Ordinarily, my practice hums happily along with few surprises, and I expected this day to be no different. I hadn’t scheduled any new clients. The folks coming in were roughly midstream in treatment; none showed signs of impending crisis. Then Stella arrived for her 9:00 a.m. session, inaugurating a day that would send my stable, orderly world spinning off its axis.
Standing in the waiting room, 83-year-old Stella was smartly dressed, as always, her hair arranged in a chic, silvery bob. But something was clearly wrong. Despite a long-standing heart problem, she was usually full of pep and sass, ready to plunge fearlessly into her new experience of therapy. But today, her shoulders sagged. Wordlessly, she handed me a sheaf of papers. It was a report from her cardiologist, detailing her “highly calcified aorta . . . her whole cardiovascular system badly affected by plaque.”
As we sat down across from each other, Stella began to cry. “I don’t have long to live,” she whispered, weeping into her slender, elegant hands. Sitting across from her, I was momentarily speechless. We’d been making plans around her slowly developing macular degeneration, as though we had years together to discuss the possibilities. I leaned forward in my rocking chair, trying to offer my silent presence until she was ready to talk.
“I knew I’d die sometime,” she continued softly. “But not so soon. Not yet.” She seemed to shrink into the couch, looking older and frailer than I’d ever seen her.
I reached out to hold her hand. “Not yet,” I echoed. “You’re not dying yet, Stella. You’re right here, now.”
She nodded, continuing to weep, and pressing my hand harder in hers. At the end of the session, she hugged me tight, something she’d never done before.
The air in the office hung still. I sat at my desk, stunned and desolate. I’d never had a client die before. I mentally reviewed what I knew of Stella’s life: she’d survived 30 years of heart attacks and high blood pressure; she’d outlived her husband and most of her friends. Still energetic in her eighties, she lived independently, attended condo board meetings, and was famous for her rich, homemade vegetable soups. Now, she’d likely be dead in less than a year. I sat still, working to wrap my mind around the concept. But my brain refused to grasp it, reminding me instead to water the plants, to call in for messages.
I listened to my voice mail. One afternoon cancellation, followed by, “Hey, ‘sup?”—the slangy, slightly scratchy voice of Alan, an adolescent client. Then: “Grandpa died last night.” Suddenly, he sounded much younger. “I gotta talk. Call me.”
I’m never surprised when a cancellation makes room for an emergency appointment. I called Alan back and set the time for after lunch.
My next client, Suzanne, came in with her eyes glued to the floor. “I was up all night,” she said dully, lowering herself onto the couch. “Oatmeal is dying.” With three special-needs children and an overworked husband, this client depended on her cat for unconditional love. Moving my rocking chair closer, I sat quietly while Suzanne wept. Gradually, we began talking of her relationship with Oatmeal—the ways they’d played together, the places they’d traveled together, how they’d grown older together. When I observed that Suzanne had many good memories to draw on for comfort, she took a shaky breath and began to describe the photo album of Oatmeal that she wanted to create. I did my best to stay present for her, but inside, my head was spinning. Today was becoming Death Day. I was a therapist; I was supposed to be able to roll with this sort of thing. Why was I feeling so spacey, and at the same time, so vulnerable?
Alan entered next, tears running down his cheeks. “I’ve been crying for hours,” he gasped. His grandfather had been the only nurturing presence he’d known. Alan had never met his own father, who’d left his alcoholic mother before Alan’s birth. Then, when he was 3, his mother had parked Alan with her parents, never to return. His grandmother had done her best to raise him, but she’d been distracted by her own problems. Grandpa had stepped up to the plate, becoming a warm and reliable surrogate father, role model, and mentor.
But over the past several years Grandpa had sustained a series of heart attacks and strokes. Again and again, he’d reassured Alan that he’d live to see him grow up—never mind that a hospital bed appeared one day in the living room, or that Grandpa could no longer get to the bathroom without Alan’s help. “I’ll beat this,” he insisted. Then, overnight, Grandpa contracted pneumonia and died. Alan felt as though he could hardly breathe. “I know I’m really not feeling it yet,” he gasped between sobs. “But if I’m like this now, what will I be like when it really hits?”
