying? Wasn't I hugging my mother in the dream? Could he really have died? So quickly? And if he had, would I feel it, somehow, before anyone told me?)
'When I was a kid, they used to tell me to think about this person or the other before I went to bed, and I usually had a dream about that person. Then the next morning they would ask me what I dreamed, and the person would pay my father. Can you believe that? My father made money out of me, and never even gave me a present for it. Not even a trinket! What a family.'
(He gave me my very first necklace. It was long, with a round medallion, all beaded. It was beautiful. I felt like an Indian princess. I decided that I wanted to marry him when I grew up. I was five. )
The top of my head spins again. I close my eyes, open them, swallow hard.
'And to think that my sister was treated so much better. She was so white though, like you. Looked so European. Maybe that's why.'
(His skin is all freckled, white, his eyes dark blue. A mole on the corner of his left eyebrow. No, the right. No, no. The left. I try not to picture him sunken against a hospital pillow.)
'I have been feeling a tightness in my head. I think maybe it's high blood pressure. Do you think it could be high blood pressure? I know you can't answer that, but I was just wondering. I'm just anxious. I'm afraid of being sick again.'
My cellphone rings. I forgot to turn it off. It's my mother. I send the call to voicemail.
'I went to the doctor's on Friday but he forgot to take my blood pressure. I wonder if I should go again.'
(My heart is pounding. My mother doesn't usually call me during the week. We just talked yesterday. She said that my uncle is in the hospital with pneumonia and he's not doing well. He's in the last stages of Alzheimer's.)
'I could go back to my doctor. Do you think I should go back? Though I have been taking my blood pressure medication. But my head feels tight. No it's not anxiety! I'm anxious because of it!'
(Could he have died? Why else would my mother call me on a Monday morning?)
'I heard that drinking water is good for high blood pressure. Have you heard that too? No? Well, I have. Though it's hard to drink too much water. I get bored of swallowing.'
(He no longer knows how to chew his food. They have started to feed him by IV because he cannot swallow.)
I take a sip of my coffee.
'I used to drink lots of coffee, you know. Always black though, never liked milk. But now I cut down, I only have a small cup in the morning, with my dry wheat toast. Food is just fuel for the body, not the other way round, right?'
(Oh, how he loved to eat! He used to call himself the human sink. You don't like that? I'll have it. Those leftovers? I'll finish them!)
My stomach lurches. I hold on to my coffee cup.
'So I spoke to my sister. She said that she's coming to see me on Saturday. I said 'ok' but only for a couple of hours, no more. I don't want to have her in my apartment all day long. She talks too much. I like my quiet. I like walking on the boardwalk, looking at the water, thinking. Exercise is good for the mind. Calms me down.'
(The last time we spoke he had just been diagnosed. He told me he wanted to come to NY to run the marathon. He was training, he said. He sounded so normal, so much like himself that I thought perhaps the doctors were wrong, perhaps it was just a misdiagnosis, a mistake that would clear itself out while my uncle, my funny, smart, loud-talking uncle would turn out to be fine.)
Something inside my head spins. It disorients me. I put down the coffee cup and grab the arms of my chair.
'I wish I could walk more, but I get tired easily now. Plus I don't want to overdo it. 30 minutes, tops. That's a good amount of exercise. Sometimes I just sit on the benches and read. I've been reading this book about the history of Japan. Incredible culture. Reading relaxes me, but only history books, or philosophy. Novels are tricky, they can give me nightmares.'
(He was planning a Japanese garden for the backyard. He had a complicated plan for a pond and a bridge and possibly some fish for the pond, maybe water lilies if the could live through the cold winters. Without wanting to, I see him hunched over his architect desk, drawing, drawing.)
It's only 11:20. I want to listen to my mother's voicemail. My patient's face goes out of focus, briefly. I blink twice.
'I think I have nightmares when I eat certain foods. I don't believe that dreams mean anything. Except perhaps for those dreams I had that were clearly warning me of things to come. I'm gifted that way. Always have been.'
(Didn't I dream that someone I loved was dying? Wasn't I hugging my mother in the dream? Could he really have died? So quickly? And if he had, would I feel it, somehow, before anyone told me?)
