TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Now, how are you today?

CLIENT: I still don’t know.

THERAPIST: [chuckles]

CLIENT: But better than last week, I guess.

THERAPIST: How do you feel different?

CLIENT: Well, last Wednesday, I went and saw Linda (ph). And she convinced me to try more Zoloft. [chuckles] And I don’t know if it’s really helping but it feels like it is.

THERAPIST: Yeah, I mean, you were on—we actually—we’ve been trading messages back and forth –

CLIENT: Okay.

THERAPIST: giving each other nuggets of information instead of having an actual conversation. I’m trying. One of the things I mentioned was that you seemed to be vibrating with anxiety two weeks ago, I think was –

CLIENT: Yeah.

THERAPIST: the worst of it, in terms of when I was seeing you. I don’t know what happens in between. And she mentioned that you were on a really low dose of Zoloft. And that maybe going up a little bit might be something helped just bring down the constant buzz that was happening for you. [00:01:08]

CLIENT: Well (ph), I was telling her how tired I was. And for some reason, the last time she tried to up it, I don’t know, it was making me feel a little jazzed. Maybe I just drank too much coffee at the time. I don’t know.

THERAPIST: Well, you were also—I mean, you’re in a different place –

CLIENT: Yes.

THERAPIST: and what you’re dealing with changes.

CLIENT: Yes, yes. And I’m not sure I gave it a fair shot before.

THERAPIST: Well, I know you’re often very hesitant about the meds. We want to respect, but we also want to make sure—I guess—I can’t make recommendations about the medication, but I can report what I see. And I want to respect your hesitation to not be on a lot of medication. But we also want to just get you whatever types of support you need right now.

CLIENT: Yeah. And, well, I hadn’t been taking it—well, in the morning, every time I take it in the morning, which is when I usually can remember to take it; it usually hurts my stomach a little bit. [00:02:04] I feel like I need to eat more. And so, I told her that. She’s like, “Just take it in the afternoon. Set an alarm. Bring it with you.” And I (crosstalk at 00:02:14) –

THERAPIST: Mm-hmm. That’s (inaudible at 00:02:15).

CLIENT: Just have been feeling like I didn’t want to take it anyway, so I wasn’t—I don’t know. I don’t know why it (crosstalk at 00:02:21).

THERAPIST: Mmm. So it hadn’t been super consistent.

CLIENT: I mean, I’ve been consistently taking it in the mornings.

THERAPIST: Oh, okay. Even though it was upsetting your stomach.

CLIENT: I don’t know. I don’t know what I was doing. But anyway, so, taking it in the afternoon works better.

THERAPIST: Good.

CLIENT: And I seem to have more energy in the afternoons. I don’t know if that—I know it takes a while for it to build up.

THERAPIST: But you already have a baseline in your system, so I—it’s not the same as starting from scratch.

CLIENT: Okay. I don’t want to get too excited but it seems to be helping (inaudible at 00:02:51).

THERAPIST: I think you’re allowed to enjoy feeling a little bit better.

CLIENT: [chuckles] Yeah, sometimes, now, I have more energy in a good way in the afternoons. [00:03:00] It’s been nice. I know we talked a little bit about Josh last time. And things haven’t really gotten better with him [chuckles] in any way.

THERAPIST: I’m sorry to hear that.

CLIENT: And it’s really just because he’s in—he has back pain. I think I told you last time. That hasn’t—we haven’t been able to fix yet.

THERAPIST: Find a way to control that, yeah.

CLIENT: And, I mean, it just makes him completely unable to do anything, so, yeah (ph).

THERAPIST: What’s it like for you?

CLIENT: It’s awful. Because I left last time really wanting to set up some sort of time we could have.

THERAPIST: Yeah, so that you could actually connect with him.

CLIENT: Yeah. And, I mean, I—he’s been a little bit better to hug. [chuckles] Do stuff like that. But I tried to—because we used to have date night on Saturday nights. [00:04:00] So I tried to actually sit at the dinner table with him and eat dinner, but he was having back spasms trying to sit in the chair and eat. So, I don’t know, it was a disaster. [chuckles] Every time I –

THERAPIST: Makes you feel like time—I mean, you don’t get what you were hoping, to have a time when you can actually connect with him. And it’s hard to see him be in pain, I would imagine.

CLIENT: Well, he felt really bad. (inaudible at 00:04:29) We had managed to make dinner. And then, we tried to sit down and –

THERAPIST: Mmm. And he can’t do it.

CLIENT: Yeah. And he couldn’t sit there. And, I mean, he’s sitting there, not just in pain but freaking out. He said it’s so bad.

THERAPIST: (crosstalk at 00:04:44)

CLIENT: I can’t even imagine. And then, also, yeah, and I’m really hoping when he got—came home that we’d be able to spend time together –

THERAPIST: Mm-hmm. (crosstalk at 00:04:54)

CLIENT: enjoying that he was home. But every time I got a little bit upset, an hour, maybe, in the morning, where he was—it was a little bit normal. [00:05:05] Then he would suddenly have back pain. So, it’s really taken away our times to be (inaudible at 00:05:12) normal. [chuckles] He can’t get in a car. I can’t get him to go outside. It’s a really big problem. So, I mean, we’ve got all kinds of drugs. We have a massage therapist come. He’s got physical therapy coming. I don’t know. I guess I hope it’ll work out eventually, but –

THERAPIST: Yeah (ph), it sounds like it’s really hard to control.

CLIENT: Yeah. I don’t know what—we don’t really know exactly what cause it is. Crazy amounts of drugs (inaudible at 00:05:40). [chuckles] Just not good. So, I don’t know.

THERAPIST: Yeah, very frustrating from a medical standpoint of trying to figure out how to help him. But also really frustrating in terms of your relationship, because without pain being under control, you don’t really have access to your boyfriend at all. [00:06:02]

CLIENT: Yeah. I mean, it’s weird. (inaudible at 00:06:05) quickly can just become—I can’t see (inaudible at 00:06:07) the middle ground between being really stressed and having to separate myself. Which, I guess, almost becomes—I start to feel depressed, I guess. [chuckles] Like last night, he was finally feeling a little better and he wanted to sit on the couch and watch some TV with me and be a little bit of normal. But he had spent the past three hours previous sleeping off some pain drugs he took because he was having really terrible back pain. I don’t know. I couldn’t –

THERAPIST: It’s hard for you to slip into, “Okay, we’re going to sit down and have the Oscar party now.”

