A Therapist Says Goodbye

We are not ‘friends’ with those we treat. But many of our patients make a very deep and lasting impression on us.

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When I first met Marvin*, he had already burned so many bridges that I wondered whether we would have enough time for us to do any meaningful work in therapy. He had managed to piss off just about every medical clinic in the area. At 75, his 6’4, 300 lb. frame was matched by his booming voice, and he took issue with everything from a misplaced sign in the lobby to a hello he perceived as disingenuous.

My first meeting with him amounted to a challenging game of “what if I told you …” to see if my reactions passed muster in his internal checklist of what made a person trustworthy. I must have passed because he came back.

We continued to meet over the course of a year, unpacking a past that was as adventurous and plot-twisting as an epic novel. He could tell a story like nobody’s business. My favorite involved him hitch-hiking across the country during the 1970s and being picked up by a middle-class, suburban couple with a 10-year-old son sitting in the back of a Ford station wagon – the kind that kids could sit facing out the back.

Marvin tried to have a conversation with the couple, but in a relatively short time, he realized that he did not share much in common with the couple. Back then he looked like a hippie, and I relished the image of him as his 30-year-old self with long hair and beard. He knew his ride would not last long, so out he went, dropped at the corner of at a Los Angeles intersection. His favorite memory of all time was that of the young boy in the back of the station wagon looking at him and holding up a peace sign, as they drove off.

The way Marvin told that story I could imagine every detail, and the moment he locked eyes with the boy who had sent up a sign of fraternity, something in him changed. He felt a connection to something bigger than himself. He chuckled remembering the moment.

Marvin’s therapy was bumpy and difficult at times, but we were making progress and working through the anger that was buried in that gruff exterior. I was hopeful for him.

But a spot on his lung changed all that.

We tried to remain optimistic after that, but I was often filled with a profound sadness after our sessions, knowing that we would not ever achieve the outcomes we had hoped for. The focus of our work shifted. He was in denial about his prognosis much of the time, and I did not push him. His grumpiness returned as his pain increased, and the gains we had made in his life satisfaction slipped away. He was very out-of-sorts for our last session.

‘When I got the call, I knew there would be no one to visit him, no flowers delivered, no cards to open.’

Three days later he was hospitalized with organ failure. When I got the call, I knew there would be no one to visit him, no flowers delivered, no cards to open. Marvin was the last surviving member of his family and never had a family of his own. He had no close friends, just a few neighbors who I only knew by first name. He had no significant attachments. I went to visit him that evening.

When I entered his hospital room, his face lit up. “Are you on duty?”

“Nope. Here as your friend.”

I know that in our profession we are not “friends” with those we treat. We make that very clear. But the truth is that many of our patients make a very deep and lasting impression on us. Bearing witness to someone’s life story and deep pain is the most honorable experience you can ever have.

I don’t remember much of what we talked about that evening. He was in a lot of pain. At some point, I looked at the clock and saw that visiting hours were over and I had a pit in my stomach. I knew I would never see him again. I think he knew that too because when I got up to say goodbye, his eyes were moist. I held his hand and smiled, “See you in my office when you get out of this place.” He smiled back. We both knew I was lying.

As I backed out of his room, I held up a peace sign. I hadn’t planned to do that, and it seemed like an awkward thing to do, but he flashed a smile and laughed his big, boisterous laugh. He got it.

The next day, I received the news that he had died.

Peace out, Marvin. I will never forget you.

* Name changed to protect his privacy.

Pat Blumenthal, PsyD, is a clinical psychologist and Director of Behavioral Health at The Portland Clinic in Portland, Oregon. She specializes in grief and loss and is a certified Grief Counselor. Dr. Blumenthal is also a contributor to the Huffington Post on issues related to mental health and has an active Instagram account where she shares relevant information on mental illness and coping skills. You can follow her @drpatpdx.

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