Creatures of a Day: And Other Tales of Psychotherapy (5 page)

“I know what
you’d
think.”

“Tell me.”

“That I know I’m walking on the road to death like Baloo.”

“Like all living souls.”

“Yes, like all living souls.”

“And you, what do
you
think?”

“I think this whole conversation is making things worse for me.”

“In that you’re more uncomfortable.”

“A few more healing sessions like this, and I’ll need to go home by ambulance.”

“All the symptoms you described yesterday—being removed from life, being insulated, not being in your life—all served to anesthetize yourself from the pain inherent in being a living soul. Let’s look at how we began. You entered my office with your photograph—”

“Oh no, not that again!”

“I know you forbade me to discuss it, but I’m disobeying you because it’s too important. Please listen to what I’m going to say. You know all this already. I’m not telling you anything you don’t already know
.
It’s just easier to fend off something told to you from the outside than it is something rising from the depths of yourself. I believe that some part of you had already arrived at the same conclusion I’m suggesting to you. It’s all there in that dream about traveling the same road as Baloo. I’m struck that your dream, which offers the key to our puzzle, returned to you just as we prepared to stop. And the photograph you gave me at the beginning was a hint to me about what direction I should take with you.”

“You say I knew all this? You give me far, far too much credit.”

“I don’t think so. I’m just siding with the part of you where wisdom dwells.”

We both looked at the clock. We had run over several minutes. As Natasha rose and collected her things, she said, “May I get back to you by email or Skype if I have more questions?”

“Of course. But remember: I’m aging. So don’t wait too long.”

~ 4 ~

Thank You, Molly

A
few months ago I attended an outdoor funeral service for Molly, my long-term bookkeeper and Jane-of-all-trades who had worked for me for decades and had been both a godsend and a major thorn in my side. I’d first employed her in 1980 to collect my mail and pay my bills while I was on a year’s sabbatical, living and writing in Asia and Europe. When I returned, Molly soon grew dissatisfied with her bit role and little by little began to insinuate herself into all my domestic matters. Soon she was managing all our financial and household affairs, paying bills, taking care of correspondence, and filing papers, manuscripts, and contracts. She discharged my gardener and installed her own gardening team and, later, her own team of painters, and cleaners, and handymen—though, if the job were small, she insisted on doing it herself.

There was no stopping her. One day I came home to find several trucks in our driveway and Molly at the base of a huge oak, calling to a man a hundred feet above, telling him which branches to saw off. I was surprised that she was not up in the tree herself. She insisted that she had discussed this project with me, but I was certain she had not. That was the final straw, and I fired her on the spot and fired her again on at least three other occasions, but she would have none of it. Whenever I objected to her fees, she reminded me, quite correctly, of the many tortured evenings my wife and I had spent paying bills and balancing our checkbooks until she had come along, and then suggested I work two more hours each month to pay her salary. She insisted she was indispensable, and my firings and objections were never issued wholeheartedly because I knew she was right. I was greatly grieved at her death from pancreatic cancer, and I knew I was never to find her replacement.

Molly’s funeral was held on a glorious sunny afternoon in her son’s large backyard. I was surprised to see several Stanford colleagues there. I’d had no idea they’d been her clients too, but I recalled she honored a rigorous confidentiality code, steadfastly refusing to reveal the identities of any of her customers. At the end of the memorial service, I immediately rose to leave in order to pick up some friends at the airport, but just as I opened the gate to the street, I heard my name called and turned to see a stately older man wearing a stunning broad-brimmed panama hat approaching me, escorted by an exceedingly lovely woman. Seeing that I did not immediately recognize him, he introduced himself, “I’m Alvin Cross, and this is my wife, Monica. I saw you for therapy half a lifetime ago.”

I hate these awkward situations. Facial recognition has never been my strong suit, and as I’ve aged, it has progressively deteriorated. At the same time I felt it would be hurtful for this former patient to learn I didn’t remember him, so I stalled for time, waiting and hoping for memories of him to coast into my mind. “Alvin, good to see you. And good to meet you, Monica.”

“Irv Yalom,” she said, “it’s such a pleasure to meet you. I’ve heard so much about you from Al. I think I owe our meeting and our marriage and our two wonderful children to you.”

“That is quite wonderful to hear. Sorry to be so slow on recall, Alvin, but in a few minutes I’ll remember everything about our time together—that’s how it works at my age.”

“I was then, still am, a radiologist at Stanford and came to see you shortly after my brother died,” said Alvin, trying to stimulate my memory.