CLIENT: Yeah, kind of. I don’t know, my brother had been over and I’ve been hanging out with my brother. Chatting for those three hours while he was fast asleep on the couch. And I don’t know, I guess I was—I felt so separate. [00:07:00] I don’t know. [sighs] God, and the minute he starts having back pain, he needs me to take care of him. Get him drugs, get him a heating pad, give him a back massage.

THERAPIST: It’s hard to slip from one role into the next. Or having some regular life of your own. Caretaking and then trying to be a girlfriend.

CLIENT: Yeah. [chuckles] I don’t know. He seems to be keeping up decent spirits about it, I think. I don’t know if he’s putting it on or putting that on for me, but—I don’t know.

THERAPIST: How are your spirits?

CLIENT: Well, not too terrible, I guess, because it felt just more—I’ve separated the moment when I take care of him. Even though he’s home. I mean, he knows we’ll be at the hospital, because it’s –

THERAPIST: You’re probably actually doing more caretaking.

CLIENT: Yeah. I mean, that has gotten better as he’s figured out stuff that he can do himself. [00:08:02] So, I don’t feel so exhausted by it all. Also, I mean, last Tuesday, because I saw you on Monday. Last Tuesday, we had gone to the hospital for his weekly check-up. And the infectious disease people had come in to see him. And I don’t know if he’d never met them before or—they didn’t know much about the whole transplant business or just the infection. And they were asking his transplant nurse if he’d been listed. She’s like, “Oh, yeah, he’s been listed for a month,” or whatever. And they said, “And how long do you think he’ll be listed for?” And she said, “It could be a year.” And I think I told we’ve been dreaming about our wedding in October.

THERAPIST: (inaudible at 00:08:42) months.

CLIENT: I don’t know. We really have been like, “It’s got to happen by the summer.” That’ll be like six months. Be just a good time to start really hoping. And they’re pretty pessimistic, the transplant nurses. But they’re usually bright. They knew (crosstalk at 00:08:58) infection (inaudible at 00:08:59). [00:09:00]

THERAPIST: So hearing “a year,” and thinking that’s probably realistic.

CLIENT: Yeah. So that really killed our spirits last week, a lot. [chuckles] It was pretty sad. To have to be like, “Okay, it could actually be a year.” Because, also, I mean, I think I told you, he’s been sleeping on the couch because he didn’t want to ruin our relationship. We’ve had several conversations about that. He’s still sleeping on the couch.

THERAPIST: Well, it sounded like that was actually a somewhat good plan for you, sleeping separately.

CLIENT: Yeah. It’s really sad. (inaudible at 00:09:34) him sleeping on the couch for a year. [chuckles] It’s terrible. He won’t even come into the bedroom because it makes him sad. In fact, he actually tried to go into the bedroom and we realized his device couldn’t fit through all the (inaudible at 00:09:51). [chuckles] Because we hadn’t actually tried to rearrange it because he hadn’t really been (inaudible at 00:09:55). That was really bad. [sighs] So, I don’t know. [00:10:00]

THERAPIST: Yeah. It’s hard to get these doses of reality.

CLIENT: Yes. And I think he still can’t really wrap his head around “a year,” so (crosstalk at 00:10:10) –

THERAPIST: I think it’s too long to think about right now.

CLIENT: It’s too long to think about. And I think it –

THERAPIST: I mean, you have to get through day by day. And you don’t know it’s going to be a year. You don’t maybe need to think in terms of a year.

CLIENT: (inaudible at 00:10:22), yeah.

THERAPIST: You’re never going to really know exactly when that’s going to happen.

CLIENT: Yeah. That was really crushing last week. I think we’re just not thinking about it at the moment. But things aren’t day by day crises anymore. Just about all his pain and whatever. So we have to come up with some kind of (crosstalk at 00:10:38).

THERAPIST: Something in between day by day crisis and planning a year ahead. There’s lot of room in between there.

CLIENT: Yeah, but I mean, anxiety-wise? At some point, I want to be feeling okay (inaudible at 00:10:55) keep us separate. It’s just sad.

THERAPIST: Right. Because it’s a big loss. [00:11:01] So there’s something to be gained in keeping yourself a little bit detached and seeing your separate life. But there’s a lot to be lost in having to maintain that distance from him.

CLIENT: I don’t know. I mean, (inaudible at 00:11:18) if it’s a sustainable way to be. It’s working this week, at least.

THERAPIST: Even if it’s sustainable, which it might be, I don’t think it’s—it’s certainly not what you want.

CLIENT: Well [chuckles] yeah.

THERAPIST: And I wonder if it’s possible to plan for something that has some semblance of what you want. I mean, no, you’re not going to get your ideal. But maybe, like you said, some sort of a life, some sort of connection where you feel like you’re actually dating.

CLIENT: [chuckles] Well, I mean, that can’t happen until his pain is under control, because it’s just so debilitating. [00:12:06] And when that will be and how that will happen, I have no idea. So, I don’t know. Have to put it on hold, I guess. We’re going to the doctor’s again tomorrow. Beg for some more options, I guess.

THERAPIST: And getting creative. Like you tried to have dinner at the table, which would have been really nice. To be able to sit across from each other and share a meal. Are there more creative solutions?

CLIENT: [chuckles]

THERAPIST: And getting creative is the only way that you’re going to get a little bit of feeling like you’re actually having a relationship. Because, right, the traditional modes of connecting, you’re not going on date nights. It sounds like even planning for dinner at home at the table is hard. You’ve talked about it’s really hard to even find a way to touch him that’s not going to hurt him, so sex is out the window. [00:13:02] And getting creative about, well, how do you have some physical connection that feels warm.

