It's about to happen

I have a chance this Saturday to either see or create my future. I'm not sure I'm willing to see it if it is not the direction I want to go, and I'm also not sure I have the ability to direct my life myself.

Last summer, on a hot day in July, I got angry at him for what still feels like a real, valid reason to me. Valid or not, though, I was furious and told him in no uncertain terms to get the fuck out of my life and "my" house. (We had moved into it together, the third house we'd rented together, about five years earlier. It was not "my" house, but that's how I referred to it when I was mad.)

I was serious. I wanted him out of my house and out of my life. My therapist and I had discussed this situation in incredible detail for four years. FOUR YEARS and the conclusion we had both drawn was that I needed to extricate myself from the situation.

I had tried to leave before. I had been staying home with our three kids, so didn't have a lot (any!) financial stability or way to move out. I went back to work soon thereafter and am completely financially independent now -- I make as much as he does. I got that financial independence and had my switch flipped when he made me so angry that hot, sticky July day. So I told him to leave.

Which he did. He went out of town on a three week business trip, and when he came home he packed up and moved into his own apartment.

The day he came home from the trip, I begged him not to move out. I had taken the previous 30 days to work through a lot of it, and I realized almost instantly what a remarkable mistake it had been to ask him to leave. I was also terrified, lonely and not at all convinced I wanted to live without him.

He would not budge. He said I had thrown him out a number of times before (true) and that he wasn't going to be a ping pong ball for me. He came clean about his feelings about me -- he was afraid of me and my anger, he hadn't really liked me for a very long time, he was only staying for the children, he had warned me not to say "get out" one more time or he would go (also true).

Look. I know how miserable it must be to live with me. I know my borderline personality disorder makes me into a total ball of fury in a matter of seconds, and that when I'm furious I take no prisoners. I know.

I can't really imagine he'd want to come home, but god I want him to come home. For me, for the kids, for him (ha!). I think there is a chance we could make a good life together. At least a chance.

A couple of months ago I stumbled across the website of a dialectical behavioral therapist who also does couples counseling. In my area!

I sent the URL to him and asked him if he'd be willing to go. He responded with "It depends. You paying? And what do you want out of it?"

I had no answer for that. The answer? I WANT YOU TO COME HOME. That's the honest answer, that's the motivation, that's why I'm very willing to pay the $250 session fee.

But I didn't answer immediately. I waited and spoke with my therapist who told me I had some choices:

-- Tell him the Real Deal and let the chips fall where they may. Maybe that would make him decide he doesn't want to go.
-- Be dishonest and say it is for some other semi-true reason -- like I want to improve our relationship for the times we have to be together, like around the kids.
-- Put my desire to get back together on the shelf -- lock it firmly away -- and go to improve the relationship in general. He caveatted this option with his opinion that he doesn't think I can do this.

It was nearly a month before I answered, and I chose option #1 -- I told him the real reason. I asked him if it's a possibility. He said he doesn't think so. He doesn't think so but he'll go anyway.

I grilled the poor man about it -- I wanted one straw of hope. One tiny little strand of hope, one sentence from him that he'd even CONSIDER coming home. Dear god let him come home. I need him home.

So the appointment is Saturday morning: 90 minutes about this. I have prepared myself the best I can. My goal will be to remain in a listening mode as much as possible, to express remorse for my hurtful behaviors and to over-repair the damage if possible. I am sure this is going to be so emotional for me that I will need a full box of Kleenex, but I don't want my tears to be the centerpiece of the discussion.

I want to know what he thinks. He as in my husband, and he as in the therapist.

I am ON FIRE. I can't sit still, I can't stop thinking about it, I can't stop crying. I can't stop crying now -- 45 hours or so before the appointment -- but I believe I can not cry during it. Yeah, right.

I don't want to manipulate. I don't want to guilt him into coming home. I want him to choose to come home. But I can't make him love me. As the song says, "I can't make your heart do what it won't."

I just so much want his heart to want to come home.

I need help. Tips, ideas, thoughts, prayers, hugs. How will I get through this? How will I convince him to come home? We were together nearly 13 years until I told him to get out. Until I threw away a chance at being together with our grandchildren, finally buying that house we can afford now. Please forgive me for throwing that away, I acted in anger and fear and I am so, so sorry. And I love you.