“Ah, yes, yes,” I lied, “it’s coming back to me. I’d really love a long talk and update on your post-therapy life, but I’m rushing to pick up friends at the airport. Could we meet for coffee and have a chat later this week?”

“Love to.”

“You still at Stanford?”

“Yes.” He took his card from his wallet and handed it to me.

“Thanks, I’ll phone you tomorrow,” I said, as I rushed off, mortified at my memory lapse.

Later that evening I went to my storage room to find my notes on Alvin. As I rifled through my files of patient records, I thought of all the deep, often uplifting, sometimes tragic, stories found in these records. Each one brought to mind the compelling two-person drama I had engaged in, and it was hard to tear myself away from reliving these old forgotten encounters. I found Alvin Cross’s file in my 1982 section, and though I saw him for only twelve hours, it was a thick file. In those precomputer days I had the luxury of a personal secretary, and I dictated long detailed notes of each session. I opened Alvin’s file and started to read. Within a few minutes, presto: everything rematerialized in my mind.

Alvin Cross, a radiologist at Stanford Hospital, phoned and requested a consultation for some personal problems. Many Stanford doctors whom I see for therapy make a point of coming very punctually or even a couple of minutes late, entering my office at the Stanford Hospital furtively because they are queasy about being seen visiting a psychiatrist. But not Dr. Cross, who sat leisurely reading a magazine in the clinic waiting room. When I approached and introduced myself, he shook my hand with a firm grip, strode into my office in a calm and confident manner, and sat tall in his chair.

I began as I usually do in first sessions, by sharing whatever information I have. “All I know about you, Dr. Cross, comes from our phone conversation. You’re a physician at Stanford Hospital, you heard my recent presentation at medical grand rounds about my psychotherapy work with patients dying from breast cancer, and you thought I might be able to be of help.”

“Yes, that’s right. You gave a refreshing and unusual talk. I’ve attended grand rounds for years, and this is the first one I’ve heard about human feelings and with no slides, data, or pathology reports.”

My first impression of Alvin Cross was of a dignified, attractive man in his thirties, with angular features, slight graying at his temples, and a self-assured way of speaking. He and I were dressed the same, each wearing white hospital coats with our names sewed in dark blue cursive letters on our left upper pocket.

“So tell me, what did I say at grand rounds that made you think I could be of help?”

“It seemed you had tender feelings for your patients,” he began. “And I was jolted by your description of an oncologist dispassionately giving your patient the results of her radiological scans. Of her terror at learning that her cancer had metastasized and her clinging tightly to her husband—her terror at being given a death sentence.”

“Yes, I remember. But tell me the relevance of that for you and me today.”

“Well, I’m the guy who writes those death sentences. I’ve been writing those kind of reports for a long time, for five years, yet your talk brought the job home to me in a different way.”

“Made it more personal?”

“Exactly. In our radiology viewing rooms, we don’t encounter the whole patient. We look for areas of calcifications or increased sizes of nodes. We look for oddities that we can show students—organs displaced by masses, decalcified bone in myeloma, distended bowel, an extra spleen. It’s always about parts, body parts. It’s never about whole people in whole bodies. But now I think about how patients feel and how their faces will look when doctors read them my x-ray reports, and I get a bit shaken up.”

“Is this a recent change? Since my talk?”

“Oh, yes, very recent and, in part, due to your talk. Otherwise I couldn’t have functioned in my work all these years. I know you wouldn’t want your x-rays read by someone who is freaking out about how you’re going to feel about his report.”

“For sure. Our fields are so different, aren’t they? I strive to be close; you strive to stay distant.” He nodded, and I continued, “But you said, your changes were ‘in part’ due to my talk. Any hunch about what else was responsible?”

“More than a hunch. It was my brother’s death a couple months ago. A few weeks before he died, he asked me to look at his films. Lung cancer. Heavy smoker.”

“Tell me about you and your brother.” As a psychiatric resident, I’d been taught to conduct a highly systematic interview starting with the presenting complaint and then following a protocol—a history of the present illness followed by an exploration of the patient’s family, education, social life, sexual development, and vocational history—and then moving on to the intricacies of the psychiatric examination. But I had no intention of following any schema; it had been decades since I proceeded so systematically. Like all seasoned therapists, I work far more intuitively in my pursuit of information. I’ve come to trust my intuition so much I suspect I’m no longer a good teacher for neophytes, who require methodical guidelines in their early years.

“When my brother, Jason, called to ask me to consult on his films,” Dr. Cross said, “it was the first time I had heard his voice in over fifteen years. We had had a falling out.” He sighed and looked up at me, his lips quivering. I was surprised to see that. It was my first glimpse of vulnerability.

