TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: I usually try to save the times. But with the snow day on Friday, I ended up rescheduling a bunch of people.

CLIENT: Yeah.

THERAPIST: But luckily this worked out.

CLIENT: Yeah. (LAUGHTER)

THERAPIST: So how have you been and what’s going on?

CLIENT: Well, I think I saw you before Josh (ph) had the surgery.

THERAPIST: Yeah. So last I heard through e-mail they were waffling on it. So they did it.

CLIENT: Yeah. So they ended up shuffling around a little which caused both of us a little stress. But they did it and it went well.

THERAPIST: Good.

CLIENT: And he’s now just recovering which is good because then we’ve got progress towards going home.

THERAPIST: Oh that’s good.

CLIENT: Just bad news every day. (LAUGHTER)

THERAPIST: Which pump did he end up with?

CLIENT: He ended up with the double pump. So... (PAUSE) It’s... It’s pretty like Medieval. Like it’s... (LAUGHTER) (PAUSE) My (inaudible at 00:00:53) the day before his surgery. That was... It was like, “Next year, there will be this internal pump that will have these like...” These two pumps, they like look like they’re from the 80’s and they hang out your abdomen, pumping your blood around, attached to a giant air compressor. [00:01:07]

THERAPIST: Wow. That’s a pretty big adjustment.

CLIENT: Yeah. I mean, he hasn’t been himself yet obviously. He’s been drugged and out of it and in a lot of pain. So... (LAUGHTER)

THERAPIST: Oh.

CLIENT: He just sent me an e-mail this morning that he’s going to go for medical marijuana as his like home pain thing because they’ve like exhausted the amount of opiates or whatever he’s supposed to really be getting. So right now he’s getting like (inaudible) and Tylenol which is...

THERAPIST: Which is probably not cutting it.

CLIENT: You know, I was really surprised. Like I thought they’d be giving him hard core drugs for a while and they’re trying to get him off of them really fast and then telling him because he’s small, thin, and young that he’s going to have a lot more pain than anybody else. (LAUGHTER) [00:01:57]

THERAPIST: Huh. That’s interesting.

CLIENT: It’s like the more muscles you have...

THERAPIST: Then it takes longer to heal.

CLIENT: ...the smaller you are, the more like it disrupts things and it just hurts more. So... (PAUSE) I don’t know. I mean, I’ve gone from crying all the time to just sort of feeling... I don’t know. I’m not sure if numb is the right word. But just I’m not really worried about tomorrow or next week. I guess (inaudible at 00:02:23) either. Just...

THERAPIST: Resigned. Does that feel right?

CLIENT: No.

THERAPIST: Okay.

CLIENT: I still feel kind of like in limbo.

THERAPIST: Okay.

CLIENT: I haven’t decided how I feel, I guess, or what emotions I’m having. I don’t know. (PAUSE) Which is better, I think.

THERAPIST: Well, I guess it’s movement from, I mean, feeling sad and hopeless to something else that you don’t know. But those are pretty hard things to sit with. I mean, being so scared and feeling so sad is really hard.

CLIENT: Yeah. (SIGH)

THERAPIST: I think you can only do that for so long.

CLIENT: Also, it’s been really hard to interact with people (LAUGHTER) especially because this week people are coming back to school. I’m trying to go to school. There are more people around. Anybody who’s asked me what they want me to do or want them to do for me when they get back... I said, “Just hang out with me.” [00:03:17]

I don’t (inaudible at 00:03:21) a lot of social plans. (LAUGHTER) So if I’m not feeling totally miserable, that’s helpful.

THERAPIST: Yeah. So you have something to go do. A little bit... Being in touch with the other parts of your life... I mean, Josh and what’s going on with him medically is one part. But it’s not everything. I think it’s hard to have it be everything.

CLIENT: Yeah. I don’t know how he’s going to take me coming to the hospital a lot less. I tried to go last night just for a few hours and had to push myself away. Or not... I mean, he was like, “Oh, stay with me. Stay with me.” I just couldn’t stay with him (SIGH) forever. And I’m going to have to like let go of not getting all the information that he gets every day. So hopefully I can make some sort of like separation (inaudible). [00:04:11]

THERAPIST: Well, what kind of schedule do you feel like would work for you? Let me turn the sound off. Sorry.

CLIENT: Oh sure. That’s fine.

THERAPIST: (inaudible at 00:04:21)

CLIENT: Am I your first appointment?

THERAPIST: Yes. (LAUGHTER) (PAUSE)

CLIENT: I don’t know. I almost don’t even care about making a schedule which is weird. I mean, who knows. If he calls me and he’s like, “They’re doing training on my legs today,” I’m going to go.

THERAPIST: You’re going to go. Yeah.

CLIENT: So we have some... There’s another couple in the hospital who are our age and the girl just had a heart transplant. So they kind of talked to us on Thursday. So it’s going to be nice. (PAUSE) So I don’t know. I can’t make a schedule. (LAUGHTER) [00:05:01]

THERAPIST: Yeah. It’s your...

CLIENT: That I feel okay with, I guess.

THERAPIST: Well, it sounds like flexibility is really what you need right now. So being able to drop whatever plan you might have had and go into the hospital or something specific is happening that day or if he really needs you one day than another or if you feel like you want to be there.

