TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: So update me. Is there a good place to start?

CLIENT: Well, it turned out Josh had spiked a fever and gotten an infection.

THERAPIST: Oh no.

CLIENT: Which is sort of what I was, was what my worst fear... So last week was pretty terrible. (LAUGHTER) It got under control. But then they ended up doing a bunch more tests which found some fluid near his heart that could have been detected. And it’s just sort of typical surgical swelling type thing that’s not good, I guess.

THERAPIST: Right. I mean, that’s one of the fears with surgery is infection after.

CLIENT: Well, and the (inaudible at 00:00:39) infection. So anyway, they did another surgery to put drains in to get rid of it. And then the drains got clotted up and gross and they had to take them out. And then they decided that the pacemaker could also be a source of infection or it just was not good to have in there if his blood was infected which it was. [00:01:01]

To take that out... So they took that out yesterday. So he’s just been in a lot of pain. He’s really frustrated.

THERAPIST: Of course. And he feels like crap because of the high fever.

CLIENT: Luckily, they got that under control.

THERAPIST: Oh, they did? Okay.

CLIENT: They just pumped him full of antibiotics. And, you know, it’s been hard for me to be at school at the right time to get answers. So I’m like trying to piece together what happened. But I had one nurse who told me that his heart fluid was infected and I thought the surgeon had said that that was the worst case scenario. I couldn’t get anyone to tell me for sure. (LAUGHTER) And I’m still not sure if it was infected. I think the final answer is that it wasn’t. (PAUSE) Anyhow...

THERAPIST: That must be so frustrating not being able to have a clear picture.

CLIENT: Well, I still don’t. I’m not sure they do. But, you know, I told one attending that the nurse had told me that this is infected his pericardial (ph) space which I still don’t understand exactly what that it. (LAUGHTER) [00:02:03]

THERAPIST: Given that you’re not a cardiothoracic surgeon. (LAUGHTER)

CLIENT: Right. And then he seemed offended that I had the wrong story because it wasn’t his fault. I don’t know. So... (PAUSE) Yeah. It’s just all... It’s all a mess. And I got pretty concerned about school. I was in a panic, I would say, about school last week because I started getting a lot more e-mails. Things were really getting going.

THERAPIST: The semester is really started now.

CLIENT: And I had owed my advisor something for weeks and I finally sent it to him. And (PAUSE) it turned out to potentially... Well, it wasn’t... It didn’t... It wasn’t crap. But I didn’t know that for a few days and he was really concerned it was crap. And he was also really concerned that I didn’t have time to put into it because I have so much personal issues.

THERAPIST: He was concerned it was crap having not read it...

CLIENT: (inaudible at 00:02:55).

THERAPIST: ...or looked at it? Okay.

CLIENT: The (inaudible) looked wrong given all of the other stuff we have been doing. [00:02:59]

THERAPIST: Luckily, it turned out to not be wrong. But it very well could have been. So anyway, that was pretty... You know, I had pushed it, pulled it together really fast because I only had an hour between running around or... (LAUGHTER) So he asked somebody to help me and step in like to do some of the stuff I needed to be doing. But I was like, “This can’t continue.” And then Josh got scheduled for this other surgery on Friday. And then the surgery turned out to be... Actually, he was scheduled on Thursday and they didn’t let him eat or drink all day waiting for his spot to open up. It never opened up. So I ended up staying overnight at my friend’s house who happened to live nearby until they could fit him the next day. It was like the most miserable day. And Friday was the most miserable day too.

THERAPIST: You’ve had a lot of miserable days.

CLIENT: Yeah. (SIGH) (PAUSE) What was I saying? Oh, okay.

THERAPIST: That you were concerned about school.

CLIENT: Yeah. So... I had talked to a couple of people about it. I didn’t really know what to do. I was pretty sure I was going to have to do something drastic at this point. [00:04:03]

THERAPIST: Meaning take a leave? (inaudible at 00:04:05)

CLIENT: Yes. So my friends were having a wine tasting party on Friday night. So after Josh got out of surgery on Friday and I saw him and everything was fine, I went home and took a shower and went to this wine tasting party where I got really drunk and my friend, and had like a mental breakdown all night at this party, where my friend and I hatched a plan, a drunken plan for what I was going (LAUGHTER) to tell my advisor which, the next day, actually still seemed like a good idea. Which was to ask him... Because my fear was if I asked for a leave of absence, I would just be totally removed from school and never go back. And also I don’t know why I didn’t give my friends more credit before. They’ve been really good. They’ve seen Josh in pretty gross states. They’ve been reading his website with updates that we post that are often pretty depressing, listening to me every day, taking on my work. I mean, I should’ve given them more credit before, thinking that they couldn’t handle stuff. So... [00:05:07]

THERAPIST: Well, it’s times like this I think where you sort of really do find out exactly who’s there and how much they’re there. And it’s nice...

CLIENT: They’re there a lot. They’re really, really...

THERAPIST: It’s nice for you to be pleasantly surprised that these, this group you have is really supportive and they really care about you and Josh.

