Throwing away the cookie cutter

One oft-heard tenet of my training is to go with the patient. When working with kids, it means that they chose the activity and direct the play. I, in turn, am a facilitator, an observer and when called upon, a participant in the fantasy world that the child creates. Children's play is often a surprisingly literal enactment of their world. What does their play tell me about their life? Is the play lifeless or repetitive, or out-of-control, or unstable, or full of painful events or hidden perils?

Recently at the beginning of the hour, a woman announced that she was unable to sit down that day. She had to have the door open and the radio turned off. In fact, if she had her druthers, she'd be outside walking. It was a lovely unseasonably warm day, so out we went. She thought she'd only need to walk around the block. I told her about a terrified little girl that had to be walked around the block three, sometimes four times, before she wound down enough to play inside. That day we ended up walking for 50 minutes. Over and over she apologized because she thought her problem was so silly. I corrected her because her difficulties were keeping her from enjoying her life and doing the things she had previously done with no difficulty. In fact, her life sounded pretty miserable to me.

Someone driving by might think we were just two ladies out for a stroll; however she was telling me about her world; a world where she was afraid to be alone, afraid to ride in the backseat of a car, afraid to drive by herself, afraid of being in a room with too few windows, and in constant fear of something happening to a member of her family. Her world is a prison in which she is rarely at peace. We discussed nutrition, the pros and cons of psychotropic medications (she has a cabinet full of them, most unopened), and small steps she might make to gain a bit of control over her life. Mostly she talked, we walked and I listened. This is hardly a by-the-book, standard cookie-cutter approach, but it was a most productive hour. So I've dusted off my walking shoes and will take them in to the office just in case we need to take another walk the next time she comes in. We will continue to walk as long as she needs to.

Merry Christmas!

by Jan Gossaert_Early 16th century




I just love the heavenly host hovering in the sky in this painting. The angels seem to be the only ones in this scene who really understand what's happening. They seem to be clapping their hands with joy. Everybody else looks most serious.

Little graces have abounded today. Youngest daughter and boyfriend arrived safely after a long trip filled with flight delays and a missed connection. Miraculously their luggage all arrived after being routed through O'Hare. Earlier I walked into Mother's room on the nursing unit to see a single red rose with a card which read "From someone who is thinking of you". One of the nurses told me that a rose was delivered anonymously to everyone of the patients on Long Term care. So many kindnesses have been extended to Mother and the others on the unit, most of whom have no idea who to thank.

Gifts are all wrapped. The tree still needs decorating. Oldest Daughter and my favorite son-in-law are en route. Good Lord willing our house will be full tonight. Well, not quite full. There is one free bed in the boy's room. Life is good. My family is healthy, normally content, employed and no one is in jail. We have food in the kitchen and will be able to pay our Christmas bills. According to NORAD, Santa is somewhere over Siberia, so Christmas is on the way. I send wishes to you for a joyful Christmas and a wish that your eyes be opened to the miracles around you.

It's beginning to look a lot like Christmas

The last month has been really tough at work. Two new couples and two new individuals have come in plus two old patients have circled back around. The hours have been long and intense. Yesterday I set a personal record of nine hours solid without a break. That is nothing compared to my colleagues but it was a new high water mark for me.

I've never been too fond of working with couples but it seems this is my season for learning how.This week I thought I'd have to get the fire hose out on two occasions when things got heated between husband and wife within the hour. And then, of course, there is Christmas. All the old hurts,disappointments, and shattered illusions now rise to the surface. Several of my people have a history dead babies in their lives and all the baby themes of the season are particularly hard for them. One lady's husband died the week before Christmas many years ago and since then, there is no joy in her heart this time of year. And of course there's money. It's a lousy time of year to be struggling financially.

If one lives with an alcoholic, Christmas brings more drinking and consequently more fights. One woman's earliest memory was of her Mom pulling a knife on her Dad during an argument over where they should place the Christmas tree. One man recalls Dad and Mom having knock down fights about when they put up the tree. Usually Dad won that fight. The family had to wait until Dad came home from the bars on Christmas Eve to put up their tree. And current difficulties like broken relationships, feeling unloved, loneliness, being poor, being sick, being laid off, being sad are all magnified in the light of the holly-jolly, jingly-bell frenzy surrounding us. One thing that keeps this unrelenting misery from becoming overwhelming are the touches of God's grace that filter through the muck. Yesterday it came through the CNA who told me she's crocheting an afghan to give to my mother for Christmas. Or through the man who left a big bag of cereal treats on my desk which I was able to share with my patients all day long. One woman told me of receiving a $500 dividend check yesterday just when she was wondering how she'd pay for repairs to her car. The bill came to $495. At such moments, my heart is lifted, I am encouraged and my prayer is "Thanks I needed that".

Owl on the prowl

This evening, a great horned owl perched in a branch above our roof. His hooting called me out of the house and it was still light enough to get a proper look at him. According to my owl authority this fellow is claiming our house as his territory. The staking of territory is a preamble to nesting. Perhaps he'll hang around to raise his family. There are lots of rodents who come in to the back yard to pick up what seeds the birds drop from the feeder, so an owl family should not go hungry here. Last Christmas eve, a pair of great horns flew in to serenade us on our front porch. It was a one of a kind Christmas present.

Brain on idle

I have been on vacation for the past week and I haven't been thinking deep blog worthy thoughts. It's been an "at home" vacation which for mothers might seem a contradiction of terms. Since my chicks are all grown up, it's great to have the opportunity to do some modified clucking over them. It was a very good visit with youngest daughter. Son was around quite a bit too. Since I have dedicated myself to simplifying the feast, I was less frazzled and enjoyed Thanksgiving far more. This is a healthy strategy!

The guys ate hot turkey sandwiches last night while I was taking youngest daughter to the airport, so we are down to just scraps of turkey. Actually the second annual flat chested mail order turkey lived up to the luscious juicy recollection of its predecessor.

Our Thanksgiving decorations will stay up a few more days since I'm not ready to start the hanging of the greens. The neighbors to the east always lead the annual Christmas decorating charge. Each year they create an amazing outdoor display of Christmas lights. Each year it grows bigger and bolder. This year many of the lights blink in synchronization to music, which we mercifully can't hear down at our house. Seeing as we do not live in a highly populated area, the glow from the neighbor's yard can be seen a good mile away, more if there were no trees to block the view. There is something outrageously wonderful about the display. It's not tasteful in the least. It's garish and haphazard, but it's fun. We get enjoyment out of the neighbor's exuberant delight and we don't have to pay their electric bill.

Saturday we went to our town's Christmas parade which is always fun. We were joined by eldest daughter's best school bud and her adorable 7 month old daughter who took all the noise and lights in stride. I admire the ingenuity of some of the floats which for the most part advertise local businesses. A memorable one was the brain child of a local plumber who created a Christmas tree out of lighted shower heads which then sprayed down streams of water. Only a plumber would think of something like that! Of course there were cubs scouts, tiny gymnasts cartwheeling down the street, the high school band, a grade school band, junior baton twirlers and pompom girls, the fair queen on her throne, local dignitaries, fire trucks and gratefully several churches reminding us what this season is really all about. Until I saw them marching in the parade, I did not know that our sheriff's department has a posse. It is a posse on horseback which trotted by in full uniform. Our tax dollars at work. The things I learn watching a parade!

Advent/Christmas Music Meme

This Meme comes from the Psalmist
1. What are your favorite Advent/Christmas Hymns?
The Candlelight Carol by John Rutter, In the Bleak Midwinter, How Far is it to Bethlehem? Joy to the World
2. What are your least favorite?
The Holly and the Ivy (monotonous!!), The First Nowell
3. Which secular seasonal songs make you want to run screaming into traffic?
The Little Drummer Boy
4. Do you play Christmas music in the house and in the car?
Oh yes. Everything from the Bach Christmas Oratorio to Clint Black singing "Milk and Cookies".
5. What is your favorite Christmas CD?
"Sing in Exultation" by the Choirs of the National Cathedral under the direction of the incomparable James Litton.
What are your choices?