CLIENT: Yeah. I mean, I guess I don’t want to be there anymore. It’s... When I’m at the hospital, I feel like definitely... I don’t know. It’s exhausting to be at the hospital. (LAUGHTER) You barely ever just get to like sit and relax. It’s uncomfortable for everybody else to be there. But... He’s got the hospital bed. Everybody else is sitting on some uncomfortable chair or something (PAUSE) moving around all the time when they come into like help with stuff.

THERAPIST: Yeah. You feel in the way.

CLIENT: Yeah. So it’s exhausting. So I’m just so tired of the hospital. So... (PAUSE) But... [00:05:59]

I mean, a lot of things have settled down. The dogs are taken care of.

THERAPIST: Oh. What did you end up doing with the dogs?

CLIENT: Oh gosh. They went to foster care (PAUSE) which like right after surgery, Josh told me how frustrated he was with me about that. (LAUGHTER) But he’s accepted it, I think. So that’s sad. But it’s done. So...

THERAPIST: Do you have a say in who the foster parents are? Is that placed...

CLIENT: No.

THERAPIST: ...by an agency?

CLIENT: It’s a volunteer group. Yep. So... But I met one of them who came to pick them up and she was really great. (inaudible)

THERAPIST: I’m sure you will. (PAUSE)

CLIENT: Yeah. I mean, I just... (PAUSE) I can’t even think about the future, I guess, which is better than...

THERAPIST: Yeah. The right now is enough.

CLIENT: Yeah. (LAUGHTER) I’ve been sleeping a lot which is good. [00:07:01]

I had a little bit of like a panic because my friend offered to go skiing with me last Saturday. But she wanted to go early and I had to like set an alarm. (LAUGHTER) I almost canceled on her. But I didn’t.

THERAPIST: How was being out there?

CLIENT: It was great. I didn’t get (inaudible at 00:07:25) lose my mind because I had her to ski with and Josh wasn’t like sitting in the lodge being miserable like he usually would be. So that was nice. (PAUSE) I don’t know. It’s hardest at night. I take the train home from the hospital and there’s some couple on the train. (LAUGHTER) (inaudible) sad days.

THERAPIST: That’s understandable. It must be hard to see other people having kind of normalcy. Your life has not been normal at all. [00:08:03]

CLIENT: Nor will it ever be or will it be for a very long time. (LAUGHTER)

THERAPIST: Yeah. Your normal is going to be different and you don’t yet know what that’s going to look like.

CLIENT: I’m surprised I’m not worried more about when he comes home. I think I just know it’s going to be really difficult.

THERAPIST: Are they making projections about coming home?

CLIENT: Weeks (PAUSE) barring any problems. So... Yeah. It could be a couple of weeks.

THERAPIST: Does that feel long or short to you?

CLIENT: Short. It feels short. (LAUGHTER) Because right now, he’s being taken care of. When he’s at home, it’ll be (inaudible at 00:08:55).

THERAPIST: Well, I think finding out what kind of home health help, what kind of aide you can get and maybe starting those conversations or starting to ask those questions about like what’s available so that it’s not just you and his mom... But is there something you can get in transition or... [00:09:11]

CLIENT: Yeah. I lot of that takes a long time to like put into place. He could get on disability maybe in February which will help with work (inaudible). (LAUGHTER) And then they’ll have a lot of options with the disability for (inaudible at 00:09:31).

THERAPIST: Yeah. But you won’t have that available when he comes home right away.

CLIENT: No. (PAUSE) And my advisor has been very nice about it, really, really nice about it. So hopefully he’ll continue to be. (PAUSE)

THERAPSIT: Yeah. Having support in school, you know, both from friends kind of doing stuff with you at school but also flexibility and, you know, understanding about, you know, your schedule. Your timeline might be a little bit different. [00:10:07]

CLIENT: I mean, I’m so grateful for school because, I mean, I was at the hospital... I just stayed there over the snow storm. I just didn’t want to leave in the snow. (LAUGHTER) And there were nurses who were told they had to come in the next day so they were like sleeping (inaudible). I got an e-mail from (inaudible) “We’re not closed. So if you need to take an unpaid day...” Like I don’t know what I’d be doing if I was still working in a real place. (LAUGHTER) So I feel so lucky. (PAUSE)

THERAPIST: Yeah. Right now you have the kind of job that allows that flexibility.

CLIENT: Yeah.

THERAPIST: I think being a grad student is a job. It’s just not a high paid one.

CLIENT: Oh right. But there’s no, not very many rules.

THERAPIST: Right. Yeah. It’s a lot of flexibility in how long you take to do your work and where...

CLIENT: It still surprises me all the time. (LAUGHTER) Yeah. [00:11:01]

(PAUSE) So I am really grateful for that. (PAUSE)

THERAPIST: I think being able to note to yourself the things that you are grateful for is pretty amazing right now and also really helpful. Being able to see that there are, even though some things are so scary, that other things you do have that you can be thankful for makes it a little more balanced. It’s pretty impressive that you can find them. They’re there. But that you can find them is pretty impressive.

CLIENT: Well, I was really nervous about telling my advisor. It caused me a lot of stress. It was there and it took me a while to find out that it was okay.

THERAPIST: Yeah. Well, I’m glad his reaction was a supportive one. [00:12:03]

When I saw you last, you were pretty upset at your mom’s reaction to how she was handling, you know, the news about Josh and also her communication with you. How have you guys been doing?