CLIENT: And to take a leave of absence would be (inaudible at 00:05:29) which would be really, not leave that but leave it...

THERAPIST: You’d have less access to it.

CLIENT: Yeah. And one of my friends who went to undergrad at (inaudible) couldn’t find any grad policies that said anything like that. But I was, worked myself up into a pretty big panic about it all weekend. So what I wanted was to ask my advisor if I could just not be paid basically and do whatever work I wanted to do or could do so that I didn’t... [00:06:03]

THERAPIST: But still be enrolled.

CLIENT: Because things are progressing that if, like on certain projects that we’re working on, that if I dropped out, someone else would have to take them (inaudible at 00:06:11). And I don’t want to sit at the hospital all day or sit at home.

THERAPIST: Right.

CLIENT: But I can’t be at school twenty four seven either. So that was my hope and this was the drunken plan my friend and I hatched or my friend convinced me on Friday night and it sounded so good. But I was really afraid it was not going to work out or he wasn’t going to be okay with that or whatever. So yesterday, I went and talked to him about it which was good because I was having dreams about it. It was basically (inaudible). I woke up having dreams about it. I was just panicked. Like... (LAUGHTER) So I made an appointment with him on Monday afternoon because if I didn’t talk to him, I was going to just...

THERAPIST: You felt like you were going to explode?

CLIENT: ...explode. You know, who knows when Josh would have another surgery or what...

THERAPIST: Right. [00:06:59]

CLIENT: So it turned out that he doesn’t care. He says he doesn’t care how much work I do as long as it’s just this semester. You know, if this is a crazy crisis for another... He says as long as I want to work, I can do whatever I can do. And actually, I should...

THERAPIST: And be paid or not be paid?

CLIENT: And be paid. Yeah. He says he was planning money. He doesn’t care with money. Which was shocking. I was really shocked. And this is also coming after... The first time I saw him after winter break because he was away, he said, “If you can work 70, 80% (inaudible at 00:07:37) no problem. (inaudible).” And I had bumped into him right after I saw you last. (PAUSE) And I had barely been doing anything, like 5%. So I had been in a panic, a small panic since then trying to figure out how I was going to work 70, 80%...

THERAPIST: Right. [00:07:53]

CLIENT: ...which led to all the rest of...

THERAPIST: Right. And he doesn’t really mean that. I mean, it sounds like this number, as long as you’re wanting to do something and do what you can, it sounds like he’s fine. (PAUSE)

CLIENT: Yeah and... (PAUSE) I mean, yesterday was a great day. (LAUGHTER) I feel really, really lucky that that’s okay with him. (PAUSE) But then there’s today where... So Josh is in excruciating pain. Yesterday, I went to visit him after being at school most of the day. So I had to wait and he just had a pacemaker cut out of him. And the pain drugs weren’t doing anything and the doctor kept coming around to try to talk about how he’s afraid he’s going to get addicted and let’s try some other pain drug. And it didn’t do anything. And I called him this morning to see how he was and he was basically in (inaudible at 00:08:49). He hadn’t slept all night because he was in such pain. (PAUSE) He really wanted him to come bring him macaroni and cheese as soon as possible. I told him I couldn’t and he got really upset. (LAUGHTER) (PAUSE) [00:09:00]

(PAUSE) So I guess that brings me... I don’t know what is going on or how I feel or anything. It’s just...

THERAPIST: It’s really day to day.

CLIENT: (inaudible at 00:09:09) (LAUGHTER) (PAUSE) But at least school... I’m still not down from the panic from the past week or two over talking to my advisor because I still have to somehow make it work but... And I’ve been in such a panic. (LAUGHTER)

THERAPIST: It sounds like you really need to take it day by day. And it sounds like the message that you got from your advisor is that, you know, he’s not worried about the money. He’s not really worried about how much you produce this semester. He’s hoping that it’s limited to this semester. And you don’t... You have no way of predicting what it’s going to look like a month from now, what it’s going to look like tomorrow. (PAUSE)

CLIENT: Yeah. I mean, even this morning, I was still in a panic over whether I should rush over and bring Josh macaroni and cheese, if it was right of him to like demand macaroni and cheese when, you know, I really need to go to school all day or if I should be feeling so bad that he’s basically got ten million open wounds all over him and all he wants is some macaroni and cheese and is that so terrible? (LAUGHTER) Like, I just... I don’t know what’s right or wrong or anything. [00:10:19]

THERAPIST: Well, there’s a difference between what’s right and what’s wrong and what’s possible. I don’t think there is a right or wrong. You know? Is it wrong of him to want macaroni and cheese when you need to go to school?

CLIENT: (LAUGHTER)

THERAPIST: No. It’s perfectly understandable. He wants whatever small comfort he can have because there’s so much that’s uncontrollable and extremely uncomfortable. Does that mean that you have to make it possible? No. I mean, there are... Maybe there are days that you can run over with whatever meal request he wants. There may be days when you can do that.

CLIENT: (LAUGHTER) [00:10:53]

THERAPIST: And then there maybe days that you can’t. As much as it’s fair for him to ask, it’s also not fair for you to not have to meet every need because you simply can’t.