Where do you think a therapist should discuss her feelings about her clients?

In defense of her offensive post in which she says disparaging things about a patient, Maderine commented on my post of earlier today that:

a) She had (or could have) changed identifying characteristics of the patient so it's perfectly OK, and
b) Gee, she was just expressing her own emotions at the experience of having this patient (oh no!) be difficult to deal with.

What you missed in my original comment, Mandarine, was that in crying out for attention about this, you are exhibiting the very behavior in which you criticize Patient X.

You certainly could have said:

"I have a patient with a difficult diagnosis that requires significant time and attention. He/she has consistently cried out for attention to the degree of feigning illness and making a false claim against me.

"This has caused me great distress, ..."

Is there any reason to identify the patient any further? This is not a scholarly article you are writing for a medical journal in which "removing identifying characteristics" is appropriate and (more importantly) agreed to by the study participants who sign a release allowing this. Do your patients sign a release allowing you to describe them in ANY way in an online blog that is personal, not professional? Doubtful. I doubt any legal privacy policy would even allow that.

If you are absolutely sure of your ethical position, let's take the post to a discussion group of therapists and ask them. Better yet, let's take it to an ethical review board in your state or let your hospital administrator review it.

Even better, you could suck it up like a moral human being and say "My feelings are hurt by this person and I'm angry and a little embarrassed by it all. I tried my best and am frustrated by the experience of treating a person who is not responding. I feel helpless. I cried out in my blog because of these feelings, and maybe I went too far. I will think about this and consider my clients' privacy more thoroughly in the future."

Maderine, the place for you to discuss your feelings about your patients is with your own therapist, a colleague or your boss. Not the Web at large. Even if you really, really want to. Just like your patient, you are desperately seeking attention. I only hope you won't sacrifice the dignity of another human being to get it.

P.S. I laughed out loud when I read on your profile that the first "interest" you list is "fiction." Maybe you ARE your patient.

I suppose if she's crazy, it's all right to make fun

A woman who calls herself Maderine wrote an offensive post yesterday in which she claims to be a therapist of some kind, then goes on to vilify a client with borderline personality disorder, violating that client's privacy and showing evidence of a fundamental misunderstanding of the need for acceptance in providing treatment for this disorder.

Since her comments are moderated, I'm not sure mine will make it on her blog, so I'll post it here:

I'm not sure you'll post this comment, but I hope you read it.

1) If you are, in fact, a person who "treats" clients, you have violated a tenet of your profession by describing -- and in this case vilifying -- at least one of them.

2) Your description of someone with borderline personality disorder is grossly unprofessional and exhibits a lack of understanding of what it means to have this disorder. You are surprised that a patient with this disorder is manipulative? Clearly, her attempts at gaining acceptance at any cost -- including wishing she had cancer so she could be part of a support group -- indicates she is not feeling accepted on a very basic level. It is one of the basic truths of treating a borderline personality disorder that the relationship between a client and a therapist be one of enormous trust and ACCEPTANCE.

It is condescending of you to say you have tried your best (don't you try that way with all clients?) to help this poor, dumb woman. You don't "truly care" for her on one hand and then ridicule her in public.

3) Your own stated need to cry out "Love me, everyone! Love me despite my many failings!" is an interesting statement. Examine that one in light of your client's needs. Isn't she saying the same thing?

4) You probably weren't racist, but you protest very loudly. Wouldn't a professional therapist be able to address this in a manner that seems pretty obvious -- that the poor woman is seeking attention in yet another manner? Is no one seeing that? Did you drop her like a hot potato? I'm betting you did; imagine how that affected her.

You are welcome to blog about anything you want, but your credibility as a therapist is now shot. What state are you in? What license do you have? Would you like me to forward this blog entry to your licensing agency? Your hospital administration?

Perhaps one of your "real life" friends would do it for me.

P.S. Here's the original post, just in case it disappears when Maderine realizes how she's exposed herself legally and ethically:

I Am NOT a Shrimp, I'm a King Prawn, OK?

Strangeness surrounds me, or maybe I'm generating it all, and it's trickling down and forming this weird miasma that just keeps rising. How would I go about finding the source of this strangeness? Consult a psychic? Throw the Tarot? Read my tea leaves (a challenge, since I use teabags)? At any rate, I know not the source but balk at the rising tide of Strange. It makes me feel small and segmented, invertebrate.