CLIENT: (SIGH) Good. I mean, they’ve been coming to visit Josh which he loves. They keep asking me how I’m doing. I mean, now that the surgery’s over, it’s good. My mom is channeling her energy more into helping rearrange my house and do like things that need to be done to help Josh come home. And we don’t really talk anymore about why I’m staying with him or anything. And since my dad was really supportive, I just sort of let it be. (PAUSE) [00:13:00]

I talked to a few friends about it. They were all like, “Of course she would say those things.” They seemed to think it was a reasonable reaction for a mom. So...

THERAPIST: What’s that like to hear them kind of validate her response?

CLIENT: It’s good. I mean, it makes it seem less horrifying. So...

THERAPIST: That they can see where she’s coming from even though they don’t agree.

CLIENT: I have a lot of friends who have way worse relationships with their mom on a regular basis than I do with mine. So... (PAUSE) As long as she doesn’t, you know, disappear...

THERAPIST: It doesn’t sound like she is.

CLIENT: Or continue to ask me what I’m doing. It seemed like a onetime thing. (PAUSE) So... (PAUSE) I mean, and the dogs were a big source of tension.

THERAPIST: I know you were really disappointed with her lack of ability or willingness to do more for them to keep them out of foster care. [00:14:01]

CLIENT: Well, and it was also hard because Josh was so, so upset about it and upset at my mom too. Like I’m sure he’ll like hold a little bit of anger about that forever. (LAUGHTER) (PAUSE) He just doesn’t understand. (PAUSE) So that was hard to have him tell me that...

THERAPIST: Yeah.

CLIENT: ...and have to like pick a side, I guess. I wanted to be on his side. But...

THERAPIST: Did you feel like you ended up defending her? (PAUSE)

CLIENT: I don’t even know. A little probably. (PAUSE) You know, my parents kept asking what they could do to help and Josh was so mad. He was like, “Well, just take my dogs.” (LAUGHTER)

THERAPIST: “Here’s the thing you can do.”

CLIENT: Yeah. I mean, at some point, we should probably talk more about the, “It’d be different if you were married comment.” But...

THERAPIST: You’re not ready to talk about it now. (PAUSE) [00:14:59]

CLIENT: There’s been more talk of like, “We should probably get married sometime before he has a heart transplant.” (LAUGHTER) But... (PAUSE) In fact, one of his friends offered to marry us and that really threw me for a loop. I got upset for a couple of days because... I don’t know.

THERAPIST: Do you want to talk about that? What was your... What was your reaction?

CLIENT: It was just anger. Like I felt kind of (inaudible at 00:15:27). And it was a party. It wasn’t, you know (LAUGHTER) you know, me marrying him in case he dies. Either at his hospital bedside... You know, we could get married but then we couldn’t... We can’t have sex for who knows how long. He couldn’t dance with me. There’d be no celebration.

THERAPIST: You wouldn’t have your wedding. There’s a difference between the wedding and the getting married. [00:15:55]

CLIENT: Yeah. I mean, he’s always been like (inaudible) and I always told him it was just tell everyone, show everyone, proclaim our love in front of everyone, whatever.

THERAPIST: Yeah. (PAUSE) Yeah. I mean, the public kind of support and acknowledgement and celebration is a big piece of, you know, planning a wedding celebration that goes along with the marriage.

CLIENT: Yeah. I mean, getting married (LAUGHTER) at his hospital bed would just seem so sad. I don’t like just... (PAUSE) Really sad.

THERAPIST: Yeah. You’d feel like you were missing out on part of what you imagined. (PAUSE)

CLIENT: Well, it wouldn’t be... There’d be nothing... It wouldn’t feel very celebratory or happy.

THERAPIST: Because doing it now feels like a formality in case of disaster?

CLIENT: Yes, yes. (PAUSE) Yeah. Which is not helpful. [00:17:01]

THERAPIST: Is not a good way to think about it. Yeah. (PAUSE) I guess one doesn’t have to preclude the other. (PAUSE)

CLIENT: No. I just have to find a way to make it (inaudible).

THERAPIST: Well, or doing it in two parts. I mean, if you want to get married for the ease of paperwork...

CLIENT: (LAUGHTER)

THERAPIST: ...now and later when he’s healthier and mobile and do the traditional wedding party that you’ve imagined, you can do that. (PAUSE)

CLIENT: Yeah. But I’d also have to tell everyone, “We got married just in case he dies.” Like I’m just... And then later it feels like tragedy. [00:17:59]

THERAPIST: Yeah. (PAUSE)

CLIENT: But it also makes me feel guilty.

THERAPIST: What do you feel guilty about?

CLIENT: I don’t know. It seems selfish of me to have a celebration because I know he’d want to get married in case he died. That would be something positive for him. (LAUGHTER)

THERAPIST: Do you want to be married in case he dies? Is that important to you?

CLIENT: I don’t know. It sometimes feels really important and sometimes it doesn’t.

THERAPIST: What would be different? What does it mean... Do you know what it means to him and what would be different for you?

CLIENT: I don’t know. We’ve never really been able to talk about it in depth because he’s unable...

THERAPIST: He’s not really able to have these conversations. Was it something you ever talked about before?

CLIENT: Oh yeah. We even talked about before his surgery how we should get married before he needs a heart transplant. It felt really important at the time. [00:19:01]

I’m pretty sure it’s really important to him. (PAUSE)

THERAPIST: What does it mean to you or what would it mean to you?

