Good Bye "Rita"

I went to work again today.  I am doing clinical work on an almost weekly basis.  I am trying to help a limited number of patients get where they want to be, and still carrying a few others who will never get there.  Today I said good bye to one of those who fit into the later category.

"Rita", ( all the details have been changed) I will call her, is even older than I am, and she is in much worse shape physically. I first saw her over thirty years ago for a brief period of time.  I saw her five years after that, and ten years after that, and finally, three years ago she really came to see me on a regular basis.  Last year I saw her only four times as she was physically unable to get to my office.  She was brought to this last appointment by her son, and she hobbled in on a cane.

Rita first came to see me on the insistence of her doctor who told her he would commit her if she didn't keep her appointment.  In those days it was much easier to send someone, especially a woman, into the hospital, and they would often stay there for months.  She was one of those women who was well known around the community.  Some thought she was volatile, others just called her nuts.

She always dressed very provocatively, which made it difficult for people to realize how smart she really was. She ran her own insurance agency and she knew her business well, and ran it honestly.  But she was ultra-sensitive to personal slights, and was overly suspicious of people's motives.

Over the years she came to trust me, mostly because I helped her stay out of the hospital.  She finally let me know about many of the thoughts she had about who was plotting against her, and how people took advantage of her.  I came to understand that the lines between what was real and what was distortions were very slight.  She wanted attention; she wanted affection, many people took advantage of that.  Because to that her fears and suspicions became exaggerated over the years. The more distrustful she became the nastier she was to people, which, of course made them pull away from her and avoid her.  She knew they were talking about her, and they were.

Now she lives in the back room of her son's house.  She hides from her son's wife.  Her only consistent contact comes when she talks to her former husband on the phone.  She pushed him away years ago.  He didn't want to leave, but now he is down south and won't come back.

The last few times she came in, including this final one, she retold some of the earlier stories of what had happened to her, how people mistreated her, and how she had responded.  It is fascinating to see how those stories have changed over the years.  In this last retelling she now recalls events as having much less conflict than in her earlier accounts.  She also has a much more positive memory of how she acted in many situations.   She now remembers herself as avoiding trouble when before she had been the victor in epic battles.

This may be because she no longer feels the power of the anger she used to have, or she just as mellowed and wants everyone to remember her as quiet and sweet.

We had a comforting last session.  We reviewed a lot of what we had been through together, but now we can leave it all in a more comfortable context.

Her children, who battled with her for years, and whose lives she certainly made very difficult, will all be with her for the holidays.  For her that it is Shakespearean: All's Well That Ends Well.

Aging Out

Been a while.

I got away.  I couldn't stand the cold so I went somewhere warm.  It was beautiful.  Came back.  It's cold again.  "Why are we here?" asks the wife.  Answer is becoming more difficult to articulate.
....Well, the grandchildren are here....

Now I am spending two and a half days seeming patients.  I get out in the middle of Thursday and leave the office for the new, young guy.  He reminds me of myself as his age: energetic and idealistic.  He is only sixty-two.

But I didn't go home.  I had to stop on the way at a rehabilitation center (nursing home) and do an evaluation of Martin.  I first saw Martin around 1983. He was sent to me by his doctor, who hoped someone could help him.  Martin was well known around town, especially by the police.  He was angry and paranoid.  He was colorful and expressive.  His ideas of who was out to get him included not only the police, but the utility companies, and the air force.  His delusions about the air force was based upon the planes flying over his house.  This later morphed into being that the birds flying over his house had been trained to spy on him.

In those days that was considered crazy thinking.  Now, of course, how many drones look exactly like birds?

Martin was once good looking and charming, when he was not ranting against the world and getting in fights.  He fathered four boys with two different women.  He wasn't the greatest father, as he would wander off for a couple of years at a time.  Once in a while he would send each of the mothers a check.  He meant well, but really couldn't maintain any consist work, relationships or even state of mind.

About ten years ago one of his boys died in of either a fight, an overdose or a fall.  It was never quite clear, and was probably a bit of all three.  That really upset him and he became more depressed, angry and confrontive.  After a few years of that he calmed down, but was still in enough trouble to come and see me. He hoped that being in treatment could help him stay out of jail, which it did.

But now he is physically falling apart.  His circulation is bad, especially in his legs, so he falls down.  The last time he fell he broke his wrist, so he was put in this rehab center.  One of his son's contacted me and told me where he was and wanted me to help get the son to be his guardian.  That's why I went to visit.