Happy Thanksgiving

In between assembling the stuffing and prepping the big bird for the oven, I send wishes for a wonderful Thanksgiving. May it be a day of constant reminders of how richly blessed we are and how bountifully( said patting my plump tummy) the good Lord provides and cares for each of us. My prayer is that we can be lifted up above our own concerns and see with those inner eyes the wonders of this life.

On a personal note, youngest daughter arrived safe and sound with a big bag of fresh bagels in hand. What a great kid! The traffic on the interstate was only heavy in spurts so it was a pleasant drive to and from the major city airport. On the way I listened to Jan Karon's Light from Heaven on CD. It is sentimental, nostalgic and a good kind of story to enjoy at a sentimental, nostalgic time of year. The Mitford series, of which this book is the last, takes me back to my years as an Episcopalian. I can hear training analyst's voice saying something about regression in service to the ego at this point. Be that as it may. It is, however, very hard to see Fr. Tim, the series main character, attending this past year's General Convention of the Episcopal church . Does the church of this series even exist anymore? Or is it a kind of Brigadoon illusion? Anyway, fiction though it may be, the kindness, generosity, and faith of Karon's stories do warm the heart and I enjoyed my visit with Fr. Tim et al.

Son will be joining us later today. Oldest daughter and her husband are enjoying the day with his family. I am forever grateful to his family for so warmly welcoming her into their family. As her mother I think "what's not to love?", but it blesses me that she has found such a great home away from home. So now I'm off to consult a cookbook so I know how long to cook this year's second annual flat chested mail order turkey. Once the bird is roasting, I'll take daughter and son out to visit their grandmother at the nursing facility. This is this the gloomy part of this day since last year she was able to join us for Thanksgiving dinner. This year she is too frail so we must go to her. It should brighten her day to see the grands. Happy Thanksgiving to everyone who stops by and remember the words of the famous chefs "Baste, baste, baste".

Delurking

I am a lurker and I didn't even know I was one until I came across this emblem when visiting a blog. A lurker reads other people's blogs but never leaves a comment or any indication, however small, that they have been there. So this week is delurking week and I plan to say hello to the people whose blogs I read. You might do the same. :)

Diagnostic Labels

I am frequently astonished by the diagnostic labels that get slapped on people all too often by an uninformed "professional". I've encoutered a school speech pathologist diagnosing autism, a massage therapist declaring a patient has fibromyalgia, or an occupational therapist telling a mother her child was bipolar. And don't even get me started on nurse practitioners dispensing psychotropic drugs. What is this nonsense?

One of my patients was told he was depressed by a mental health counselor. He sees his depression as something external that once he sheds it, like a heavy overcoat, all will be well. I had him tested by Mecte, my esteemed colleague to the east, who is very skilled at such things. He does the standard intelligence tests and the MMPI but also administered the TAT, which looks at emotional themes and psychodynamic underpinnings. Well, this gentleman tested highest on anxiety and far lower on depression. I decided to use this to my advantage in treating him, by pointing out his worst difficulty was his fear not his depression. But he doesn't like that one bit. Being afraid is a lot different than being depressed. And he knows, because some counselor told him, that depression is his problem. He is depressed in the same way someone else is diabetic. He, like so many people, doesn't quite get the idea that the labels they wear might be wrong or that they might no longer be valid. In treatment, people change and with time and work, they get better.

But what would it mean if he were not that depressed any more? Well, it would mean his family is going to expect a lot more out of him and there will be fewer concessions made on his behalf. Being sick in the mind, as he calls it, does have its pay-off. If he's sick, he doesn't have to work, be responsible and be a grownup. The crazy person always wins and that's often tougher to treat than the presenting problem itself. I used an automobile assembly line illustration with him. At the beginning of the line, there is a chassis. Then the engine, the brakes, the seats, the doors, side panels are added. As the car moves down the line, more and more things get put on. Like an assembly line, his treatment is dynamic. He does not stay the same and will continue to change as we move on down the line.

Sacred cows make the best hamburger-Mark Twain

A colleague forwarded this story about happiness to me this week. I have read Dan Gilbert's book which I found worthwhile although a tad redundant. One point that I found useful was that what we imagine something to be and what it really turns out to be are two different things. And it's important to get a grip on what the imagined part is based on.

One woman is cooking Thanksgiving dinner for her six children, their spouses, significants, eight grandchildren and ex-husband in ex-husband's house, because it's the only place large enough to house everyone. Her reason for doing this is "my children want me to cook for them." She was fuming because one of her sons wanted to invite her ex-in laws too. There is no love lost between the long suffering cook and her ex-mother-in-law. Now, whose fantasy Thanksgiving is she trying to create? And is this even possible? Or rational? From the outside it seems like everyone is pretending that Mom and Dad didn't get a divorce.

I'm not faulting her because there is a lot of this that goes on within families, including my own, especially at the holidays. We bump into Hallmark and Norman Rockwell images right and left. We carry within us long faded postcard images of childhood holidays, which we magically hope we can re-experience. But sometimes what we re-experience is a lot of hurt and rage..like Uncle Ike has to take one more dig at how much weight you've gained or how bald you are, as if you didn't know, or Grandma lets you know she doesn't approve and never has approved how you are raising your kids etc. etc. One young couple grabbed their their little girl and in a huff left a family gathering after Grampa said that the child was retarded. Ah, families!

In thinking back, the traditional Thanksgivings have blurred together in my mind. It's the off beat ones I remember like the family gathering in Boston my sophomore year in college. We went to old North Church for services, paid our respects to Plymouth Rock and ate dinner at the Top of the Hub with a panoramic view of downtown Boston. There was another year in college where we cooked a goose with a bunch of friends in the kitchen of a Baltimore row house. We ate so much that we all ended up taking a nap between courses. Some years later, I recall eating fresh lobster as a newlywed when hubster was a young resident and we couldn't be with our families. I kept the lobsters in a crate in the kitchen and was amused as they rustled around. There was last year's flat mail-order turkey, or memories of the dreadful inedible green olive stuffing. And there were the poignant gatherings like the one at my brother's house right after Dad was released from the hospital after a nearly fatal episode of heart failure. He was so painfully thin and weak. It was his last Thanksgiving with us. As the years pass there are more of those empty chairs.

Three years ago I did a big blow-out Thanksgiving dinner for 25. My sister-in-law and I had an unspoken agreement for years that I cooked Thanksgiving dinner and she did Christmas. But things had changed. Our families were expanding, another family had joined us, and both of us had gone to work. The day after, a colleague asked how my Thanksgiving had been. I moaned that I was exhausted after spending all day in the kitchen. He looked at me and asked "Then why do it?" That was a very good question and a question I have asked myself every year since. Anyone for hamburger?

Eating ribs and shooting turkeys

To say I lived a sheltered life in suburban Ohio when I was growing up would be an understatement. It was a very narrow existence where everyone was more or less like myself. We were white, for the most part comfortably Protestant, college educated, Republican, middle class and very insulated. And I do not miss that life one bit.

It was an adjustment, a great adjustment, for me when we moved to this small town. I grew up in the city, surrounded by people like myself. Now there was no one like myself. It took me forever to figure out that each community has it's own way of doing things. For example, in my neck of the woods, it was customary to send wedding gifts directly to the bride's home in advance of the wedding or directly to the couple afterwards. Here, one brings the gift directly to the wedding because opening gifts is one of the reception activities along with tossing the bouquet and cutting the cake. If someone dies, the city tradition is to send flowers and a note of condolence to the bereaved. Here one takes over food and goes to the wake to personally express sympathy. I bumbled around for many years.

Hubster's vocation, as was my Dad's and now mine, tends to be isolating. We have been perceived as fat cats and snobs by some, and as people who really don't know what constitutes real work and are a bit dense. In many ways that was correct. One of the unexpected blessings of my work has been to peek inside the lives of people who live in very different worlds that I do. I treat a mechanic, an oil field worker, an automotive plant assembly line worker, a teacher, a cashier, a forklift operator, a warehouse supervisor, a bricklayer etc. Son's work as an electrician and firefighter has also helped me to understand the life of the working man and woman. And as a result I am able to connect more easily with the people in my town.