CLIENT: For us to get married before he had a heart transplant? (PAUSE) (SIGH) (PAUSE) I don’t know. I guess that we’re really committed going into this no matter what and everyone else knows it. (LAUGHTER) (PAUSE) I don’t know if that’s enough. Or I guess that we were planning on having a life together (PAUSE) no matter what. I mean, I haven’t felt I’ve wanted to run away recently. (PAUSE) [00:20:05]

THERAPIST: Well, I mean, a thing you keep coming back to in here is that it’s a question that comes up for you but you keep deciding to stay. Like every time the question comes up, you decide to stay. (PAUSE)

CLIENT: Yeah. And I would really love a day off from going to the hospital.

THERAPIST: Of course you would.

CLIENT: Except that then I would feel really sad that I didn’t see him. (PAUSE)

THERAPIST: That’s pretty informative. I don’t think anyone wants to hang out at the hospital. I mean, not wanting to go to the hospital doesn’t mean that you don’t want to be with him. I can understand why you don’t want to be with him in the hospital. The hospital is not a fun place to be.

CLIENT: Yeah. (LAUGHTER) And I’m still getting used to seeing him... I mean, he looked awful.

THERAPIST: Yeah. That must be really hard to see.

CLIENT: I didn’t even know he was (inaudible at 00:21:01) at all until the social worker came and was like, “He wanted to talk to you about how he looks when he comes up from surgery because he looks...” He looked like he was dead. He looked creepy. And he was on a ventilator and had a million tubes coming out of him. [00:21:15]

You know, they weren’t sure if he was going to wake up for a day or for a couple days or when. Yeah. And he asked for her to come and talk to me which was good actually...

THERAPIST: Yeah.

CLIENT: ...because he looked pretty scary. And he has a huge gory slit down his chest. (PAUSE) And he hasn’t been able to eat for a long time, not really, so he’s like wasting away. He can’t shower. He won’t even like let me... He’s so sick of other people touching him he doesn’t even care like at all. [00:21:55]

THERAPIST: I’m sure vanity drops pretty low on the list.

CLIENT: I mean, there were definitely stages of him attempting to have a little privacy or like clean up a little.

THERAPIST: It’s gone.

CLIENT: It’s gone at this point. Yeah. (LAUGHTER) (PAUSE) And the nurses before were trying to keep him in one piece for a while. With all the stuff he’s had post-surgery, there’s just like no way. (PAUSE) He still wants people to come see him.

THERAPIST: Yeah. It’s a really shift in perspective than (inaudible) that he’s gone through have really shifted his perspective on what is important.

CLIENT: I don’t even know what his perspective is right now. It’s definitely different. But he’s definitely not... He’s like in slow motion basically is what it feels like when I talk to him. Yeah. And even... I can’t hold like a real conversation with him that much.

THERAPIST: Yeah. I’m sure that’s probably pretty normal.

CLIENT: Yeah. They say he’s doing great. So otherwise I would be worried. (LAUGHTER)

THERAPIST: Your perspective of great and theirs is probably different. (LAUGHTER) But they may know what... They know what the typical reaction is to such a major surgery and being so sick for so long... [00:23:11]

CLIENT: Yeah. I don’t know what he’s going to be like when he’s finally like back to the real world. (LAUGHTER) (PAUSE)

THERAPIST: I don’t have a ton of inpatient experience but I have a little bit of working with patients from the hospital. And one thing that sort of happens when you go home is you have a mix. Right? There’s the elation of being out of the hospital and back in a more comfortable place. But there’s also a lot of fear for a lot of families and the patients because so much of the support and like the safety net of the nurses stations right outside...

CLIENT: Yeah.

THERAPIST: ...the monitors right outside that let you know what’s going on are gone. So sometimes that can be really scary. I think the other thing that sometimes people have kind of mixed emotions about is that when you’re in the hospital, it’s a little bit easier... You know, what’s normal around you is, you know, a bunch of other people that are in hospital jonnies (ph) and are being completely exposed to everybody else in the world and so a lot... [00:24:19]

You know, that privacy, that need for being a little bit put together... It’s easier to let that go in the hospital because the baseline for...

CLIENT: Yeah. (LAUGHTER)

THERAPIST: ...what’s going on is so different. And when you’re at home, it’s kind of harder to hold that perspective sometimes because what you’re used to at home is having a certain level of, you know, privacy and daily living kind of hygiene type of stuff that you kind of get a pass on in the hospital. You don’t have to keep that stuff up.

CLIENT: (LAUGHTER)

THERAPIST: And so it can be harder to remember like that he’s not going to be able to do that kind of stuff still. Hopefully, by the time he gets released, he’ll be feeling better and he’ll want to, you know, brush his teeth, have you wash his hair, that kind of thing. But it will be hard. [00:25:07]

CLIENT: Yeah. I haven’t done well with stuff like that in the past. He’s either been constant where he, something was wrong all the time...

THERAPIST: I mean, he was scary.

CLIENT: Yeah. And it’s...

THERAPIST: (inaudible at 00:25:15)

CLIENT: He was right. Yeah. And his VADs (ph) going to be pretty precarious. There’s a pretty high chance of a problem happening. So I don’t know. Hopefully he’s not just constantly in a panic about it. (PAUSE) And I don’t know what he’ll be like in public. We had this... My brother’s friend...

THERAPIST: Right. He’s going to be... Pumps are obviously really visible.

CLIENT: Yeah. The guy... I think I told you my brother’s friend has a pump.

THERAPIST: Yeah.

CLIENT: Just one though. He came and talked to him and he is still one medication to not be depressed about it.