CLIENT: I mean, I know it’s also not just about macaroni and cheese.

THERAPIST: Right.

CLIENT: I know he didn’t sleep all night because he was in, what he calls a twelve out of ten pain and no one seems to be... It’s not they’re not listening. They just...

THERAPIST: But they have concerns about how they can manage it. (PAUSE)

CLIENT: Yeah. I don’t know. The whole pain part of it lately has been really (inaudible at 00:11:31) the worst. I mean, (inaudible).

THERAPIST: Yeah. I mean, that’s something you were struggling with when I saw you last, preinfection. They were having trouble with the pain management then too. He just wasn’t getting relief.

CLIENT: I don’t even remember. But I guess it was probably true. (LAUGHTER)

THERAPIST: I get less information. So... (PAUSE)

CLIENT: Yeah. And I mean, he was in so much pain last night. He was like in tears, could barely talk because it hurt. Like...

THERAPIST: That must be really hard to see. [00:11:57]

CLIENT: It is. And there’s nothing I can do. And he’s trying really hard to be nice to me. But I know he really just wants to scream.

THERAPIST: Right. I’m sure he’s got, you know, about this much frustration tolerance. (LAUGHTER) (PAUSE)

CLIENT: Yeah. Anytime I couldn’t bring him macaroni and cheese, he was like... (PAUSE) (LAUGHTER)

THERAPIST: Yeah. I mean, he’s got nothing left to manage those emotions.

CLIENT: Yeah. And then the last time I was sitting there, he was trying to like relax and then someone came to take his blood and he was... And then someone came to take his temperature and somebody came into check his VAD (ph) things and it was like...

THERAPIST: Give him a break.

CLIENT: Yeah. And he started like just like crying so he couldn’t take it. (SIGH) I don’t know. (PAUSE) Yeah. I don’t know. (PAUSE) I decided today that I will go there because if I don’t I will just go to school and think about what is going on. So I’m going to go bring him macaroni and cheese and hope that it will be the right decision. I’m going to try to come back later and get into a class later today. I hope it all works out. (LAUGHTER) [00:13:09]

THERAPIST: You’re really having to juggle two completely different worlds. (PAUSE)

CLIENT: I think it’s better than having... I mean, I was ready to just not get paid and go to school because I’m pretty sure not going at all would be the worst...

THERAPIST: Yeah. See that’s one piece of sort of normalcy that you can try to keep a foot in.

CLIENT: Hopefully I’m not deluding myself because I do do that sometimes. (LAUGHTER)

THERAPIST: Well, you just need to... If you, you know, try to do this and it’s not working and you can’t keep up with school, then it’s not, you know, it’s a decision you can change.

CLIENT: That’s true. (PAUSE)

THERAPIST: It would be hard to go... If you took a leave of absence, you can’t change that until the end of the semester. I mean, you... But it sounds like your advisor has given you a lot of flexibility so you can continue to be paid and do as much as you can. And I think you need to be honest with yourself and kind of continually reassess, “Can I still do this.” And if at some point you can’t, then you can take a leave then or you can ask to not be, you know, be taken off the roster then.

CLIENT: Yeah. [00:14:17]

THERAPIST: But this is a decision that can easily be undone, right, because you’re not making a change right now.

CLIENT: That’s true. (PAUSE)

THERAPIST: You just have to give yourself permission to check in everyday as to what’s going to work best for today?

CLIENT: I’m just really grateful that my friends... I’ve been able to use them because my parents are so terrified of me dropping out of school that I was talking about being the hospital a lot last week for surgery... Like I basically waited there for two days for surgery that kept getting pushed off. [00:15:05]

You know, my dad... He was really concerned about school and this was before I talked to my advisor so I was pretty worked up about what I was going to say. And if I talk to them about it, they would just not be calm about it. (LAUGHTER) So I ended up, my poor dad, just snapping at him.

THERAPIST: That’s hard to feel that pressure from your parents.

CLIENT: I basically did what Josh does to me when he’s in so much pain. I did that to my dad. And I felt really... I still feel really guilty about it. I wasn’t that mean. I just was pretty, I don’t know, abrasive, I guess.

THERAPIST: It’s understandable that you might lose your cool. (PAUSE)

CLIENT: Well, my dad and I have such a tense relationship anyway. There’s not really space for me to lose my cool and him to know how to deal with that. (LAUGHTER) [00:16:00]

THERAPIST: What did he... How did he respond? (PAUSE)

CLIENT: He just didn’t really say anything. He kind of... I mean, he backed off. (PAUSE) But I also scared my parents to death because Josh really wants to talk to a lawyer about this electro physiologist (ph) and maybe that’s not a reasonable thing to do. I mean, it (inaudible at 00:16:25). But he asked me to call them and see.

THERAPIST: Educate me a little bit. Which one is that?

CLIENT: The electro physiologist is the one who put the pacemaker in...

THERAPIST: Okay.