After more than a year of blogging, I told some real people (meaning people I've actually seen breathing) about my blog. Now I am reluctant to write. That wasn't my intent. I thought it would be a nice connection; that these, my real-life friends, could read what's on my mind at any given moment, comment if they wish, ignore things if they wish. It made sense at the time. Now I need some verbal Viagra or something.

My heart cries, "Love me, everyone! Love me despite my many failings!" But my fingers are still, my mind blank. Sorry, folks (and You Know Who You Are)--maybe you should just go somewhere else. Leave me with my imaginary friends here. Seriously, I'll be fine. Call ya next week.

And the sudden cessation of my waterfall of words is only the first thing that's playing my nerves like a lutist. The second is that one of my vast collection of patients with borderline personality disorder has decided that I'm racist. She has a limited IQ but an amazing capacity for manipulation. She has a number of illness that are not based on physiology, for example: pseudoseizures, a congenital anomaly that she insists is a tumor, a biopsy-proven benign breast mass for which she has attended a number of breast cancer support groups (and, might I add, she has been politely evicted from these groups across the city). Despite the challenging nature of our relationship, I truly cared for and took care of her. And she has informed the hospital risk-management (read "legal") team that I'm a racist and she's taking her case straight to the governor.

What? WHAT??!?

Since when does not kowtowing when a patient's demands are truly not in her best medical interest (with "best medical interest" as conscientiously defined by a group of her primary and consulting physicians--not just something I randomly made up) constitute RACISM?

There are two schools of thought about the role of race in medicine. One school says that every patient presentation should include race right up front: "This is a 40 year-old white male who is in today for follow-up of hypertension." "This is a 28 year-old Native American woman who is in for a routine OB visit." "This is a 19 year-old student from Vietnam who is in with concerns about abdominal pain." The thinking of that particular school is that there are certain conditions--both acquired and congenital--that are found in certain races with greater frequency than in other races. Therefore, the logic goes, you pave the way to a good diagnosis by presenting race up front.

The second school says that race is irrelevant in the initial part of a patient presentation. "This is a 40 year-old male who is in for follow-up of hypertension" and so on. Their logic is that, at the point at which race becomes important (IF that point is reached), the question can then be asked, "Is this patient at any increased risk for Condition X based on race?" If the answer is yes, it is explained. If the answer is no, it is left to lie. They believe that biases based on race are unconsciously or consciously evoked up front and premature conclusions may be drawn if race is one of the first things a physician hears about a patient.

I fall into this latter camp. If race becomes important beyond the category "Human Race," then we'll cross that bridge when we come to it. I philosophize with residents about this. I rarely specify a patient's race when I am describing a patient. I try, honestly, not to see color at all (while at the same time being culturally sensitive). And now I feel like this person--this desperate, needy person--has just hurled a javelin into my heart. Does my exacting care not mean ANYTHING?

The hospital administration is on my side. They have reviewed the records extensively and concur that I have provided exemplary care. But somehow what they think doesn't matter nearly as much to me as what SHE thinks.

And almost as important as me suddenly becoming racist is this: I'm a Genus-ist, too. I'm all anti-Canine now because of a rather dreadful experience I had with a piece of fruit.

I was cleaning up after dinner this evening and saw half a piece of apple on baby boy's plate. I popped it in my mouth and noticed several odd things simultaneously: the apple piece seemed warm and softer than I would expect. It had a salty flavor that was unusual. It seemed almost moist. I was about to write this off to just being baby boy drool--to which I am no stranger--when big boy came in. "Oh, Mom, I'm glad you moved those plates. The dog was licking baby boy's!" Oh, URP. You have got to be kidding me...I just ate ABC apple from the DOG!!!!

Yes, I know that there are those of you who are doing something else right now and not reading this at all who are thinking, "Dog saliva is better for you than human saliva." All well and good, but go show me the primary research that proves this AND tell me if the research dogs drank out of the toilets and ate tampons for fun? I bet they didn't.

Shit, maybe THAT'S where the miasma is coming from!

...Oh, my Absence of Readers, what else? Plenty more, but I'll save the rest for another time. I feel low tonight, blue and empty. Invertebrate. And nauseated.