TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Hello. It is chilly. I know. We’re actually by the window. It’s really cold.

So, where are you? Where are things?

CLIENT: So, I saw Linda (ph) last week. She said she was going to call you.

THERAPIST: I have not heard from her yet, but I will reach out to her.

CLIENT: Which is really good. She hadn’t heard about anything since November.

THERAPIST: Oh, my goodness.

CLIENT: So, it was a lot to (inaudible at 00:00:27) all at once. But I decided not to ask her for a recommendation to somebody else because (inaudible at 00:00:33) so nice to walk in and she knows who I am and she knows what’s going on. Hopefully bad things will stop happening during Joshtmastime when (inaudible 00:00:42) is here. And she reminded me I can always count on her, so . . .

THERAPIST: Oh, yeah. You should take advantage of that if you need to.

CLIENT: So, last time, I’m sorry, I was a little nuts last week.

THERAPIST: Was that my professional assessment? I don’t think so. (laughs)

CLIENT: I was feeling –

THERAPIST: You were feeling . . .

CLIENT: crazed. [00:01:00]

THERAPIST: Okay. That’s different. That may be true.

CLIENT: And then I was just exhausted the next week. Just I was so exhausted. I mean, I had tried some of the things we talked about. Tried to slow down.

THERAPIST: Hmm. Too hard.

CLIENT: And it was just like a crash a little bit. And so, she said that makes no sense. And if I want to try, oh my gosh. Ativan to see if I could stop that somewhere before it crash. And I’m suddenly forgetting what was making me so crazed. And I feel like it was still the infection and stuff going on with Josh that was making me just a little nutty.

THERAPIST: Well, he was in an awful lot of pain. And one of the things that you had talked about a bit was the immense amount of pain that he’s in. And the fact that it’s not well controlled. And just the constant switching, people not knowing from one shift to the next. [00:02:02] Some of the things that actually do make an impact. And feeling so responsible for having to be the consistent person is a lot of pressure.

CLIENT: Yes. And I tried to do some things at the hospital. I don’t know if they really worked or not. But things were getting better, sort of. He’s still there.

So, anyway. So, I had some Ativan. I really would have killed for Ativan the day of his surgery or several of the days after surgery (chuckles) so I tried one yesterday, just to see what it was like. And she said that maybe it would be a good idea.

THERAPIST: Mm-hmm. Yeah, see how it affects before you need it in crisis.

CLIENT: Right. And I think I just got a little sleepy.

THERAPIST: Yeah, some people do.

CLIENT: But it wasn’t very much of it, either, so . . .

THERAPIST: Do you feel like it took the edge off at all?

CLIENT: I think so. Maybe.

THERAPIST: Maybe that’s really (inaudible at 00:02:55) is that in a crisis situation or in a panic attack that you could take some of the edge off with something that works so quickly. [00:03:02]

CLIENT: Yeah. And she said I could take more if I needed it, so, I don’t know. I’m supposed to go away this weekend. I’m in a little bit of a panic over whether Josh is going to come home or if I’m—I feel okay to leave him. School’s pretty busy.

THERAPIST: Have you been able to go to school?

CLIENT: Yeah. And in fact, today, someone is graduating and I had promised to go to their party tonight. Her graduation thing. Somebody I worked a lot with. And I told Josh (inaudible at 00:03:36) him today. And he got kind of sad. And I started feeling really guilty. And he’s like, “Maybe I can go in the morning or the middle of the day.” And then I started to just freak out about it. There’s no way I could get –

THERAPIST: There’s too many people that need you.

CLIENT: Right. No way to get the work done I wanted to and see him and go to this graduation.

THERAPIST: Mmm. It’s hard to have to make choice about who gets you.

CLIENT: Ugh. Well, and I told him when I saw him last night that I couldn’t come. [00:04:01] And he got sort of upset because he’s just been really lonely. (sighs)

So, anyway. So, I arranged for his mom to go see him. And I suddenly felt much better, once I finally decided I wasn’t going to go. But if I had tried to, I would’ve shown up here a total nut again.

THERAPIST: You’re being torn (ph) into many places. Torn in (inaudible at 00:04:24) directions. You can only take on so many roles at one time.

CLIENT: Right. And it’s really hard. Every day, I’m trying to figure that out. Tomorrow, I know I’m supposed to go there for (inaudible at 00:04:38) training in the afternoon, so I’ll try to go school and do that. And hopefully, there’ll be nothing else necessary to happen.

I’m (inaudible at 00:04:50) a bit guilty about going this weekend, also.

THERAPIST: Where are you going?

CLIENT: Ugh, it’s a bachelorette party (inaudible at 00:04:57) had planned for like six months.

THERAPIST: Well, that’s a pretty special thing. [00:05:01]

CLIENT: Yeah. For my next door neighbor when I was born. I’ve known her my whole life, so it should be—if I was going to go to anyone’s, it would be hers.

THERAPIST: You’re going to hers, yeah.

CLIENT: And it’s like a ski weekend. So, that sounds –

THERAPIST: Fun.

CLIENT: fun.

THERAPIST: Yeah. And you’re allowed to have a life.

CLIENT: I know.

THERAPIST: Do you know that?

CLIENT: Well, I forget what I’m doing lately, but most of the things I’ve been doing have been coping things. Like I’ll go exercise just to calm down. Relax.

Oh, yeah. Last Saturday, I went skiing with my mom. Just in Falmouth. Not far away. Just cross-country skiing. And it was, I don’t know, something that is one of my favorite—probably my favorite thing to do. And it was just so fun. It was more than just coping. It was just so fun. And I swear, every time I going skiing, it throws me into a bit of a sad place. Because I know it’s also Josh’s favorite thing to do. I know if I tell him about it, he’ll get really upset. [00:06:01] It was just so –

THERAPIST: He’s missing out.

