My Life on the Couch

This is part three of a longish series of posts about how I’ve gotten where I am today. You can find the other posts here and here.

So we left off, gentle reader, with me trying to figure out what I was going to do with the rest of my life at the ripe old age of 38. As I mentioned, occasionally my therapist would mention ideas to consider but generally I would dismiss them – after all, I didn’t think movie producer was a likely career choice at my age, although it sounded intriguing. But then there were the offside comments like, “you’d probably be good at this work,” or “well, you’ve been doing this all your life . . .” to describe my once again attempts to fix my friends’ lives (to the exclusion of my own usually). And even, “well, if you’re going to do this, you might as well get paid!” I don’t think she was necessarily suggesting I should become a therapist, but she felt it warranted a look.

And I agreed with this, but between considering it and doing it took some time. My first time looking at it was attempting to volunteer at a local counseling center, but it was clear to me that I wasn’t remotely ready to do it. Sitting in a room, hearing people’s problems for an hour at a time? I mean, I was the complainer, not the listener. A few years later, though, after a tough break-up with a boyfriend, I decided to try again with a somewhat different venue. I’m not sure how I found out about it, but I applied and eventually became a Hospice Volunteer with Kaiser Permanente. For those who don’t know, Kaiser is the first and, by some measures, premier managed care facility located mainly in California. I was a volunteer for a little over a year and it was life, and career, changing.

Kaiser had developed their Hospice program in an effort to save money, of course, but even so, it was staffed with wonderful clinicians and us volunteers, comprehensive, humane and very moving for those who chose to spend their time with the dying and their families. My first week there I had three AIDS patients, all close to death, but after that, I mostly dealt with patients who were a bit further away from their final reward, so I had the opportunity to get to know them and their families. The program was set up so medical and social work services were delivered to the patient in their homes but they could check in to the hospice facility for a week a month for respite care – this was to give a respite for the caregivers (usually a spouse).

I learned a few things from this experience. One, You die as you live. If you were a grouchy grump in life, you didn’t magically transform into Mother Theresa while you were dying. And those with a real joy of living seemed to keep that sense, even in pain and suffering and indignity. As one patient said to me, laughing, “Gee, except for the cancer, I’m healthy as a horse!”

I was once assisting a nurse in bathing a gentlemen who couldn’t resist winking and making comments about his “studly” physique (he was pretty emaciated by then) and we would chuckle and comment on his musculature, keeping it all professional of course. On the Hospice ward the rules were somewhat relaxed, so family brought in small pets and kids to visit (as long as they were well behaved), and it wasn’t unknown for a patient to take a nip of the brandy that a family member brought in. Why not? They were dying, so stupid hospital rules be damned!

Another lesson was this – you are alive until you are dead. Sounds obvious, but what was amazing to me was how strong the individual personality was even to the very end. Again, if you were a jokester type, you kept it up – you just couldn’t help yourself – until you drew your last breath.

There was also a corollary to this lesson – death is both an event and a process. The first patient I ever saw die proved this to me. He’d had brain cancer and was very agitated the day he died, so the nurses had put soothing music on the boom box in his room. Sometime that morning, I entered his room and remember seeing him calm and for a change, sleeping. As I went up to him, though, I realized he wasn’t asleep, but had in fact probably died. He looked so peaceful. I went out to find a nurse and we went back into the room about ten minutes later. She pronounced him dead and left to call his family. I stood there with him, just taking it in, and realized that in the few minutes I’d been out of the room the energy in the room had shifted. It was obvious the patient had died sometime before I’d entered the room the first time, but it “felt” like he was still there – in fact, that was what I’d thought, that he was asleep. But by the time the nurse and I re-entered the room, it felt colder somehow and he seemed less present.

I know this sounds all woo woo, but I don’t mean it that way. All I can say is that there was a definite moment when he took a last breath and a definite moment when his heart stopped beating and his brain stopped firing neurons (although each of these events may not have happened at the same exact moment in time), and that each of these events were part of an overall process of the body shutting down. If there is this thing called soul or spirit apart from the body well then I had a small experience of that because somehow the patient was less present in the room than a mere ten minutes earlier.

There were very hard moments when I had a patient who was just about my age and, of course, children and teenage patients were excruciating to deal with (well, often they were more philosophical and accepting of their own demise, but it was their haggard and exhausted families who were harrowing). Luckily, I guess, most of the patients were elderly and had lived long and full lives. Even so, I remember times of crying in my car before I would drive home, but once I got home I still had a child to raise and a job to get to. It was difficult to completely shake the experiences there.

When people asked me about this it was usually “how can you do this?” What was particularly hard to explain was how wonderful it was and how alive we all felt. For me at least, I don’t think it was the helping aspect that made it wonderful, but it was that I was privileged to be with these people who allowed me into their lives for a moment, to share a smile or a joke or a story.

Which led me to my last lesson – We’re all dying every day. I remember one time being with a patient around my age who was quite aware she had little time left and I had a momentary sense of “that could be me!” I could have cancer in my body right now but it just hasn’t gotten to critical mass yet, so I’m not sick. But . . . it could be growing and multiplying and . . . that could be me! And it was true. But I need to emphasize – it was just an awareness, not the start of a hypochondriachal journey down the rabbit hole to find a disease. It was an awareness that we all will die of something some day. The important part is how we live on those days in between.

Yes, that patient in the bed really wasn’t so different from me and there was a time when she had been perfectly healthy and now was within six months or less of death. So yes, on some level every day we’re here and alive and healthy is a gift and also is one day closer to that day when we will take our last breath, think our last thought and pump our last bit of blood throughout our bodies.

What did I learn ultimately, along with my lessons? For me, I learned that I could feel very deeply the sadness of what was happening, but I didn’t need to take it home with me. I could shift gears pretty easily. And this was what I needed to know about myself before I made my decision to attend graduate school to become a therapist.

We’re almost to the end, dear readers – so hang in and I hope to finish this up and bring the last ten years to a conclusion.

2 thoughts on “My Life on the Couch

  1. i too will be 38 and have no idea what i want to be when i grow up..maybe i will figure it out when my little one starts school in 18 months!

  2. Hello Laura,

    Your personal story is thought provoking. Death is inevitable and I got new insights about it from your article. Now, I’m more aware that I should appreciate the life that I have. You have what it takes to be an excellent therapist.

    Thanks for a heartwarming post.

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