Last night we enjoyed an excellent rib dinner at the American Legion. It was a community fundraiser to provide goodies for our local men and women in the military. I have treated one of those young people who is currently serving in Iraq. Today we plan to head out to the Fire Department's annual turkey shoot. Despite the name, no live turkeys are killed in this process. It's actually target shooting. The winner of each round can either take home a turkey or a ham donated by local stores. Shooting competitions are actually a great equalizer. I've seen a judge square off against a hot shot 12 year old. Once it warms up, it'll be a nice day to be outside. And there's always lots of ribbing and that's part of the fun. As I slip shells into my husband's shotgun, I'll chuckle. I remember being taught to curtsy, now I'm learning to take aim.

Some days life ain't fun

Lots of turmoil in the past week, but thankfully it is now mostly in the review mirror. I was really looking forward to a peaceful weekend last week after two months of riding the roller coaster with Mother's health and long days clearing out her apartment. But instead of a peaceful weekend, I found myself in a battle zone. Hubster's (and mine) unconscious anxiety in regards to a mass removed from his neck went underground and resurfaced in a bizarre fashion. The all-clear biopsy results finally came on Thursday of this week and everyone is back to what passes for normal around here.

In addition Hubster's little, and favorite, brother is having problems with his shoulders and chest muscles. Seeing as little bro can't walk and uses his arms to support his body, then shoulder difficulties are very serious indeed. Little bro is getting tests and in the best surgical hands, this will not be easy work. I suspect this didn't help Husbster's general mood and disposition.

Then my Mother's former roommate called her on Sunday and was placing demands on her that she could not possibly accommodate let alone comprehend. It took some twenty minutes to calm Mother down after the call. All I could think was "What kind of moron 'walks' into a sickroom and starts making demands?" Mother begged me to handle it. I wasn't sure just what I was supposed to do. I had to run it around my mind for several days, bounce it off my sister, while working through my furor at this so-called "friend". Eventually I composed and sent a letter to former roommate. I'd also come to the realization that "friend" might have been putting extra pressure on Mother in hopes of timing a visit around Thanksgiving and thus wangling an invitation to my house for the holiday. Don't blame her, because I am a very good cook.

So all of this doesn't lead to the creation of witty and interesting blog entries. I wrote two that I didn't think it wise to post. Anyway I needed to figure out how to bring some sanity and calm into all of this agitation and hang on until we hit calmer waters.

Another one bites the dust

I was saddened to see another Christian leader toppled this past week. It is good that the truth was brought to light but once again, the church gets smeared in the eyes of the world. So often, it seems, that we hate in others what we hate in ourselves. As Freud said when a patient talks he can only talk about himself. So when someone rants hard against dancing, gambling, greed, homosexuals, hypocrisy, drinking, smoking, or any other subject, I have to take into consideration the unconscious motivation of the speaker.

I don't know Ted Haggard. I gather he was a pretty influential man. I can't help but think of his family and the members of his church. One man I know is still hurting over the deception at the hands of his best friend and pastor. His friend/pastor was having an affair with a parishioner and he lied to everyone when the rumors started flying. This man stood by his friend when everyone else in town and in their church wanted to run the guy out of town. He was the only one to believe the fellow's lies. Finally his friend tearfully fessed up and resigned from the church. Three years later the ex-pastor is annoyed that his former parishioners are still mad and cross the street to avoid him. He seriously compares himself to David and preaches to anyone who will listen about restoration. Meanwhile his former best friend still feels betrayed and foolish for having trusted him. It takes a long long time to heal after trust has been broken

Various things

An additional thought concerning yesterday's dream analysis has to do with the hubster trying to use bullets that are too small. Sometimes people will dream about guns or being shot and this represents getting a shot. Hubster injected mother's hip on several occasions and she had several epidural injections too. These provided some relief but no healing, ergo the bullets just weren't big enough.

A while back I blogged about a woman who had plopped down in anger and was refusing to do much of anything, acting like a stubborn toddler. This week she called to move her appointment because she is working now. Yay!

Another bright spot was a proud Mama sharing with me her son's engagement. He's been dating this girl for ages and has been dragging his heels about making a commitment. I paraphrased Goethe by saying that when we move to commit, Providence moves too. I predicted some neat changes for this young man.

Other good news is that Mother is settling comfortably into the nursing unit and I can see clearly now that she does really need this level of care. It's easy to delude myself on her good days that she is doing better than she really is. It is precisely because she is receiving so much support that she functions as well as she does. And on her bad days, it is all too evident how far she has declined. This awareness decreases any second guessing on my part and I am such an expert on second guessing.

The Dream

It is no surprise that my mother's rapid decline would prompt some unusual dreams and that has, indeed, been the case. Last weekend, as I was clearing out her apartment, I cranked out the following dream:

"I am climbing up a dark steep staircase from the basement. A girl (early teens) is going to break in a window, which is to my right. The window is a half window partially below ground and blocked part way by a shutter.I am terrified beyond belief. I scream and scream but no sound comes out of my mouth.I get to the top of the stairs, enter a kitchen where I find my husband loading a gun to get the girl. He has a 9mm handgun but the bullets he's trying to load are too small-more like 22 caliber.His hands are shaking so badly that he's dropping bullets. I know he won't be able to help me."

The dream is very complex and taps into multiple levels. When I encounter breaking into one's house in a dream, it is often a surgery theme, the house being symbolic of the body. Being unable to cry out for help is related to anesthesia. The girl outside is for some reason very scary. I, at first, identify her as mother, but upon later reflection, I realize she is my teenage self. Training analyst says this is an old dream which began in my teens. Outside I am a teenage girl soon to become a woman, wife and mother. Inside, however, I am terrified little girl who is silently screaming for someone to help her.

Sometimes the unconscious will do a reversal. So males are females. Big is little. Old is young. In that vein, I wondered if the menacing young girl was really old man death.The Blind Boys of Alabama singing "Hush" comes to mind. And instead of my husband, the person I go to for help is my mother. The shaking hands is the tip off here. The first association to people with shaky hands would be her and secondly to my father who would shake when he got agitated. And it is my realization now that my mother who used to protect me is no longer able to help me. She might want to, but her hands shake and the bullets are too tiny, that is, not powerful enough, to do the job. Once, if I were frightened, I could run to her to feel safe. That sense of security is gone. Now, I comfort her and I'm the one who has to keep her safe.

Reality TV: "Who wants to be a Saint?"

Happy All Saints Day to one and all! The concept of sainthood has always intrigued me, at times amused me since it seems to go so contrary to the humility that Jesus models for us. Yet, there sainthood sits with its implication that some people do the faith walk far better than others. They make the all-star team and win the believer's super bowl ring. They are held up as ideals of charity, fidelity, zeal and all manner of Christian virtue. Some saints in the making are blessed with stigmata and the ability to be in two places at the same time. Personally I'll pass on bloody hands. And I get in more than enough trouble as is, in just one place.

Saints, however, are rarely lay men or women, and to my knowledge never ever married lay women. So I am already out of the running. I might stand a chance, a very slight chance, should I outlive my husband, then become a nun and found a new religious order. What silliness it is to think that ordinary people cannot be Saints of God! I personally think that the world is full of these beacons of God's goodness who are doing his work anonymously out in the world every day. Anonymously, that is the right hand not knowing what the left hand is doing. These Saints may not be responsible for documented miracles, but their lives bless those who cross their paths. I think of the Saint who brought my mother a heated blanket when she was lying in the emergency room. Or the Saint who changed our flat tire and then gave us his jack because ours was broken. Or the volunteers who come to lead worship services or help with activities for the old people in nursing homes. Or Saints who bring food to bereaved families right after the funeral, send cards to shut-ins or prisoners, and treat all people as though they were God's children. Some differentiate between big "S" Saints and little "s" saints , a nod that saintly activity just might occur outside the walls of that church body.