CLIENT: It was more than just exercise. It was just so wonderful to be outside and –

THERAPIST: It was living.

CLIENT: It was living! Right. And I haven’t been doing things that are just really living. (inaudible at 00:06:12) everything feels like coping.

THERAPIST: Those are distinct, differently—distinctly different things.

CLIENT: Even when I go out with my friends and have a couple drinks, it still feels like coping. Even if, I mean, to pass time, we don’t talk about, I mean, more—depending what it is, I’m not even talking about him or anything, but I don’t know why it still feels like coping.

THERAPIST: But it feels like an escape from your life, rather than living your life.

CLIENT: Right. And so, this weekend will be more like living. (chuckles)

THERAPIST: Mm-hmm. And I think it’s really important for you to live.

CLIENT: Right. But it’s going to—I mean, I’m sure it’s going to be really hard to do. I mean, the skiing made me really happy and then made me really, really sad.

THERAPIST: Mm-hmm, yeah, because you want to be able to live with Josh. And you want him to be able to have some of this stuff, too. And he can’t right now. [00:07:00]

CLIENT: I know it (inaudible at 00:07:03) into, “Well, why am I doing this? Should I just,” I don’t know. And unfortunately, (inaudible at 00:07:09) dinner later that night with a friend who, I don’t know, doesn’t really like Josh.

THERAPIST: Doesn’t like Josh or doesn’t the like situation that Josh is in?

CLIENT: She never got off—over the whole when he stole a bicycle thing. I don’t know. She’s not someone I would trust for true life advice, but she still doesn’t like him. She doesn’t trust him. So, I’m feeling really sad (inaudible at 00:07:32) a friend who disapproves, even though I don’t take her disapproval for much. I don’t know.

And usually, when Josh is feeling good, I’ll just tell him, so— “She made me really sad because she’s saying these things about you and they made me really mad.” He can’t handle that right now.

THERAPIST: He’s too fragile right now to be able to take that kind of information in.

CLIENT: Yeah. And in fact, it’s been really tough, because he seems like he’s feeling well sometimes. [00:08:04] And sometimes, well, we’ve had a couple—they weren’t even fights. Maybe they were insights. I was telling him about the bachelor party and he doesn’t remember things like that. (chuckles) I can tell him (crosstalk at 00:08:17), I can tell him a million times. I think it was middle of last week. And how I was going to bring a coffeemaker and if that was okay with him. He got really upset, saying how he’s afraid I would break it, I was really clumsy. He was really upset. I had also just taken a walk with him, trying to push his IV around with him. And it was just a mess. (inaudible at 00:08:38) was getting really frustrated. He was ready to rip everything out of him.

And then, we were trying to—it was a bad moment to try to have a conversation about how I was going to go away. (chuckles) (inaudible at 00:08:49) I was trying to change the—every time I try to change the topic and talk about life, it always hits a sore spot. I mean, I got upset at him for saying that I was clumsy. [00:09:00] And then he started to cry. I mean, this has happened a couple times over just nothing. Because he can’t be—he can’t be there for me. He can’t talk about things that are –

THERAPIST: Outside of the hospital right now.

CLIENT: Outside of the hospital. Really, yeah. Even if (inaudible at 00:09:20) careful not to say—I mean, I made him cry so many times by just saying something that was—if I tell him I hugged a puppy, (chuckles) then he might start to cry.

THERAPIST: He’s so absorbed in what’s going on with him right now and in the hospital. The outside world is too much to take in –

CLIENT: Yeah.

THERAPIST: for him. But you’re not living in the hospital. And you being the—you needing to maintain some elements of your life is really legitimate. [00:10:02]

CLIENT: Yeah. I mean, I feel like I’m managing. It’s really hard. Every single day is just really, really hard.

THERAPIST: Mm-hmm. Yeah. It’s a lot to manage. To manage his world in the hospital and school and trying to maintain some of your world outside of the hospital. It’s a little bit too much.

CLIENT: That reminds me why, also, I was feeling crazy two weeks ago was because I had just—I think I just confronted my—not confronted. Asked my advisor if I could take a leave of absence. And he had said no. Whatever you can do (inaudible at 00:10:42). (chuckles) Now, we’re all going to a conference in April, for which he will pay for us only if we have legitimate results. Which he didn’t ask—well, he didn’t ask (inaudible at 00:10:55) to go. He said I’m going. And he said he’s paying for me. He said I—we all, the four of us who are going better have legitimate results. [00:11:00] So, that’s fine.

THERAPIST: But that sounds a little bit different than the expectation of however much you can get done this semester, you get done.

CLIENT: Right. And I’m still going to be involved with this group of people’s work if I’m at all at school. And they all need stuff [from me] (ph), so I was so thrilled to have that pressure lifted off. But now, there’s a little bit of pressure. And that’s fine. It’s just was a weight that was lifted for like a week completely and (crosstalk at 00:11:33) –

THERAPIST: And now, a little bit of—does it feel like it’s all been put back on?

CLIENT: No. I know he knows where I’m coming from.

THERAPIST: So there is still some awareness.

CLIENT: But I’ll have to have another discussion with him about what I’m going to try to do. To see if I can –

THERAPIST: Right, because you don’t know.

CLIENT: Is it even worthwhile?

THERAPIST: This is April? You don’t know what April’s going to look like.

