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.