I was catapulted back to the day that my own grandmother died. More than 40 years later, I still remember the hospital scene: the elders holding each other, so absorbed in their grief that they never thought to comfort me, a mere grandchild. But I was 4 when my grandmother had moved into our home to take care of my brother and me when my mother became ill. Gently, quietly, Grandma would sit with me on our porch glider, rocking back and forth, telling me stories, teaching me to play gin rummy, or simply holding my hand and listening. Standing there in the hospital room, I literally didn’t know how I’d survive without her. But no one noticed my desperation. Instead, my father assigned me the task of phoning relatives from a pay phone in the hallway, then hovered to be sure I got the wording correct. “Not ‘died,'” my father instructed: “say ‘passed away.'”
“Just sit with Alan,” I told myself now. “Listen to him. This isn’t the time to structure a Gestalt double-chair good-bye or instruct him to write a letter to Grandpa. Let him cry.” After a while, I gently tried to put some words to his grief, words like “alone,” “sad,” and “angry,” reflecting his sobbing sighs, shudders, and clenched fists. Finally, Alan looked up at me and took a long, shaky breath. “Thanks for letting me be here,” he said softly. “I don’t have any more tears for now.” He stood up and shuffled out the door.
I walked down the hall to the bathroom and splashed cold water on my face. I stretched up to the ceiling, swung down to touch my toes, and twisted from my waist. Usually, under stress, I snack. But today, I had no appetite. I struggled to distance myself from my clients, to remain a trained observer of their grief. My body churned with nameless emotion. I never let clients get away with the generic, “I’m upset.” But today, making my way back down the hall to my office, I couldn’t define my state of mind any better than that.
A few moments later, I heard a mother and baby chuckling and cooing in the waiting room. I laughed out loud at the contrast between my dark thoughts and these small explosions of joy. “Sitter cancelled at the last minute,” Nancy grinned, bouncing her year-old son on her lap as I greeted her. I always enjoyed seeing Matthew. But after sitting with Stella, Suzanne, and Alan, I took extra pleasure in his liveliness. Over the past few years, Nancy had endured much: fertility treatments, a hard-won pregnancy, a difficult labor, and then, when she should have been breast feeding, a double mastectomy. Years ago, Matthew wouldn’t have been born, and Nancy wouldn’t have survived cancer. But here they were, mother and child, laughing together.
We sat on the floor, Matthew busily exploring while Nancy talked of the quiet pleasure she was finding in her baby and her life, touching her soft, new curls as she spoke. I reminded her of how far she’d come in recent years: she’d found a boyfriend, married, borne a child, recovered her health—all blessings she’d once thought were beyond her reach. I offered a toast to life—”L’chaim!”—and we laughed, clinking together glasses of cold water. Yet after she left, I wondered: had Nancy come here today to look back and celebrate her successes? or had I led her there, my own soul struggling to grasp life over death? I’m not sure. But when I glimpsed my face in the small mirror on my office wall, I radiated joy.
Next hour: a session with Joel, a successful businessman changing careers in his fifties. He was doing well with this transition; I expected no heavy drama. But as he sat down, he surprised me by reaching for a tissue. “I saw a baby in the elevator,” he began, his eyes bright with tears. “I haven’t talked about this before, but I’m afraid of never getting close to my new grandson. I’m afraid my son will keep him away because he’s so angry with me.” For the next hour, Joel used tissue after tissue as he spoke of his estrangement from his own father, his yearning for family closeness, and his terror of dying alone as his father had.
Please, day, be done! Even the joyous presence of a baby had triggered an exploration of loss and death. But why was I so discombobulated by this topic today? I’m no stranger to death. As an 11-year-old, I babysat a 6-year-old neighbor who had leukemia. I can still see David, skin over bones, propped up on pillows in his plastic oxygen tent. I’d unzip the tent door and slip my hands through to color with him, or to turn the pages of a book we’d read together. Then one day, my mother told me she had something sad to tell me. David was gone.
Since then, I’d weathered plenty of “Sit down; I have something to tell you” moments. Grandma’s death, of course. I’d grieved my father’s passing, and had said final good-byes to several other relatives and two close friends. Currently, I was seeing clients who were struggling with the deaths of elderly parents, sisters, friends, and their own mortality in the abstract. But today was different, in a way I still didn’t understand.
My 4:00 p.m. client, Paul, entered with a look of grim determination. “I can’t live like this anymore,” he began. “It’s as if we’re already divorced. We have no relationship.” Paul’s body was heavy, weary. He spoke into his beard. For nearly a year, he’d worked in therapy to gain enough strength to face the reality that his wife had dropped out of his life. Clinically depressed, she rarely got out of bed, refused to bathe, and dressed only to see her psychiatrist for meds. “I know now that I’ll have to hospitalize her if I have any hope of getting her back,” Paul continued in a dull monotone. He looked up at me sadly. “I need your help in figuring out how to do that.”