CLIENT: I know. They just put him at 1A (ph) again. So, he’s at the top-top of the list. So, he’s only competing with other people who are at the top. Of which there’s still a good chunk, so it’s not like he’s going to get a heart immediately, but . . . [00:12:03]

THERAPIST: But the timeline feels like it’s been sped up.

CLIENT: I mean, I guess. We could legitimately get a call any time.

THERAPIST: Any time.

CLIENT: Although it probably won’t be for months. Yeah. And I know that when Josh comes out, it—we still have not (inaudible at 00:12:28) a good discussion about us calmly. He had asked me the other day if I would take the leave, instead, when he got the heart, so that I could help recover. And I almost started to panic. I thought (inaudible at 00:12:40) I just managed to stay in school. I’m not going to take a leave again. (sighs) Once what we’re hoping for happens and—I don’t know. He’s asks a lot and he’s very, very (chuckles) needy. [00:13:01] All of which is perfectly reasonable. It’s just hard.

THERAPIST: But it’s hard to be on your end of that. You are not a limitless well of caretaking.

CLIENT: Yeah. I mean, depending how he’s feeling, he’ll say, “Fine, go to school. Get (inaudible at 00:13:25). But if he’s not feeling well –

THERAPIST: But he’s not always feeling up to that.

CLIENT: At least, I mean, we spent the weekend trying to get answers from the doctor about what was going on. And he was really stressed about it. In fact, last week, he was pretty much on the verge of tears every day. And it’s gotten a little better since we got answers. And they put him on Ativan, which I just think is funny. He made me feel really bad. I was really happy that I had something else to help if I needed it. [00:14:00] And he’s just in a constant state of stress. He’s never got all the right information. No one respects his privacy. He has no privacy.

THERAPIST: No, you really don’t at that point.

CLIENT: Right, but he also is not someone who likes to interact with people 24/7. He always needs quiet time and it’s almost impossible to get. We’ve instituted so many signs. We got a nurse to put another “Do Not Enter” sign up again for a little while.

But anyway. I mean, I almost yelled at him that how could he possibly think that he would be—basically, he said he felt like a junkie, asking for basically more Ativan to calm down. There was a kind of uncomfortable conversation with the nurse over how he was feeling. It took a lot for him to tell the nurse how terrible he was feeling. (inaudible at 00:14:55) the nurse is like, “You seem fine this morning.” He was like, “I was ready to scream at you. You just don’t know.” [00:15:00] (sighs)

So, anyway. I don’t know what I’m trying to say here, exactly.

THERAPIST: Is the Ativan helping him?

CLIENT: It is.

THERAPIST: It’s been a push for a long time to try to get him to accept some sort of help, whether it be anti-anxiety or antidepressant.

CLIENT: Yeah. But then there was always—(inaudible at 00:15:23) it’s always a weird conversations with the doctors. Similar to the pain med discussion.

THERAPIST: Mmm. Feeling like he’s not being believed?

CLIENT: Yeah. Well, more than that. More like they’re always worried about him becoming addicted. Yeah. Yeah. And the (inaudible at 00:15:38). I mean, no one knows how he feels. He can only express that and it’s hard to do that—if you do it calmly, then it doesn’t seem super-real. And then they say things like, “You don’t seem upset,” when he’s just trying to keep it together. I don’t know. It’s just really confusing sometimes. [00:16:00] (inaudible at 00:16:01) understand, so, anyway. It’s working. He’s on a schedule of Ativan now.

THERAPIST: I’m glad. It’s perfectly reasonable for him to be really panicky and distressed. And that doesn’t help recovery, so . . .

CLIENT: Yeah. I’m sure he’s exhausting himself. (chuckles) And his pain seems to be okay at the moment, too. He’s just getting really depressed about never being able to leave. I mean, now they’re saying next week.

THERAPIST: Yeah. And it’s been next week for a lot of weeks.

CLIENT: Yeah. And, I mean, he keeps saying (inaudible at 00:16:41) he just wants to stay in the hospital until he gets a heart, at this rate.

THERAPIST: Mmm. Because? Is he scared to go home?

CLIENT: Yes. Yes, he is. Definitely super-scared. And it could be awful to have him home. I don’t know. [00:17:00]

THERAPIST: Mm-hmm. I think it would probably be a lot of work.

CLIENT: Well, (inaudible at 00:17:04) like just him worried that something’s going wrong all the time. I mean, he had some sort of bump or something under his sutures. He was freaking out about it. And all the doctors came to look at it. No one knows what it is. It’s just (crosstalk at 00:17:18) –

THERAPIST: And that’s scary.

CLIENT: Right. And if he got a bump, we’d go to the ER or go to the doctor’s. (chuckles)

THERAPIST: Right. It’s a lot easier to (inaudible at 00:17:26) call in a consult. And then have whatever tests available that you might need. Whether it’s running a blood sample, seeing if that bump is an infection or not.

CLIENT: (sighs) Right.

THERAPIST: Taking a scan and seeing what it is. And being at home, you have to sit with more of that uncertainty for longer. And getting a consult is a lot more cumbersome.

CLIENT: Yeah. I feel terrible, because I just—I’m so sick of going to the hospital every day. It’s just so much effort. (chuckles)

THERAPIST: Yeah. It is. [00:18:00] It makes sense that you feel tired of going to the hospital every day. And that you don’t—that’s not what you want to do. If somebody had asked you what you’d be doing this semester –

CLIENT: (laughs)

THERAPIST: that’s not what you would’ve said. And of course you don’t want to do it. At the same time, I know you really want to be there to support him. And you like to know as much what’s going on as possible. So, it’s hard to be so conflicted.