CLIENT: Yeah. I mean, I guess it’s hard to even accept any of it. Even if we’re just sitting on the couch, because at any minute, he’s going to start –

THERAPIST: It could be –

CLIENT: freaking out.

THERAPIST: switch.

CLIENT: Which would just then be so sad and upsetting, if I was just trying to relax and be okay (crosstalk at 00:13:28).

THERAPIST: If you put your guard down.

CLIENT: Yeah. So, I don’t know. I guess this is where I just become—I don’t know. It just feels really depressing if I’m not anxious about it.

THERAPIST: Mm-hmm. So the anxiety protects you from thinking about missing out—on what you’re missing out on.

CLIENT: [chuckles] Yeah. I mean, you mentioned sex. Ever since they mentioned a year last week, the thought of a whole year. [chuckles] [00:14:02] And more. The whole (inaudible at 00:14:04) thing. That’s been suddenly shot to the top of my mind. I’ve been not really thinking about it, I guess, until (inaudible at 00:14:12) this past week.

THERAPIST: It’s a big component of a relationship. And it’s been removed as an option for potentially a long while.

CLIENT: I think it could be an option eventually, if he ever feels good.

THERAPIST: Mm-hmm, yeah.

CLIENT: (inaudible at 00:14:33) But, I mean, I think I’ve told you before. I mean, a lot of the times, when I have horrible thoughts and I tell him, it makes me feel better. But something like that is not something he can make me feel better about, because it’s so painful for him. Well, I did say it to him and it just made him feel bad. I don’t know. I’ve said a lot of these things, but I think that was really bad. But he can’t stop being in pain, either.

THERAPIST: Right. He doesn’t have control (inaudible at 00:15:01) either. [00:15:01] I’m sure that he would like to also not be in pain and be able to have a normal sex life with you.

CLIENT: [chuckles] Yeah.

THERAPIST: But even though, I mean, (inaudible at 00:15:12) the ideal is the same for both of you. I’m sure you would both like to be healthy and be able to not even think about it. Just whenever you had an opportunity, you would have sex and it would be great. It’s different for you because it—you’re still a healthy young woman. And he’s in a lot of pain. So when you’re in a lot of pain, your sex drive really drops. It’s probably not something he’s interested in now. In an ideal world, he’d be interested. But my guess he doesn’t really have much of a libido. That doesn’t make yours go away. And so, you being in the position of being healthy, having a libido, and yet, not really being able to have any—much access at all to your boyfriend is different. You guys are coming from a different place. [00:16:00] Being able to talk about with no—without either one of you blaming or feeling resentful is important.

CLIENT: Yeah. And no, we did talk about it a little bit but there’s not really a solution.

THERAPIST: No.

CLIENT: So . . .

THERAPIST: You’re stuck in a really difficult position.

CLIENT: And that’s when I start thinking about this whole year, how awful that would be if it really is a year. (inaudible at 00:16:36) it’s Rhode Island it’s a really long wait compared to other places. It would be half the wait time in Washington.

THERAPIST: You can’t transport him?

CLIENT: You can, actually. If he wanted to go. If he wanted to (inaudible at 00:16:51) out there, he could. People do. But the thought of that is just too nuts. [chuckles]

THERAPIST: That’s pretty daunting, too. [00:17:00]

CLIENT: Yeah. Just for another six months. I mean, six months in that context feels like nothing. But it feels like a whole lot of work just for six months. But then, six months is (inaudible at 00:17:10).

THERAPIST: Right. Because he can wait a year with the bad . . .

CLIENT: Mm-hmm, yeah. (inaudible at 00:17:19)

(pause)

THERAPIST: When you talk about it with him, what are—what does he say? Can you guys problem solve how to get through the next year?

CLIENT: I think really everything is put on hold by this (ph) pain. We’ve talked about it a little bit and how we’ll make it work. But, I mean, right now, our conversation’s gotten as far as we’ll make it work because we have to. [chuckles] [00:18:00] Yeah. I guess we haven’t gotten into solutions because the pain is just such an (crosstalk at 00:18:06) problem.

THERAPIST: (crosstalk at 00:18:07) So it’s like revolves around figuring out how you can manage the pain.

CLIENT: Yeah. And I mean, whatever’s happening just stops. Even this morning, my dad came to spend the day with him, which is the first time my dad’s done it. And he walks into the kitchen and Josh is having a muscle spasm thing. My dad came over to work, but he’s just—you can’t just leave him groaning in pain while you try to do something else. And he started offering him massages or whatever. And there’s just nothing to do but just watch him suffer. Yes.

THERAPIST: Gosh, that must be so hard.

CLIENT: Yeah. I mean, it’s awful. [chuckles] Because it’s keeping him from getting stronger. It’s keeping him from getting out.

THERAPIST: How does it feel to be able to leave and not have to watch and have somebody else there? [00:19:01]

CLIENT: It’s great.

THERAPIST: It’s nice to get a break.

CLIENT: Yeah. I mean, I’ve been leaving him. I left him this week—I had a great weekend on my own. I left him to go to a yoga class. I left him to go biking. I left him to go grocery shopping. I stopped there and drank a bottle of wine with my brother while he was asleep on the couch from pain drugs. And that’s what’s been making me feel better. But just more separate from him.

THERAPIST: Right, because you were (ph) able to maintain a life for yourself right now or this week.

CLIENT: Mm-hmm, yeah. So, I don’t know. It’s just really sad. [chuckles]

THERAPIST: Mmm, it is really sad. And it sounds like what you need to do right now in order for you to be able to keep going. And to be able to be strong enough to help him when he needs it.

CLIENT: Yeah. And I’m feeling less really down about, less—like I just want to stay in my pajamas all day. [00:20:02] Maybe because of the Zoloft? Maybe just because I practice? I don’t know.

THERAPIST: It could be partly because of the Zoloft and partly because you got out and did those other things. You were getting some distraction and some joy and sense of satisfaction.

