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90834

Image credit here.

Image credit here.

“He used to let me do everything for him.”

“Life was so good,” she sighs, “until the accident.” She wasn’t even sure how it had happened. Sherry recalled having felt out of sorts that day. She had asked Marco to put an extra shot in her Americano but the creeping nausea had caused her to reconsider. She had broken the rules and stolen a few moments on the cool leather couch in the women’s lounge off limits to staff. But in the end, she had thought it better to get up and push through. Sherry had been an athlete, and she understood this paradox: the cure for too much activity is more activity.

She had finished her shift at the restaurant, pulled out into traffic, and come close to waking up in the afterlife. Instead, she had come to in a hospital room, awakened by the sound of her own breathing. Her first thought: “And I didn’t even finish ironing John’s shirts.”

Sherry’s heart attack had left her with one good eye, one good arm, and one shiny blue wheelchair. “Cobalt,” she smiles, “I thought it would bring out my eyes. John always did like my eyes. He used to tell me what to wear and how to do my hair so I’d look like a million bucks.”

Past tense.

John had visited Sherry in the hospital. Once. After that, their conversations had taken place through attorneys. However, Sherry is not one to dwell on her misfortunes. She understands his wanting to protect his assets–what, with her care being so costly–and she doesn’t take it personally. “He is very, very close to his mother,” she confides, “and it seems only fair that he should have her money to himself once she’s gone.”

Sherry is a mite disheartened that John has not returned her calls. A few times she has used a paratransit service to organize a ride to his new condo. One time, a woman answered the door. “The cleaning service, I guess.”

Sherry doesn’t mind living with her mother for now. Not really. She had been disappointed to learn that she would not be able to return to the cape cod she had shared with John. She had had little choice but to go from the rehab facility back to her childhood home. The house isn’t fully accessible but she manages well enough with help from mother–though she is sometimes impatient and rough. Sherry imagines her mother’s disappointment at spending her golden years negotiating ostomy bags, and she forgives her.

“Now that the divorce has been final for a few months, we should be able to get back together. What’s a piece of paper, after all? I know John has been holding off to be sure all the legal stuff has settled.”

I take a deep breath, blink, and lick my lips, as I buy a moment to formulate my response. Before I can speak, Sherry continues.

“So do you think I should try calling this time or just show up?”

90834 is the billing code for a 45 minute individual counseling session. This is the code most commonly approved by Medicaid for individual therapy. You can find another post about a therapy experience here.

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M&M Days

Image credit here.

Image credit here.

Sept. 14, 2012

Don’t even ask me why I thought of M&Ms. I was having a hard day today–after having had a hard day yesterday–when the image of an orange M&M presented itself to me. Not having the energy to fight off this tiny UFO, I capitulated. So today I am an M&M. Yes, the candy. I know it’s dumb, so save your breath.

I’m orange and shiny on the outside. I am smooth and pleasingly shaped. A perfect little pod of Happy. I create a cool and pleasant “click” as I collide companionably with all of you other M&Ms in the larger M&M community.

Except that there is brown stuff inside me. Brown stuff which is threatening to liquefy at any moment. In fact, maybe it already has. Well, and you would assume it’s chocolate and shrug it off. But what if it’s not? What if I happen to be the one poop-filled M&M in all of M. County, XX, and you just haven’t figured it out yet?

I dropped by our administrative offices today to pick up some materials. The ladies who work there are great, great people; and I look forward to stopping in. I am not exaggerating. I ADORE them! But today was difficult. My neediness scared me, and I had to get out fast, before I had an accident. I longed to join their little fun-size bag of office camaraderie even if it meant volunteering for grunt work. I couldn’t do it. I couldn’t. The caring and warmth of these women would have resulted in melting, and who knows where that might have lead? One little sneeze, one unintentional elbow or funny look, one chance remark….In fact, one false move of any sort would have started the hairline crack in my Happy, and poop would have happened.

Just being in the office this morning took great effort. It was hard to focus on the small talk and the task at hand because of the energy drain inherent in having to operate on Manual Override. On the one hand, I noted how much healing, growth, and self awareness I have under my belt at this ripe old age of 48. I realized, with surprise and gratitude, that I rarely have to operate on manual at all these days. On the other hand, this insight meant that today was a trip back into the familiar land we counselors like to call emotional dysregulation. Ain’t it grand? Come to think of it, that thought is probably why the M&M was visited upon me in the first place. M&Ms: pretty on the outside, crazy on the inside. M&Ms: melt in your mind, not in your hand.

I am just so darned experienced that I can (mostly) hide the craziness and (mostly) function normally until I wrangle the gerbils back into the cage. You can do this too, and here is a quick lesson. You just have to ask yourself about every 30 seconds: Am I being appropriate? What would a Normal Person do now? Then you do it. And you hope nobody sees the brown stain slowly blossoming on seat of your shorts. Afterwards, you go have a good cry and take a nap because Manual Override takes everything you’ve got.

It’s challenging to be professional at best, non-life-sucking at worst, when you crave a haven of unconditional love. Instead of unloading on the Executive Director, who is one of those Moms around whom you can’t help but feel safe, I had to try to be that normal person. Surely the chocolate-filled M&M wouldn’t throw herself on her superior, an overworked mother of three young boys (who is, by the way, at least a decade younger) and demand care. I am a counselor, for God’s sake, and this woman is my boss. Certainly Normal Me would not cry and feel left out because the director now has, as her office administrator, the woman who has been her best friend since childhood. They get to hang out together all the time! What–do I want her to be my best friend? YES! I mean, wait, NO! No offense intended. That’s the poop talking. I hope the office owns a canister of Febreze.