CLIENT: ...and who treated us pretty badly. He told Josh he just gained weight instead of retaining water and sent him home from the ER, sent him home from his office, said he was fine.

THERAPIST: So you feel like there’s some malpractice there?

CLIENT: I don’t know. But Josh is just so angry about it especially since they just took it out. And I’m furious that he’s been in so much pain for this pacemaker that put him in the hospital...

THERAPIST: Right.

CLIENT: (inaudible at 00:16:57).

THERAPIST: In a pretty dire condition. [00:17:01]

CLIENT: I don’t know. I’m sure he would have, his heart would’ve continued to get worse given what they told us (inaudible at 00:17:11) or not...

THERAPIST: Right, right.

CLIENT: Whatever. I don’t know...

(CROSSTALK)

CLIENT: ...or if it’s the source of all his infection. I don’t know. (SIGH) And Josh has also been upset ever since it happened that he signed papers like a couple hours after he came out of one surgery. I’m pretty sure that’s not right. I don’t know. He just really wants some validation...

THERAPIST: Right.

CLIENT: ...about whether what happened was right or wrong or... I’m sure he should just talk to somebody who knows something about it. But, of course, he can’t really talk to the doctors about that.

THERAPIST: Right.

CLIENT: (LAUGHTER) So I was trying to help him. But (inaudible) I called a lawyer yesterday also before I talked to my advisor and talked and talked and asked him about how this all works.

THERAPIST: Right.

CLIENT: And I told him the story and he started to call me “Hon” and just get through this and call him later and that he was an ambulance chaser but that I should give it some time to resolve. And... I don’t know. It made me feel so bad that I had even done that. [00:18:11]

THERAPIST: You felt bad that you had called?

CLIENT: Yeah.

THERAPIST: Why?

CLIENT: He seemed to be saying like, “You should just be in the hospital helping him get better. You don’t need a lawyer right now.” He said that a couple times. (LAUGHTER) And I felt so terrible about that. And then I can’t even talk to Josh right now. I haven’t been able to talk to him probably since last week because the procedures and the pain and stuff.

THERAPIST: Yeah. It’s interesting that you feel badly about it because you were... You contacted the lawyer because it’s something that Josh was interested in doing. You were doing that for him. That was, is one of your ways of supporting him.

CLIENT: Well, and for me too. I was there too through it all.

THERAPIST: Yeah. [00:19:03]

CLIENT: Like it’s so painful to think through like all the decisions that were made for me too.

THERAPIST: Yeah.

CLIENT: And I was pretty excited to talk to a lawyer about like...

THERAPIST: You felt like he could give you some clarification, help you understand all these experiences that you guys have been pushed through.

CLIENT: And maybe it’s just an outlet for our frustration. (PAUSE) So I just didn’t expect the conversation to turn that way.

THERAPIST: Yeah.

CLIENT: I expected either, “Yeah, this could be a case. Let’s talk about it.”

THERAPIST: Right.

CLIENT: Or, “I’m sorry. But this is not something I can help you with.” Not like a, “You should be with your boyfriend, hon.” (LAUGHTER)

THERAPIST: It sounds like a fairly unprofessional response. He shouldn’t be calling you “hon” for sure. (PAUSE)

CLIENT: I’ve never talked to a lawyer except for my aunt who’s a lawyer. (LAUGHTER) So... I (inaudible at 00:20:01) about it. (PAUSE) [00:02:07]

THERAPIST: Yeah. It’s all new territory. Each new doctor and new procedure and new avenue of if you’re going to pursue legal process is all new territory that you don’t have any experience with. And why should you?

CLIENT: Josh tells me sometimes I come into the hospital room like a hurricane. (LAUGHTER) Like I just want to know what’s going on and I’m just rushing around trying to get him his macaroni and cheese or whatever or there’s no one there who will tell me... I have a nurse who doesn’t know me or, and who doesn’t seem to want to explain or... Once I walked in, there was just nobody there. Like... (PAUSE) And I feel like a hurricane a lot lately. Also a lot of really tough days have been followed by my friends taking me out getting lots and lots of drinks usually which has been really helpful lately which is surprising because it’s not something that is something I want to do for a long time (PAUSE) whether it’s good or bad. [00:21:11]

It seems good. I even had a couple sleepovers mostly because friends wanted to stay with me or someone offered me a place to stay (inaudible at 00:21:23).

THERAPIST: Right. That sounds nice to be surrounded by people.

CLIENT: It is and it has been really nice. Yeah. It’s just very different than... Not the...

THERAPIST: Yeah when you’re trying to handle everything by yourself and not let yourself lean on anyone.

CLIENT: Or even when Josh was home and sick, there was a lot more just about him being sick at home (inaudible at 00:21:49).

THERAPIST: Right. Well, there wasn’t much just taking care of Laura (ph) going on.

CLIENT: Right.

THERAPIST: And it sounds like your friends are recognizing that, yes, you’re doing a lot to take care of Josh but they also need to take care of you.