CLIENT: Yeah. I mean, and also—I think the Celexa’s helping me concentrate at school, I think. I feel like I can do more work than I was. I don’t know. Just a little bit (inaudible at 00:20:32) having a lot of a guilt about that.

THERAPIST: Yeah. So it feels good to be able to be effective in your life, too.

CLIENT: Or actually more effective [chuckles], yeah. And I mean, also, just changing Josh’s dressing becomes less stressful.

THERAPIST: Yeah. (inaudible at 00:20:52) some practice behind you.

CLIENT: Or just any of the things that seemed so horrible the first few times or many times are not as horrible anymore. [00:21:04] [That’s good] (ph), I guess.

THERAPIST: Yeah. Well, getting used to it is—if this is going to be the routine, then having the routine not be so jarring and so draining.

CLIENT: So (inaudible at 00:21:27), yeah, I still don’t know where things are. [chuckles] They’re somewhere different.

THERAPIST: One of the things you talked about last time is the one of the things that seemed to be helpful to him, like having your dad –

CLIENT: (crosstalk at 00:21:43)

THERAPIST: are so—sometimes make it more difficult for you. How have you guys been managing that?

CLIENT: [sighs] I don’t know. I trying to think if anything like that’s happened this past week. [00:22:00] I don’t know. I don’t know if anything’s happened (crosstalk at 00:22:06).

THERAPIST: So you just got lucky this week?

CLIENT: Maybe. [laughs]

THERAPIST: [laughs]

CLIENT: I don’t know why it really him—I mean the pain is just really what he needs to deal with. I don’t think he has any room to have my dad emotionally support him or anything. It’s just that the pain has just taken over.

THERAPIST: Mmm. So anything that can—anybody can do to help him with that.

CLIENT: Mm-hmm. Yep. I don’t know. We’ll see how today went with my dad when I get home, I guess. [chuckles] I don’t know. Josh’s friends are coming in two weeks from Washington. Yeah, I mean, I guess, at first, I was worried about what we would do. Now, I don’t care, I guess. [chuckles]

THERAPIST: What’s the switch?

CLIENT: I (inaudible at 00:22:56) lower expectations, now, of what we could even accomplish. [00:23:00] I mean, they’re just going to have to be confronted with the situation that –

THERAPIST: Right. The reality of what you (crosstalk at 00:23:05).

CLIENT: [Is what it] (ph) is. And it’ll just probably be not as much fun as we hoped. I was trying to be hopeful that they would be (inaudible at 00:23:13) house and get him feeling better. But only if we can get his pain fixed.

THERAPIST: Has the pain increased? It sounds like it’s become much more of a focus.

CLIENT: I think it increases the more he moves around. I don’t know. I mean, it was pretty bad in the hospital. He’s got (ph) less drugs available, I think, maybe is part of it. In fact, he’s out of one of them. And I don’t know if we’ll be able to get him more. Well, I’m not saying I’m worried about it. I don’t know what—I guess that—it’s not that I don’t care. I just [sighs] I don’t know. I don’t know if (inaudible at 00:24:00) do anything about it. [00:24:01] He’s been bounced back and forth between his primary and there’s a psychiatrist who’s in charge of the pain drugs at the hospital. So that he doesn’t get (inaudible at 00:24:13), I guess. But they keep sending him back to his primary care, who doesn’t want to deal with it. I don’t know. [laughs] I don’t know where we’ll (inaudible at 00:24:20).

THERAPIST: Nobody wants to prescribe the opiates, huh? [chuckles]

CLIENT: I guess not. Yeah.

THERAPIST: So, who becomes the person that advocates for that? When he’s getting bounced back and forth the between one doctor and the next. Is that all in your lap or . . . ?

CLIENT: I mean, he’s been making the phone calls.

THERAPIST: Okay, so he does that.

CLIENT: I don’t know if he succeeded today, but . . . yeah, I don’t know. I’ve been waiting until tomorrow to see if we can make things happen with (inaudible at 00:24:56) improve things.

THERAPIST: Mmm. Yeah, being face to face with people (inaudible at 00:25:01) can get you a little bit of a faster result. [00:25:04]

CLIENT: It’s really hard to get in touch with any of the doctors in (inaudible at 00:25:07). You have to page them and (inaudible at 00:25:10) available and wait for them to call you back. Make sure you don’t miss each other (crosstalk at 00:25:14). Especially on the weekends. No one’s available. [chuckles] Which is why they wanted the primary care to deal with it. But she doesn’t want to prescribe opiates, especially for muscle pain. I don’t know. Google doesn’t help you much with back pain.

THERAPIST: I’m sure. [chuckles]

CLIENT: It mostly tells you to relax and go see a psychiatrist (ph). And it’s hard, too, because I have to believe him, because I see him. I have to believe it’s this really horrible pain and it’s not something else.

THERAPIST: Well, he doesn’t have a lot to gain from pretending.

CLIENT: Not pretending. I mean, I don’t know. It’s hard when people keep questioning why you need all these pain drugs. [00:26:03] And not able to find a cause for it. I don’t know. [chuckles]

THERAPIST: Yeah. So much of pain is unexplained. And it’s hard to—there’s not always an identifiable reason why someone’s feeling what they’re feeling.

CLIENT: You can’t test it.

THERAPIST: Right. It’s so subjective.

CLIENT: (inaudible at 00:26:22)

THERAPIST: Yeah. I would imagine he’s really feeling very intense pain. It sounds like that’s what he’s displaying.

CLIENT: Mm-hmm. I mean, he has intense muscle relaxants. They don’t do anything. It’s really confusing. I don’t know.

THERAPIST: It’s so hard to understand why things aren’t working for him.

CLIENT: Mm-hmm. And he can’t move in ways that—he can’t just stretch his back out like he normally would or whatever. [chuckles]

THERAPIST: Yeah. I wonder if that’s part of what the problem is, right? Because sitting in awkward positions and not having a level of physical activity and being able to stretch is not good for pain. [chuckles] [00:27:08] All those things that you would normally do, right, aren’t possible for him. And being inactive is not what his body’s used to.