CLIENT: Yeah. I mean, (sighs) the information thing (ph) at the moment, it seems like they just don’t have (inaudible at 00:18:44). So, I don’t feel as bad not being there now. I feel bad that he’s so upset. I don’t know.

THERAPIST: Is there anything else that feels comforting to him besides you? [00:19:02]

CLIENT: I mean, whenever we have a new visitor, he’s always—he’s a little better. We had some visitors on Sunday who were from out-of-town, who happened to be in Providence and came by. And he seems much more like himself when there’s a visitor. I don’t know if that’s comforting.

THERAPIST: Mmm. Well, it’s a good distraction, at least.

CLIENT: It’s a good distraction (crosstalk at 00:19:25).

THERAPIST: Maybe not comforting, but something to look forward to and a good distraction.

CLIENT: Yeah. I don’t know what the right thing to do is. I hate to even suggest things. My dad (inaudible at 00:19:38) push him into doing online classes or (inaudible at 00:19:43), it’s pretty –

THERAPIST: And that seems like a lot of effort.

CLIENT: It does, it does.

THERAPIST: That’s maybe a little bit more intense than . . .

CLIENT: It does, yeah.

THERAPIST: I was thinking movies. (chuckles) (inaudible at 00:19:53)

CLIENT: (inaudible at 00:19:53) pretty much all he does is do medical tests and PT and movies, which is good. [00:20:00]

THERAPIST: Mmm. Well, of the three, the movies seem best.

CLIENT: (chuckles) No. He loves PT, because I always tell him he’s doing much better than average. So, I think that’s comforting, in fact. And they put him up at 1A (ph) because he’s physically ready.

THERAPIST: Oh, great.

CLIENT: Probably earlier than other people would be. Well, that definitely is comforting.

THERAPIST: Mmm. Well, it’s nice to have a little bit of athlete come back and help him.

CLIENT: Yeah. I don’t know. (chuckles) It sometimes worries me a little bit that he’s just—I don’t know why it worries me.

THERAPIST: Well, let’s explore that. What it is that—what worries you?

CLIENT: I mean, he always takes things to the extremes.

THERAPIST: So, you think he’s pushing too hard in PT?

CLIENT: No. I just know that when he gets the heart, he’s going to just—I mean, I think he distracts himself by thinking what that will be like and what he’ll do. [00:21:03] Sometimes it just makes me a little –

THERAPIST: (inaudible at 00:21:07)

CLIENT: nervous (ph).

THERAPIST: Pinning too much hope on it?

CLIENT: Probably.

THERAPIST: So, he’s being not as cautiously optimistic as you are comfortable with. Maybe a little bit more optimistic or hopeful. And you don’t want it to be dashed.

CLIENT: I don’t know.

THERAPIST: What do you hope for?

CLIENT: When he gets the new heart? I don’t know. I mean, to be able to enjoy things that we do, with me without—I mean, most things we’ve done in the past three years have been—there’s been a dark side of him feeling terrible or worrying he’s back in (inaudible at 00:22:03) or being in (inaudible at 00:22:03) or—I don’t know. [00:22:07] I hope for some kind of normalcy, I guess.

THERAPIST: Mmm. Not to have this shadow hanging over you.

CLIENT: Although I’m not sure it’s going to be better with a new heart. I mean, we’re going to be constantly worried about it being rejected. He’s going to be on so many drugs that will do who-knows-what to him.

THERAPIST: Yeah. It sounds like some of the information that you’ve gotten, that it’s unlikely to expect that it’s ever going to be like it was when you guys met. Right? You’re not going to get Washington back.

CLIENT: Right.

THERAPIST: That’s disappointing.

CLIENT: Well, (chuckles) I’ve definitely come to terms with that. That’s fine. I don’t really know what I’m trying to say here, either. I would like to—I don’t know. [00:23:00] I mean, I keep thinking I’m doing better, but I would like to not get myself into a panic on a regular basis over just trying to keep things together. That would be great.

THERAPIST: How often do you feel like you’re panicking? Separating panic from that constant buzz of anxiety. How often do you reach the panic level, you think?

CLIENT: I don’t know. I mean, there are so many different (chuckles) kinds. I was panicking this morning, because I felt like if I went to the hospital, I was just going to drive him crazy because I’d be sitting there not able to help him at all, because I just needed to leave and go to school. I don’t know if that’s actually panic.

THERAPIST: Well, what did it feel like?

CLIENT: I mean, it felt like panic. I didn’t know what to do and I had to do something. And none of the options were good. But I had to do something, because I couldn’t do [it all] (ph). [00:24:00]

THERAPIST: Do you feel frenzied?

CLIENT: Mm-hmm. But then, the week I was feeling a little crazy, which, then, caused me to become exhausted, it’s obviously not a healthy thing. And all I felt was panic.

THERAPIST: Mmm. Well, if you think about how it would be described in the DSM, for panic attacks, they’re very discrete periods, fairly short-lived, typically. We’re (ph) talking minuets, not days and hours –

CLIENT: Mm-hmm.

THERAPIST: of really intense that frenzied, feeling trapped, wanting to escape, heart pounding, thoughts racing. Fast breathing. That’s what the DSM would call panic.

CLIENT: Mm-hmm.

THERAPIST: Versus the anxiety, which is the more constant worried thoughts. Maybe some of that physical distress, but not the same acuity. [00:25:00] Does that resonate for you?

CLIENT: Yeah.

THERAPIST: So, the week where you feel like you kind of exhausted yourself, were there panic attacks in there, too? Because the other thing that’s—sometimes happens is you have a panic attack superimposed over the general anxiety. It’s not that you only have to have one or the other. In a situation where—with—like yours, where there does—there really are—there’s the real world triggers, like something happens with Josh.