CLIENT: Right. And I didn’t know that they would. It’s just been really nice. [00:22:05]

(PAUSE) It’s also just terrible that I didn’t let that happen before or whatever. I mean, I guess it (inaudible at 00:22:17) school. Like I was always going to have to be part of any relationship with anybody. (LAUGHTER)

THERAPIST: Right. (PAUSE)

CLIENT: There was no before any of this ever happened.

THERAPIST: Right.

CLIENT: (inaudible) (PAUSE)

THERAPIST: It’s just part of what your reality is and that, therefore, is part of their reality too.

CLIENT: That is really hard to like let my friends have to deal with all of this stuff. But they seem to be doing okay. (LAUGHTER) So...

THERAPIST: Yeah. It sounds like the way they’re responding, they don’t feel burdened by it. They don’t feel like it’s a problem that you need some support. (PAUSE) [00:23:00]

CLIENT: Yep. (PAUSE)

THERAPIST: They want to be able to help you.

CLIENT: Yeah. So that’s been really, really good. I had a horrible thought yesterday that I really hope it continues after Josh comes home.

THERAPIST: That’s not a horrible thought. Why is that a horrible thought? You will continue to need support after he comes home.

CLIENT: I guess right now because the hospital world and my world are very separate and I don’t know how they come together exactly. So... (PAUSE)

THERAPIST: Yeah. I hope it does continue in that I hope your friends do continue to support you, take you out, you know, take care of you.

CLIENT: Yeah. I mean, I guess it’s not that I hope that they will. I hope that I can keep doing it. You know, there’s the hospital (inaudible at 00:23:57)...

THERAPIST: Right.

CLIENT: ...self-medicate myself or whatever I’m doing lately. But unfortunately, that might not be for a long time at this rate. That’s another thing. I have no idea if there’s any plan. (inaudible) anyone. (PAUSE)

THERAPIST: They might not be planning that far in advance or that many steps down the road. Right? I mean, it’s... (PAUSE) He’s got to recover from these surgeries now.

CLIENT: Yeah and I still... I still don’t know what the state of the infection is. I think I’ve had a different story from every person I asked and no one seems to think... I mean, they tell you good and bad news kind of in the same way. It’s hard to even tell a good or bad thing (inaudible) tell you sometimes. (PAUSE) I don’t know. I waited for his surgeon pretty much all weekend. He was supposed to come by and (inaudible) other people to save. [00:24:57]

He’s one of the few people who will actually talk to you like a, not like an equal, but kind of. (PAUSE)

THERAPIST: It’s hard to get face time.

CLIENT: Which is perfectly understandable. (LAUGHTER)

THERAPIST: Right. (LAUGHTER) (PAUSE) But frustrating because an important piece of care is knowing, having someone that can explain to you kind of what is the status right now and what is the expected next step.

CLIENT: And I still worry about Josh all the time and he’s in too much pain to speak up or (PAUSE) notice that and listen to him for a couple of minutes to find out, oh, he does really need more drugs or has anyone checked the (inaudible at 00:25:51) in the past day. I don’t know. (LAUGHTER) Maybe they do check on all this stuff but it sometimes doesn’t seem like it. [00:25:55]

THERAPIST: You know, I was... I think one of the fears is that with so many different care givers that things can get lost and fall through the cracks and somebody else thinks that somebody’s paid attention to this piece. It puts a lot of pressure on you to try to hold together all the different pieces and make sure that none of that stuff gets missed.

CLIENT: Well, and even stuff like they don’t seem to... I mean, people just don’t know him either. Like if they leave his pumps uncovered because they’re trying to teach someone how to like look at the flesh to see if blood is pumping, he’s in like a lot of pain. It’s not all positioned properly. No one asks him that. Maybe one nurse will know. I don’t know. Like information isn’t always passed along about like personal things or like just comfort things.

THERAPIST: Yeah. I’m assuming he’s got a white board in his room. You know, like hospital rooms have a white board.

CLIENT: He does actually. So like somebody... I was thinking about that yesterday because I watched some nurses teach another nurse and it was really... (PAUSE) I could tell he was in a lot of pain. (LAUGHTER) [00:27:03]

But they were like trying to switch machines around and they were pretty stressed. It was pretty uncomfortable (inaudible at 00:27:11).

THERAPIST: Yeah. So little things that like wouldn’t be in the chart but make a difference to his comfort level, things like his pumps need to be arranged just so or it creates a lot of extra discomfort, those are things that you can put on the white board.

CLIENT: That’s a good idea.

THERAPIST: Or if you know other things... Because that’s the kind of thing that will make a difference in the quality of his day but probably isn’t going in his chart because it’s not a, you know, it’s not a medical note like, “I have him his morphine drip at ten AM.” You know, they write down that. They might write down how much urine output he’s having. But they’re not going to write down that he’s much more comfortable if he’s got three pillows under his head.

CLIENT: (LAUGHTER) [00:27:53]

THERAPIST: And that’s the thing that you can put up on the white board and they might notice. You know, you can kind of train nurses like to look there so there’s some continuity about that kind of stuff when you’re not there to do it for him.