CLIENT: Yep. I don’t know. I feel like I’m at a loss in many ways for what to do.

THERAPIST: Yeah. You’re just hanging on. What do you have to look forward to this week?

CLIENT: [laughs] What do I have to look forward to? Well, I don’t know. We’ve still been having lots of conversations about dogs. And I’m starting to really think that I could handle them coming home or I really like them (inaudible at 00:28:00). [00:28:01]

THERAPIST: You’re starting to think you can handle it or you’re starting to think you would like them to?

CLIENT: I guess both.

THERAPIST: You were pretty sure last week you couldn’t handle . . .

CLIENT: Right.

THERAPIST: What’s different?

CLIENT: [sighs] I don’t know. I feel better this week. I feel like I have a little extra time if I wanted to. All the things that Josh needs to have done every day feel like less (crosstalk at 00:28:25).

THERAPIST: It does sound like taking the expected medical chores—do seem like it’s taking less of a toll on you. I mean, you were—the first week, you were really apprehensive about changing the dressings and now it sounds like it’s no big deal.

CLIENT: Yeah. So, the nurses at the hospital, the way they taught me to do it was touch anything, you change everything, you throw away, you start over. Very, very careful. Sterile, which is really, really (crosstalk at 00:28:55). [chuckles]

THERAPIST: And really hard to do, yeah. And really hard to do in an apartment.

CLIENT: It is really, really hard to do in an apartment. I mean, we went to the appointment last Tuesday. [00:29:00] The nurse practitioner in charge of it all did it not much less sterile, but much more—well, I mean, it would be less sterile compared to (inaudible at 00:29:12). In a much more manageable way. [chuckles]

THERAPIST: Did you ask her about the difference?

CLIENT: Yeah. And she didn’t explain it in great detail, but she basically (inaudible at 00:29:24) seemed to see it was good enough. And I mean, the nurses up in the ICU or whatever would always say that they had to be extra, extra careful because—just because of the setting [they were in] (ph). And they would say, “At home, you can do it a little bit less this or that,” or something. But I don’t know.

THERAPIST: And is that because in the hospital, there’s so much you could possibly be exposed to? Compared to at home. It’s your own germs. Your own stuff.

CLIENT: I think so. Yeah, yeah. I think so. (inaudible at 00:29:54). The nurse seeing so many so many sick people.

THERAPIST: Right. They go from patient to patient to patient.

CLIENT: Right, right. [00:30:00]

THERAPIST: He’s exposed to you fairly consistently. And you’re exposed to fewer people.

CLIENT: So, the fact that she wasn’t so stressed about it . . .

THERAPIST: Helped you to relax with it.

CLIENT: (inaudible at 00:30:09) and that’s—I guess it’s been hugely helpful. [chuckles] And stressing about giving him an infection or something. (crosstalk at 00:30:20), so—and also, it’s been about (ph) two weeks and nothing horrible has happened yet, so . . . [chuckles]

THERAPIST: Yeah. You’ve been doing –

CLIENT: Keeping him alive.

THERAPIST: an adequate job. [chuckles]

CLIENT: Yeah, yeah, (inaudible at 00:30:30). And they told me I was doing a good job last week, so, it was calming (ph).

THERAPIST: Yeah. Got a little experience under your belt. Well, maybe it’s something to chart for a couple weeks before you make a decision. See if you have—you feel extra energy or time that you could have been taking care of other living beings this week. And then, look at that the next week. And if there’s consistency and you feel like it would be good for you to have them home, too. [00:31:01]

CLIENT: So Josh has been trying to distract himself from the pain, also. Bought an Xbox to distract himself. [chuckles] Great. And he keeps telling me that the dogs would be a good distraction, which makes me feel guilty (inaudible at 00:31:19).

THERAPIST: Well, I mean, I think the—it’s important to be realistic about the benefits and the risks of having the dogs. Absolutely, they’d be a good distraction. And animals are typically supposed to be anxiety relievers. Pet therapy. [chuckles]

CLIENT: [chuckles] For some people. [laughs]

THERAPIST: Right. But maybe not for you, because it—you wouldn’t be—it’s not like having a pet therapy dog come in that someone’s then going to take away and take care of.

CLIENT: Right, right.

THERAPIST: So, you become the handler. So, I mean, I think the benefit is, yeah, it would probably be nice to have your warm, furry, loving animals around. [00:32:05] But they also have needs. And those needs are going to be met by you. Josh isn’t taking them for walks. He might not always—there may be times when he’s able to get out their food for you and feed them. But there are going to be times when pain takes over and he can’t do that. And it’s one more thing for you to remember during the day.

CLIENT: Mm-hmm.

THERAPIST: Or at the end of your day, when you’re tired. I don’t know what other—you know your dogs best of all. So thinking about what else do they bring into the picture when they’re there. I’m sure there are lots of good things. But there may also be things that are too much. And how do you—I think maybe thinking about it over the coming week. What would it be like to have them here? So that you can balance the benefits and cons.

CLIENT: Yeah. I was looking forward to the thought of it [chuckles] this week. [00:33:00]

THERAPIST: Yeah. You must miss them.

CLIENT: Yeah. And I mean, in a way, it would help Josh. I hate to keep something from him that he’s been wanting for so badly. Could distract him from his awful pain. And he’s promised me lots of help from his mom. And he e-mailed her. Doggy daycare. With his sob story and they said they would help us out. So, seems like (crosstalk at 00:33:27) –

THERAPIST: Help you out how? Would take them during the day or . . . ?

CLIENT: Yeah. They have a van service that they would pick them up and his mom can give us a special deal or something. So, I mean, it’s—it could be okay.

THERAPIST: Yeah. So, there are ways that you could work it in so that you’re not totally on hook for all of the care.

CLIENT: And it’s something positive. Something I could do. Maybe it would help us connect. [00:34:01] I don’t know. A little more.

THERAPIST: Does he have the attention span to read or watch movies? How (ph) is that?

CLIENT: I don’t think to read yet. But watch movies, yeah.

THERAPIST: I was thinking of other ways you can connect, too.