Martin was very welcoming and happy to see me.  He was taking a bit of medication, something he had resisted for years, and it was helping his stay calm and almost reasonable.  He confided in me that he knew everyone was still watching him, but he was OK with that now.  They were nice about it now, even if it was all a cover-up.

His wrist was in a cast.  His knee was in a brace.  He sat in front of a walker, and held on to that so he could sit-up.  His roommate sat in a wheelchair.  There were people in the hall attached to chairs by a thin cord that would set off an alarm if they tried to get up.

Martin looked to me to be about a hundred and three.  It said in his chart that he is five years older than I am.  That's why I am not starting with any new patients.  I am finding that not working is a lot easier than working.  I didn't feel that way, way back when I was sixty-two.

Denial?

As I said a couple of posts ago, I am beginning the transition.  I am morphing from who I was and what I have been doing for the last forty years into whatever it is that comes next. It is an interesting time. I left work today(Thursday) in the middle of the afternoon.  Some young guy (62) now comes in and takes over my office.  I walked out into the parking lot and there were still cars in it.  I drove home and my wife was still on the phone, working.

If I haven't said it yet, I want to make it clear that I realize that I am very fortunate, and that I can do this out of choice.  I am getting older, but except for the reality that I can no longer run very fast, play basketball with people who are thirty years-old, and that I have much more trouble remembering names that I rarely use, I am in good shape.  I am nicked and bruised and sore in spots, but I am healthy. My skin is saggy and my legs are bowed, but I am fine.

I  also have enough money to be able to survive quite well. I am not buying a yacht, but I could buy a small boat and I am happy with my kayak. I am in a good relationship with someone who is certainly still interesting, to say the least.  Also, and very important, my two children are grown, all solidly self-supporting, both married and also in good relationships, and they now have their own children who are, so far, healthy, enthusiastic little bundles of joy and enthusiasm, when they're not fussy.  And all of these people live within twenty minutes of me.

So, with the fundamentals, things couldn't be better.

Given that, I am still trying to sort out what I want to do, what I can do, and what is important to do with the time that should be available since I won't be spending thirty-five hours doing clinical work and another ten to twenty hours doing the shit work I have to do to get paid, write letters, file reports, make phone calls...... all the stuff that goes with trying to be professional and get paid.

Well, the first thing I learned upon not working as much and getting older is it seems that unless I make a concerted effort to do other things, life will be spent doing things to stay alive. That includes more of what we used to call "daily life skills" in our evaluations.  Who knew they could take so long.  Dressing, cleaning, flossing, shopping, cooking, loading the dishwasher, emptying the dishwasher, reading the paper, checking on-line to see if what the paper said was accurate.

The next big thing, is getting the exercise that I haven't gotten since i played basketball. Go to a gym in the middle of the morning and who is there, women with rich husbands and old people.

Then there is the big one, going to some kind of doctor. My wife, unfortunately, has a complex medical condition, so she goes to the doctor more than she ever did.  I went with her last time, and just going to the big medical complex can ruin any positive outlook.  We are near Boston.  We really have the best medical care in the world. The best doctors, the best hospitals, the best research.  But who is there: old, sick people.  People shuffling along, people on walkers, people looking sunken in and ashen.

Most of these people are my age, some are younger, some are older, but everyone knows this is the next step, and the step after this is worse.

That's where denial comes in. Foe me it seems best to just keep going and ignore all you can. My shoulder hurts a little, so I don't throw any down-field blocks.  My knees can give me trouble so I don't jump, and if I do I try not to land.  My tooth got chipped, so I'm getting that fixed but it still bothers me. Still -- just keep going.

I know that I have ideas of good and semi-important things I want to do, but I don't have to do any of them.  No one has called up (or sent a text) asking me when I will be finished.  I realize that what I really need to do is relax, play and have fun. But exactly how to do that is still a bit vague.  I don't think I can go out into the street and find six friends and play Ring-a-levio, like I did sixty years ago.  I don't my wife will call me in when it gets dark.

For years it was a lot of fun just to rest and relax after a week of hard work.  Right now, in the afternoon, when I am accustomed to still having five hours of work ahead of me, I'm not that tired. So having fun means...I'm still not sure....and it feels kind of weird.  Not bad exactly, certainly less stressful, but still weird.