THERAPIST: That’s very common with heart patients. [00:25:57]

CLIENT: Did I tell you that they tried to put Josh on an antidepressant but it was, not quite a sedative... They said it was for helping him sleep (inaudible). It was kind of one of the old ones that ended up being more for sleep than for him.

THERAPIST: Oh okay.

CLIENT: But anyway, it turned him into this zombie. It was really scary.

THERAPIST: Oh. That’s not great. (LAUGHTER)

CLIENT: So I hope... I don’t know if he’ll try again.

THERAPIST: Yeah.

CLIENT: I don’t know what his mood is. Like...

THERAPIST: Well, it’s something to monitor.

CLIENT: They keep asking him, “Do you want anything? Do you want something for anxiety?” He’s, “No, no, no.” But they’re asking him like constantly.

THERAPIST: They’d like him to say yes. (LAUGHTER)

CLIENT: They would which is a little... Yeah. I don’t know if that’s good or bad. (LAUGHTER)

THERAPIST: Well, I think depression after cardiac events, I mean, even more minor cardiac events... It seems strange to call a heart attack a minor event. But in comparison, it is. Depression is pretty, more common after a cardiac event even for people who have never previously experienced depression. And having that properly treated is really beneficial to recovery from the cardiac event as well. So...

CLIENT: Yeah. [00:27:05]

THERAPIST: Having them, you know, continue to offer, ask, evaluate is really important because if he does start to have symptoms of depression which is different from him being sad, him being concerned, him being angry about what’s going on... That’s not depression. That’s a normal reaction to his situation. If, you know, if that continues in a way that makes it more indicative of depression than a normal reaction to what’s going on, then treating that is really important both for mental health and for his recovery physically. So having people on top of that when he’s... You know, right now, he’s not really able to participate in therapy. But when he is, making that sort of an option as well...

CLIENT: Yeah. I mean, the (inaudible) worker, I hope, the social worker’s potentially starting.

THERAPIST: Great. [00:27:57]

CLIENT: So that’ll be really good.

THERAPIST: Yeah. That may be something he’s more willing to go to than traditional therapy.

CLIENT: He has... Yeah. But he probably should have had therapy a long time ago. I’m not sure now he’ll need it as much. I mean, I’m hoping that the... He’s really excited about (inaudible at 00:28:11) part and the thought of that in the future...

THERAPIST: He’s really excited. Great.

CLIENT: I don’t know how these pumps are going to make him feel especially if he has to have them for months and months and months.

THERAPIST: Right.

CLIENT: Who knows? But I’m hoping that the...

THERAPIST: He has to have them until he gets a new heart. Right?

CLIENT: Mm hmm. Yep. And they have a pretty high complication rate. So there’s a non-small chance that he could end up back in the hospital with them. There’s other people waiting in the hospital until they get a heart. It’s awful. So I’m glad he gets to come home at least because it’s definitely a chance he wouldn’t.

THERAPIST: But kind of being on edge, looking for something that’s gone wrong with the pumps is going to be hard.

CLIENT: Yeah. I don’t know if he’ll be like that or not. He does go once a week until he gets a heart for like a clinic checkup. [00:28:59]

THERAPIST: That will probably feel like a good safety net for both of you. Right? So then you get to not have the be the person responsible for determining whether something’s a problem or not and...

CLIENT: Yeah. As long as he doesn’t find a problem the day after. (LAUGHTER) But yeah. Really, I would like to find a way for me not to have to take him every week also. (PAUSE) Which I’m sure I can figure out. But, I mean, at this point, if he had had therapy a long time ago, it could have almost helped everything.

THERAPIST: Well, just to have another person who’s supportive and pathic (ph) and kind of part of the team.

CLIENT: Yep. And he’s changed so much since he went into the hospital about how he feels about all of this. Yeah. Who knows how he could think when he comes home.

THERAPIST: Yeah.

CLIENT: Even just wanting all these people to visit... He had his boss visit last night, just sitting there looking like death, thrilled that his boss came to see him. So that’s huge. [00:30:07]

THERAPIST: Yeah. I’m glad there are so many people that will and do come see him.

CLIENT: Yeah. I mean, he said my friends can come. He doesn’t care, anybody.

THERAPIST: I think that support is really important for both of you, you know, for you to be able to stay in touch with people. Asking your friends to hang out with you is great. But also so it’s sharing the burden, right, of spending time in the hospital, of being his support. That’s a lot of work. That’s a lot of energy. So for you both to take advantage of the fact that he’s got a network of people that want to check in on him and care for him...

CLIENT: Right. But we’ve never done that before which is such a big regret. (LAUGHTER)

THERAPIST: It took you some time to get comfortable.

CLIENT: Yeah.

THERAPIST: Your process of getting to a place where you could share that was the process that you had to go through. [00:31:05]

CLIENT: Yep.

THERAPIST: I think it... You figuring out how to be comfortable with letting people in and letting people know what you need, figuring out what you can ask for, it took you a long time to figure out how to do those things. But now you’ll take advantage.

CLIENT: I was wondering maybe the other day if... (PAUSE) Like a lot of my anxiety came from having problems that were big but not so big that I was forced to like basically shut off my like worrying about tomorrow. I don’t know. I think I’m happy about how I’m feeling at the moment which is starting at the moment and thinking about it. Tomorrow will be whatever it is which is very different. (LAUGHTER) [00:31:55]

THERAPIST: It’s almost like some, the enormity of this crisis was big enough that it didn’t leave any room for questioning in your mind.

