Creatures of a Day: And Other Tales of Psychotherapy (10 page)

Then four months later, an email arrived indicating that Rick’s therapy had indeed been catalyzed but in an unexpected way.

Hi, Dr. Y.

I’m better. You did help me and it’s time to thank you. Since I returned, my therapist has focused full-bore on my competitiveness and why I couldn’t (or wouldn’t) admit to you that you had some good insights during our session. She’s right, and I’ve been reluctant to acknowledge it. So, here’s something I want to confess. When you said that I regarded Fairlawn Oaks as a prison, you were really right on. And I knew it even then when I was with you but I just refused to admit it. Remember my telling you how fascinated I was by that song?

Well, what I could have shared with you, and didn’t, was that I sang you the lyrics of the second stanza of “Don’t Fence Me In.” I didn’t mention the lines of the first stanza. Here they are:

Wildcat Kelly, lookin’ mighty pale

Was standing by the sheriff’s side

And when that sheriff said, “I’m sending you to jail,”

Wildcat raised his head and cried

Oh, give me land, lots of land under starry skies above

Don’t fence me in . . .

—Thanks, Rick

~ 6 ~

Show Some Class for Your Kids

Because I could not stop for Death,

He kindly stopped for me.

T
hese opening lines of an Emily Dickinson poem came to mind when a phone call informed me that Astrid had died from a ruptured aneurism. Astrid, dead? Impossible. An unstoppable life force, Astrid had shaken off one crisis and tragedy after another and kept on walking. Such boundless, crackling energy. And now forever quiescent? No, I couldn’t steady that thought in my mind.

Astrid was a therapist for whom I had served as both a supervisor and a therapist for more than ten years, and we had grown close. When an email from her family announced a ‘life celebration’ for Astrid to be held two weeks later at a local community center, I immediately accepted. On the designated
day I dressed in a suit and tie—very rare for me as a
commit
ted
Californian
—and showed up promptly at noon. Along with two hundred other guests, I was greeted with champagne and hors d’oeuvres. No flowers. Nothing black. No tears or long faces. No suits and not a necktie in sight, aside from mine. Soon a small child, probably one of Astrid’s grandchildren, walked through the crowd with a megaphone in hand and announced, “Please take your seats. Ceremony to begin.”

We then viewed a polished, forty-minute video celebrating Astrid’s life. It took us seamlessly through images of her life. First, as an infant in her father’s arms, she yanked off his spectacles and waved them gleefully. Then, in rapid succession, we saw Astrid’s first steps toward her mother’s outstretched arms, Astrid playing pin the tail on the donkey, Astrid as an adolescent surfing at sunset beach in Hawaii, Astrid at her graduation from Vassar, Astrid as a bride at her most recent marriage celebration (she had married three times), several shots of Astrid pregnant and radiantly smiling, Astrid playing Frisbee with her children, and then the heartbreaking finale that brought tears to my eyes: Astrid gaily waltzing with her six-year-old grandson the evening before her sudden death. When the film ended, we sat silently in darkness. I was sorry when the lights came on because no one knew what to do. One brave, self-confident soul clapped, and soon most of the audience joined in. I found myself longing for a traditional religious ritual, a very rare state of mind for me. I missed the cozy familiar cadence and orderly sequence of events led by clergy and rabbis. What is one supposed to do at a funeral
manqué
that commences with champagne and hors d’oeuvres and has no place for weeping?

After some hurried discussion among themselves, her three children and five of her grandchildren strode in a cluster to the microphone, and each in turn, showing remarkable poise, shared remembrances of Astrid. Each was well prepared and well spoken, but I was most fascinated by an eight-year-old granddaughter who described how Grandma Astrid used to invite them to play by creeping silently up behind them and shaking a box of jigsaw puzzle or Scrabble pieces.

Since this was a life celebration and not a funeral, I was not surprised that there was no mention of her fourth child, Julian, who had been killed by a lightning bolt on a golf course when he was sixteen. But Astrid and I had devoted more than a full year of therapy to dealing with his death.

Next, many of Astrid’s friends spontaneously rose to take the microphone and share their memories. After two hours, quiet reigned for a few moments, and I expected someone to signal the end of the event. Instead, to my surprise, Astrid’s third and last husband, Wally, rose to address the celebrant-mourners. I was astonished at his composure; I tried to imagine speaking at such an occasion only weeks after my wife’s death and knew I would not be up to it. I would not be able to raise my head to the world. I examined Wally closely. For years I had heard Astrid’s version of him and was now faced with the odd task of superimposing the flesh-and-blood Wally on the image of him Astrid had given me. Every single time I have encountered a patient’s spouse, I have been surprised. Almost without fail I exclaim to myself,
Can this possibly be the same person I’ve heard about for so many hours?