CLIENT: Well, yeah, I mean, we can watch movies. But the likelihood he’ll be able to sit there for an hour and not have to pause for some pain is small. [chuckles] I mean, (inaudible at 00:34:38) it’s also just that when he is feeling okay, it feels—obviously (ph) it feels harder to switch.

THERAPIST: Yeah, for you to them get ready to—yeah.

CLIENT: Into girlfriend. [chuckles] I mean, also, it takes a lot for me to take care of him and give him back massages. And listen to him groan. But I have to block it out. Block myself off just (inaudible at 00:34:58). [00:35:00]

THERAPIST: How do you block yourself off?

CLIENT: [sighs] I mean, I don’t know. I just put side whatever else I wanted to do or how tired I am, because he’s just so needy.

THERAPIST: Yeah. So you’re really setting aside your own needs.

CLIENT: Right. Which I would do generally, from time to time, if he was having us—I mean, one of us is always having a bad moment. The person with the less bad moment is the one who—and he –

THERAPIST: But he’s having the bad moments all the time. You’re not.

CLIENT: Right.

THERAPIST: It’s not very balanced. So I wonder if there are other places—other ways that—so you wouldn’t have to constantly be putting your needs on hold. Can you schedule a massage for yourself so that you’re getting some tension relief? And you’re getting some of the benefits of having physical touch?

CLIENT: [laughs] Well, this makes me want my dogs back. [00:36:01]

THERAPIST: Yeah. Because that’s one way to get that. To get that warmth of another being.

CLIENT: Yeah.

THERAPIST: It’s okay for you to need that stuff. Everybody needs some. Touch is really important. And not just sexual touch. But just human touch is part of what keeps us connected to other living beings. And he can’t do that for you right now.

CLIENT: Yeah. I mean, and maybe I’m painting too terrible of a picture. I mean, he can sit next to me and hug me. It’s good. It’s better than nothing.

THERAPIST: But he can’t necessarily do that when you need it, right? He can do those things if he’s not having—in the middle of a back spasm.

CLIENT: Sure.

THERAPIST: And if you’re actually in the mood. And not trying to focus on work.

CLIENT: (crosstalk at 00:36:51)

THERAPIST: And I feel like being—having to have all those variables line up, for you to have your guard down and actually be open to having a—to holding hands or having a hug or—and him be in a place where he can actually provide that. [00:37:06] Not sleeping off pain meds or not having a back spasm. It’s like there are so many variables that need to align.

CLIENT: Mm-hmm.

THERAPIST: And sometimes, having other ways of feeling like, yeah, you get to be focused on yourself and not thinking, “What does he need?” and “I need to set this other thing aside for that.” And that’s what your times for yoga and going for a run is the time for you to be able to focus on, “This is what I want right now.” And just increasing those. Finding lots of little ways.

CLIENT: Yeah. And this past week, I felt like I can. Because I have enough energy. I didn’t spend all day or all weekend in pajamas feeling gloomy. That was good.

THERAPIST: Yeah. Feels much better.

CLIENT: Yeah. I mean, and we had a bunch of visitors come by. [00:38:03] Our neighbors brought their dog by (ph). I got to hug their dog. [chuckles] I don’t know. I guess I don’t feel a desire just for human contact as much this past week. Just sex. [chuckles]

THERAPIST: Mmm. That’s harder to come by with somebody else.

CLIENT: Yeah.

THERAPIST: Not impossible. You decide whether or not that’s . . .

CLIENT: Yeah. That’s not something that he would ever go for. Sometimes I feel like a bad person because I could imagine creating some sort of arrangement, but –

THERAPIST: Mmm. He’s not open to that.

CLIENT: No. It’s completely understandable.

THERAPIST: (inaudible at 00:38:48)

CLIENT: I want to think I am but maybe I’m not, really. If the roles were reversed? I don’t know. [laughs]

THERAPIST: Yeah, it’s really hard to answer that question for yourself. It’s not a position that many people have to find themselves answering. [00:39:02]

CLIENT: But, yeah. I mean, the thought of when we could ever have a normal or comfortable relationship again it could be a really long time from now. It’s already been a really long time.

THERAPIST: How understand was he that you still have a normal sex drive, even though he’s not available and might not.

CLIENT: Oh.

THERAPIST: Does he get that piece?

CLIENT: Yeah. Definitely. His brain understands. His body just doesn’t.

THERAPIST: Yeah. Well, his body’s in a very different place than yours. His body’s being ravaged by lots of different things right now.

CLIENT: Yeah. And I think he’ll be willing to talk about all kinds of stuff once the back starts (inaudible at 00:39:50). I mean, he just goes into pain world. I’ve been teasing him about it. Hopefully he doesn’t mind. I’m teasing him about being in pain world (crosstalk at 00:39:58). You can see it in his face, it’s just –

THERAPIST: He goes to a different place. [00:40:02]

CLIENT: Mm-hmm.

THERAPIST: Well, humor can be a useful way or trying to diffuse the tension in the situation.

CLIENT: Yeah. I mean, I don’t think I made him cry this week by teasing him about something that’s not—I shouldn’t have. [chuckles]

THERAPIST: That you found out was off limits?

CLIENT: Or, I mean, he seems to have a more—I don’t know, emotional reserve, maybe? Despite all of his pain. I don’t know why. And in the hospital, he’d be so exhausted and frustrated. I mean, maybe (inaudible at 00:40:38) it’s helpful in that he’s got control.

THERAPIST: He’s got more control. People aren’t coming in and waking him up every two minutes.

CLIENT: Right.

THERAPIST: At night.

CLIENT: So I guess, objectively (ph), things are a lot better except for this pain. And his mental state.

THERAPIST: Yeah. Well, hopefully if he’s sleeping bit better, that does give him a little bit more of emotional reserves, because the—pain will certainly contribute to having a lot of mood swings. [00:41:03] And just being very on-edge. Having everything really close to the surface.

CLIENT: Mm-hmm.

THERAPIST: Sleep deprivation is another thing that often makes you more emotionally (inaudible at 00:41:13). And so, that your emotions are right there.