CLIENT: Right. Which as awful as it is, almost feels...

THERAPIST: It’s a relief not to...

CLIENT: ...it’s a relief. Yeah, yeah.

THERAPIST: ...not that have to be the one in charge of deciding whether it’s big enough. It just is. It’s big enough to make it all about right now and give you permission to ask for the help you need.

CLIENT: It’s almost like when there’s a huge snow storm and everything is shut down. You just can’t do anything.

THERAPIST: You can’t go anywhere. Right.

CLIENT: (LAUGHTER)

THERAPIST: You don’t have to decide whether it’s safe to go in or not or...

CLIENT: Right, right. Exactly. (PAUSE)

THERAPIST: Yeah. This was a pretty big snowstorm.

CLIENT: Yeah. But the having no choice is great (LAUGHTER) in a way, a twisted sort of way.

THERAPIST: Yeah. Well, the responsibility of having to make the choice is a lot of responsibility and I think the responsibility did cause you a lot of anxiety. Your challenge now is how to hold onto your comfort with asking for help, getting support, making those decisions without it feeling stressful and without needing it to be such a significant crisis. [00:33:11]

CLIENT: Well...

THERAPIST: You don’t want to have to live in crisis mode all the time.

CLIENT: There was also the problem of like when I had to give this talk right before things got really bad and I just didn’t even care. I had to like really drag myself back into... I guess that was a little bit of anxiety. Right now, if my advisor said, “Oh sorry. Goodbye,” I’m not sure if I would care. (LAUGHTER) Like which is not good either. But I want to do that without being a little, I don’t want to say anxious, but a little, I guess.

THERAPIST: Engaged, aroused. I mean, those are words that you can kind of give yourself as that, as a place where you do care about stuff. Of course you don’t care that much about school right now. [00:34:01]

In the scheme of things, it’s not that important. Right? I mean, yeah. You need to have a job and work at some point. But you don’t necessarily have to put it all on the line to have this particular job. And most likely, you’re not going to have to make that choice. Right?

CLIENT: Right.

THERAPIST: But...

CLIENT: But it’s weird to me. At least before things got weird with Josh, I wanted to do a good job and have a career that I liked and all that stuff. And at this point I couldn’t really care less. (LAUGHTER) Yeah. If I’m doing anything important... (PAUSE)

THERAPIST: I mean, I think right now you’re facing life and death questions. Career really important... Certainly my wish for you is that you’re going to have a career that you really like and is fulfilling. But when you’re talking life or death, it’s second in line at least. [00:34:57]

CLIENT: Oh my gosh. There’s a lady recruiting for nursing school the other day at the hospital. If somebody had pushed me, I would just quit Yale and go into nursing school. Because there’s also like... It’s been so fascinating in a little bit of a way. It’s like...

THERAPIST: Yeah. You’re learning a lot.

CLIENT: Yeah. (LAUGHTER) And like that I would feel like I was doing something useful and important.

THERAPIST: You are doing important and useful things.

CLIENT: Well, career wise. (LAUGHTER) (PAUSE) Yeah. I think I spent all last week looking at how you can become a nurse. (PAUSE) It’d be easy. It’s not that hard.

THERAPIST: I’m sure you could do it.

CLIENT: Well, it’s only like a year or two. (PAUSE) And, I mean, Josh’s daily life depends on how good his nurse is.

THERAPIST: Yeah. They’re very important people.

CLIENT: And his nurses like 90% have been amazing. Sometimes they’re not. [00:36:05]

THERAPIST: Yeah.

CLIENT: (inaudible at 00:36:07)

THERAPIST: Well, you’re going... I think, the amount of time you’re going to spend in the hospital, you’re going to be learning a lot about what his particular care needs are and will be able, I’m sure you probably have at times, picked up some slack where the nurse wasn’t great or caught something.

CLIENT: Well, yeah. But then there’s a lot that goes on that...

THERAPIST: That you don’t know about.

CLIENT: ...I don’t get to know about. Yeah, yeah. (PAUSE)

THERAPIST: I think you being able to acknowledge and appreciate that the nurses play a huge role in somebody’s quality of life in the hospital... (PAUSE)

CLIENT: Yep. (PAUSE) (inaudible) (LAUGHTER) (PAUSE) Yeah. I don’t know. I mean, I hope I can get back into being excited about my path. [00:37:03]

It took a lot of work to get here. So...

THERAPIST: Yeah. Your focus will be there when it can.

CLIENT: Yeah. I mean, Josh... Who knows what he’s going to do. And I, for some reason, don’t care about that either. I used to care a lot about whether he actually got a reasonable career of any kind together and I just don’t.

THERAPIST: You might need to focus on him getting well, getting well enough to choose a career. (PAUSE)

CLIENT: Yeah. I mean, it could be a long time.

THERAPIST: Yeah. You don’t know what he’s capable of right now.

CLIENT: And he (inaudible at 00:37:41) forever because I had been really good to him. He won’t have to go to grad school with a heart pump or waiting for a transplant or on drugs or whatever it is. [00:37:59]

THERAPIST: Yeah. Would that be okay with you?

CLIENT: Right now it would be because I can’t really think too much about the future.

THERAPIST: Yeah. That’s really... That might be a far off question. (PAUSE) Yeah. Getting him well enough to come home comes before getting him well enough to go back to work.