'When I was a kid, they used to tell me to think about this person or the other before I went to bed, and I usually had a dream about that person. Then the next morning they would ask me what I dreamed, and the person would pay my father. Can you believe that? My father made money out of me, and never even gave me a present for it. Not even a trinket! What a family.'
(He gave me my very first necklace. It was long, with a round medallion, all beaded. It was beautiful. I felt like an Indian princess. I decided that I wanted to marry him when I grew up. I was five. )
The top of my head spins again. I close my eyes, open them, swallow hard.
'And to think that my sister was treated so much better. She was so white though, like you. Looked so European. Maybe that's why.'
(His skin is all freckled, white, his eyes dark blue. A mole on the corner of his left eyebrow. No, the right. No, no. The left. I try not to picture him sunken against a hospital pillow.)
'You may have a point. Sometimes I think I look for things to make me anxious. My whole life I've had to worry about something, now I have nothing. Maybe I'm afraid that I would feel lonely if I didn't have my anxiety. I would miss it.'
(I miss him I miss him I miss him. His back burnt from working in the yard, his smell of sweat, the red mini-morris he had before he got married, his horrible singing voice, his passion for dogs. I want to see him in his bee-keeper outift, shaking bees out from under the sleeves. Let me see him one more time.)
My patient rustles his plastic bags. 'This session went by so quickly. I'll go see my doctor's today. Have my blood pressure taken. See you next week.'
He leaves.
I dial my voicemail. My mother sounds like she has food in her mouth. She wants to know if I can send her my new address again. She seems to have lost it, and wants to send me a package.
Saturday, August 7, 2010
Why
Why do you constantly call me without ever leaving a message? I can see your number on my caller ID, it showed 21 times today. I know who you are. You've done it before. What I don't know is why? I am left guessing:
You don't want to leave a message because you feel that I should be answering your call.
You cannot comprehend that I have other patients besides you, but if I must see other people, the least I could do is interrupt their sessions to answer your call. Aren't you, after all, my most important patient?
There is something extremely urgent you need to let me know. Your shoelaces are untied. Your wife/husband/father/mother/child is not paying you enough attention. You heard on TV that Armageddon is coming.
You have all these free minutes on your cell phone and figured it might be fun to have a chat. With me. During someone else's session.
You have an emergency, much like the time you called, breathless with urgency, to tell me that you received a Jury Duty summons for the following month. And you don't like the idea of serving as a Juror.
Or perhaps you just want to make sure that I am still here, waiting for you, ready to welcome you back into this space where you feel safely loved and important, exactly where you left me yesterday and where you will find me again next week.
Unless Armageddon comes.
You don't want to leave a message because you feel that I should be answering your call.
You cannot comprehend that I have other patients besides you, but if I must see other people, the least I could do is interrupt their sessions to answer your call. Aren't you, after all, my most important patient?
There is something extremely urgent you need to let me know. Your shoelaces are untied. Your wife/husband/father/mother/child is not paying you enough attention. You heard on TV that Armageddon is coming.
You have all these free minutes on your cell phone and figured it might be fun to have a chat. With me. During someone else's session.
You have an emergency, much like the time you called, breathless with urgency, to tell me that you received a Jury Duty summons for the following month. And you don't like the idea of serving as a Juror.
Or perhaps you just want to make sure that I am still here, waiting for you, ready to welcome you back into this space where you feel safely loved and important, exactly where you left me yesterday and where you will find me again next week.
Unless Armageddon comes.
Friday, August 6, 2010
Bless you!
Life is funny. Just when I was losing faith in my patients' ability to identify and acknowledge me as a real person, as opposed to a nebulous maternal object placed in front of them in a listening capacity, something happened to restore my faith.
I was in session with my first patient of the morning. This is a patient that, sadly, I have had to learn to endure, mostly because he smells. He also happens to be very narcissistic, which means that a previous therapist's attempt to bring up the body odor caused a major disruption in the treatment, ending with said patient dropping out, and wanting a new therapist.
Enter: me.
I have never said anything to him directly, but I did come up with a pretty smart technique to fight the smell: I spray industrial quantities of Lysol before he enters. As a side-note, I hate the smell of Lysol, but it is pervasive enough to numb my sense of smell for about half a session. The other half I endure. I have tried holding my breath for the duration but 45 minutes really is too long, hence the Lysol.
