When I got to the punch line—the bars are open on each side—John smiled for a second in what seemed like recognition but then batted it back at me. “Oh, give me a break,” he said, rolling his eyes. “Do other patients actually fall for this?” But he was the outlier. The intervention has worked beautifully with everyone else.
Still, the most important skill I’ve learned from Wendell is how to remain strategic while also bringing my personality into the room. Would I kick a patient to make a point? Probably not. Would I sing? I’m not sure. But I might not have yelled “Fuck!” with Julie had I not seen Wendell be so utterly himself with me. In internships, therapists learn how to do therapy by the book, mastering the fundamentals the way you have to master scales when learning to play piano. For both, once you know the basics, you can skillfully improvise. Wendell’s rule isn’t as simple as “There are no rules.” There are rules, and we’re trained to adhere to them for a reason. But he has shown me that when rules are bent with thoughtful intention, it broadens the definition of what effective treatment can be.
Wendell and I don’t talk about John or Margo again, but a few weeks later, as I settle into my chair in the waiting room, Wendell’s door opens and I hear a male voice. “So this time next Wednesday?”
“Yes, see you then,” replies Wendell, then his door clicks shut.
Past the screen, a guy in a suit slips out the door to the hall. Interesting, I think. Maybe the woman before me ended her therapy, or maybe she was Margo, and Wendell engineered the switch to protect my privacy in case Margo eventually figured it out. I don’t ask, though, because it doesn’t matter anymore.
Wendell was right: The awkwardness had disappeared. The secret was out, the psychic poison diluted.
I’d gotten all the counseling—or was it therapy?—I needed.
50
Deathzilla
It’s ten minutes before Julie’s session, and I’m mainlining pretzels in our suite’s kitchen. I don’t know when our last session will be. If she’s late, I think the worst. Should I check on her between sessions or let her call if she needs me (knowing she has trouble asking for help)? Should therapists’ boundaries be different—looser—with terminally ill patients?
The first time I saw Julie at Trader Joe’s, I’d been reluctant to get in her line, but every time after that, if I happened to be there when she was, Julie would wave me over and I’d happily go. If my son was with me, he’d get an extra sheet of stickers and a high five. And when Julie wasn’t there anymore, he noticed.
“Where’s Julie?” he asked, scanning the counters for her as we approached the checkout. It wasn’t that I wouldn’t talk about death with him—a close childhood friend of mine had died of cancer a few years before, and I had told Zach the truth about her illness. But because of confidentiality, I couldn’t reveal more about Julie. One question would lead to another, to lines I couldn’t cross.
“Maybe she changed days,” I said, as if I knew her only as the clerk at Trader Joe’s. “Or maybe she got another job.”
“She wouldn’t get another job,” Zach said. “She loved her job!” I was struck by his response: even a young child could tell.
Without Julie there anymore, we’ve been going in Emma’s line—the woman who offered to carry Julie’s baby. Emma also gives him extra stickers.
But back at my office, waiting for Julie to arrive, I ask the same question Zach did: “Where’s Julie?”
There’s a word we use for the end of therapy: termination. I’ve always found it to be oddly harsh-sounding for what’s ideally a warm, bittersweet, and moving experience, much like a graduation. Generally, when the therapy is coming to an end, the work moves toward its final stage, which is saying goodbye. In those sessions, the patient and I consolidate the changes made by talking about “process and progress.” What was helpful in getting to where the person is today? What wasn’t? What has she learned about herself—her strengths, her challenges, her internal scripts and narratives—and what coping strategies and healthier ways of being can she take with her when she leaves? Underlying all this, of course, is how do we say goodbye?
In our daily lives, many of us don’t have the experience of meaningful goodbyes, and sometimes we don’t get goodbyes at all. The termination process allows someone who has spent a great deal of time working through a significant life issue to do more than simply leave with some version of “Well, thanks again—see ya!” Research shows that people tend to remember experiences based on how they end, and termination is a powerful phase in therapy because it gives them the experience of a positive conclusion in what might have been a lifetime of negative, unresolved, or empty endings.
Julie and I have been preparing for another kind of termination, though. We both know that her therapy won’t end until she dies; I made her that promise. And our process lately has consisted of more and more silence, not because we’re avoiding saying something, but because this is how we’re facing each other most honestly. Our silences are rich, our emotions swirling in the air. But the silences are also about her declining state. She has less energy, and talking can take a toll. Jarringly, Julie looks healthy, if thin, on the outside, which is why so many people have trouble believing that she’s dying. Sometimes I do too. And in a way, our silences serve another purpose: They give us the illusion of stopping time. For fifty blissful minutes, we’re both granted a respite from the outside world. She feels safe here, she told me, not having to worry about people worrying about her, having their own feelings.
“But I have feelings about you too,” I said the day that Julie brought this up.
She thought about this for a second and then said simply, “I know.”
“Would you like to know what they are?” I asked.
Julie smiled. “I know that too.” And then we went back to silence.
Of course, between the silences, Julie and I have also been talking. Recently, she said she was thinking about time travel. She’d heard a radio show about it and shared a quote she loved, a description of the past as “a vast encyclopedia of calamities you can still fix.” She’d memorized it, she said, because it made her laugh. And then it made her cry. Because she’ll never live long enough to have this list of calamities that other people acquire by the time they reach old age—relationships they’d want to mend, career paths they’d want to take, mistakes that they’d go back and “get right” this time.
Instead, Julie has been time-traveling to the past to relive parts of her life that she’s enjoyed: birthday parties as a child, vacations with her grandparents, her first crush, her first publication, her first conversation with Matt, one that lasted until dawn and still hasn’t ended. But even if she were healthy, she said, she’d never want to travel to the future. She wouldn’t want to know the plot of the movie, to hear the spoilers.
“The future is hope,” Julie said. “But where’s the hope if you already know what happens? What are you living for then? What are you striving for?”
I immediately thought of a difference between Julie and Rita, between young and old, but flip-flopped. Julie, who was young, had no future but was happy with her past. Rita, who was old, had a future but was plagued by her past.