I suppose a new reality show could be developed called "Who wants to be a Saint?", or "The Christian non-Idol". The Vatican's ratings have been kind of low recently. Canterbury's ratings aren't any better. A new attractive charismatic saint who could go on an international tour might just be the ticket. But my version of this reality show probably wouldn't have any bishops, heads of charitable organizations or theologians . My version would never get off the ground because the people I see as Saints never see themselves that way. They wouldn't even show up for the auditions because they'd be visiting the sick, feeding the hungry, raising their kids, and loving their neighbors.

Presenting Symptoms

When an individual comes in for the first appointment, he or she usually has some specific difficulty for which they are seeking help such as a morbid fear of Toyotas. Their reason for consulting me is called the presenting symptom; however this is often not the real problem. Sometimes the problem is unconscious in origin, but sometimes it is not repressed and thus easier to uncover, that is, if I'm paying close attention and asking the right questions.

The couple I mentioned previously in "The Sadomasochism Tango" came in again this week. All in all they are doing quite well. In passing the wife mentioned that she'd had a doctor's appointment this week. It seems that many years ago she was diagnosed breast cancer. There was recurrence a year later and then several more lumps which turned out to be cysts. During this time she was in treatment for her cancer, the two of them hardly mentioned their fears for the future. Each bottled up their emotions and suffered in silence. As they talked I'm mentally calculating that the husband's drinking became problematic about the time of the cancer siege. This week's appointment was to see her family doctor to check out a new lump. She is scheduled to see the surgeon next week, but her doctor is 90% sure it's another cyst. Suddenly everything made sense to me. I asked when she first noticed the new lump. She told me the date. It was the next day she called to make an appointment with me asking for help with her husband's drinking. His drinking appears to be his coping mechanism to handle his fears about his wife. And it also serves to effectively divert his wife's anxiety on to him. The "problem" is no longer her cancer, but his boozing. Aren't people complex?

Another man came in recently after having a truly horrible fight with his wife. He's wondering if their marriage can be saved. He's so miserable that he's not sure it's worth trying any longer. He mentions casually that he thought the last time he and his wife had a fight like this was a year ago, just about this time of year. We did a little checking and found out that they'd had a baby die..wanna guess when?....in late October. Training analyst says it takes on the average eight years before a couple can talk about the death of a child. It has been four years for them. The rage they feel, they direct at one another and for the guilt they each feel, they seek punishment. The fight had to do with unresolved grief no matter what else they might have thought it was about.

Mommy programming

I had the funniest mental blip the other day. As I entered my mother's hospital room, I found myself thinking "I wonder if she'll think I look nice today?" Here I am, a mostly mature adult in my late 50's, a wife, a mother, a professional woman hoping my mommy, my half-blind dear old addled-brained mommy, thinks I look pretty. When I realized what I was thinking, I told myself that I didn't need my mother's approval to feel ok about my appearance. I happened to think I looked rather spiffy that day. Even so, I found myself pleased when she did compliment my appearance that day. Isn't that strange that we, correction I, still want good old mommy to pat my head and smile approvingly over what I say and do?

When Mother was readmitted to the hospital, I firmly resolved that there would be no more assisted living for her and the next move would be into a nursing home. As the days passed, I expected she'd start talking about going back to her apartment but she didn't. I went ahead and made arrangements to reserve her a room in the long term care unit and also to clear her stuff out of her apartment, but I didn't discuss any of this with her until today. She accused me of sneaking around behind her back. I played my trump card which was this was what her doctor recommended. That made her think for a moment, but she kept saying she was totally surprised even though minutes before she was saying she doubted she'd ever leave there. My little girl thinking came rushing to the forefront with its second guessing, its wondering whether mommy was mad or mommy was happy with what I had done. She seemed pleased when we showed her the new room. It is just down the hall from her current one, but once more she said I'd been doing all the planning behind her back. She's right. The mature me knows that this transition would likely cause some protest. Who would want to go to a nursing home if given the choice? I guess that's the rub: there is no choice. I made it and no matter how I sugar coat it, it is a lousy thing to have to do to your mommy.

Fleshly delights

Oh, boy! A most delicious odor is wafting in from my kitchen. I have dedicated this afternoon to making up two trays of lasagna, one to eat tonight and the other to freeze. The days of my herb garden are numbered so I thought it best to dump into the sauce large amounts of the remaining parsley, rosemary, basil and oregano. I'm not experienced in herb cultivation but it seems that the rosemary has gotten much stronger as it has matured. But the smell of fresh cut herbs is positively wondrous and the taste samples of the simmering tomato sauce are even wondrouser.

The lasagna recipe I use is an approximation of my mother's which I have tweaked over the years, most notably by using 2 parts Italian sausage to 1 part ground beef. If my daughters use this recipe, no doubt they will add their unique signature touches.

My book of the week is Miroslav Volf's Free of Charge: Giving and Forgiving in a Culture Stripped of Grace. A culture stripped of grace....what a great phrase! He is one of those people whose love of life is positively infectious and I find my heart warmed by his generous spirit.

I have three way tie for CD of the week. First is Tony Bennett's Duets: An American Classic in which Tony and selected friends sing a wide variety of pop standards. My favorite number is Tony and Elvis Costello doing "Are You Havin' Any Fun?" which is just a rollicking performance accompanied by a big fat lush orchestra. My second CD of the week is These Days, a 4 disc set by Vince Gill who has got to be one of the most versatile performers out there. I have downloaded several songs. My favorite is "Some Things Never Get Old" with Emmylou Harris singing harmony. And if this isn't enough good music, I have recently discovered a very talented young Brit by the name of Jamie Cullum who has a great pop voice and plays a mean piano. OK, I know he may be old hat to my hipper more musically cognisant relations, but he's a delightful find and uses first class jazzy back up instrumentalists.

The Ugly Duckling

USA Today ran an article about 101 most influential fictional characters this past week. Of course part of the fun of reading such lists is disagreeing with the compiler. Fairy tales once again got a bad rap. These stories are not the psychically damaging, anachronistic, patriarchal propaganda that some parents groups believe. They are how children over many ages have been able to safely discharge their forbidden inner aggressive and sexual impulses. Children love fairy tales, the more violent the better. They love it when Handsel and Gretel shove that mean old witch in the oven. They love it when the wolf eats Grandma and when Jack outwits the giant and steals the goose that lays golden eggs. Experienced Moms and Dads know full well how small children beg to hear these stories over and over and over again.

The list authors state that The Ugly Duckling insults 90% of the population because it emphasizes beauty. Boy, do they have that wrong! In my office, I have multiple copies of that story including the original version, a little kid simplified version and gorgeous Caldecott award edition which I hand out to patients to read. Adults and children love the story because it helps them see their long-standing sense of alienation, of not fitting in or of not belonging in an entirely different light. The adult who walks into my office is usually the pick of the litter, the best one of a disturbed family system. It's the problem solver of the family who seeks help. I've had competent, capable, accomplished people sob because their family members routinely run them down when they excel and ascribe to them selfish motives for very kind acts. One woman was deeply hurt because her mother called her the ugly duckling of the family. The woman didn't know the story. She thought her mom was once again reminding her, as if she didn't already know, that she was not as pretty as her sister. I sent her home with two versions of the book. She needed to know the end of the story.

I also read this story to little kids who have been removed from bad homes or have been adopted to help them understand that the problem is not them but the owners of the nest into which they were born. I will read this to very bright children who have been born into an average family. Such kids are routinely misunderstood by the adults in their lives and not infrequently think they are stupid or have dumbed themselves down to fit into their world. The Ugly Duckling tells kids that is you won't always be living with this bunch of birds you are living with now and it is possible to find similar birds to hang with when you leave the nest.

Shameless Plug

This is a blatantly shameless plug for one of my favorite charities which is The International Rescue Committee.

The IRC can be found in the hardest, most miserable and remote places on earth helping with basic needs of people displaced by famine, natural disasters and political disasters. In checking Give.org, 90% of the monies the IRC raises go to directly to their programs. Their are no cute red phones, cool white bracelets, or pink ribbons to con you into giving. It's just people with more than they need sharing with those who have nothing.