CLIENT: Yeah because I feel like every time I go to school for a full day and show up at night, there’s something that makes me so sad I wasn’t there all day.

THERAPIST: And you... I mean, and you can’t. You just can’t be there all day. Even if you’re spending all day in the hospital, you have to get up and go get something to eat. (LAUGHTER) You have to go take a walk. I mean, you can’t be there all the time. But if... You know, if you can find a way to leave some notes for people about things that you would do or that you know would make a small difference in his day, maybe you’ll feel a little bit better and maybe it’ll help with communication of these kinds of things that just don’t make it into charts.

CLIENT: That’s so hard too. This is something I don’t know what’s right or wrong. He is in so much pain. He waits for... He asks the nurses when his pain drugs are due and he like watches the clock waiting for them to come and if they’re like a couple minutes late, he starts to freak out. You know, they’re running around taking care of other people. But it’s really hard to sit there and not be able to like just go the pills. I see they’re right there but I can’t give them to him. [00:29:09]

THERAPIST: Right.

CLIENT: It’s just... (PAUSE) You know, I can’t be like, “Can you please be on time to the second for his pain drugs? Just watch the clock,” when they’re trying to save somebody else next door. You know?

THERAPIST: Well... So but you don’t know that that’s what’s happening. You can say, “He really waits and it watching the clock and it’s a lot of discomfort if there’s a delay in getting his meds on time.” You can let them know that because there are other patients for who maybe on that floor, it doesn’t matter so much if there’s a five minute delay. You know, maybe they’re saving somebody’s life.

CLIENT: Well...

THERAPIST: And if that’s the case (LAUGHTER) then his pain meds wait. But, you know, maybe they’re also just not watching the clock and just, you know, are five minutes behind or ten minutes behind for something because, you know, they didn’t realize it made a big difference. So there’s a way to be able to say, “You know, it makes a big difference to him because he’s in a lot, he’s continually in a lot of pain and he’s like counting the seconds until he can have his next dose.” [00:30:11]

If they know that, there may be some times when that delay can be avoided.

CLIENT: I guess I can put that on the white board too.

THERAPIST: Yeah. Or, you know... And when you are there, when you leave... When you leave, that’s a message you can leave. “I’m leaving now. He’s counting the moments until he can have his next dose at whatever time.”

CLIENT: Well, that’s something I can every nurse every twelve hours.

THERAPIST: Yeah.

CLIENT: Or more... (LAUGHTER)

THERAPIST: Yeah. (PAUSE) Yeah. So a couple bullet points on the white board and you do... When you’re there, you can repeat yourself and just phrasing things in a way that let them know what he needs in a nonbullying way. [00:31:01]

CLIENT: (LAUGHTER) Yeah. I mean, you can tell the nurses are so stressed out and I don’t want to inadvertently upset, not upset them, but... (PAUSE) I don’t know. They’re just very tense with their interactions like everyday sometimes. (PAUSE) I don’t know. (LAUGHTER)

THERAPIST: What makes you think that you’re upsetting them? (PAUSE)

CLIENT: I don’t know. I mean, some of them seem like they’re in such a rush and trying to pester them with questions, they seem pretty like not (PAUSE) able to... They’re just like not able to sit and talk to you.

THERAPIST: Yeah.

CLIENT: They’re just constantly running around. There was one woman who got worked up because there was some other patient being rushed over from the ICU and needed a transfer like a fourth patient. I don’t know. Like they need more nurses. (LAUGHTER)

THERAPIST: You feel like they’re understaffed?

CLIENT: Yeah. (PAUSE) (inaudible at 00:32:07)

THERAPIST: Is there anyone... I mean, now that he’s been there for a while, is there anyone that you have a better relationship with or you know a particular nurse that comes onto rotation that you feel better or able to talk to? [00:32:19]

CLIENT: Oh definitely. But they work three shifts a week and there’s a fourteen week... Is that right? (LAUGHTER) And then sometimes I’m not there so like...

(CROSSTALK) (PAUSE)

CLIENT: I don’t know. It’s just impossible to have everything... I can get school under control and...

THERAPIST: Right.

CLIENT: ...the hospital’s a disaster.

THERAPIST: Yeah. Well, there’s too much to be able to manage everything right now. So this is kind of the balancing act of how much can you have things under control in one place. And it’s not under your control. What happens at the hospital is so much out of your control. [00:33:05]

CLIENT: Yeah. I mean, things were at the worst for my mental state this past weekend, I guess. I felt terrible. (PAUSE) And I fixed that quickly, you know, I think. So I was happy about that.

THERAPIST: Yeah.

CLIENT: So big crisis averted at the moment.

THERAPIST: How many times a day are you sitting down and taking ten deep slow breaths? (PAUSE)

CLIENT: I don’t know. I mean, I did go to yoga class on Sunday.

THERAPIST: Awesome.

CLIENT: And I was really worked up this weekend. So I would say it took the edge off. (LAUGHTER)

THERAPIST: Which I think is all that we’re going to expect right now.

CLIENT: But it was not much of an edge off a very (inaudible at 00:33:51).