It's a pity the grand-girls don't live here so I would have someone to dance with. I'm sure they would lend me a tutu.

Old White Man

For various reasons I had a sessions this week with two brothers and a sister.  They were in their late forties and they compared their impressions about what it was like growing up in their family.

But now their father, who was a distant father but a very successful businessman, is eighty-eight. He has been a widower for a long time, and now he is home, by himself, and moves with great difficulty.  His children, mostly his daughter, come to see him four or five times a week to bring him food and cook for him.

He is not very sociable, because is usually tired, and they often find him asleep in his chair.

His daughter explained that this is true because every night he sits up in the chair, facing the door, trying to stay awake.  He holds a 35 caliber pistol on his lap and waits for "them" to come and try to take away his.........well, that's not quite clear.

One of his son's says that the gun doesn't have a bullet in the chamber and the old man doesn't have the strength in his hands to pull the lever and get his weapon ready.  But it's the thought that counts.

Their Children

I noticed an interesting thing yesterday: of the eight people I saw, two were children of people I had seen years ago.  These were not their young children who live with them, but adults who are grown up, but when they got anxious, lost, or upset about something, they came to see me.  I had not seen them when they were children, although I had heard about them.  There have been several other children of former patients who I have seen, and others who I am now seeing.

Now, in part, I take it to mean that the work I did with their parents was helpful, and that the children heard about it somehow, and felt it would be helpful to see me -- also because I know their parents and what they had to deal with.

But I guess there is also a negative here, in that the kids felt that part of their upbringing was chaotic and unstable enough that it caused problems. I didn't cure their parents

But I overlook the second one, because I can see that the world is difficult for everyone, and the idea of coming to talk to someone like me is so widely accepted that it doesn't mean that people are crazy, or can't cope.  They just feel that coming could be really helpful during a bad time.

This is so true that insurance companies want to pay us a lot less --- because so many people use our services.  This is the opposite of supply and demand.  It is the Republican version of a "free market." That is, regulated for the good of profit and corporations, not for the people who provide or receive the service.

However, the fact that I am beginning to see children of several of my former patients means, really, is that I'm getting old.

Heading out again

We are leaving for the airport in an hour to head out to the Amalfi coast.  I am leaving my patients, the crazy politics of this country, not that Italy is any better, and the state of my profession.

I gave a talk at our state Psychological Association conference yesterday.  I tried to show them ways to use new technology to enhance psychotherapy.  I was given a very good reception, but more for  the delivery than the message. At least I kept them entertained.

The professional lives of Ph.D. Psychologists is under a lot of pressure that the general public doesn't see, and really doesn't care about.  The changes health care system, which is complete flux, partly from politics, and partly because it is such a mess, does not pay much attention to Psychologists. We are more expensive than social workers or "counselors" and we are not MDs like psychiatrists, who also are getting marginalized.

I am older, and if they stop paying me I will stop working and find another way to keep busy and perhaps make a few dollars.  Maybe I will take the advice of the person who last commented about this blog, and jazz it up and market it and be another voice in the wild bloggosphere.

But for right now I am of to Italy, to set and watch the sea, eat grat food, and wonder where I will fit in to the world.  I will miss the grand-girls.

Bye-bye form Pop-Pops.

I am OK -- but..

I am OK.  In fact I am doing surprisingly well. This has been a great summer.  I am in good shape and healthy.  My eye is better, my knee is better.  Nothing really hurts.  I have been very active kayaking, biking and chasing my grandgirls -- only one of whom can actually walk, so it's not that hard -- but the one who can walk loves to run away.

I like hot weather, so the summer has been good to me.  We go off to the beach house and play.The kids have been coming and bringing their kids. Friends have been coming. We discuss how the world is  falling apart while sitting in great comfort.

Then I go to work and things are different.  but that is the nature of what I do.  People very rarely come to me to tell me how happy they are, or how excited they are about the interesting, creative, fulfilling things they are doing.  That happens occasionally, but that means it is the last session.

But I have been doing this for years.  I can deal with depression, even terrible depressions.  Anxiety; hey, everyone I see is anxious, also I can be helpful for loss, loneliness, confusion, stress, relationship problems, addictions, even violence. Hey, let's talk about it. My kind of therapy at least doesn't have side effects.  It won't make you constipated or gain weight.