That said, I've been enjoying the calm after the chaos of last week. I'm finally sleeping well and restoratively. The decorating boys are back this week. They are tackling the master bathroom. Once the painting is done, I have the tough job of selecting new towels, rugs and curtains. I wish I were better at decorating. I kind of guess using the WWPBD(what would Pottery Barn do) approach. Next we will be hiring a carpenter to build us a new ramp up to the front door. Yes, brother-in-law will use it but it's been handy for the dog these past few days. Our dedicated slug decided, in an impulsive burst of energy, to chase after three deer who were munching on our magnolia tree early Sunday morning. Fifteen minutes later he limped back unable to put any weight on his right hind leg. I doubt highly he got anywhere near Bambi and friends but he must have twisted something in trying. He's healing slowly. The hubster, at first, made some noises about putting him in a cast, the thought of which amused me greatly. So far, the dog is getting lots of pats and attention due to his crippled status and also because he's been tied up while the painters are here.

Family doings and undoings

I have a way of thinking that family functions will be a lot worse than they normally are. I worked late on Saturday and came home totally spent. I think last weekend's siege with my mother was finally catching up with me. The last thing I wanted to do was go to a family party where I'd have to summon up enough energy to be somewhat sociable. The occasion was my brother-in-law's 60th birthday. The nieces and nephews would be there which is usually fun. They are neat young adults although I am beginning to see the seriousness and stodginess of adulthood taking shape in them. Dang, they are acting more and more like their parents!

Actually it turned out to be a lovely occasion. There were superb steaks and homemade cheesecake. This cheesecake was the specialty of my husband's late aunt. My sister-in-law has since become the guardian of her cheesecake recipe. She has the process down to perfection. I ducked out when the party headed outside to carve pumpkins, though not before there was a maiden voyage of the birthday boy's new Loch Ness monster in his pond. I can't imagine who would think to give him such a silly toy! It was a big hit with oldest niece's dog.

I hadn't visited my mother yet that day, so I headed off to the hospital. I found Mother pretty fuzzy and uncomfortable. Her pain pills were due shortly so I didn't fret much. She was happy(and she remembered) that my sister had called that afternoon. Tomorrow I call the moving company and begin in earnest the process of moving her stuff out of her assisted living apartment and into storage. I will have to sort through her belongings so I know what to take with me for safekeeping and what she might enjoy in her nursing wing room...like some photographs and her brightly colored bedspread. The phone service needs to be stopped and change of address notifications need to be done as well. Not much fun any way you look at it.

The Sadomasochism Tango

I met with a new couple for the first time last night. They've been married 27 years and for most of that time, his drinking has been a problem. He drinks, she gets mad. He drinks and lies about it, she gets madder still. There is a blow up she pulls out all the stupid hurtful things he's ever done and he feels like the world's biggest loser. She simmers and sulks. He gets drunk. And on it goes. They perform a well-established dance, the sadomasochistic tango. One psychiatrist stated that when you treat such a couple, you are in fact treating four people because they take turns as sadist and as masochist. I'm not sure yet why she needs to be punished. She almost growled when she said "I don't believe in divorce." No one in the room had brought up divorce!

But she gets to punish him all the time for being such a bad boy. My antennae went up when I found out that he'd been a Roman Catholic altar boy as had his two brothers. They are also drunks. He denied anything inappropriate happened with a priest or seminarian, but I still leave this open as a possibility. It would certainly explain the booze. There is something called repression and drinking suppresses dreaming. And dreamland is where those repressed memories are alive and well. I can't jump to conclusions after just one hour. As my training analyst says "Go for history, history and more history". And so I shall.

Careful little parameters

I had to laugh when re-reading yesterday's post. I now see my thinly disguised rage at the hospital system dripping psychological name calling and topped with sugary nice words. I guess I can be forgiven for some anger.

Meanwhile, I just finished "Leaving Church" by Barbara Brown Taylor. Since I left church almost two years ago, after many many years of dutiful attendance followed by many more as a "pillar" of the church, I was curious to read her story. She writes beautifully-at times achingly so. Her story is not mine. Her reasons for leaving church are not mine either, but there are familiar stories of too much frenetic church activity and too many demands for one human to endure. Later she speaks eloquently about seeing God at work outside the safe walls of the church.

Many years ago, I described myself as living within careful little parameters. Little by little, I found them to be flimsy cardboard parameters which I could knock down or step over with ease. But before they fell, they gave the illusion of being huge, permanent and insurmountable. Over time, the parameters which had both defined me and restricted me have been systematically demolished.

The institutional church for me was the last careful little parameter to fall. I have traveled from denomination to denomination and each one sooner or later became another prison to me. Although I am thankful for what I learned from each faith community, ultimately I learned the same thing: "you don't belong here". And I would move on. When I left the last church, it was very hard because I knew I would not be going to the warm welcome of another church home. I would be homeless and live on the edge of the map as Barbara Brown Taylor describes this place. The surprising thing has been my faith is still strong, although at times I sorely miss having a faith family and a faith identity. But that lack of identity removes a potential barrier between me and my patients. I am less of a threat to anyone who has been badly hurt by religion, to the non-Christian or to the unbeliever. I am also familiar with the parlance of many Christian traditions. For example, I can use a Catholic frame of reference to teach a former nun or a conservative Christian one to treat a Southern Baptist. The institution of the church formed me from birth. I am who I am, in great part, because of it. But the warnings Jesus gave to the religious folks of his time are still pertinent today and I've learned that The Way does not always stay with the careful little parameters of the institutional church.

Tuckered out...

I thought I might take a break from writing gloomy posts but this weekend topped it all. One thing for certain, I am exceedingly glad I never went into medicine after spending the better part of two days at the hospital. Methinks a reaction formation may lead many to chose this field. In others a repetition compulsion may be operational, like the woman who becomes an emergency room physician after the sudden death of her brother from cardiac failure. Regardless, I bless the men and women who do work in hospitals and am grateful to those who do their work not only well but with gentleness, good humor and kindness. But I digress....

My dear mother performed a revolving door routine on Saturday when she fell in her assisted living apartment not 8 hours after she was released from the hospital. Miraculously she did not break any bones but we are back to square one. She is currently on the medical floor, very sore and quite confused. She'll get moved up to third floor within a few days. The powers that be will decide whether she goes immediately to extended care (their name for the nursing home wing) or to transitional care for more rehab.

I awoke this morning afraid I might be getting sick but I think my body is just achy from tension and fatigue. I found myself thinking about the stupidest things in the middle of the night like whether it would hurt her partial to leave it in denture cleaner overnight. Now I've learned that when my mind obsesses over silly stuff, particularly something I can't do anything about at 1 am (as if I'm going to run out to the hospital to save her partial from certain death by Polident), that the real anxiety is my dread of her death and that somehow it would be my fault. Those fears are displaced and become a long mental litany of "what-ifs" followed by my famous toilet training based game of second guessing of myself: did I make a mistake or am I doing it right?

However I did find that a nap in the hammock this afternoon proved very beneficial. The current crisis has past so now it's time to rest and regroup. Why, I can think about the implications of North Korea's bomb or better yet listen to my CD of the week Amos Lee's "Supply and Demand". Yeah, I like the second option a lot better.
,

Amnesia and dancing

Tomorrow, good Lord willing, my mother will be discharged from the hospital and will return to her assisted living home. And to think six weeks ago I was planning what to wear to her funeral. Not long ago I told her that I thought she was dying when she entered the hospital. She was totally astonished. I said that was why her other two children came to see her. She didn't remember their visit or much of anything since the middle of August. Wow! All those hours spent at her bedside, the effort, time and money expended by my siblings to get here, the raw emotion, the fitful sleep, and gratefully, the severe pain, she didn't remember any of it. We've survived a tough battle and she doesn't even know it. Time will tell how much of her amnesia is the result of dementia and how much was due to the severity of her medical crisis. Yes, I'm totally aware of my own little narcissistic need for a pat on the head from my mommy who then tells me what a good girl I've been! But my mommy, dang it, can't remember any of it! Sigh!

