Ali Hashmi November 1, 2000

Tags: Medicine , Children , Divorce , Family , Poverty , Marriage

href="/tag/family">family of origin. They may have gone through physical or sexual assault or been abused as children or adults. They may have medical illnesses causing changes in their mood; Parkinson’s disease, Alzheimer’s dementia, thyroid problems, ‘fibromyalgia, to name a few.

It is pretty much a given though that no one comes to see me because they are happy or content with their life. It can make for a stressful day, hour after hour listening to people pouring their hearts out about all that they perceive to be wrong with their lives. The majority of the people that I see are also euphemistically called ‘indigent’ meaning they are poor. Added to all the above woes are the everyday demons of poverty and need. Homelessness, domestic abuse, drug use, crime and destitution are a daily part of the lives of most of the people that I see. Often times, they come to me looking for that most intangible of elixirs: hope. Unfortunately, I haven’t had free samples of that for quite a while. It remains up to me then to walk the fine line between offering what help I can but not encouraging grandiose fantasies of medicines and therapy improving their day to day lives beyond a certain point. Amazingly though, most of my patients seem more than happy to know that I am simply there to listen to them and share their pain. Over and over, when I have felt hopelessly inadequate, I have heard from someone that such and such patient was praising me to the skies because I ‘really listen’ to people.

Jane (\\*not her real name) comes to mind. I will always remember her because she was my first ‘therapy’ patient. A sad looking thirty-ish woman (she was 38, I later found out), I first met in the psychiatric emergency room after she came in complaining of headaches and thoughts of suicide. After a brief hospital stay, she once again showed up in the emergency room one day when I was on call. I was in the first year of my residency, green to the gills, and looking to ‘pick up’ a couple of patients for long term psychotherapy. I offered her weekly sessions and she accepted gratefully, even though she would have a hard time meeting the clinic sliding scale fee. For the next 2 years, I saw her regularly once a week (barring holidays and vacation) until she moved to another town. I felt like an utter failure because nothing I tried seemed to help, not my well thought out ‘interpretations’ nor any medicine cocktails that I could dream up. She suffered from regular headaches and would end up in the emergency room every other week or so for pain medication. I did manage to keep her out of the hospital for those two years and (as one of my advisors once told me), just the fact that she kept coming back week after week meant that I must have been offering her some help. She didn’t even miss appointments when her husband lost his job and the whole family had to move into a shelter for a few weeks. She had been abused sexually by her grandfather (it came out in therapy) and her mother had never believed her. Her sister had been abused as well and they had shared it with each other but with no one else. She had never been able to enjoy a normal sexual relationship with her husband and even though he understood (he had been through something similar), it was like a wall between them that neither could breach.

When we said goodbye after two years of therapy, I felt like an abject failure. Her husband had gotten a better paying job and they were moving to another city. She told me during our last session that she had dreamed about me the night before and in her dream, she was shaking my hand, saying goodbye. This was the extent of the intimacy that she could allow herself with a man, no more. We talked about the last two years, her hopes for the future and our sadness at parting. Our time was up. She stood up and extended her hand. I shook it and she left. The story might have ended there, except that I heard from her about 4 months later. She called the clinic and said she was visiting. She had simply called to say hello and to tell me that she was doing fine. I offered to meet her in the office and she accepted. She looked the same, a little thinner.

After the pleasantries, she mentioned that her teenage son (the fifteen year old; she had another who was nine) had recently died, cause unknown. They had simply found him dead in his room. While I was still digesting this and thinking of an appropriately empathic thing to say, she dropped her other bombshell. In a grateful tone, she said she wanted to thank me for all that I had done for her and wanted to let me know that it was the things I had said to her during her therapy and the things she had learned that had kept her going. I learned a valuable lesson that day; I didn’t necessarily have to do anything to help. ‘Listening without judgement’ was sometimes all that was needed. I think about her sometimes, when I feel discouraged and dejected because someone is not improving as fast as I would like. I remind myself to just be there with them, share their pain and listen.