CLIENT: Mm-hmm.

THERAPIST: Like you get a phone call and he says, “They’re having a meeting. Can you come in right now?” And your world changes all the sudden.

CLIENT: Yeah, yeah.

THERAPIST: And then, there’s also the mental triggers, which are not necessarily anything’s changed in the moment, but all of the sudden, you start wondering about a what-if.

CLIENT: Yeah. That’s what I do at night. (chuckles)

THERAPIST: Yeah. And those can create—those can trigger a panic attack, too. [00:26:00]

CLIENT: Yeah.

THERAPIST: What are the what-ifs that go on in your head at night?

CLIENT: Ugh. There’s was just one night, I forget when, where I just didn’t know how—or I was reading a book that was too heavy. I shouldn’t have been reading it before I went to sleep. It was too serious. So then, I just started thinking about life, which led me to think about how I was going to make it all fit together. That’s what I think about. That’s what I’ve always thought about is (inaudible at 00:26:28) planning things. (inaudible at 00:26:30) work out. Which is made worse when it just all seems so important.

THERAPIST: I mean, the variables all of the sudden got (inaudible at 00:26:37). And it’s always hard to think about how you’re going to make everything work out, because, as probably part of you is aware, you’re not actually in control of all that stuff.

CLIENT: Yeah. I mean, I was—Josh was supposed to come home this week. (inaudible at 00:26:52) today. Tomorrow. Wednesday. And this past weekend was just a mess. I was going to go away and I was feeling pretty determined to go away, regardless. [00:27:05] (chuckles) Which also made me feel really guilty, because I knew I’d just be really sad if I missed my friend’s party. And then, I had to—I had a conversation with Josh’s mom about how—if she was going to be able to take care of Josh. And she said maybe. (inaudible at 00:27:21) I’d have to bring him with me up to Maine where I’m going. Which means I have to borrow your car. Which means we have to switch cars.

I don’t know. It’s just something that really, really complicated. And even just getting Josh home will be really complicated and (inaudible at 00:27:36) comfortable. And I’m sure he’s going to be in a panic for—he keeps telling me how he’s not going to move out of the living room until he gets a heart.

I don’t know. It’s just I was unfortunately relieved when they said he was going to spend another week.

THERAPIST: That’s okay. It’s not necessarily unfortunate. [00:28:00] It could make sense. You feel safer with him there. And it’s a little bit easier on you to have him there, because there are other people that take care of him.

CLIENT: Well, it’s easier and it’s not.

THERAPIST: Mmm. Yeah, the traveling is tough.

CLIENT: Yeah, but sometimes I get in a panic just driving over there. (chuckles) Driving over there at like 6:00 or something, because if I go too late, he won’t be so exhausted. (chuckles) It’s just so awful. I mean, I’ve definitely gotten into panics just from traffic. (chuckles)

THERAPIST: Because the driving itself makes you really uncomfortable. Or is the where you’re driving to?

CLIENT: Well, because I know it’s going to take me twice as long as it should. And it’s such a colossal waste of time. Can’t seem to get—he asks me to bring him something (inaudible at 00:28:46) never—and I’m never going to get it there. It’s just so frustrating. (inaudible at 00:28:51) feels like a colossal waste of time, trying to fit all this stuff in.

THERAPIST: Yeah. To be stuck in traffic.

CLIENT: Mm-hmm. [00:29:00] I don’t know. (chuckles) It’s just the last little thing is just too much. When I was living in Washington, originally, I was driving like 45 minutes to go 6 miles or something every day. And I started picking in my ear because I was so stressed out. (inaudible at 00:29:27)?

THERAPIST: Hm-mmm.

CLIENT: I don’t even know. I don’t know why traffic does that to me, but—and then I moved like a mile away. (chuckles)

THERAPIST: Good problem solving.

CLIENT: I guess. (laughs)

THERAPIST: Yeah, well, there was a way around that one. I mean, this is hard because there isn’t a way around it.

CLIENT: (inaudible at 00:29:51) Sometimes, I bike to the hospital. I biked the other day (inaudible at 00:29:55) was covered in (inaudible at 00:29:56). (chuckles) And it’s pretty dangerous. [00:30:01]

THERAPIST: Mmm. Yeah. The lanes are so reduced from all the snow.

CLIENT: Right. Yeah. There’s a lot of traffic. I was very ambiguous [going to] (ph) to the hospital. (chuckles) There’s just construction (inaudible at 00:30:17). I don’t know. Providence. (sighs) It’s just a mess, so . . .

THERAPIST: Do we (inaudible at 00:30:27)?

CLIENT: (crosstalk at 00:30:27)

THERAPIST: Well, I’m sorry it continues to be so difficult to manage.

CLIENT: I mean, the longer it goes on, too, the less people write on his website. I mean, we had the outpouring of support. We still have a good little support, but I (crosstalk at 00:30:51) –

THERAPIST: (crosstalk at 00:30:51) feels like it’s drying up a little bit.

CLIENT: It’s just become such, I guess, drudgery.

THERAPIST: Is he still updating his website? [00:31:00]

CLIENT: From time to time. I made him cry once by asking or by telling him that—I mean, I can ask all the time how he’s doing. If I don’t update the website for a few days, I’ll get a call from somebody. And I was like, “Please, please write something from you so people know you’re okay. Everyone is waiting (crosstalk at 00:31:24).” And he started to cry because he just couldn’t gather his thoughts. And he was just really upset at the thought of having to do it. I was like, “Oh my gosh.” (sighs)

So, we updated it from time to time (inaudible at 00:31:38).