Yesterday, Mother's 97 year old roommate was being visited by two tiny great-grandchildren. The youngest was Kaitlyn who spontaneously began singing to herself while the adults were talking. She was perhaps 18 months old. Her songs had no words but they were so enchanting, that conversation stopped as we delighted in her singing. It was pure unadulterated joy! Then she wiggled down off of her grandmother's lap and began to dance. She danced to her own rhythm as we clapped along with her. I thought of my own youngest who sang before she could talk and was nicknamed boogy-baby because she too, would dance just because dancing made her happy and maybe because dancing was a lot more fun than walking. Thank you Kaitlyn!

Happier thoughts

National headlines have been so unbelievably gruesome and shocking this past week as everyone, who has not been in a coma, knows. I started writing yesterday and stopped because I was glooming myself out! I get way too cynical and pessimistic. It doesn't help anyone to play the "ain't-it-awful" game. So I turn to less disturbing topics....

-My oldest daughter is planning a trip to a camel dairy.
-I brought home a big fat mum and some Indian corn to decorate the newly power-washed and weather-proofed front porch.
-My youngest is coming home for Thanksgiving.
-My youngest is coming home for Christmas with her fellow.
-My mother had her third epidural yesterday and is making a splendid recovery.
-Son has a new girlfriend who does not appear to be a flake.
-In my on-line trivia game I placed second for the entire month of September.
-In my on-line trivia game, I am in the hall of fame. It may be the only hall of fame I ever achieve, but I'm a gen-u-ine hall of famer now.
-I believe I have figured out what is behind the very strange "panic attack" that sent a young woman to the emergency room a few weeks ago and led to her seek my help. If I am correct, this will be a case I should write up for a journal.
-I have been enjoying some fabulous music performed by the Dale Warland singers on their "Harvest Home" CD. Listen to the clip of Beautiful River to give you an idea.

And that, say I, is that.

Holding on

I having been thinking a lot about the difficulty some people have in letting go of the past. It may be an old girlfriend or boyfriend that dumped them or the ex-husband or wife from hell. Others obsess about some wrong done against them or some sin they committed. Stolen family fortunes, broken promises, affairs, abuse,betrayals and unfulfilled dreams overshadow and contaminate the present. It's as if there can be no happiness, no satisfaction in life, and no future because of whatever it is in the past that they cannot leave behind.

These people typically are what psychoanalysts call an anal character i.e. one who hangs on to stuff, can't let go and fears making mistakes. And any mistakes get blown out of proportion as if they were life and death matters rather than very human errors. Anal characters tends to hold grudges and thus find it hard to forgive themselves or others. They are still valiantly fighting the toilet training battle crying out for all the world to hear "You can't make me do it!"

One woman bitterly blames her ex-husband for everything wrong in her life. They've been divorced ten years! And they were separated many years prior to that. There is no doubt he was a jerk, but ten years later she's still hanging on to her anger. I found myself thinking that this gal is having a sit down strike. She recently lost her job and now she won't exercise, eat correctly, look seriously for a job, keep her apartment clean or do much of anything. Loss=loss. The loss of her job pings every one of the previous losses in her life...like dominoes tumbling all the way back to her early childhood when her mom, perhaps too harshly, too early and too abruptly demanded she mature and use the potty. So now, when she's mad and when she faces one of life's inevitable set-backs, she goes on strike. She sits down like an angry toddler. She hides out hoping that no one sees what a mess she's made. The key is to help her improve her life now. If the present is better and there's hope that the future will be even neater, then she doesn't have to hang on to the past. Gradually she'll learn that the sit-down strategy she used as a toddler is not the best one to use an adult.

Striking out on your own

I have been working with a woman for several months who has been increasingly miserable in her job. There is a major change underway in the top echelons of her company. She represents the old guard and she's not sure what her role will be in the years to come. Mostly she hates the long hush-hush, closed door meetings and the current absence of a clear chain of command. She learned recently that an independent firm, which does just what she does now, is up for sale. She has the experience, the contacts, and a client base already established. If she were able to buy out the independent firm, she could have her own business doing what she loves without having to deal with the ever-shifting company politics. The timing is exquisite since her house is paid off, her kids are through school and on their own, and her husband's business is thriving.

I told her about setting up my practice. At the time it seemed like a lot of cash up front to rent an office, to furnish it and furnish me with some proper professional attire. I bought second-hand furniture which I've gradually been replacing with nicer items. I still use the thirty dollar desk I bought eight years ago. I have to re-glue the drawers which loosen up each winter. I keep a bottle of wood glue handy. I share a secretary and phone and I do my own bookwork which keeps down expenses. I was amazed when my business broke even after only seven months and I managed to clear a tiny profit after ten. I'm still amazed.

To run your own business, it's necessary to be a self-starter and highly disciplined. This woman has those attributes. And it really helps to have someone by your side saying "you can do this". I sent her on a fact finding mission so she can determine whether buying the business or starting from scratch will be the best route. In closing, she said wistfully I always told my kids to do what they love. Then she smiled.

Stuck

Thank God it's Saturday! It's been another hard week. It's been a good kind of hard where I know I've done some first-rate work, but my body and brain feel beaten. Within the past four weeks, I have had two new couples to work with and four new individuals. The newest one came in yesterday and it was an intense two hour interview. She was born in the late 1950's a month premature. She weighed in at a little over 3 pounds. Soon it was discovered she had an impacted bowel and in a last ditch effort to save her life, surgery was performed. Her early formative weeks were spent in the hospital and for the next 9 years she rotated in and out of hospitals. This prevented the formation of a good bond with her mother and plunged the family into financial disaster. She recalled they had to sell the family car and Dad had to bike a long distance to work.

Her opening words to me were " I feel stuck". At first I considered that might mean her birth had been a long arduous one. But as soon as I heard about her prematurity, the multiple surgeries and hospitalizations, I knew feeling stuck was the theme song of her life. She'd been stuck in an incubator and stuck repeatedly in hospitals. And she'd been stuck over and over with needles, syringes, IVs and who knows what else. It was such a sad story, but everything else in her life began to make sense in light of this horrendous medical history. I came away knowing I would be able to help her even though it will take some time to do so. And as I reviewed the new people I am working with, I realized that these are all tough cases.

One couple doesn't appear will require long term treatment. Unconsciously they did not want to have a second baby, and this drive was so strong that they were destroying their marriage to make sure it wouldn't happen. Once that was uncovered, they began to see that just having one kid was perfectly ok and they were easily able to get back on track. Where do you find that in the analytic books? That a couple would nearly bail out of a perfectly good marriage just to avoid having a second baby?

Oh, and in addition there are still those daily trips to the hospital. Mother seems more comfortable this week. It could be the result of the second epidural. She is more aware and involved in life. She asked me to send off her pledge check to her church, to trim her nails, to write a thank you to her church for the flowers they brought her, and to check what doctor's appointments she had for October. This reflects a vast improvement; however she still needs two people to put her on the pot and can only use the walker with her physical therapist or an aide helping her. She walked 150 feet yesterday and that's an accomplishment. I don't know what is normal anymore. For the time being, normal is includes a once a day visit to the hospital. I caught myself referring to it as my appointment with my mother. Weird expression, but that's what it is.

T'was a good day..

I have enjoyed a blessedly normal day and a productive one at that. The house painters arrived this morning and spent the day power washing the house. Oh, it's going to look so great once they are done! I worked inside on the bathroom that will soon be re-papered. I washed down the log walls and used scratch remover on all the dark woodwork. It's looking better already. I also washed the curtains and canopy in our bedroom.

It's suddenly gotten very cool which might explain my burst of energy. It was too nice a day not to experience first hand, so I took an easy amble in the woods. The sassafras has changed and the maples are beginning to gain color. The woods have shrunk back significantly in the past few days. Yesterday I sent off my brother's birthday box, so I'm beginning to think of presents for the October and November birthday boys. I even ordered one Christmas gift this morning which is so totally un-me, that I astonish myself.

