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.
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