THERAPIST: How do you feel about doing that?

CLIENT: I mean, I understand his feelings. It’s not like he wants to—he writes things that really—or how he feels. For him, it’s a lot to write it down. It takes a lot of energy. I mean, I just know people want to know what’s going on. [00:32:01] But he can’t approach it like that. So, that’s fine.

THERAPIST: Mm-hmm. Provides, too, a very different purpose for you, for him, and for the people reading it.

CLIENT: (chuckles) I don’t know what I’m trying to say with (ph) the website, either.

THERAPIST: Well, you were talking about how the outpouring of support has started to dwindle a little bit. Or the support and attention you’re getting from other people sounds like it’s getting less.

CLIENT: (inaudible at 00:32:38) I guess it’s not really a problem.

THERAPIST: Well, it makes you feel more alone.

CLIENT: I mean, things don’t feel hopeless right now, because I know that there’s hope. I feel hopeless in the short term, I guess. That’s possible. [00:33:00] Right, because I feel a little hopeless. And I keep disappointing myself or letting myself get disappointed by thinking that Josh is doing better and he’s okay. And he’s really just in such a, I guess, a fragile, fragile state that . . .

THERAPIST: That that bubble of hope gets burst so quickly.

CLIENT: Well, I guess I made the mistake, really, of thinking he’s okay mentally (ph). He’s supportive of me.

THERAPIST: Yeah, to be your boyfriend.

CLIENT: (inaudible at 00:33:33) And he can (ph). (chuckles)

THERAPIST: So, it’s really hard to be in a relationship with someone who can’t reciprocate right now in very many ways.

CLIENT: Well, he did send me a giant vase of flowers (inaudible at 00:33:51). (chuckles) I’m not sure why. He just (inaudible at 00:33:55) a lot of time on his computer.

THERAPIST: It’s something he can do.

CLIENT: Yeah. That was a really sweet thing to do. [00:34:03] (inaudible at 00:34:06) cares. (laughs)

THERAPIST: I’m sure he does. And I’m sure he really appreciates you in the same way that he has in the past. But there are fewer ways that he can express it. And it’s hard for him to be attentive to any of your needs, because his needs are so overwhelming. And it’s really hard to be a caregiver. And I think especially so young. This is not a role many women your age are thrown into.

CLIENT: Actually, I think after I (inaudible at 00:34:43), we had a couple who—the girl with the heart transplant was our age come with her boyfriend. Did I tell you about this?

THERAPIST: I know that they existed. But I don’t think I heard about what it was like when you met them.

CLIENT: Well, it was the first time I had met her boyfriend. [00:35:00]

THERAPIST: So, their situation was reversed, where she’s the one with the heart transplant?

CLIENT: Mm-hmm. He was in the Army, so he’s a little older. But he was just about to start undergrad. And we bonded over things just like—not bonded, but it was nice to talk about things just like how, when you say (inaudible at 00:35:18) to get professors to believe him (inaudible at 00:35:19). He had just started school, so no one knew him. That his girlfriend was really ill in the hospital and he had to pretend that she was his fiancée sometimes. Or just how work felt so pointless sometimes.

So, anyway. So, I mean, so nice. I’d say that made me so happy for a couple days. (chuckles)

THERAPIST: Yeah, to have someone who truly understands your experience.

CLIENT: Mm-hmm.

THERAPIST: And can empathize with what a difficult position you’re in as the healthy partner.

CLIENT: Yeah. And I didn’t know him well. Obviously, it was the first time I met (crosstalk at 00:35:53) so I didn’t go too far (inaudible at 00:35:53) (chuckles) into (crosstalk at 00:35:56) –

THERAPIST: And (ph) you met him under pretty extreme circumstances.

CLIENT: Yeah. And it was the four of us. [00:36:00] (inaudible at 00:36:02) hopeful.

THERAPIST: Do you guys have plans to talk again or communicate again?

CLIENT: They come and see him every time she’s in the hospital. So far, it’s only been once a month. And, I mean, I know—he said it was pretty disconcerting to come back up to the floor (inaudible at 00:36:20). I felt like I really (inaudible at 00:36:22) to them, I’m sure I could.

THERAPIST: Yeah. I mean, it might be useful for you to just have some correspondence with him, because having a true understanding of what you’re going through and what it’s like can be really supportive for both of you. Some of the questions that you wrestle with. Giving yourself permission to go and do something that’s actually fun. To actually get to live a little bit of your life is something that he could probably really understand in a way that other people might not truly understand. Or you might not feel comfortable expressing to somebody else. [00:37:01] And having someone else who really gets it.

CLIENT: [And now] (ph), he does say that he hid from his friends. Because I was saying how I had hid from them. And (inaudible at 00:37:11) really great. He was saying he’d done that (inaudible at 00:37:14).

THERAPIST: He’s staying (ph) in hiding mode (ph).

CLIENT: Yeah. (inaudible at 00:37:21) little bit worried (ph) (inaudible at 00:37:22) with him.

THERAPIST: I doubt that you’re going to hurt him or make things any worse than what he’d already experienced in having a partner who’s so sick.

CLIENT: Yeah. I mean, and then the other kinds of things I guess I would want to say would be how awful the—things that I wouldn’t want Josh to ever know, probably. It’ll probably take a while to have a relationship with this guy (inaudible at 00:37:52) say those things. I don’t know.

THERAPIST: Mmm. Are they things that you say in here?

CLIENT: Oh, sure. Yeah.