THERAPIST: Very high cliff. (LAUGHTER)

CLIENT: Yeah, yeah.

THERAPIST: I think that’s... I think right now, I think finding ways to take the edge off is probably the realistic expectation. You’re not going to likely get to a real Zen space. But if you can find your way to a yoga class, great, maybe it’ll take the edge off. [00:34:15]

In lieu of that, or in addition to that, I think finding some spaces during the day where you stop, find a chair, sit down and close your eyes and really do ten deep breaths where you count in two, three, four and hold for two, three, four and then exhale for two, three, four. And if you count them out like that and make yourself inhale, hold, and exhale, you will slow down your breathing. And maybe that will help take the edge off the hurricane feeling. Like if you can do that before you enter the room... Like walk down the hallway, stand outside his room... Maybe do four breaths because I know you’re not going to stop and do ten. (LAUGHTER) But just to slow yourself down and to give yourself a little bit of the... It may not work... It might slow you down mentally which would be great.

CLIENT: Yeah. (LAUGHTER) [00:35:01]

THERAPIST: It’s definitely, if you can do that, even if you do four of those counted breaths, it will slow your heart rate down a little bit and it will force you to take longer, slower, deeper breaths, maybe take your blood pressure down which will just make a little bit of a difference in how you feel. If you can stop and do that at a couple points during the day, rather than escalating all day long, you’ll at least kind of maybe hold it back a little bit. You know?

CLIENT: Yeah. And I have been running which is the opposite of that. But it helps. (LAUGHTER)

THERAPIST: Well... Yeah. It’s not really the opposite. It works in a different way. You know, while you run, I mean, yeah, you’re breathing heavier because you’re running but you’re releasing all sorts of tension. You are relaxing your muscles because you’re getting nice and warmed up and then the coming down off of running, your blood pressure lowers. As your heart rate comes down from the high place where it was running, it gets lower than what it was before. I mean, exercise works beautifully to decrease your stress anxiety. We know that that’s been, you know, kind of a good practice for you. [00:36:07]

So if you can find a way to sneak in a run, even if it’s a short one, you probably will feel some calm after you run or calmer.

CLIENT: (LAUGHTER) Right. (inaudible at 00:36:17) it’s not even I have to sneak it in. It’s like more important...

THERAPIST: To do that. Yeah.

CLIENT: ...than going to school. Yesterday, I went for a run after I went to the lawyer because it was either I was going to sit on the couch and cry for an hour, which I was pretty close to doing, or I was going to go running.

THERAPIST: Right. Running is probably a better choice. It probably felt better. (PAUSE)

CLIENT: Unfortunately, like on last Friday night, instead of running in the middle of the night...

THERAPIST: Right.

CLIENT: ...I ended up drinking all night. But for some reason that was also really good too. It seems to be helping lately. Running and alcohol. (LAUGHTER) Maybe I can try the deep breaths. (LAUGHTER)

THERAPIST: I’m not going to judge you for drinking. You know, it’s probably a useful anxiety relief at this point. You do want to limit it of course just because it’s got some side effects that the other two don’t have. [00:37:09]

You know, alcohol... One of the things about alcohol is because sometimes you can, as it leaves your system, you can sometimes have a rebound anxiety effect and I don’t want... You don’t need any extra.

CLIENT: Oh yeah. I know.

THERAPIST: So, you know, use alcohol in moderation safely with your friends. But mix in some of these other techniques too just so that you can have other things that you use effectively and you don’t have to worry about whether or not you’re going to feel crappy hung-over or get an anxiety rebound effect or interrupt your sleep which sometimes alcohol can interrupt your sleep.

CLIENT: It always does. It always usually causes me extra anxiety in the middle of the night and I stay up late and it’s like the calming effect has been so worth it which is not usually the case. (LAUGHTER) [00:37:57]

THERAPIST: Yeah. So keep... You know, just keep your wits about you.

CLIENT: Yeah.

THERAPIST: See if you can add in some deep breaths because I think it will help. And one kind of presentation that Josh is picking up on is that you’re coming into the room like a hurricane which doesn’t feel good for you or maybe give you a little bit of relief or at least keep things from escalating.

CLIENT: Right now I kind of feel like (inaudible at 00:38:21)...

THERAPIST: Yeah.

CLIENT: ...lay at the end. There also was in this class a woman who I went to her elementary school teacher. There was an elementary school teacher in this class I visited happened to be in the class. That didn’t help either with my like being calm.

THERAPIST: Right.

CLIENT: Like we have to lay at the end...

THERAPIST: Yeah.

CLIENT: Like I almost was like twitching. I was just... I couldn’t even focus on breathing because...

THERAPIST: Right.

CLIENT: ...I just had to try and focus on laying there and basically (inaudible).

THERAPIST: Yeah. That was really hard. [00:38:55]

CLIENT: So I go through the whole deep breaths things... That might be something... What would you do before you took deep breaths? I don’t know.