But you know what upsets me.  Dealing with people who have chronic, physical pain.  I mean pain that has lasted years and comes from degenerative diseases.  Diseases that not only resist treatment, but that the treatments for them seem to create other painful conditions.  The drugs lead to passing out, or digestive disorders or kidney failures.  Pain raises blood pressure, the drugs for that causes dizziness, people fall down, cut themselves and go to the hospital and pick up a staph infection. The antibiotics for the staph infection cause colitis, which leads to a colostomy.  But still the pain, from the degenerating bones, or the pressure on the nerve from the back injury, or whatever it was that began the whole process goes on, and no one can really find it, and if they find it they rally can't do much about it.

Part of why it bothers me is that I am getting older, my friends are getting older and my clients are getting older.  For me, I can no longer run and jump.  For me, who played basketball for 25 years with the same group of guys it is a loss.  But I can cope.

What i know is that more is coming.  More of my friends have had knees replaced, hips and shoulders too.  They are on all kinds of meds because this or that number comes up too high. I take one little pill. Other friends have stents in their bodies, or have difficulty getting out of chairs, or even, are dead already.

So far, most of my friends and family are basically OK.

I plan to be immortal, until I am dead.

Back Again

So, i went away.  I had a very busy week from January 16 to 20,including having to go to a funeral. Fortunately, this was the funeral of a friend's parent, and not of a friend.  Those are getting closer, I know, but at least not yet.

Then I went away.  Took off to the South to find some sea and sun.  Being of this transitional age, we now have friends who are there when we get there.  More and more of them are taking time, many are taking much more time than we are.  They are either older, richer, or laid-off and letting it all go.  So this trip was different.  I usually go away with just my wife and maybe we will meet someone as we travel, as we have gotten good at stranger-travel conversation.  I find that interesting to talk to people from other cultures, like Mississippi, which we did last year.  Now we are meeting our own friends, and this time we meet with their friends, each of whom had brought along a friend.

So there we were, at one time there were more than a dozen of us; old wrinkled people, charming, well read, well intentioned, but certainly not as attractive as any of us once were.  It's a shame.  I realized how much I like to be with attractive people.  It tinges things with a bit of excitement.

Now we talk about art and food and wine. (I don't like wine, I'm a beer or whiskey {not whisky} guy). These folks were very interesting, well read, well traveled, successful.  We were way down at the Southern end of the country, but we all had lived most of our lives up here within a twenty mile radius of each other.  Small world? His kid had played basketball for the same high school my kid played for, only four years earlier, but we had never met. They were business people, an artist, a writer,an editor,  a couple of teachers.

But everyone was kind of a bit confused about what comes next.  Do we just amuse ourselves, or can we find a way to help the world do a little better.  We all agreed that it certainly needed the help.  No one was particularly asking for out help, except to send checks.  But all of us were amazed and disturbed to see that how the people who want to be leaders are so full of fury, venom and destruction.  Any talk of compromise or conciliation at any level, from the neighborhood to between two nations, was only seen as a sign of weakness.

I am back now, dealing with 18 messages, six new people in the middle of crises, with fewer people offering any way out. I won't be taking time off again for a while.

another upbeat week

Let me repeat, as I may have said it before, and that in itself is part of the problem, I mean, me saying it before, and again. And what I'm saying is, that sometimes, part of it is, that growing old kind of sucks. And I'm not even that old, or even in bad shape or anything. But there are the things you don't know, and can't even think of when you're young(er). You can't know; and you don't think you will get like this, but you will, even with super-growth-hormones.

"Old man, take a look at my life, I'm a lot like you are." I remember that song from when Mr. Young and I were both 23. Now, we are getting to be (get that,only getting to be) the old man.

But that's OK. The getting old is OK. What makes it hard is that everything just comes around again. Just when you gather up enough hope to think it's better, it gets washed away. How many times? Many.

And I feel like a sucker each time, that's what hurts more. Each time I get riled up and think maybe I, we, they, have figured out a way, to make it better and to make it last. But then it gets washed away, like the castle in the tide, and now the hard sand on the beach is all flat again.

Does it matter? Not really, to me, directly in many ways. I'm still OK, my kids are OK. I am basically healthy (but slower) solvent, no real debt. The house is warm and dry. I have more 'stuff" than I know what to do with. The internet works fine. I could spend the rest of my left playing Soduku. Who would notice? My wife doesn't really know what I do up here anyway. I gave up porn years ago when I saw what could have been one of my clients in one of those movies. Really freaked me out.

