I walk Michelle out, ashamed about getting flustered and distracted, of not gathering the history and having to report to my supervisor empty-handed. All through graduate school, we students had been awaiting the Big Day when we would lose our therapeutic virginity, and now, I think, mine turned out to be more disgrace than thrill.
Then, relief: Discussing the session that afternoon with my supervisor, she says that, despite my clumsiness, I did just fine. I’d sat with Michelle in her suffering, which for many people can be an unusual and powerful experience. Next time I won’t worry so much that I have to do something to stop it. I’d been there to listen when she needed to unload the burdensome secret of her depression. In the parlance of therapeutic theory, I’d “met the patient where she was”—history-taking be damned.
Years later, when I’ve done thousands of first sessions, and information-gathering has become second nature, I’ll use a different barometer to judge how it went: Did the patient feel understood? It always amazes me that someone can walk into a room as a stranger and then, after fifty minutes, leave feeling understood, but it happens nearly every time. When it doesn’t, the patient doesn’t return. And because Michelle did, something had gone right.
As for the clock snafu, though, my supervisor doesn’t mince words: “Don’t bullshit your patients.”
She lets that sink in, then goes on to explain that if I don’t know something, I should simply say, “I don’t know.” If I’m confused about the time, I should tell Michelle that I need to step out of the room for a second to bring in a working clock so that I’m not distracted. If I’m to learn anything in this traineeship, my supervisor emphasizes, it’s that I can’t help anybody unless I’m authentic in that room. I had cared about Michelle’s well-being, I’d wanted to help, I’d done my best to listen—all key ingredients for starting the relationship.
I thank her and start toward the door.
“But,” my supervisor adds, “be sure to get that history in the next couple of weeks.”
Over the next few sessions, I get what I need for the clinic’s intake form, but it’s clear to me that’s all it is—a form. It takes a while to hear a person’s story and for that person to tell it, and like most stories—including mine—it bounces all over the place before you know what the plot really is.
Part Three
What makes night within us may leave stars.
—Victor Hugo
31
My Wandering Uterus
I have a secret.
Something is wrong with my body. I could be dying, or maybe it’s nothing at all. In which case, there’s no reason to disclose my secret.
This question of my illness started a couple of years ago, a few weeks before I met Boyfriend. Or at least I think it did. My son and I were on our summer vacation, spending a relaxing week in Hawaii with my parents. The night before we were to return home, though, a painful, angry rash seemed to appear out of nowhere and devour my body. I spent the plane ride back hopped up on antihistamines and slathered with over-the-counter cortisone cream, scratching myself so hard that my nails were caked in blood by the time we landed. Within a few days, the rash subsided, and my doctor ran some tests and chalked it up to a random allergic reaction. But the rash had felt like an eerie foreboding, a harbinger of what was to come.
Something seemed to be lurking inside me, attacking my body over the next several months while I looked the other way (which was, at the time, directly into Boyfriend’s eyes). Yes, I felt fatigued and weak and had an array of disturbing symptoms, but as my condition worsened, I convinced myself that it must be a change in stamina that happens in one’s forties. My doctor ran more tests and found some markers for autoimmune disease but none that could be linked to a particular illness like, say, lupus. He sent me to a rheumatologist, who suspected that I might have fibromyalgia, a condition that can’t be diagnosed with a specific test. The idea was to treat the symptoms and see if they improved, and that’s when the off-label-use antidepressant ended up in my record at the CVS across from my office. Soon I was at that CVS often, picking up cortisone creams for bizarre rashes, antibiotics for unexplained infections, and antiarrhythmics for my irregular heart rate. But my doctors couldn’t figure out what was wrong, and I reasoned that this was a good sign; if I did have a dangerous illness, my doctors would have found it already. No news is good news, I told myself.
Just as with the misery-inducing happiness book, I plugged along, keeping my health worries as private as my writing worries. It wasn’t so much that I purposely hid my medical situation from my close friends and family. It was more that I chose to hide it from myself. Like the physician who suspects he has cancer but delays getting scanned, I found it far more convenient to just not deal. Even as I no longer had the strength to exercise and inexplicably lost ten pounds—I felt sluggish and weighted down even as I became lighter—I assured myself it must be something benign, like, I don’t know, menopause. (Never mind that I wasn’t in menopause yet.)
When I did let myself think about it, I’d go online and learn that I was dying of basically everything, only to remember that in medical school, we students suffered from “medical students’ disease.” This is an actual phenomenon, documented in the literature, in which medical students believe that they’re suffering from whatever illnesses they happen to be studying. On the day we studied the lymphatic system, a group of us felt each other’s lymph nodes over dinner. One student put her hands on my neck and exclaimed, “Whoa!”
“Whoa what?” I asked.
She made a face. “It feels like lymphoma.” I lifted my arms and felt my neck. She was right; I had lymphoma! Several other classmates felt my neck and agreed—I was toast. Better check my white cell count, they said. Let’s biopsy those nodes!
In class the next morning, our professor felt my neck. My nodes were big but within the normal range. I didn’t have lymphoma; I had medical students’ disease.
I probably had nothing now too, I figured. Except deep down, I knew it wasn’t normal for somebody in her forties who used to be a runner not to be able to run anymore and to feel sick every day. I’d wake up tingling, my fingers red and thick as sausages, my lips swollen as if stung by bees. My internist ran even more lab tests, some of which came back abnormal or, as he put it, “quirky.” He sent me for MRIs and scans and biopsies, some of which were also “quirky.” He sent me to specialists to interpret the various quirky labs and scans and signs and symptoms, and I saw so many specialists that I began calling my odyssey the Medical Mystery Tour.
It was indeed a mystery. One doctor thought I had a rare form of cancer (based on lab tests, but the scan ruled this out); another thought it was some kind of virus (starting with the rash); another thought it was a metabolic condition (my eyes were riddled with deposits that nobody could diagnose); and yet another thought I had multiple sclerosis (my brain scan showed spots that weren’t typical of MS, but they could be an unusual presentation). At various times it was thought that I might have thyroid disease, scleroderma, or, yes, lymphoma (again, those enlarged glands; did this actually start back then, in medical school, lying dormant until now?).