To my surprise, Wally was a stately man and much taller, more handsome, and more graceful than I had expected. And far more present. Astrid had often portrayed him as absent, as a man who, even into his seventies, was wedded to his hedge fund and to his office that he always entered at six am to prepare for the opening bell of the stock market. Absent on weekends also, either sailing or fixing his twenty-seven-foot sloop. Astrid told me she had never set foot on it. I remembered our chuckling together when she told me she got seasick whenever she saw a boat, and I responded that I get seasick even looking at a picture of a boat.

“Thank you all for coming to say goodbye to our Astrid,” Wally began. “I know there are a lot of her shrink colleagues
here, and as you all know, she never tired of teaching. So I’m sure she’d have appreciated my passing on to you a bit of her legacy,
her top secret weapon against anxiety: egg salad sandwiches!
”

I cringed.
Oh no. Don’t do this, Wally. Dear Astrid dead only ten days and you inflict a Jay Leno imitation on us.

“When Astrid was a child,” Wally continued unabashed, “and upset about anything—school, argument with friends, boyfriend trouble, you name it—her mother always soothed her with an egg salad sandwich. Just chopped eggs, mayo, celery, and a bit of pimento on toasted white bread. No lettuce. Astrid called it her Valium and claimed it had four and a half times the potency of chicken soup. Whenever I came home late in the evening and walked from the garage through the kitchen, I always took a look at the sink, and if I spotted eggshells there, I braced myself for the worst.”

I looked around. Smiling faces! Everyone except me was engaged by Wally’s attempts at humor. For a moment I felt very alone, as though I were the only one who seemed to be taking this seriously. Then I reminded myself that I was not the outsider—I was the
insider
, the one who really knew Astrid.

Throughout the event, I had vacillated in my feelings. At first, as the speakers described their special contact and their stories about Astrid, I had felt smug about my privileged place in her life. After all, wasn’t I the one who had the inside truth, the one who knew the
real
Astrid, the authentic Astrid? But as time passed and I listened to speaker after speaker, I wavered. Perhaps my belief in a privileged place in her life was illusory. Yes, she and I had shared that special hour each week for so many years. And I had access to the real stuff—special knowledge of her fears and passions and inner conversations and fantasies and dreams. But was that more real, more true, more privileged than knowing what made her smile? Which folks she liked most? What she liked to eat, her favorite movies, books, shops, yoga poses, music, clouds, magazines, games, snacks, and TV series? The in-jokes with husband and friends, the sexual secrets known only to lovers? I especially wondered if I knew her better than that grandchild who had heard her footsteps as she crept up behind the sofa shaking pieces of a Scrabble game or jigsaw puzzle? Yes, I think it was that grandchild who put me in my place, who made it clear that, though I knew some parts, there was so much of Astrid I never knew.

I had first met Astrid over ten years earlier, when she asked me to supervise her work with several patients. She was fifty, and though she had been in practice for many years, she always sought to sharpen her skills. She was a delightful student: savvy, empathic, intelligent. For the next two years we met for an hour every other week. The supervision was a pleasure. Rarely had I known a student with such wonderful clinical instincts. But toward the end of our second year, things changed between us when she began to discuss her work with one of her patients, a young man named Roy who was a disorganized alcoholic with whom she became uncharacteristically over-
involved
. She gave him her home phone and took calls from him at all hours of the day or night; obsessed about him frequently during the day, even while seeing other patients; and allowed him to run up a large bill of several thousand dollars that he would obviously never pay. Once Astrid started discussing Roy, she moved from being student to patient. When it is evident that the student has strong and irrational feelings toward a patient (“countertransference” in the professional jargon), the supervision often must change form.

There was no mystery about the source of her powerful feelings toward Roy: Astrid had a brother, Martin, six years older than she. He had been her savior during and after their mother’s death from breast cancer, when Astrid was an adolescent. Martin had protected Astrid from their abusive father, and she remembered the car ride home from their mother’s funeral when he put his arm around her, leaned over, and whispered in her ear, “For the rest of your life, Astrid, count on me. I’ll be there for you.” Martin kept his word until he enlisted in the Marines and served in the 1991 Persian Gulf War, from which he returned with Gulf War Syndrome and multi-drug addiction. Though she did her best to be there for him, she was no match for heroin and could not protect him from a fatal overdose in 2005. Astrid never forgave herself for not saving Martin. Her over-involvement with young Roy was only the latest embodiment of her reliving her attempt to save her brother.