After four years as his therapist, I have learned that this patient really wants very little from me. Mostly, he needs to come and talk, uninterruptedly, for the entire duration of his session. Often he starts talking when we're still in the waiting room, and continues talking on his way out the door. This is the kind of patient that understands a session is over only when I get up from my chair, walk to the door, open the door, and start walking out. On him.
Anyway.
What he does is he talks about everything that has or has not happened to him in a given week. Any interruptions on my part, I have learned, bring on extreme anxiety and at times confusion. The general idea is that he needs to come and dump his thoughts onto me, as his maternal object, and this will make him feel less adrift. However when I say something, I stop being an object and become a person. He does not like that. It annoys and confuses him. Imagine you are talking to the picture of a loved one. Maybe someone who has passed away. And suddenly, the picture talks back! You can understand how it might be disorienting. So I have learned to be quiet, and listen, and try not to space out too much (that's true, therapists do space out! but that's for another post).
There is an old joke in the field about the 'cardboard cutout' therapist. That is the kind of therapist that this patient requires, someone who is there, but does not have dymension, or a mouth from which to speak. A listener made of heavy duty paper. This is one of the most difficult things for me to endure as a therapist. Forget the smells. Forget the heart-breaking topics. Forget the rage, the depression, the traumas. The cardboard thing depersonalizes me and fills me with un-therapeutic resentment. It forces me to juggle my countertransference so I can be what the patient needs me to be. Nothing new, only hard.
This is until this morning, when fumes of recently-sprayed Lysol tickled my nose and, while the patient talked, I sneezed. The sneeze was followed by a short silence, at the end of which there was a curt and annoyed "Bless you!".
I felt momentaily confused and disoriented. It was great.
I was in session with my first patient of the morning. This is a patient that, sadly, I have had to learn to endure, mostly because he smells. He also happens to be very narcissistic, which means that a previous therapist's attempt to bring up the body odor caused a major disruption in the treatment, ending with said patient dropping out, and wanting a new therapist.
Enter: me.
I have never said anything to him directly, but I did come up with a pretty smart technique to fight the smell: I spray industrial quantities of Lysol before he enters. As a side-note, I hate the smell of Lysol, but it is pervasive enough to numb my sense of smell for about half a session. The other half I endure. I have tried holding my breath for the duration but 45 minutes really is too long, hence the Lysol.
After four years as his therapist, I have learned that this patient really wants very little from me. Mostly, he needs to come and talk, uninterruptedly, for the entire duration of his session. Often he starts talking when we're still in the waiting room, and continues talking on his way out the door. This is the kind of patient that understands a session is over only when I get up from my chair, walk to the door, open the door, and start walking out. On him.
Anyway.
What he does is he talks about everything that has or has not happened to him in a given week. Any interruptions on my part, I have learned, bring on extreme anxiety and at times confusion. The general idea is that he needs to come and dump his thoughts onto me, as his maternal object, and this will make him feel less adrift. However when I say something, I stop being an object and become a person. He does not like that. It annoys and confuses him. Imagine you are talking to the picture of a loved one. Maybe someone who has passed away. And suddenly, the picture talks back! You can understand how it might be disorienting. So I have learned to be quiet, and listen, and try not to space out too much (that's true, therapists do space out! but that's for another post).
There is an old joke in the field about the 'cardboard cutout' therapist. That is the kind of therapist that this patient requires, someone who is there, but does not have dymension, or a mouth from which to speak. A listener made of heavy duty paper. This is one of the most difficult things for me to endure as a therapist. Forget the smells. Forget the heart-breaking topics. Forget the rage, the depression, the traumas. The cardboard thing depersonalizes me and fills me with un-therapeutic resentment. It forces me to juggle my countertransference so I can be what the patient needs me to be. Nothing new, only hard.
This is until this morning, when fumes of recently-sprayed Lysol tickled my nose and, while the patient talked, I sneezed. The sneeze was followed by a short silence, at the end of which there was a curt and annoyed "Bless you!".
I felt momentaily confused and disoriented. It was great.
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