Action. The possibility of change. For the first time that day, my energy surged. Calling on my earlier experience as an inpatient therapist, I coached Paul through the process of creating a hospitalization plan. We decided that after he left my office, he’d call his wife’s psychiatrist (who was also his own psychiatrist) and explain what he wanted to do, and why. The following day, he’d drive his wife to her scheduled psychiatrist appointment, where he and the doctor would gently but firmly confront her with her choices: she could enter the hospital voluntarily, or Paul would commit her. As we discussed each step, I frequently paused to ask, “How are you feeling? Do you feel ready to go through with this?” Each time, Paul nodded resolutely. As our plan grew clearer, his voice became more spirited, and he seemed to grow taller. I felt my own body expand with fresh vitality. Plans equal hope, I thought. Hope equals life.
My last session of the day was with Katy, the single parent of two spirited teenage girls. As she barged through my open office door, late for our appointment, she was already talking. “I’m leaving those impossible kids!” she declared. “I can’t take it anymore!” Katy paced for a while, then fixed herself a cup of tea, but was too jangled to drink it. Finally, she threw herself down on the couch, spitting out: “Let them raise themselves!”
Her anger distracted and enlivened me. I’d been there myself, raising three sons on my own. I’d felt similar frustrations, had thought the very same thoughts. As Katy vented, I tried to normalize her feelings, acknowledging my own moments of motherly ambivalence. Gradually Katy’s fury spent itself, and she turned her energy to a playful fantasy of escape from responsibilities. “I dream of around-the-world cruises—alone!” she said, her eyes dancing. Together, we spun a scenario of a shorter Mediterranean cruise, and then modified that into a weekend getaway downtown. Eventually, we came up with a realistic and fun list of ways by which Katy could take care of herself, including signing up for a Latin dance class. By the end of the session, we were laughing. I loved the inner fire that pushed her forward.
I wanted to move forward, too, to flee the office and escape the day. Instead, I fell into a soft leather chair, exhausted. Even the energy of Katy’s fury and determination couldn’t erase the fact: Stella was dying. I whispered the words aloud. Why couldn’t I wrap my mind around this irrefutable reality?
Death had never entered my office before, not in a client’s body. At that moment I lurched forward in my chair, as though I’d been physically pushed. Death had never entered my office. I understood, all at once, that I’d been holding onto an extraordinary belief: that my office was a space protected from death. Unconsciously, I’d decided that my clients couldn’t die, not so long as we were working together on a better future. Therapy was hope. And hope, I’d persuaded myself, had the power to ward off death.
But here was the truth, hard and unyielding: Stella would die soon. And with her death, our relationship would die. Nothing—and certainly not therapy—could stop that from happening. My mouth went dry. Tears welled in my eyes.
I wasn’t ready for Stella to die. And then, unbidden, came an even more disquieting truth: I wasn’t ready to die. I said the words out loud: I’m not ready to die. I’d created a life that—finally—I truly treasured. After 15 difficult years as a single parent, I was living a balanced, connected, happy life. I was married to a man I deeply loved. My children were grown and launching well; miraculously, they now actually seemed to like hanging out with me. My grandchildren were pure delights. Most of my friends were still alive and well. Life overflowed with blessings. Death, now, was unthinkable.
I was stunned by my own magical thinking. Imagine: I actually believed that as long as I practiced therapy, I wouldn’t die! As long as I was helping people change, they—and I—couldn’t pass from this life. My desperate equation: change equaled hope. Hope equaled life. Ergo: good therapy could keep death at bay.
I heard myself giggling out loud. So Death couldn’t work his will until my clients and I were done? By that logic, we’d never be done. I smiled at the image of Death in my waiting room, checking the clock and tapping his foot impatiently while I scheduled more sessions, rechecked my messages, took yet another emergency call. I imagined myself poking my head into the waiting room, admonishing, “Death, you’ll just have to wait your turn.”
But the joke was on me. I sat quietly for a while, letting the knowledge seep into my body.
I finally stood up, gathered my things together, and took out my key to lock the door. I remembered, then, that I’d just renewed my two-year office lease. Good thing, I thought. I’d need some time to learn to live with death.
Barbara Stock, Ph.D., is a psychologist in private practice in Evanston, Illinois. Previously a stringer for the suburban Chicago Tribune, she’s also a freelance writer.