CLIENT: We don’t have any money. I try not to even think about it. I don’t want to say I don’t care because if course I care a little. But (inaudible) (LAUGHTER)

THERAPIST: Yeah. But it’s fallen lower on the list. (PAUSE) You’re both facing a lot of life experience questions a lot sooner than when you’d normally face them. (PAUSE)

CLIENT: Yep. I’m definitely excited to meet this couple.

THERAPIST: Yeah. I think somebody who can... I mean, the closest thing to being able to truly empathize with what you two are going through... (PAUSE) [00:39:07]

CLIENT: Yeah. I have really wanted to ask, I think it’s still the boyfriend of this girl, a lot of uncomfortable questions. (LAUGHTER)

THERAPIST: (LAUGHTER)

CLIENT: Hopefully we’ll get along and we can do that. (PAUSE) Apparently he’s also in grad school too.

THERAPIST: Wow. The parallels are pretty crazy, huh?

CLIENT: Yep. And she was also on a double heart pump for a while. (PAUSE) So... (LAUGHTER)

THERAPIST: Wow. You guys really do have a lot in common in your, what you’ve experienced. I hope they’ll be a good support to you just to be able to have somebody else who can really understand some of the feelings that you’re feeling and the questions that you have.

CLIENT: Yeah. I mean, that’s also why I feel really lucky that we’re in Providence at a top hospital where there could be somebody else.

THERAPIST: Right, right.

CLIENT: Because like there’s a couple other people in the hospital with double heart pump.

THERAPIST: That means they’ve done it before.

CLIENT: That means that probably just a couple times that in the Providence area... You know, there’s only a few hospitals in Providence so they can do this. And that basically takes up all of New England. There’s not many. [00:40:09]

THERAPIST: Yeah. (PAUSE) It gives you a little bit of confidence that you’re in the right system. If he’s going to have to do this, this is the place to do it.

CLIENT: Right. Well, and even if we were somewhere else where they could take care of him, there’d be nobody else doing it.

THERAPIST: Right.

CLIENT: It’d be just him. (LAUGHTER) (PAUSE)

THERAPIST: What do you feel like you need to kind of stay in this place where you’re not anxious about it and you’re...

CLIENT: I don’t know. I have no idea. (PAUSE) (LAUGHTER) I wish I could try...

THERAPIST: Yeah. Maybe it’s not doing anything. Maybe it’s just breathing and facing each moment as it comes.

CLIENT: Yeah. I mean, I’ve been feeling like I can, like I don’t want to hide out. I’m trying not to hide out because I could just like watch TV all day.

THERAPIST: Yeah.

CLIENT: (LAUGHTER) [00:41:15]

So yesterday my friend invited me to get my nails done spontaneously and my first reaction was no. I’m just going to hide out all day. But I didn’t.

THERAPIST: And your nails look great.

CLIENT: Thanks. (LAUGHTER) So I don’t know. I’m going to try to work on being spontaneous.

THERAPIST: Yeah. So I think the idea of just taking each moment as it comes and when somebody asks you to get your nails done and your first, your gut reaction is, “No way,” you next thought is, “Why not?” And if there’s good reasons why not, then okay. But if there’s not really a great reason why not then you kind of face the public. And that can be for, you know, whether it be going into school, going into the hospital, going in to get your nails done, just to double check your responses and push yourself to be out there. [00:42:11]

CLIENT: Yeah. Because that’s always been a problem. But...

THERAPIST: Yeah. Hiding out doesn’t really help. You do need time to yourself. But that’s different than feeling like you’re hiding out.

CLIENT: But having no expectations or not caring (inaudible at 00:42:25) makes it easier.

THERAPIST: It makes it easier. Yeah.

CLIENT: I don’t know if it’s healthy. I don’t care what I do. (LAUGHTER) It’s like...

THERAPIST: Yeah. It’s working now. Yeah. I think, when you’re in crisis mode, thinking about what’s working right now should keep you okay. That’s what you’re focused on. Is not caring forever a good long term strategy? No. But this isn’t a long term thing. This... You know, day by day. (PAUSE)

CLIENT: That’s probably progress that I’m not crying all the time.

THERAPIST: I think it is. [00:42:59]

CLIENT: (LAUGHTER)

THERAPIST: It feels better, right?

CLIENT: Yeah.

THERAPIST: So sometimes the straightforward simple answer is actually the right answer for you. You don’t have to double, kind of second guess it. You feel better, then it’s better. (PAUSE)

CLIENT: It doesn’t feel like myself. It feels good. So...

THERAPIST: No. So that’s...

CLIENT: (LAUGHTER)

THERAPIST: It’s where you are for right now and it’s where you need to be for right now. So...

CLIENT: (SIGH) On Christmas Eve, I knew I was going to spend a bunch of nights in the hospital and I can’t sleep in the hospital. So I was out (inaudible at 00:43:37) closed because I haven’t been there. (LAUGHTER) So I managed to get a random emergency mental health doctor on the phone to get a prescription for Ambien and it was a really awkward, strange, uncomfortable conversation. They’re like, “Who are you? What is going on? What are you saying? You need this like hardcore sleep medication? Why? What? Are you in Providence? Why aren’t you on vacation?” (LAUGHTER) [00:44:09]

That almost started my not really caring because it’s like...

THERAPIST: You were talking to an urgent care guy from Yale?

CLIENT: Yeah, yeah.

THERAPIST: Okay.

CLIENT: There was like one person, probably like one person in mental health, one person in the urgent care in case...

THERAPIST: Yeah. They have somebody...

CLIENT: Yeah.