CLIENT: And he’s not sleeping super great. I mean, he’s also on blood thinners that are constantly out of whack. He’s been waking up with blood everywhere the past couple nights. Which would be a giant problem if the pain wasn’t a bigger problem. [chuckles] We had to get a nurse special aid just to come yesterday to check his blood thinner levels, because his mouth was (inaudible at 00:41:46). Something I think I teased him about. And he was okay about yesterday. It was that he kind of looks like a vampire or something when he smiles there’s (crosstalk at 00:41:53).

THERAPIST: He’s drooling.

CLIENT: Blood everywhere.

THERAPIST: It’s amazing what you become comfortable with, huh?

CLIENT: [chuckles] I know. Our neighbors came over. [00:42:00] And he was telling them about that. And one of them is a—she’s a doctor. I’m pretty sure she’s a doctor. Anyway. But they were both just cringing. [chuckles] That sounds really gross. He’s just telling them about his (inaudible at 00:42:16). How he woke up in the middle of the night with a candy coating of blood on his (inaudible at 00:42:20). That (inaudible at 00:42:24) really gross. But it’s our normal.

THERAPIST: Right. It’s become your normal. You’ve been learning to tolerate all sorts of things that you’d never thought you’d be exposed to.

CLIENT: Yes. But his pain is such a much bigger problem than that. [chuckles]

THERAPIST: It interferes a lot more.

CLIENT: Yeah. So, (inaudible at 00:42:45) sleeping great at all, because he keeps waking up with blood –

THERAPIST: (inaudible at 00:42:49)

CLIENT: oozing blood, yeah. And unfortunately, this drug is managed by a whole separate service of people. [00:43:00] Which are hard to get in touch with, too, so . . . just—I mean, it’s good. It’s their only job, is to keep his blood levels (inaudible at 00:43:09). In check, but –

THERAPIST: Except that they’re not doing it very well. [chuckles] Or it’s proving to be challenging, it sounds like.

CLIENT: Yeah. I mean, everything you eat, everything you do changes –

THERAPIST: Changes it.

CLIENT: the levels of the—they constantly keep asking if he eats too many green vegetables.

THERAPIST: Usually, that’s not a problem. [chuckles]

CLIENT: Right. But if you eat varying amounts of green vegetables, it can really mess with this drug, so . . .

THERAPIST: It’s really complicated.

CLIENT: It is really complicated. Yeah.

THERAPIST: And so keeping track of all these details . . .

CLIENT: And we had gotten into an okay place until—for a few days, at least, until (inaudible at 00:43:49). I think, at one point, it had gone too low. I mean, he could die.

THERAPIST: You don’t want clots.

CLIENT: He could just die. I mean, in an instant, if it goes too low. [00:44:02] And they freaked out. And they sent us to see if he has to get this bag of needles full of a quick-acting blood thinner that—and this was late at night when they—I got this call from CVS that they had these needles. [chuckles] And, I mean, they’re beyond what I do for his antibiotics. They’re just needle needles that you just inject in the skin. And the pharmacist didn’t know what to tell me. She was like, “This is beyond my expertise.” [chuckles] “I don’t know what to tell you about this.”

THERAPIST: Oh, gosh.

CLIENT: So we just read the instructions. And he stabbed himself in the stomach.

THERAPIST: And you learned it. Oh, he did it?

CLIENT: Except that he’s on all these blood thinners, so he –

THERAPIST: Right. So if you stab yourself in the stomach, you start bleeding.

CLIENT: Well, not even that he started gushing blood. But he’s got, still, after half a week, this huge, bloody bruise on his stomach because—I don’t know. It’s just awful. It’s awful.

THERAPIST: It’s just bleeding under the skin.

CLIENT: [chuckles] I’m sorry. (inaudible at 00:44:58) telling you all this.

THERAPIST: Oh, that’s okay. [00:45:00] This is a safe place for you to talk about whatever you need to talk about. And I’m not easily grossed out by medical stuff.

CLIENT: [chuckles] I’ve become so used to this. I mean, it makes me happy, in a way. Cut my finger. Didn’t make me nauseous like it used to.

THERAPIST: Wow. [chuckles] You’ve come a long way. [laughs]

CLIENT: [laughs]

THERAPIST: I mean, we laugh about that. But Laura (ph), I’m amazed by your resilience. Not just in accommodating to getting comfortable with seeing your partner in pain and oozing blood and dealing with these things, but just your resilience of how you’ve been able to accommodate to your life changing. Day to day and week to week, sometimes. In ways that you could never have prepared yourself for. And you’ve been able to figure out for yourself what you want. [00:46:02] And figure out how to get through it day by day. Being able to step back sometimes and just honor for yourself of how much you’ve done and how much you continue to do. You’re pretty amazing.

CLIENT: Thanks. Well, you only see what I tell you about this. [chuckles]

THERAPIST: I think you’re pretty honest. And being amazing and strong and resilient doesn’t mean that you don’t sometimes freak out. Or that you don’t freak out a lot of the time. There’s a difference between being strong and being unfeeling. I think you’re getting really strong, because there are challenges and it is really hard. And yet, you’re doing it anyway. And you’re taking the best care of yourself. And you’re taking really good care of him as you can. And I know that you get freaked out about it. And that you’re anxious. And that it gets in the way of your sleep sometimes. And that you don’t do all the things that used to be on your to-do list. [00:47:03] But you’re still persevering.

CLIENT: I feel so bad when I think about the year that I dealt so poorly, that I didn’t sleep at all, because of how traumatized it made Josh about—he won’t even try sleeping in our bed for one night, because he’s so traumatized by that year.

THERAPIST: How hard it was for you when you—well, not sleeping is a really big deal.

CLIENT: And trying to figure it out now. I’m doing a much better job.

THERAPIST: You’ve got a lot more practice under your belt. That was the first—I mean, I think part of what we talked about back then was that was the first time that you had ever felt that way. Up until that point in your life, when you developed really bad insomnia and a new type of anxiety that you had never really dealt with before. Because it sounds like, up until then, you’ve been anxious but it’d been motivating anxiety.