“Tell me about it,” I spoke more gently now.

“Jason is two years younger—
was
two years younger—and I guess I was a tough act to follow. I was the good kid, always at the top of the class. Without fail, every time poor Jason entered a new school, he’d be greeted by a chorus of teachers talking about me and saying they hoped he would be the student that I was. Ultimately he chose not to compete, to opt out. In high school he rarely cracked a book and got heavily into drugs. Maybe he
couldn’t
compete. I don’t think he was all that bright.

“At the end of his senior year, he became involved with a girl who ended up defining his future. She was a fellow druggie, good-looking in a cheap way but intellectually limited: her life aspiration was to be a manicurist. They soon got engaged, and one evening he brought her home for dinner. That was a disaster of biblical proportion. I can still see the scene: the two of them, unwashed and unkempt, smooching the whole time, just flaunting it in everyone’s face. My parents and grandparents were shocked and disgusted. Frankly, I was too.

“Everyone in the family detested his girlfriend, but no one said anything because they knew Jason would do the exact opposite. So my parents gave me the job of warning him about her. They also made me promise I wouldn’t mention their having asked me to intervene. I had a big-brother talk with Jason and laid it all out. I told him that marriage was a momentous decision, that the time would come when he’d want more—a lot more—in a wife, that she’d drag him down. The next morning we woke up to find he had gone, along with all the money and silver in the house. He never spoke to any of us again.”

“The family put you on the spot. Talk about a damned-if-you-do and damned-if-you-don’t situation. Are there other siblings?”

“No, just the two of us. In retrospect, I think that maybe I could’ve been a better big brother and I should have tried harder to contact Jason years ago.”

“Let’s tag that and come back to it. First, tell me what happened to your brother after he split.”

“He simply vanished. From that time on, all we ever had were a few stray scraps of information that drifted in from his acquaintances. He was doing construction work, then stone masonry. I heard he got reasonably good at it and ended up building fireplaces and stone walls. Continued heavy drug use. And then out of the blue, a couple of months ago, came the phone call. ‘Alvin, this is Jason. I’ve got lung cancer. Would you look at my x-rays? My doctor said it would be OK for you to see them.’

“Of course, I agreed and got his doctor’s name and promised
to contact him that very day. I found out Jason was living in North Carolina, and I asked if I could visit him. After a pause, a pause long enough that I thought he’d hung up, he agreed.”

I looked at Dr. Cross’s face. He looked so taut and so sad that I wondered if this was too much, too soon. We’d hardly said hello before we had plunged into deep and very dark water. I gave him a breathing spell by reflecting on what had happened up to that point between us.

“My plan, as I told you on the phone, is that we meet today in consultation and see if starting therapy might be a good idea. Have you been in therapy before?”

He shook his head. “No, I’m a therapy virgin.”

“Well, tell me, Dr. Cross—”

“If you don’t mind, I’m fine with Alvin.”

“Okay. And I’m Irv. So tell me, Alvin, what’s it been like so far talking to me? Seems we’ve moved quickly into some heavy feelings. Perhaps too quickly?”

He shook his head. “Not at all.”

“Are we on track? Is this what you hoped to discuss?”

“My reaction to Jason’s death is exactly what I wanted to discuss. I’m just surprised—pleasantly surprised—that we’re there already.”

“Any questions for me so far?” I asked, wanting to establish the norm of free interchange.

He seemed puzzled, then shook his head, and said, “No. Most of all what I want to do is to tell you this story. I need to get this out in the open.”

“Please, go on.”

“So after Jason’s call, I hopped on a plane to North Carolina and went to see him. In Raleigh I first stopped at his doctor’s office and reviewed the films. Jason’s tumor was deadly. It had infiltrated his left lung and metastasized to his ribs, spine, and brain. There was no hope.

“I drove an hour on the highway and then three miles down a North Carolina dirt road to a run-down house, little more than a shack really, although it contained an impressive stone fireplace he’d built for himself. I was shocked by his appearance. His cancer had already done much of its work and turned my younger brother into an old man. Jason was emaciated. His body was stooped, and his face was pallid and weary. And he smoked marijuana without stop. When I complained the fumes were getting to me, he switched to tobacco. ‘Not a good idea with lung cancer,’ I almost said, but held my tongue. Having looked at the films, I knew my words would be pointless. So there I sat, watching my cancer-riddled kid brother chain-smoke. I caught his glance a couple of times as he lit up. I’m certain I saw a look of defiance. I’ll never forget that scene.”

“Reminds me a bit of that dilemma you faced years before when you so disapproved of his choice of a mate. Damned if you spoke, damned if you didn’t.”