THERAPIST: And you think they’re awful? [00:38:00] (inaudible at 00:38:02)

CLIENT: Well, (crosstalk at 00:38:02) makes me want to run away on a regular basis.

THERAPIST: Yeah, I don’t think that’s—I understand that you feel awful about it, but I don’t think they’re awful things to say. I don’t hear them that way.

CLIENT: Again, I would say these things to Josh if he was well, because then he would make me feel (inaudible at 00:38:21). (chuckles) Which is kind of what I’m missing right now.

THERAPIST: Right. You want him to be able to take care of you and help you with your hard feelings.

CLIENT: Towards him, which is weird.

THERAPIST: Well, it’s interesting, because it’s not really him. It’s the disease. The situation.

CLIENT: Mm-hmm.

THERAPIST: I mean, you want to run away from the situation, not him.

CLIENT: Sure. Yeah.

THERAPIST: Obviously, they’re inextricably linked. Right?

CLIENT: Well, and that’s the same thing that I did when I wasn’t sleeping. And then, I tried to break up with him, to see if (inaudible at 00:39:04) it would be fine on my own. [00:39:06] And he’s the one who said (inaudible at 00:39:09) fix this.

THERAPIST: Thinks he wants to help you fix it.

CLIENT: (crosstalk at 00:39:12) it is, you can break up with me but (crosstalk at 00:39:14). I mean, I think he would understand if he was feeling well. And would be hopeful. (chuckles)

THERAPIST: Right. But in his fragile state right now, he can’t—there’s no distance that he has right now from it.

CLIENT: I don’t even know what’s going on in his head. Last week, he was really—he was crying because he didn’t know why he was crying. Couldn’t even understand why he was so upset. He was just on another planet. He’s coming back. [00:40:00]

THERAPIST: Yeah. That’s scary for him. And for you to watch.

CLIENT: Yeah. Yeah.

(pause)

CLIENT: I don’t know what I’ve been saying at all. What is actually going on.

THERAPIST: (chuckles)

CLIENT: (chuckles)

THERAPIST: Well, I’ll give you the recording. (chuckles) I wonder if the reason you feel like you don’t know what’s going is that there are lots of different places that you are in your head. I mean, if you—if you were to listen to the playback, everything you’re saying makes sense. It sounds like you’re in different places. There’s the part of you that wants to run away and have things make sense and be able to live your life. [00:41:02] There’s part of you that feels really guilty for even thinking about it. There’s part of you that wants to be there. And there’s part of you that’s just drained because you are vacillating from a place where there’s pressure to get some work done and be a functioning member of the team at school. And there’s pressure to be at the hospital and be the person that’s his main advocate. And there’s pressure to help him deal with all of his feelings of heartlessness and anger. And there’s a wish for it to all go away and just be normal.

CLIENT: Well, and every week, it’s a different combination that results in something completely different.

THERAPIST: Yeah, so it’s hard to prepare for it. It’s like any game plan that we create to try to manage these different pieces is really temporary, because the different pieces change from day to day or week to week. [00:42:00]

CLIENT: Well, I guess I’m hopeful, because trying to deal with everything is what always gets me in trouble.

THERAPIST: Mm-hmm. So, if we can whittle down –

CLIENT: Like today, not going to the hospital, despite the fact that it made me feel really guilty is now making me feel not in a panic. It’s good. It’s just then I have to deal with –

THERAPIST: What if you gave up your guilt?

CLIENT: (chuckles) [I know] (ph). Yeah. (sighs)

THERAPIST: I think accepting that you have limits. So, if there’s three things that you’re constantly juggling and you know that your limit is to deal with two of them a day, then you pick two a day and leave the guilt to the side. Of course you have limits. You’re a human being.

CLIENT: I know. That’s another thing. I mean, I said to Josh on the phone I just can’t. I’m [starting to] (ph) go into a panic. [00:43:00] And I feel terrible saying this stuff to him, because (chuckles)—but I guess we’re past the point where I just need to be there no matter what. He’s been in the hospital for so long, it’s not an emergency (crosstalk at 00:43:11).

THERAPIST: You can’t be. You can’t be there all the time.

CLIENT: And at first, he said, “Oh, no problem. Come see me (inaudible at 00:43:18),” he said. And then he started saying, “Well, or the next day. I mean, you’ll come—maybe you’ll never come again,” or something. (chuckles) [I was like] (ph), “Oh God (ph).” (chuckles) And I’m sure he was teasing, but also not a little bit.

THERAPIST: Yeah. It makes sense that of course, he’d want you there. But you can’t –

CLIENT: Well, he got really upset at his mom last couple days or something because she comes once or twice a week. And just got really—and she’s been feeding basically. He won’t eat hospital food anymore. And he asks for the—make her special—she makes really good food. Her special macaroni and cheese, and special this, and special that. And so, that’s awesome, because I don’t have time to make him food. [00:44:01] And he won’t eat hospital food anymore. And if he doesn’t get (crosstalk at 00:44:06).

THERAPIST: He needs to eat.

CLIENT: He won’t, otherwise. And he really needs to eat. So, anyway, so that’s great. And so I’ve been really appreciative of her coming once or twice a week with food. But he got really upset with her for not coming all the time, either. I’m not sure what I was saying with this (chuckles) either.

THERAPIST: Because nobody can be there as much as he wants. And she’s not reliable as someone to help you share or it sounds like she’s somewhat reliable to help you share the burden, but not as much of it as you would hope. Or as he would hope.

CLIENT: I mean, I guess he wants (inaudible at 00:44:45) all the time, 24/7.

THERAPIST: But that’s not sustainable.