THERAPIST: Well, so limit it. Right? So if you can only stand... If you can only stand to sit for one measured breath of counting, then do one. And you think the hard part about that end pose in yoga... And I spent years in grad school laying thinking, “I have like a lot of stuff to do right now that would be much more useful than laying here for ten minutes while I breathe.” Those were the thoughts that were going through my head. And a really high stress point for you right now... Laying there for ten minutes might be, feel more harmful than helpful. So that’s why doing it on your own... Maybe it would have been physically helpful to do one or two breath cycles and maybe that’s all you could’ve handled right then.

CLIENT: Well, I guess what I’m trying to say is the laying there is so hard. (LAUGHTER)

THERAPIST: It’s way too hard. It’s way too hard right now. It’s way too different from where you are to get... Right? I think what’s helpful usually is when you have like one degree of stretch from where you are. [00:40:03]

CLIENT: Right. I don’t know what that is though.

THERAPIST: I think it could be sitting in a chair. You’re doing it now. And counting out one measured breath.

CLIENT: (inaudible at 00:40:15) (LAUGHTER)

THERAPIST: That might be it. See what that’s like.

CLIENT: This is like when I sat in the hospital room sitting with a visitor, feeling like this and I picked my entire manicure off.

THERAPIST: Yeah. (PAUSE) Maybe it’s pacing. You know, like... There’s walking meditations where you kind of just pace up and down the hallway and count your steps. And the counting of the steps is kind of what keeps you from being in that loop in your head that’s making it, you know, that you think whatever anxious thoughts that you’re thinking. Forcing yourself to kind of count and walk down the hallway twenty steps and walk back the hallway twenty steps and doing that a few times. It might be helpful for you to move and have a kind of maybe a walking meditation or...

CLIENT: That sounds better than... [00:40:59]

THERAPIST: Yeah. So alright. Let’s do that. Try that. And that’s... You know, it’s official. They’re called walking meditations. So it’s not like you’re making something up. And give yourself something to focus on whether it’s counting the steps or some other, a phrase that you go to recite like, “This walking is going to help me.” Something that you can focus on so that you’re not thinking in your head, “I would rather just go in and see what’s going on.” (LAUGHTER) But give yourself something specific that you’re going to say in your head and maybe do, you know, four laps or twenty paces or something and see if it can calm you down a little bit.

CLIENT: I’ve come up with things to say before. I’m not sure I will call on any of them.

THERAPIST: Use one that works for now. It doesn’t have to be the same any time.

CLIENT: I don’t even know what they’ll be. I’m thinking that this walking is going to help me. It just makes me worry that it won’t. (LAUGHTER) (inaudible at 00:42:01) I don’t know what to think about. [00:42:07]

THERAPIST: What about saying... Would something that sort of said like, “I’m going to get through this,” or, “I’m getting through this the best I can...” Would something like that feel genuine?

CLIENT: Actually, “I need to slow down,” sounds like something useful to say.

THERAPIST: Ah. Can we change that to, “It will help me to slow down a bit,” because I’m just worried that, “I need to slow down,” is going to feel like a command that you might feel like you failed just in case it doesn’t work right now. It will work sometime. But it might not work every time and I don’t want you to feel like you failed.

CLIENT: Right now I feel like I’m getting through with brute force. So it feels like brute force. (PAUSE) But I suppose if it doesn’t work then... Or, “I am slowing down.” [00:43:03]

THERAPIST: Yeah. Yeah. How about that? That sounds supportive, encouraging. You’re... You’ve got... It’s like your natural tendency is to go to the mentality of like a really tough coach. Like you’re just going to muscle through this any way you can no matter what. And bringing in like a softer, kinder coach of, “I’m going to slow down,” or, “I am slowing down right now...” It’s like the nice coach coming in. (PAUSE)

CLIENT: I really need to slow down a little. (PAUSE) (LAUGHTER)

THERAPIST: Yeah. So that you can keep going. (PAUSE) Give that a shot. See what happens. Experiment with it. We’ll, you know, sort of build on it or work on it to see if we need to come up with something else for the next week. [00:44:01]

CLIENT: Do you have to learn how to meditate in grad school?

THERAPIST: No. I... (LAUGHTER) I... One of the things I did to supplement my graduate income was I taught group exercise classes.

CLIENT: Oh. At Yale?

THERAPIST: So... No. I didn’t do my grad work here. I did my post doc here.

CLIENT: Oh.

THERAPIST: I did my grad work in Ohio.

CLIENT: Oh okay.

THERAPIST: So I worked at the gym as, to supplement my like TA stuff and so I just ended up getting into yoga and stuff through there.

CLIENT: Because the Yale yoga spaces are so stressful.

THERAPIST: Yeah. Right. (LAUGHTER)

CLIENT: They’re so loud. So I was hoping you weren’t teaching there.

THERAPIST: No. I...

CLIENT: They’re like in the middle of the exercise equipment.

THERAPIST: No. Actually, I worked at a gym. I went to grad school in a teeny little town in Ohio. It was quite.

CLIENT: Oh that’s good.

THERAPIST: Let me stop there for today. Do you think this time for you might work next week for you too? I know it’s always subject to change.

END TRANSCRIPT