I heard an early Dylan song also. He was running down the road because someone called him a Communist. They still chase you down the road even if the think you're a Socialist.

And who get hurt? As I said not me. Yes, people get hurt, many. The same ones. The ones in the cheap houses, with no credit to get the pipes fixed when they freeze. They live on the low-lands near the river and get flooded when the snow melts and the river rises. They lose their jobs when the factories move to China. Their kids have to drop out of college because they are smart enough to get a $10,000 scholarship, but college costs $47,000. So they go back to selling Toyotas, and now even they are busted.

Or they live in Gaza city.

And so many more people are getting on the State Insurance now, just like people were afraid of. State run stuff, can't be good. And you know what? That's true too. The state pays me less and they send out new, incomprehensible rules every day.

Private insurance companies are greedy. They lie, cheat and swindle. They take your money and throw you in the gutter. Public insurance is complicated, incompetent, and inefficient. They take you taxes, put you in a dirty bed, and leave you there.

The problem is that they are both run by people. THAT's the problem.

Can't blame people though, because that's who were are: cute, lovable, well-meaning, but flawed.

Can't just sit around either. That makes me feel as if I've given up, kind of useless, old. Don't want that.

So, I guess it''s back at it. Or at least it will be on Monday.

How's that for a happy ending.

Re-emerging

Now the summer is beginning to fade. I have been away from everything for a while. We have been wandering around down here,taking time off. It was something I needed to do more than I realized. The last few months, with the back pain, with other vague but unrealized health worries, had put the focus on me much more than ever before.

With that comes the awareness that at my age sickness can lead to crumbling, can lead to being wiped off this planet. Isaac Hayes was just slightly older than me. Gene Upshaw was my age, so were abut twenty per-cent of the people on the obituary pages. It all kind of spooked me out. Me who is supposed to be so full of perspective and so calming.

I spent so much time thinking about thinking that it all kind of got to be a bit too much. I couldn't think about it any more. Who I was, what I was doing, what I want to be, how I want to spend the rest of my time, what is really important to me, all these things kept swirling through my head burning a deep hole but leaving no answers.

So we came down here, as we do every year. I thought I could use the time to get away, and maybe I could figure things out. Maybe something clear would emerge.

So far I've spent time hanging out with friends and doing things that take up time. Even golf. It's been very beautiful. The weather, the sea, the rolling green, the blue sky, the golden sun. The time has been easy, fun and even sociable.

Yet, there remains the vague feeling of something not yet accomplished. I have not yet mastered the art of just taking care of myself. Making deals and keeping myself entertained somehow just never seems to be enough. I'm not sure why.

Must be something my mother did or said. Maybe it was my father.

Still, I'm not sure what it is that I am expecting.

So today, after almost two weeks away, I am beginning to schedule appointments for next week. For the first time is six weeks I don't feel afraid of it. I am even just beginning to look forward to seeing everyone -- well almost everyone -- again.

Yet, I have decided that I need to re-allocate my time, find out what is missing, and what it is I expect to do, not just return to what has always been done and keep the ball rolling down the same familiar hill.

As I have said here many times, change is difficult. Even for me. Hopefully, this blog will help hold me accountable.

old brains

We often go and visit my wife's father. He's going to be 94 soon. Until last year he was doing pretty well, but last spring he contracted pneumonia and, although he recovered physically from that, it seems the stay in the hospital knocked out his mental equilibrium.

Now he often doesn't know what decade he is in. Often he is 16, back in the town where he was born, looking for his neighbors. Sometimes he is fifty and waiting to be picked up to play golf. There are lots of other disorienting things. It's sad that brains tend to shrink with age and then confusing things happen.

Would it have been better if he stayed more involved with others and had more interactions to keep him alert? He was never that naturally social. His wife did all the arranging. Once she died he slowly withdrew.

But, I don't know. He's 94. What can you expect?

At the doctor's recommendation we gave him Zoloft. We gave him one pill at a sub-therapeutic level to try it out. The next night he was up all night making phone calls, mostly to people who had been dead for twenty years. He called 911 because his wife was missing.

We didn't give him another pill.

Really, he should come and live with us, but we have too many stairs and we are not home enough. (I'm saying this just in case my kids read this.)

At 93 I'm buying a motorcycle. If I remember.