I remembered the day, the patients that were scheduled and I anticipated lunchtime with fervor like never before. I forced myself to focus on my first patient Hectors Azares. I couldn’t allow my personal life to interfere with my professional practice and if ever there was a day I was challenged by that particular code of ethic, it was this day.
I jumped right in to the session feet first, figuring if I concentrated on that, time would pass quicker and the sooner I would meet up with Sophia and Jane.
I opened the folder before me on my desk and sighed with frustration. “I realize Hector that this is the last place you want to be right now but when you tried to talk your family into playing Russian roulette you had to know if you survived, you’d have to see a shrink at the very least? Right Hector?” I had patients that tried my nerves and patients that gave me the nerve to try on their behalf. Hector was the former.
Twice a week I rented office space in town where I saw patients that were considered clinically insane but functional, whatever that meant. They seemed to be my expertise so they were referred to me from such sources as the state penitentiary and Wheaton Medical, never more than ten patients at a time, five a day and that was it. I had a great support staff with the local psychiatric hospital less than a mile from my office. I didn’t accept insurance so patients were all self-pay. For most of them this wasn’t a problem but for Hector it was so he bartered and I went for it. Hector’s brother owned a swimming pool business and banged out a brand new in-ground in a week two summers ago.
I usually never asked my patients where they came up with three. That was their business. They’ll pay three hundred dollars for a day at a spa so why not for their therapy. When they had to pay directly from their pocket like that and cut out that third party, they demanded more for their money and behaved more like consciensous consumers instead of victims to the healthcare system. I for one liked that sort of market driven system. It was also pretty certain most if not all would have to come at least once a week due to the severity of their psychosis. It was also the reason I didn’t see these patients in my home. I made it a tenet never to mention my family member’s names or have pictures of any of them, one never knew especially given the population I was dealing with. Over the years I had learned it was a safe practice most cops, hospital staff and therapists abided by. There were some very crazy folks out in the world and most of them were not taking enough medication.
Hector didn’t say much during our sessions and I knew he was bored but he had yet to show the appropriate remorse for the fright he had given his wife and kids that night. He just kept repeating that the gun wasn’t even loaded so what was the harm. He obviously didn’t get it and I wasn’t doing him much good at this point.
“Have your probee call me before your next session, he’s got my number.”
“Why man, what the fuck did I do?” Hector tensed his shoulders and stuck out his jaw. “Why you wanna get me in the red, man?”
I wasn’t quite sure what “in the red” meant but I let it pass. “You didn’t do anything Hector but that’s the whole point, you’re contributing nothing to these sessions and yet my four-year-old spent the past two summers jumping in the pool your bro put in my yard. You’re not getting your bang for the buck here!” Somehow I needed to break through to this guy. “I’m willing to refund the pool money and you can get another more competent therapist for your situation. No hard feelings, I’m happy to pass on the file to the new guy, unfortunately most of the notations are me trying to get you to say something.” I smiled at Hector who caved in and slumped back down on the couch in his usual spot.
“Doc, listen, I don’t want another guy, you do good work. It’s me, I’m just not good at communicado. You know. I clam up. You got all these degrees and I didn’t even finish high school.” Hector waved his hand around the room at walls that had nothing hanging on them, just bare beige walls.
“Don’t even go there Hector, if I didn’t have a degree there would be some other poor bastard sitting in my chair instead of me and you’d still be sitting there. This is not an even playing field because it’s not a game. I am here to help you and when I can’t see that working out for you I find it in your best interest to refer you to someone better equipped.”
“You know, I thought about joining a gang a few weeks ago and I didn’t do it because of you. I thought of you and knew you’d be disappointed in me so I didn’t. I really am a decent guy. That night with my family I can barely remember. I never would hurt them intentionally and now I see my little Nalya flinch whenever I go near her. She used to run up and hug me but she doesn’t do that anymore and I feel ill.” I saw tears in Hector’s eyes and I felt like crying myself. We had a breakthrough for the first time in four years. I handed a tissue to Hector.
