Friday, July 24, 2009

Crazy Days

Most days, I am not scared of my patients. I understand they are troubled or struggling or suffering and 'there but for the grace of God go I', so I try not to be judgmental, and to find a way to be helpful, or at least not hurtful. I have been challenged this past year by a patient who has been unable to follow the usual and customary rules of engagement between therapist and patient. I have consistently set boundaries which she has ignored and transgressed. I respond to her pleas for attention and concern, and because of her make-up, I have tried not to abandon her, but to stay steady and supportive and relevant. I have answered her phone calls at all hours of the night and day, I have given her more time and attention and focus than all of my other patients combined and whatever I give is never enough or even adequate. She wants to be my whole world, and I cannot give her what she wants or needs.

She showed up at my front porch one day last month, which is unquestionably unacceptable. My husband was shocked and worried and focused on protecting the children from potential harm. She left after a short discussion, but I was rattled and unable to sleep that night. I realized that there had been many sleepless nights worrying about this person, who regularly could not find a reason to live. A few days later, the patient called to tell me she was in the parking lot ready to kill herself. This was not the first time this had happened, and I knew that I would be unable to pick up Maya form school. I called Eric to do the pick up and meet me with ice cream before we went to the mall to look for eyeglasses for Maya. When I met my patient in the parking lot she was drinking, impaired and cutting herself and ultimately I called the police and had her escorted to the hospital for a higher level of care. The police were perfectly reasonable, but she resisted the transfer and fought them physically to avoid entering the police car. It was ugly and I was shaking and distraught watching the process.

I did not want to see her again, but I steeled myself to engage in three 'termination' sessions to say good bye and arrange transfer of care. She was off on a vacation and I believed I had done what I needed to do to ensure that she pursued treatment.

She has been emailing and calling since I returned home this week, begging for a meeting and threatening to hurt herself if I did not see her. Yesterday I finally arranged for a visit with her therapist, the patient and myself today at 4:30. I found that I was frightened. I worried that I would not survive this meeting today. Although the patient had never displayed any violence, I was convinced that I would be hurt. When I am nervous I talk too much and I overexplain and over convince. So Mimi, Teri, the patient and myself presented ourselves to the patient today. I was careful with my words and said what I felt I had to say. In the end she was cooperative and appropriate and I survived the session, not feeling great, but feeling relieved.

Termination of patients can bring out the craziness for people. We all hate being abandoned, left behind. My life has taken on another dimension and I have left so many people behind as I move to Ecuador and take on my new life. My patients stay in their lives and keep repeating their patterns and want to keep me in the same place in the same life in the same familiar spaces of before. I feel a little guilty, but not too much. I lived through the day, and my plans for Ecuador are intact.

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