Mother was perky today. She'd had her hair done yesterday and a second epidural this morning. I brought her in a butterscotch sundae. She mumbled something about just having eaten lunch. I said that she didn't have to eat it if she didn't want it, but then she asked me if I had remembered to bring a spoon. She polished the whole thing off, scrapping right down to the very bottom of the dish. Today she was most appreciative of the hospital and its staff. Some days all she does is gripe. At least I could leave her in a good state and didn't have to worry. Hubster has called in the speech pathologist to see if there is anything to be done to help her expressive aphasia. I have my doubts, but at the very least it's more company during the day. Her church has been wonderful. They've sent cards, flowers and visited her. She has relished the attention.

Back home, the scent of pulled pork cooking in the crock pot was a lovely greeting when I entered the house. I picked up People magazine's Best and Worst dressed issue for some utterly vapid reading or as my youngest says to do some serious contemporary cultural research. I was also happy to learn when I checked my online news sources that the state police of Louisiana are tough on crime...nabbing Willie Nelson and cohorts for possession of marijuana. I wonder what made them check out his tour bus? I doubt if it will tarnish Willie's reputation. It will probably enhance it. Johnny Cash played up his prison record all his life.

After a good dinner with hubster and son, I downloaded some tracks from Diana Krall's newly released CD which I am enjoying as I type this. It has been a good day indeed and that is a very fine thing.

In Everything there is a Season

It seems that this is a season of letting go for me. My on-going question seems to be "what are you hanging on to?". And when something is over, do I spend too much time looking backwards and risk turning into a pillar of salt like Lot's wife? A pillar of salt... someone crystallized by their own tears.

Experience tells me that when an old patient leaves, a new one arrives. It tells me that what I view as an excellent result may not be what the patient has in mind. A person comes in with a D grade life may leave, delighted, with their new and improved C+ life. I'm the only one who knows that a B+ is possible for them. But there are others who keep working because they want to have the neatest life possible. In those cases, their hard work is not only benefiting them, but the lives of their children and grandchildren. Others are with me just for a short season and I have to have some faith, that the changes are still on-going in them. After all, there are interactions we have with people which may be brief yet are life-changing.

Sometimes it takes several people to get the job done. One angry alcoholic, who claimed he wanted to drink himself to death, was seen for a while by my training analyst. Perhaps a year later, I started seeing his wife and I treated her for almost two years. She left treatment for financial reasons when her husband finally got fired (long overdue) for his drunkenness and absenteeism. I got word several months later that once he was fired, he sobered up and he has remained so since.

A beautiful seventeen year old girl recently let go of her boyfriend. Last spring he was in a terrible car wreck which resulted in severe spinal injuries and brain damage. It was touch and go for him, but he made it and is now home recuperating. The boy she once loved is gone forever, but the boy and his family have hung on to her as if she alone were responsible for his well-being. It was a horrible place to put this young girl. Bless her heart she stayed with him until he got home but her life was being side-lined with his. There is another boy in her life now and she was unsure if it was ok to date him. Her mother thought she should wait a bit. I said go for it. She's been locked into a tragedy not of her making for way too long. Let her be a kid again and enjoy her life.

Trust vs Obedience

I got fired this week. I have been working with two adopted sisters for seven and half years. In July, the older sister told me that the two of them were sneaking out of the house at night to meet friends. This put me in a horrible bind. I knew their Mom and Dad would be furious with them if they caught them, and they would be livid with me if they learned that I knew and didn't tell them what was happening. But I was told this in confidence, so I did not tell their Mom and Dad. I didn't even let on to the younger sister that her sister told me about their nocturnal capers. The only good part was that I didn't feel they were in any real danger. It was stupid kid stuff, but it was also a flagrant violation of their household rules. I had to work on resolving this mess in the best way I could. In Freudian terms, these girls operate with impulse-driven ids. Their Mom and Dad function as their super-ego. I have been the ego, mirroring more mature thinking and helping them strengthen their egos.

Well, the shit hit the fan this week. Dad found out about the sneaking and lying. At first the girls may have thought I'd ratted them out. In order to deflect Dad's rage away from them, the older girl let it be known that I was aware of what they had been doing. Dad fired me in front of the girls accusing me of not caring about his daughters. That stung because I care for them very much. My response to Dad was to remind him of confidentiality and how essential it was that the girls learn to trust me. That fell on deaf ears. It was a lose-lose situation: either I violate the girls' trust or I violate the trust their parents placed in me.

The younger girl started crying. I hugged her with tears in my eyes and told her that I would miss her too. The older girl hung her head. She'd set me up and she knew it. I hugged her too. My boss thinks the older girl did this to avoid talking about the hard stuff. She'd rather run headlong into adulthood in an attempt to leave behind the horrible, painful, scary stuff of her first family. It's easier to run, lie, cover-up and pretend. I had to go.

Was I mad? Yes. And very sad too, when I realized that I was the only one who cared that their old fetid emotional sores were debrided and treated. Obedience was more valued than learning to trust.

Thank you NYFD

Our New Yorker with one of New York's Bravest.

Leveling Off

The last few days I have been much less anxious about Mother. Good thing too since work has been hard this week. Not bad, just hard. It's really strange since training analyst is gone for week #2, sous-analyst is on vacation, my esteemed colleague to the east (aka Mecte) is off at a conference, and one secretary decided this was a great time to be sick. That leaves only me and our secretary, who is manning three phones and the schedules of five shrinks. She's maintaining her sanity quite admirably. We have heard very little from the boss man so I guess he trusts us to keep the ship afloat until everyone returns. But it's way too quiet in the building.

Mother has perked up a lot in the past two days. She's been sitting in a chair for longer periods She has lost a great deal of weight and strength. Her downward spiral has stopped and her status is evening out, albeit at a lower level of functioning. This is allowing me to breathe deeper. I am no longer jumping every time the phone rings. There is, however, a new twist to this saga. The hospital radiologist sent Mother's MRI off for a second opinion and that opinion is she has an extruded disc fragment. This is unrelated to her first back surgery and is believed to be the cause of her severe pain. Hubster sent her MRI to a back surgeon for his opinion. Oh boy! Another wrinkle in the plot. My mind began to race as I considered the logistics of surgery not to mention the risks. At this point, mother's health has had so many ups and down, twists, and switchbacks that I'm refusing to waste anymore mental energy obsessing about the "what-ifs". So if today is the day, I read to her and then tomorrow may be the day I round up something she needs. To think farther ahead is counterproductive and definitely not fun. After all, who ever obsessed about fun stuff?

Meanwhile I"m back to thinking about selecting some new wallpaper and that's definitely more enjoyable. I may just take off someplace out of town to do so. My, that's sounding awfully nice even if just for part of the day. Perhaps Monday....

The old leather notebook

Today I brought an old friend over to mother. When she was seventeen she started her poetry notebook. Over the next few years, she'd carefully copy down her favorite poems and her little brown leather notebook was gradually filled with the works of famous and not-so-famous poets. There were poems by Amy Lowell, Emily Dickinson, Walter de la Mare, Sara Teasdale, Elizabeth Barrett Browning and a fair sprinkling of writings by the ever-popular author, Anonymous. Her penmanship was once elegant, but the ink has now faded after seventy plus years. The notebook entries were dated from 1934 to 1938 and then there were no more entries until September 1988 shortly after her husband's (my Dad) death. Then she added Oliver Wendall Holmes' "The Chambered Nautilus". That was one I read to her today. The familiar words of these much loved poems brought a blessed respite.

I read a wide variety of poems and when I stopped, she asked me where she could keep her notebook. I hesitated for fear it might get lost, but she really wanted to be able just to touch it. I lay it down on her tray right where she could rest her hand upon the cover of her very dear old friend.