“Okay, so are we ready to get into the real work now?” I asked in all sincerity.
Hector tossed the tissue in my direct and gave a wave off with his hand and laughed like we were old friends. “You always so serious doc. You need to lighten up sometimes. I promise to be a better patient if you promise to let me make you a margarita, Hector style.”
“You’re not supposed to be drinking alcohol Hector, remember part of your probation?”
“I’m not drinking it, just mixing it, you’ll be drinking it! I bartend down at Cuervo on Markus Boulevard.” Hector smiled at me and I saw genuine pride in his face that he had a legitimate, paying job.
“I’m happy for you but just be on guard for the triggers. The things that drive you backwards towards old behaviors which let’s face facts, Hector, were very bad.”
“Hey, I had a breakthrough, you said so yourself so don’t be a parade rainer. Let me enjoy the moment. Now I’m going to leave here with that chip back on my shoulder because of you.”
“My job is to bet the eyes in the back of your head.” I closed his papers into the manila file on my desk. “See you same time next week and don’t worry about your probee making the call this time but keep up the momentum or I’ll will feel like a failure and we can’t have that.”
My second patient that morning was Laurel Jamison one of my borderline patients; smart, talented, beautiful and completely narsasistic. But there was also something very special about Laurel. I couldn’t quite put my finger on it as it remained somewhat elusive and that was why I accepted her as my patient recently, though granted, her wounds were fresh an deep and permanent. My job was to simply keep her alive.
“I want to have sex with him but then I think he would want more and I’m not capable of giving more.” Laurel was “Listen Laurel, you don’t love the guy so really it would be just sex. Is that what you want? Loveless sex?”
“It’s better than sexless love.”
“You’re hopeless and times up anyway darling.”
Laurel liked me, I knew that because she came back each week this month and I saw that as a good sign. She confided that if her sister hadn’t died she’d never have gotten any help for all the other things that were so messed up about her. As strange as that is, I understood what she was saying. She had already been a tortured soul even before the tragedy. When Laurel’s baby sister drowned, she was supposed to be watching her but instead Laurel was fooling around with a boy from school. Her borderline tendencies went full throttle. Then almost two months ago, Laurel’s mother committed suicide, and without a father Laurel was on her own at eighteen.
In four months’ time, Laurel had lost her family and she blamed herself and always would. I knew that. Her guilt was almost unbearable at firsnext to me an droll my snow globes around and around. She described the snow falling as tiny fairys with no rhythm and when they settles she said it made her sad. Like it was an ending to something beautiful. She said someday she was moving to the north pole. Her mother had told her it was wher her father lived when she was growing up. She damitted she knew her mother was schizophrenic, that she said things she believde to be true but were indeed false. Still, she dreamed of living in a place where it snowed all the time. Everything was blindingly white.
I had known we had much work to do on Laurel’s stability but at least she spoke even if it wasn’t really directed at anyone in particular. She’d pick up the snow globe and it was as if a key was turned and she relaxed just a bit, just enough to let in some light. I had used the snow globe, a trick from early days of grad school to allow a patient to see the chaos of the snow but how physics will always allow the snow settle – their lives will calm down no matter how bad the storm. It worked and I had always kept a snow globe on my desk, ironically finding Vermont to be the perfect setting. It wasn’t the North Pole but it was still quite wintry all the same.
There were sessions, Laurel paid for ninety minutes and just sat curled in a ball in the arm chair, watching the snow settle only to shake the glass globe vigorously again. I understood what she saw in that globe, it was like focal point for her pain. Having read and reread her case file, I saw the connection and I let it be. She casually admitted one session, globe in hand, she herself had contemplated suicide, the first few weeks it was a daily struggle not to buy a gun. Somehow managed to get through that phase of grief. After many hours of soul searching therapy, Laurel was able to, at the very least, contemplate intimacy. I was proud of her for that and told her so before she left my office that day.
Finally, I recalled being so grateful that so far two of the five of my patients both had okay sessions that morning. It was noon and time for me to meet Jane and Sophia at the doctor’s office.