Two years after Martin’s death, the lightning bolt that struck her sixteen-year-old son once more shattered the illusion that she could protect either others or herself. Grief after the death of a child is the harshest grief of all. It is, in the words of Yeats, “tragedy wrought to its uttermost,” and often there is no outlet beyond tears. Astrid’s tears flowed without cease during our twice-weekly sessions throughout the next year. Gradually she rebounded, once in a while even displaying her infectious joie de vivre, and we moved back to a once-weekly schedule, then to a format where we moved back and forth between supervision and therapy. Finally Astrid regained so much of her tranquility that I raised the question of termination, but we never really ended: she took solace in my presence and called every few weeks for a supervisory session.

Then, a year ago, Astrid left a phone message on a weekend evening telling me that she had fallen from her bicycle earlier in the day, suffering only minor injury, but that now her bruises were growing in size at an alarming rate and she was feeling a bit confused. She couldn’t reach her internist and asked me whether she should go to the emergency room. I called back and told her that these problems definitely warranted a trip to the ER.

Not hearing back from her during the next few days, I left a couple of phone messages inquiring about the ER visit and received a call from her son, who told me his mother was
unable
to take calls: she was critically ill in the intensive care unit with a diagnosis of autoimmune liver disease. I knew nothing about this disease. It had not been described when I attended medical school fifty years ago, but a quick search of the medical literature informed me that this was a serious, often lethal ailment for which a liver transplant offered the best chance of survival. Two weeks later I received a call from her son informing me that his mother’s condition had deteriorated precipitously; she had severe jaundice and was in acute liver failure. A few days later he called back with great news: the hospital had miraculously located a liver, she had had the transplant, and she was now in serious but stable condition.

Three weeks later I had a brief phone discussion with Astrid, who told me she was getting stronger and was shortly to be released. I visited her at home for a couple of sessions, and soon Astrid was strong enough to travel to my office. “To hell and back,” she told me. “The most awful, frightening, anguished time in my life—and as you know, I’ve had quite a few. For days in the hospital I couldn’t stop trembling, couldn’t stop weeping. I was certain I was going to die. I couldn’t talk to you . . . couldn’t talk to anyone. And then, suddenly, I turned a corner.”

“How did you do it? Was there a specific turning point?”

“Very specific. A conversation with a nurse—a tough-assed, no-nonsense head nurse who had a good heart. It was just before my children were coming to visit. I had been in extremis for days. I was absolutely terrified of dying; I could not stop shivering and sobbing. And then, just before my family entered my room, she leaned over and whispered in my ear, ‘Show some class for your kids.’ That changed everything.”

“Tell me how.”

“I’m not sure how. But it was damned powerful. Somehow it just got me outside of myself. Up to then I just couldn’t stop being terrified. I was so close to death so many times. I couldn’t talk. Couldn’t cope, couldn’t even pick up the phone to have a session with you. All I did was cry. That statement, ‘Show some class for your kids,’ jolted me back to thinking of someone other than myself and let me see that I could still do something for my family, that I could set an example for them. That nurse was something. Tough love.”

Astrid was discharged from the hospital, gradually resumed her previous life, and soon began seeing her patients again. But her reprise from death was short. One day a few months later, she slumped forward in her hairdresser’s chair and died instantly of a ruptured aneurism in her brain. All this passed through my mind as I walked out of the community center with the other celebrants. All that drama, that hard life, that valiant effort: working through her grief for her mother, liberating herself from her father, surviving her brother’s death and, most of all, her son’s death. She had worked through so many knotty situations with her own patients and in her own therapy work with me. She had survived her liver disease by virtue of a liver transplant from a young man killed in a motorcycle accident. And, then, all of
this remarkable drama extinguished in an instant by a single
small artery exploding in her brain. Everything gone in one moment: her extraordinary universe of self; that lush,
layered trove of sense data; her teeming memories of a lifetime; all that pain, that courage, that struggle and transcendence; that army of transplant surgeons and nurses; all that terror, that wailing, those gutsy recoveries. And for what? For what?