CLIENT: Mm-hmm.

THERAPIST: An anxiety that you could control by being super high achieving. [00:48:02] And suddenly, you were faced with anxiety that wasn’t working in the same ways. And it wasn’t pushing you to achieve. It was getting in your way and interfering. And now, you know how to manage that, too. [And it was] (ph) something you had never seen before, so you weren’t very good at it at first rush. But who is?

CLIENT: But I ignored it, basically. Just tried to make it go away. But for a really long time. [chuckles] Which is hard to (inaudible at 00:48:29).

THERAPIST: You did the best you could with what you knew at the time. That’s how we make all decisions, right? I mean, we’d make the best decision that we know how to make and act on that. And then, sometimes we get feedback that it’s not working.

CLIENT: [chuckles]

THERAPIST: And that was the process you went through.

CLIENT: Yeah (inaudible at 00:48:55) decisions. But every time Josh says something like, “I don’t want ruin our relationship (crosstalk at 00:49:03) sleep in the bed.” [00:49:04] Can’t help it. I think (inaudible at 00:49:07).

THERAPIST: Maybe you can help him to recognize what’s going on in the current and how that’s different than the past. And you both need to live in the relationship that you have now and the relationship that you are working to have for later. Which is different than where you were a year ago.

CLIENT: Yeah. I think we can talk about it a whole lot more when he’s able.

THERAPIST: Yeah. For the moments that he’s able to be more present and not dealing with him in crisis. It’s hard to have to put those things on hold, as you don’t know when there’s going to be a pain spike or something else that gets in the way.

CLIENT: Yeah. It makes me think about how do you talk about biking (inaudible at 00:50:01)? [00:50:02] He would always say how good he was at suffering. [chuckles] He is. On a bike ride, he’d just basically sit in pain for six hours. At your physical limit. Suffering. [chuckles] And I mean, in some ways, he’s really good at that, just –

THERAPIST: He’s got really high pain tolerance.

CLIENT: I don’t know. But he’s good at sitting with it for a really, really long time. I wonder if he has really low pain tolerance. [chuckles] At least, from what people tell us. Or he (crosstalk at 00:50:37).

THERAPIST: Which is why he’s feeling it so much.

CLIENT: I don’t know.

THERAPIST: But yet, enduring it. Really high endurance, maybe, is the way to –

CLIENT: Pain endurance. Yeah. I forget where I was going with this.

THERAPIST: You said that thinking about your relationship reminds you of the way that he would talk about a bike ride.

CLIENT: Not relationship. I guess the way he deals with it. He’s just able to be up—I mean, because he’s—he’s still working at his limit—physical limit. [00:51:03] Doing really, really well, while in incredible pain. Just a hard thing to be able to do, I think. Not just on a bicycle but in life. So, functioning well.

THERAPIST: Even with the pain.

CLIENT: I mean, people keep trying to help us fix things. But there’s not a lot we can fix right now. Just has to fix itself eventually. It just has to suck right now. We just have to let it. And be okay with that.

THERAPIST: I guess I wonder if it would be helpful to find some people who are willing to sit with you while it sucks. Because sometimes, it’s the comfort of having somebody there with you. Not necessarily trying to fix something if it’s not something that can be fixed. And just being willing to sit with you while he’s in pain, while you’re suffering because it’s not—things aren’t the way you want them to be. You have people that are good at that.

CLIENT: My brother, last night, I mean, he was perfectly willing to sit there while Josh slept off his pain drugs. [00:52:01]

THERAPIST: Yeah. And be with you.

CLIENT: Yeah. And so, I mean, that’s something I’m doing better this time. Is letting people see how much it sucks.

THERAPIST: Yeah. And letting them support you. It’s a huge difference.

CLIENT: I mean, today I had tea with my lab mates. And they were like, “How’s Josh?” (inaudible at 00:52:15) terrible (ph). [chuckles] And they were like, “That sucks.” So it’s really, really helpful.

THERAPIST: Yeah. It is, to have people you can be real with and who won’t get scared off by that. And they can agree with you that yes, it sucks. And (inaudible at 00:52:30) seems to like to sit and have tea with you.

CLIENT: And also just doing that has become less of a—not event, but less anxiety provoking (ph).

THERAPIST: Yeah. Because, well, you’ve tried it out. You’ve tested out the waters. You’ve let people in. You’ve let them see what it’s like. And there’s been a whole bunch of people that haven’t run away screaming. Yeah. Some people can’t handle it, but a lot—it sounds like you’ve got some good people in your life that can be there in the (inaudible at 00:52:53) you need them to be. So, and you lean on them as much as you can. [00:53:00]

CLIENT: Yeah. I mean, I am worried about my dad all day. Causing him lots of anxiety. Because he’s definitely a fixer.

THERAPIST: Well, let your dad—your dad’s a grown-up. He’s dealt with it a long time. You don’t have to fix it for him.

CLIENT: Right. I’m sure today’s going to cause him a lot of stress, though.

THERAPIST: That’s okay. Your day also causes you stress sometimes. It’s okay for your dad to be stressed out. He can go home and work it out however he can. Him having an anxious day will not dramatically alter what the rest of his week is like.

CLIENT: But you don’t know. He’s so much like me. I don’t know. [chuckles] I guess I feel extra bad, because –

THERAPIST: You can empathize with that is like.

CLIENT: Well, sometimes I’m mad at him because I blame him. [00:54:02] For giving me all this anxiety. And I also don’t want to cause him more (crosstalk at 00:54:09) make sense, so . . .

THERAPIST: Well, it is very empathic of you. But you’re taking care of enough people. Let him take care of himself. Or let your mom take care of him a little bit. You have yourself and Josh. That’s enough. Why don’t we wrap up there for today? And I think next week, we’re on for Wednesday.

CLIENT: (inaudible at 00:54:38)

THERAPIST: Perfect. We ran out of batteries just in time. [chuckles]

CLIENT: (inaudible at 00:54:42) all we’ve got –

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