CLIENT: Right. But then having to say no, it’s just so hard.

THERAPIST: But you do have to say no, because it’s not sustainable for you to be there 24/7. [00:45:03] And it may not be sustainable for you to be there even through 3/7. You can’t be there every day.

CLIENT: (chuckles)

THERAPIST: There are some days where you have to choose the other two things. And part of it sounds like what you’re doing is trying to get her to play a role. And take up a big role, maybe. And find other people that can take a night or a day or even seeing if you can facilitate people to be a little bit more active in responding to the blog a little bit.

CLIENT: Yeah. Maybe I’ll write an entry about how we need a, I don’t know, something.

THERAPIST: You need a social (inaudible at 00:45:48).

CLIENT: (laughs) Yeah.

THERAPIST: (laughs) Well, I think you’re doing a fabulous job taking care of him. [00:46:00] And allowing yourself to take care of you, too. Even if that means you do a tiny little bit less caretaking of him. Because your needs are also really important. And he can’t meet them right now, so that means that you have to allow yourself to take advantage of the other times when other people can do that. Yeah. I think enjoying going cross-country skiing with your mom and going to the bachelorette, those are things that are really important for you. And you count, too.

CLIENT: Yeah. I’m going to go cross-country skiing again on Saturday.

THERAPIST: Good for you.

CLIENT: Well, I could try—well, at the bachelorette, I’m going to try not to look at all the other people skiing and get so sad.

THERAPIST: Mm-hmm. It’s okay to be sad. Allow yourself to experience the other things, too. So you don’t let the sadness chase away all your good stuff. It makes sense that there be a piece of you that is sad, because you long for him to be able to enjoy it with you. [00:47:04] And it’s part of the way that you honor your relationship. Let there be room for that, along with their being room for enjoying that you can be out there and you can celebrate with your friend. And that it’s nice to be out in the fresh air and not inside the hospital. That there’s room for all those feelings to exist in the same space.

CLIENT: Yeah. I mean, the first time this happened, I cried all night and talked to my friend for several hours on the phone. She also made me feel sort of bad about it, because she had never met Josh and was like, “What are you doing?”

I don’t know. I guess it’s not really (inaudible at 00:47:45) it, but this last time, I had a couple drinks with my friend (inaudible at 00:47:49) eating ice cream for dinner. Just feeling sad. I guess that’s not too terrible, though.

THERAPIST: Once in a while, it’s okay.

CLIENT: (laughs)

THERAPIST: Ice cream for dinner every night, you might start to not feel so great. [00:48:02] But ice cream for dinner –

CLIENT: Well, ice cream and wine (inaudible at 00:48:05).

THERAPIST: (chuckles)

CLIENT: Because I’ve been a little self-destructive lately, just (inaudible at 00:48:08). I don’t know.

THERAPIST: See if you can get Josh’s mom to make you some dinners, too.

CLIENT: My mom’s making me food.

THERAPIST: Good.

CLIENT: If I ate Josh’s mom’s food, it’s so good, (inaudible at 00:48:20) left. (chuckles)

THERAPIST: (laughs)

CLIENT: Seriously. That’s all he’ll eat, so . . .

THERAPIST: Well, I mean, just—I know you mentioned the drinking a little bit as an escape last time, too. And I think it’s important to just keep tabs on how much.

CLIENT: Wow, I mean, it backfired. I started to get really exhausted and then I had a drink. It just destroyed me. I don’t know. My body was just over it. I couldn’t do it. And I’ve had just a couple nights in the past two weeks. And every single one, again, this is a little bit self-destructive, because I keep doing it and it just felt horrible. [00:49:00] It doesn’t feel like –

THERAPIST: It’s not helping anymore.

CLIENT: It’s not helping. Yeah. Like it was (inaudible at 00:49:05). (chuckles)

THERAPIST: So (inaudible at 00:49:06) time to switch over to something else. And maybe if it get—if you feel like you need something, try the Ativan. Not mixing with alcohol, but instead –

CLIENT: (chuckles) I know.

THERAPIST: to see if you can get a little bit of the escape and relief that you need with fewer side effects.

CLIENT: (inaudible at 00:49:24) it is exhausting, constantly I have to come with things that help. I guess I couldn’t expect alcohol to help forever, but it could have helped for a little while. More than a week or two, (chuckles) that would’ve been nice.

THERAPIST: Well, I will help you coming up—I will help you to come up with alternate coping techniques. And that’ll be my job. And you just try them out. Or (inaudible at 00:49:48) to. Why don’t we wrap up there for today? And are we on for next week, at this time?

CLIENT: Yes.

THERAPIST: I think I have you in there already. [00:50:01] Oh, gosh, no, I didn’t. Can we do 11:30?

CLIENT: Sure.

THERAPIST: I forgot. Next week has President’s Day in it, so it’s going to go a little—all right, and then back to 12:30 for the 25th. Let me make sure I have (inaudible at 00:50:19).

CLIENT: Okay. So you put me in for two weeks?

THERAPIST: So I put you in—I’m holding a spot for you on the 18th at 11:30. And then the 25th at 12:30?

(pause)

CLIENT: Okay.

THERAPIST: And I put in the 4th at 12:30, as well. Again, if things come up and you need to change them, as long as you tell me a day ahead, that’s fine.

CLIENT: Okay. (inaudible at 00:50:50)

THERAPIST: Okay, no problem.

CLIENT: (crosstalk at 00:50:52)

THERAPIST: It’s totally fine. It all works. Do you want receipts, since it’s cash? (inaudible at 00:50:56), okay. [00:51:00]

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