Redemption - March 27, 2008

With the nursing home strike still going strong it's been tense going into work. While no one has crossed the line into overtly violent behavior there is plenty of yelling involved when anyone gets near the building. I've escaped with mostly insults thus far, the most enigmatic being "Go away you reverse Uncle Tom!" One striker "accidentally" tripped into me and knocked over my coffee and my "How Do You Feel Today?" workbook into a pile of mud, rendering me dangerously under-caffeinated.

One of my clients at the home, Ruth, was particularly agitated when I walked into her room. With my personal nemesis Dr. Phil blasting in the background she immediately clicked off the television and motioned for me to sit. "Rob, I don't feel right."

"What is it? Are you ill?"

"No, no. I'm not sure. I think I'm dying."

Oh my God. Not again.

With a skyrocketing heart rate and my stomach turning into knots I remembered what Andy said to me that day and how poorly I handled it. When we are reminded of previous (and traumatic) experiences our bodies will often respond in a way that is similar to how it did during the original event. This is a premise of trauma work: the body believes it is re-experiencing the event and needs time and a reminder that this new experience is not the same as the previous. I could taste the shame I felt when I found out that Andy had died. I hated myself for what had happened with him but wasn't about to make the same mistake again.

Rob, stay calm. Unlike last time, pay attention and fucking listen.

"Ruth, tell me what it is that makes you say that."

"I don't know I just feel strange. It's scary."

"Okay...okay. Tell me more."

"I don't want to die yet, I'm not ready."

The nurses always tell me if a resident is ill so I knew there wasn't anything physically wrong with Ruth. That was the case with Andy as well though.

"Ruth, the nurse hasn't said anything about you being sick but only you truly know how you feel. Is it possible that you're confusing your fear of death with actually dying?"

"I don't know. Maybe. I just don't know."

"That's okay. You don't need to know for sure. We're just considering some things."

"You won't leave me will you?"

"I won't leave you."

"Promise me."

"How about this: I promise to not leave you if you do the same for me."

"What do you mean?"

"I can only keep working with you if you stick around here. You have to promise not to go anywhere just yet."

Ruth gave a hint of a smile at this. "Okay," she said. "Deal." She paused. "Since neither of us are going anywhere just yet do you want to watch Dr. Phil together?"

"Honestly? Not really. I can't stand him."

This time there was a full smile. "That's okay. Let's talk more about my feelings. You seem to like doing that and I clearly have some things on my mind."

Smarter people have said and continue to say far more insightful and helpful things than I do but at least my words did something positive this time around. Although she is elderly and won't be here forever, for the moment Ruth is feeling better. As we've talked over the past few sessions she's a bit less agitated and fearful about death. Discussing it has started to give her what she is lacking: a sense of closure about her life. The elderly who have a fear of dying often lack the ability to look back on life with integrity and a sense of having lived it as best as possible. And although Ruth, like many of us, is still struggling at times with the prospect of dying we've developed a credo for her that she repeats every day:

"I can reflect on my life with pride. I did a lot of things, loved a lot of people and was, for the most part, a happy person. I will be with God and my husband at some point so there's no reason to fret."

A professor once told me "do not utilize your work with clients to navigate through your own issues." In theory this is a great rule but simply not realistic. When I go to the home now and see Ruth not just alive, but growing as a person in her last stage of life I feel fantastic. Not just for her but for myself as well. The unfortunate reality is that therapy is not a panacea and sometimes it does nothing for people. But when it does work I feel the most powerful experience in the world: validation for what I set out to do with my life.

After Andy died I used wine to self-medicate my shame and guilt from what I considered inexcusable behavior. I can't take back what happened with him. And yet it's as if I was given a second chance, a chance for redemption. By doing right by Ruth I could do what my therapist instructed me to: forgive myself for my mistake. It was important to do a good job. To do a great job. And now I feel...well, redeemed.

Posted by Rob Dobrenski at 8:00 AM

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Comments

This blog made me sad, happy, and nearly sent me into a panic attack. I've been getting those a lot lately. They're quite annoying.

It seems you handled yourself well with Ruthie, Rob, you should be proud.

Posted by: Amber at March 27, 2008 11:00 AM

That very nearly made me cry, but in a good way. I'm happy for you, and this story really made my day. Thanks.

Posted by: Anonymous at March 27, 2008 11:31 AM

Isn't that what therapy is really all about, giving people a second chance to relive some event that did not go the way they would have liked? A mental do-over.

Posted by: FutureColleague at March 27, 2008 02:39 PM

Geez, Rob, way to make me get all teary-eyed at work! Could you stop with the moving stories already?!

Posted by: Alainne at March 27, 2008 05:46 PM

There are exceptions to every rule and your professor's rule sounds like such a rule. Perhaps one of the biggest indicators that you've chosen the right path in life career-wise is that every once in a while you leave the "office" truly feeling content/fulfilled that you've made a difference.

In the 1-10 spectrum of Dr. Phil to Dr. Drew this entry clearly puts you at an 8.5.

(please tell me you like Dr. Drew)

Posted by: Gris at March 27, 2008 07:13 PM

Great story, Dr. Rob! You have a very big heart.

Posted by: Robin B at March 27, 2008 08:40 PM

I know what you mean with that feeling, being charged up with life, its a high. When I work with clients and they actually respond to me and do something, it is so gratifying and makes all the work worthwhile.

Posted by: Mark at March 27, 2008 11:15 PM

More awesome from you. Thanks man.

Posted by: Wayland at March 28, 2008 01:15 AM

I'm not sure why - this article got me teary eyed. Thanks for making me feel like a sissy you bastard. Good entry. You're my favorite writer on Rudius so far - keep it up.

Posted by: Tom at March 28, 2008 09:42 AM

This journal is the only must-read for me, for posts like this. Thanks for showing us that sometimes things do work out in your field.

Posted by: Jason at March 28, 2008 12:34 PM

I cried DocRob.

Posted by: Maggy at March 30, 2008 07:15 AM

I'm glad you feel better... i do have a question although... Have you ever heard of someone "smelling death"? I can.. nurses or hospital workers often do... that is where i developed my sense somehow... but unfortunately my first realization of it was with my grandfather.. I think that this is good for you and your patient.. she feels good with you and that is really saying something about you! Thank you Dr. Rob for sharing with us..

Dr. Rob Note: I have heard of that but have no experience with it. Did anyone else catch that report about the cat who can sense death and spends the night in the room of the dying?

Posted by: Chelsea at March 30, 2008 10:55 AM

Posted by: Anonymous at March 30, 2008 12:22 PM

I often need to remind myself that an effective therapist isn't the one who knows the most, but the one who can best apply what they know. I think what you did with her showed not only an awareness of what she needed, but also an understanding of how to handle yourself differently than you previously did (we so often miss our personal growth). Personal reflection is often avoided, particularly with issues that hit close to home or cause the kind of counter-transference that we wish wasn't there....but that is when we REALLY need to do it.

God knows I've sat in session and had the patient tell me something that sent me off in my own world, and sometimes it took me a couple times of that happening before I brought it up with someone I work with, because I realized that it was something I needed to address, so I could help my patients address their issues in the future. (Fear of dying...hello!)

Posted by: Therapeutic Ramblings at April 1, 2008 12:22 PM

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