Not total gloom

I wish I didn't have to write another sad post, but mother is no better. She's been moved to the rehab unit. She's off IVs but hubster had to up her morphine dosage again this morning. This is in addition to Vicodin every 4 hours. He's been simply wonderful to her. She was quite comfortable this afternoon, however she kept nodding off as I read to her. I washed her slippers today and took some of her clothes out to her. I had to wonder if she'll ever wear them again. She's not sitting up and most ominously she's eaten next to nothing for the past three weeks.

However.....on a more positive note, it was good to see the sibs and how pleased mother was to have them visit. Also, we've been blessed with perfectly gorgeous weather this weekend. Hubster and I took a leisurely walk in the woods this morning and we've opened the house for the first time in many weeks. Thus I am enjoying the busy sounds of the evening as I type. I've also downloaded some new songs which always makes me happy. And we were given some catfish fillets which I fried up Cajun style for dinner tonight. To that I added some fresh green beans, hash browns and slaw. T'was a marvelous candlelit meal eaten out on the back porch with the good hubster and son. After supper I indulged myself in some internet clothes shopping. So there is happiness in the midst of all of this. I need to remind myself that I am able to escape from the hospital, I am healthy and I can and should enjoy my life. It's plain stupid not to.

Long winding road

This has been the strangest week. In one day I celebrated my oldest daughter's 28th birthday, summoned my siblings to mother's bedside for a death watch, remembered the anniversary of my dad's death and then discovered my boss had suddenly left mid-day without an explanation. Patients were scheduled non-stop so I really couldn't allow myself to dwell on the events occurring outside of the inner sanctum (my term for what analysts call the consulting room). It was so good to end the day with a lovely phone call to the birthday girl.

And sleep was fitful as it has been for the past two weeks. This is not fun. Then yesterday mother rebounded significantly. Siblings arrived and were questioning why they had been called. I learned that the boss had a case of food poisoning. His hasty departure made perfect sense. And I'm still exhausted. This stuff is so maddening too because all the normal stuff you want to do like getting new tires for the car, running to the cleaners, washing the stinky dog or selecting wallpaper end up shelved. And there's no clear point at which I know I'll be able to tend to these things. People have been wishing me a good weekend and I can think only of more trips out to the hospital.

Mother has rebounded before and then slipped again. Over the past 4 months, there have been some modest temporary improvements but alas the overall curve has been steadily downhill. Son sighed and said "Will I have to go through this with you?" I don't know the answer to that question. I do know that sometimes life is just plain hard and the right path is not always the easy one. I know that working through the tough times makes a person stronger and that love is never wasted.

One of the greatest events of the 20th century.....

Another Planet

Monday I took my mother to the hospital. If old age is a different country, then hospitals are a different planet. I have no complaints about Mother's care. People have been kind and gentle to her, but an old sick person is an old sick person. And an old sick person becomes a frustration to doctors and nurses because they really don't get well. At best, they get somewhat better. Doctors like dramatic recoveries. I guess we all do.

I was really gloomed out yesterday morning to see her confused and in such pain that even the slightest movement caused her distress. Then there was the somber business of obtaining a medical power of attorney and setting up do-not-resuscitate provisions. All of these wishes are part of her living will, but I gather a living will and medical power of attorney are not exactly the same thing. It seems there are different rules on this new planet. Curiously we both felt relieved when the papers were signed. I suspect we felt some tiny bit of control in a situation where we have so very little.

The physical therapist gave her ultra-sound and deep heat treatments yesterday which provided some much needed relief. I had to ask myself why this had not been tried before. That, however, is a pointless question. Whatever eases her pain now, even by a little, is welcome. By evening, she was loopy from the pain pills but resting comfortably.

This planet has its unique language. I am not fluent in it but I can get by, which is a help. If you speak their language, you are accorded more respect. Here, there are special uniforms, rituals, customs and a caste system. The newcomer is expected to absorb all of this quickly. Old sick people don't adapt well nor do they learn new rules easily. Mother is still learning how to press the call button to summon a nurse.

There are many other planets: prisons, schools, some corporations, and the military. After visiting Mother, I had to run out to our local big box emporium where I met a former patient of mine. He always had some melodramatic grand crisis occurring in his life and then, it was no different, as he offered up a brief summary of his current one. Actually, he lives on his very own planet and the sun really does revolve around him. He is very funny, so I truly enjoyed a brief excursion into his orbit. I left him chuckling. I am glad to be in my own world however strange it may be at some times and grateful that my interplanetary travels are only visits. But I do wonder how Pluto is feeling these days?

Another Country

Experiencing the realities of my mother's extreme old age really has been like entering a foreign country. Mary Pipher's book on aging is aptly named. The world of the very old coexists side by side with the regular world of work, school, family and home responsibilities. It is, however, for the most part a hidden world kept secret from most of us on a day to day basis. The psychoanalysts know that death, sex and bathroom duties all are linked at the unconscious level. Huh? Yes, because they are all hidden activities that tend to be ungainly,messy and rarely discussed in polite company.

Many days I really wonder if all her years of careful diet (low sugar, low fat, low salt etc.) have been such a great trade-off. She's lived to a ripe old age to be sure, but her bone structure is weakening, her brain is fuzzy, her eyesight is fading and her heart isn't pumping effectively. Then there's the emotional toll of loneliness from outliving so many people, of lost freedom when you can no longer drive or even walk without assistance, and rage at not being the person you once were. The only plus to senility is you can't remember your former self.

Is it all bad? Some days the Eskimo ice floe solution to old age seems quite sensible, but then I recoil in horror. This is my mother I am talking about! What transpires is a psychic tug of war. Part of me thinks that her death would not be such a bad thing. The other part of me scolds "How could you think such a thing?" I have been through this territory with patients many times. What I am bumping into is old primitive rage from frustrated needs when I was teeny-tiny. No doubt my dear old mother told little me that I couldn't eat a cookie one time because it was too close to dinner. Little me was furious and thought "I wish you were dead!" Now, fast forward to today and the old gal is fading pretty fast. Who is responsible for her inexorable descent towards the grave? Why me, of course! Little me's curse is now coming to pass. It's a tough interior battle, because my mother at one time was so essential for my very survival. Little me is terrified. Big me knows this is the way of life......Sigh!

[Elton John breaks into "The Circle of Life" while a beautiful sunset appears on the horizon]

Light a candle

One Catholic tradition that I have always loved is lighting candles. I used to have silly thoughts that you had to be Catholic to light a candle or you had to have money. As a non-Catholic, I used to light and run before anyone caught me and questioned my denominational identity. In reality anyone is as welcome to light a candle as to say a prayer in a vacant pew. Slipping a few coins in the box just helps to pay for candles and matches. I'm sure any surplus goes to a good cause.

I am frequently moved by the sight of a stand of lit votive lamps, each candle representing the heartfelt prayer of someone usually unknown to me. What are those prayers for? Are they for healing, to conceive a child, for a wayward child, to find a spouse, for a difficult spouse, to find a new job, for discernment, for a safe trip, for wisdom, for strength, for patience or to be able to forgive? It is a poignant reminder that everyone struggles with something no matter what they look like from the outside.

The Path

I have come to a place where there is no road.
-Iris Murdoch

Pilgrim, there is no path.
The path is made by walking
- source unknown

Stand right there at the place
Where there is no place to stand.
-Buddhist tradition

Have faith, way will open
-Quaker saying

He is able
-Christian tradition

This is the beta version and this is a gripe

So far this has been quite simple to use and lots faster. Kudos to the good folks at Blogger. It should be fun to explore some of the new features. I already added some links which is a breeze to do now.

I should pull up my rotten tomato picture and toss it toward the state capitol which has no capital to pay its bills at present. Fairfield Community Hospital is owed $2.8 million dollars by the state. A local pharmacy closed its doors last week after some 80 years in business because the state was not reimbursing them. They could float for a while by dipping into savings, but no longer. They were bought by CVS. And our governor, who is running for re-election, has just foisted an even more expansive healthcare program onto the backs of healthcare providers which it can't fund anymore than it is funding existing programs. What a farce and what a tragedy for rural hospitals, physicians and pharmacists.