What is wrong with me!? Do you know that in the last two days, I’ve been doing my errands in a daze, once briefly forgetting where I was and feeling lost? This afternoon, I found myself unable to remember if I had eaten breakfast. Yes, counselors, we call this dissociation. I was in a haze like this once in the days after learning of the death of a dear friend. Same kind of weirdness.

I have friends. Very, very, very good ones! Well, yes, but they are very busy, and I don’t want them to think I’m dumping on them.

What I need most is to call my best friend, Hanna; or Skype with her; or write her a long letter. She knows my whole life. She always, always understands me, and she never gets tired of me–even when I have to process a-million-and-one iterations of the same matter, in my completely obsessive and annoying way, in order to bring my mind to rest. Sadly, reaching her is tough. She lives in Europe, and she works full time, and her husband tends to take over every conversation, but still….

Oh no! I just remembered: She fired me 9 months ago.

My direct supervisor, Tim, is very wise. Yesterday morning, I met with him to consult about a new case, a new couple I had met for the first time the day before. I was trying to figure out why worry had kept me from sleep. I was uncharacteristically distressed and felt completely stuck. The husband had assured me he didn’t have anything he needed to discuss in counseling. The wife had maintained she had come only in support of her husband. Hmmm, where did that leave me since they had asked for couples counseling and intended to return.

Part of what disturbed me about this couple was the wife’s denial. She had been alarmed enough about her husband’s behavior and the potential for violence to set up counseling. However, once she got him into my office, she had pooh-poohed (more excrement) and minimized everything. Obvious manifestations of mental illness were, in turn, labeled charming, fun-loving, rational, insightful, and demonstrative of superior intellect. Tim wondered if she had acted this way because she was scared of him. I’m not so sure. The couple owned a kennel, by the way, and spent a lot of time scooping…poop.

I lamented to Tim, “How can you know something and not know something at the same time, especially when it is so obvious?”

A long pause followed.

“Interesting you should ask that,” he replied with care….”I don’t think I can ever recall your saying a case kept you up at night. You don’t have to take this case, you know.”

It took a few moments for his meaning to penetrate. I had both known and kept myself from knowing so many things. At so many junctures. About Hanna and her husband Niko, who suffers from paranoid schizophrenia. My eventual refusal to collude with their reality had cost me their trust and a lifelong friendship.

“I can’t help them,” whispered. And then I just felt like crying.

I referred them out.

Later I climbed onto Jesus’ lap, curled up, and buried my face in his chest. He held me and told me I was good, and He stroked my hair.

His hand felt like my Dad’s.

This post is the latest in the thread The Story of Hanna. For the prior post in the thread, click here. For the next post, click here.

90837

Image credit here.

Image credit here.

I have known Avril for precisely 203 hours. I have known Avril for 8 days and 11 hours.

I have known Avril one hour at a time for 6 years and 8 days. She was barely out of childhood when we started our secret meetings. She had to sneak around so that her grandma wouldn’t learn about me and kick her out of the house. Now she is a career woman, a single parent, and a home owner. I am her therapist.

Today when Avril left my office, I dashed for the ladies room in the darkened part of the building. My swollen heart was near bursting. I drew a few quaking breaths, grabbed it in both hands, and wrung. When just enough of it had squeezed out my eyes to ensure that it would fit back into my chest until lunch, I allowed myself one luxurious minute more. Maybe two. Another client was on her way. I dabbed my kohl and returned to my post.

I was not sad. The culprit was gratitude. It had been welling and swelling all morning, and Avril’s face had set me off.

Four weeks ago, Avril had returned after a six-month break. She was aware she was starting to falter. I had held up the mirror and shown her how far she had come. She had curled into herself:

“Stop!” she had cried, “Stop it now!”

Two weeks ago, she knew was flirting with disaster. She was scared because she had stopped feeling scared. Would she grasp for the help she needed before she was all used up? Avril had been taught that depression is not real, that medication is an affront to Jesus. She had gutted it out before–but the stakes had seemed smaller back then.

Avril was but a nub that day. Her face was stony, her voice a near monotone. I thought I spied a spark of “Fuck You” simmering behind her eyes but I couldn’t be sure. It both reassured and alarmed me. The starving, the cutting, all those games.…These had been her tools, both comforting and despised, to secure her care. They had been friends once upon a time. Now they fit her like a too-small skin. Weary from trying so hard to embrace her new size, she sought solace in the familiar. She panicked when she realized she couldn’t go back, and this made her strain even harder. In trying to force matters, she had nearly done herself harm.

She had not yet become small enough for me to intervene. I was worried but I would not mother her. Avril had become a woman, and she had to choose for herself.

Today, Avril arrived with a gaunt face, a giant mug of tea, and no hello. She started talking and left me to fill in the blanks:

“The medication is making me really tired. But I stopped trying to avoid food. I know my appetite will come back if I wait.”

Her face was soft and almost shy.

90837 is the billing code for a therapy session lasting 53-60 minutes.

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