THERAPIST: And actually isn’t there pharma (ph) on call now (inaudible at 00:44:29).

CLIENT: Who knows? Yeah. I’m not sure. I haven’t actually gone there. But I’ve managed to get a prescription and it was great because I wouldn’t have slept in the hospital without it.

THERAPIST: That’s fine.

CLIENT: (LAUGHTER)

THERAPIST: That’s what on call urgent care is for is in times like those. (PAUSE)

CLIENT: Yeah. I guess. It’s when you’re getting... Oh I’m sorry. Go ahead.

THERAPIST: That’s okay. Now that school’s back in session, make sure you get your script refilled. (LAUGHTER) [00:45:01]

CLIENT: Yeah. I mean, I love Linda (ph) a lot but I was considering asking her if she wouldn’t mind if I saw someone else not related to Yale because it is hard when they’re closed all the time.

THERAPIST: Yeah.

CLIENT: And she’s so busy. I couldn’t get another appointment with her until February. (PAUSE)

THERAPIST: Yeah. She’s not going to be personally offended. I mean, right now the student mental health service isn’t really working for you because you need a little bit more flexibility than they can provide it sounds like and a little bit more frequency.

CLIENT: I can see you too because I just...

THERAPIST: Yeah. The system is really overwhelmed.

CLIENT: The system is overwhelmed. (LAUGHTER)

THERAPIST: (LAUGHTER)

CLIENT: Yeah.

THERAPIST: Yeah. So, you know, she may be able to give you a recommendation of who to see. And she won’t be, she won’t be personally offended.

CLIENT: It’s a lot of work like... But it’s also exhausting.

THERAPIST: (inaudible at 00:45:51)

CLIENT: With Yale, you have to like, yeah, over and over... You know, if there wasn’t someone available I haven’t been seeing (inaudible).

THERAPIST: Right. [00:46:03]

CLIENT: ...all the time.

THERAPIST: Yeah. It’s unfortunate. I also think the situation that you’re dealing with are not the typical situations of the student population.

CLIENT: Yeah. I’m sure I have lots and lots of problems and the situation. (LAUGHTER) But...

THERAPIST: Yeah. But how many of them have their boyfriends in the hospital who just had a heart pump implanted?

CLIENT: (LAUGHTER)

THERAPIST: I mean, generally... And it doesn’t make them unqualified to care for you. But I think being able to empathize with that your situation is and what your stressors are and the kinds of things that you’re dealing with... You may find that somebody who works with not a typical student population has a little more breadth of experience and can understand what your situation is a little bit better.

CLIENT: Yeah. I mean, it’s not their fault.

THERAPIST: No.

CLIENT: It’s just the whole system.

THERAPIST: Yeah.

CLIENT: You get maybe a half an hour appointment maybe one or twice a month, maybe. [00:46:59]

THERAPIST: Yeah. No. I think they’re great clinicians.

CLIENT: Yeah.

THERAPIST: I know a lot of them. But it’s... It is a student mental health service and it’s set up to meet the needs of, you know, the undergrads and graduate students and your situation is not typical right now. (PAUSE)

CLIENT: Yeah. So I might say that next time I see, time I see her.

THERAPIST: Yeah. She may... I would give you names if I knew somebody that was great. But she may have a lot more knowledge of other prescribers and to other therapists.

CLIENT: Do you know any names?

THERAPIST: No. Not... The couple of people that I know that used to be at Yale, now at private practice won’t do just meds. They’ll only do meds and therapy together. I don’t think right now is a good time for you to switch to a new therapist. (LAUGHTER)

CLIENT: (LAUGHTER)

THERAPIST: So she may have a broader range of kind of prescribers she knows that might be a good match (inaudible at 00:48:01).

CLIENT: Is that typical outside of a school to have someone just do medication?

THERAPIST: Not in private practice and I tend to know other private practice people. In other facilities... Like if you go to (inaudible), they do, they have an outpatient mental health place where they have plenty of prescribers working there. [00:48:15]

They will separate it out where they’ll do the psychiatrist or clinical nurse specialist do the meds and they work in conjunction with a therapist if there’s therapy as well. Or any of the other clinics like, you know, there’s a bunch of Yale places around, there they separate meds versus therapy. Most psychiatrists that go into private practice, it’s been my experience that they go into private practice because they don’t want to do meds only. So they tend to only take on patients that are willing to do both their therapy and their meds.

CLIENT: Yeah. I guess that makes sense if you’re not associated with anybody else. (LAUGHTER)

THERAPIST: Right. So... Well, why don’t we wrap up there for today and pick a time...

CLIENT: Yes. [00:48:57]

THERAPIST: ...to meet again. (PAUSE)

CLIENT: Sorry.

THERAPIST: It’s okay. (PAUSE) So next week I have lots of time on Tuesday the 14th and I have some time on Friday the 17th. I know it’s hard for you to predict.

CLIENT: Yeah. I mean I’ve got nothing planned. So Tuesday is good.

THERAPIST: Twelve thirty or two thirty? Which would you prefer?

CLIENT: Twelve thirty.

THERAPIST: Okay.

CLIENT: What was that day?

THERAPIST: The 14th.

CLIENT: Fourteenth. (PAUSE) Can we make one more?

THERAPIST: Sure. Want to do the same time on the 21st?

CLIENT: Yes. (PAUSE) [00:50:00]

(PAUSE) Cool.

THERAPIST: Alright. I will see you next week. Let me know if you need to switch it.

END TRANSCRIPT