TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

CLIENT: I'm upset about a variety of things.

THERAPIST: Sorry to hear that.

CLIENT: Weirdly what comes to my mind most because it just happened, Chet, my manager, he's out until after the Memorial Day, but he didn't mention that to me. [...] (inaudible at 00:00:48) and I was talking to him about the vacation I was taking this week. I don't know how I feel about it. I'm insulted and confused. [00:01:07]

THERAPIST: There is one thing I wanted to mention. It's that I'm out all next week, not just Monday. Is that the week you're away? You said that already. You told me about it.

CLIENT: Yeah, I may have. We might as well check this while we're here. On the 27th or the 28th.

THERAPIST: Look at that. Right there. You are away the 27th and 28th. Okay. Sorry, I didn't mean to...

CLIENT: No, no. I'm just sort of like, "What? What?" I was replying to his CC to ten people and I'm like [...] (inaudible at 00:01:53). Oh, it's my manager. What? [00:02:05] I don't know. I'm just don't know how I feel about it, other than not great. I get that he wants to be my buddy boss plus micro-manages my time, but then didn't say anything. (laughs) Unfortunately the two other people that he has as reports, one of them is out and one I just didn't run into so I don't know if they were aware of this. At any rate, I just want to do some additional looking into my time. [I may just want to allocate my time.] (ph?) [00:03:09] I'm pretty sure I've mentioned my friend, Jersey, who has a variety of disabilities.

THERAPIST: Yeah. [...] (inaudible at 00:03:16)

CLIENT: She has a below-the-knee amputation and a knee replacement in the other.

THERAPIST: And some chronic pain and she's had some major surgeries the past few years?

CLIENT: Yeah. She was paralyzed from the waist down when she was a kid and kind of stubborned her way out of that and also has this weird where it comes up [...] (inaudible at 00:03:43). It basically comes out of nowhere and then [...]. It's really crazy. So the bones in her feet are puffed up. Her legs are puffed up, et cetera. [00:03:57] I've been there for her [indication] (ph?), her knee replacement, and some other things I can't remember right now. When she decided to get one of her legs amputated, a lot of people were really freaked out and I was really pretty chill about it. I talked to her about it like "that's your body so you should do what you think is best" and "you can't really walk on your legs." It's really hard for her to walk unassisted. She uses crutches usually. Usually she's in too much pain to crutch around very much. She's basically always in pain. I was like, "I think if you off your leg you would be more comfortable." [00:04:59] She said that I was one of the few people that was just like "do it." That surgery was probably the easiest surgery I have ever visited her for. They amputated. She hat tattoos going down both her legs and they happened to miss the tattoo. She wasn't worried about it, but they were like, "Yes. We didn't mess up your tattoo." I was just like "yay." One of her uncles who is a former soldier and was in combat could not cope with her having her leg amputated at all. He was able to be in the room with her for five or ten minutes. She's covered from the waist down so all you see is this knotted bump on one side and he just couldn't deal with that. [00:06:01] This time he managed to sort of be in the hospital room for 45 minutes. This was the adjustment to a knee replacement, which is an improvement.

THERAPIST: This is what?

CLIENT: Jersey went in for an adjustment to her knee replacement.

THERAPIST: Okay. I don't know technically what that means, but I know [...] (inaudible at 00:06:25)

CLIENT: It's a complicated weird thing. Part of the issue was that the surgery incidence success and what she considers successful are not the same. She was like, "I would be able to walk around and stand with stability." The surgeon was like, "Well, you can stand. That's successful." Like your leg didn't fall off. That was successful. She wants to be able to move around and that's not a measure of success. [00:07:04] Most importantly, she wanted to get closer to 90° of rotation in her knee. I think she had 30° maybe. Her decision was amputate above the knee or have them go in to try and see what they can do.

THERAPIST: This is the knee on the leg that was previously amputated?

CLIENT: This leg was amputated below the knee. This leg had the knee replacement and the rest of the leg.

THERAPIST: And she's saying for that one, if you can't improve this much then get rid of it.

CLIENT: Basically. But no one wants to do amputations on her. No one wants to do a multi-amputation on someone who is 34.

THERAPIST: Why does she want it amputated? [00:08:04]

CLIENT: She's constantly in pain. So there are two things: Constantly in pain and also, if she has two prosthetic limbs, she would be way more stable and able to walk and move, actually. It's one of those weird things where...

THERAPIST: I don't have to know that, but I can imagine how it could be.

CLIENT: Yeah. Double amputees walk. It's more difficult and people freak out when they see she has a prosthetic. That would be more so. For a while she would wear longer things to cover it up, but now she will wear a skirt or shorts and you can see the prosthetic. She was leaning towards the amputation and then the bombing happened and there were all these horrible pictures of people with their legs blown off. [00:09:03] She was like, "I can't." She just got really freaked out and also the surgeon who was willing to do the amputation mostly did bone cancer, so when she visited him she was in a cancer ward. She said it was too much. So she was in the hospital and this surgery didn't go well. Instead of the incision that she expected, it was about six inches. She had an incision from below her knee to up here and they cut apart her quads and did strange things. I don't know. They cut them apart, but they want them to regrow to maybe make her muscles attach better to bone and the implant, which wasn't totally what she thought was happening. [00:10:12] She is so weak. She's running a high fever. I talked to her on Saturday briefly. She was really upset.

THERAPIST: When was the surgery?

CLIENT: The surgery was Friday morning.

THERAPIST: So she's still in the hospital.

CLIENT: She's supposed to check out today, but isn't. So Saturday she was like, "It's not successful to my mind. I'm really upset." So I went to visit her on Sunday and I've never seen her this bad. Also when I went to hug her she was burning up. I was like – fuck. There's really nothing to [...] (inaudible at 00:11:02). [00:11:06] I've known Jersey for a very long time. I met her through [...] (inaudible at 00:11:13). She was married for quite a while, eight years, and got divorced a few years ago and one of the things that was very scary for her was the idea of having major surgery without a partner. Also, she was really upset with her ex-husband. She kind of sliced out a lot of – she didn't want to go to a lot of stuff where she was at. She was like, "I don't want my friends to choose, except I kind of do." (laughs) I was like, "Okay." She was like, "You shouldn't have to choose, but I really want you to." [00:12:07] I was like, "Okay. I hear that." So she made a whole bunch of new friends in the last couple of years through rock climbing and they're all early 20s, just figured out that maybe they're queer or kinky or [...] (inaudible at 00:12:27) or something. They're really nice people. The level of shell-shock they had in their eyes at the hospital was kind of intense. They left a mess everywhere. After some of her friends left I saw one of the other persons was like, "Pick up this trash. Let's organize your tray. Let's go grab something from the nurse." [00:13:00] She is dating some guy who was like, "I want to be with you through this major surgery."

THERAPIST: He's one of the rock climbers?

CLIENT: He is 28 and now he's like, "I don't want to visit you in the hospital, even though I know I should." He didn't quite say that, but that's what he meant. Where she lives is a nice place, except it's hard to get to without a car. For me it's two busses and [...] (inaudible at 00:13:41), so I'm worried about her surgery and I'm worried about her recovery and that she's still – in previous surgeries she's been like, "Yep. I'm walking around and doing things" right away; and this time she isn't. [00:14:09] Yeah, so I'm just really worried about her. She was complaining at one point about this guy she was dating, who is 25. She was complaining that he was kind of an immature guy. I was like, "Yeah, he's 25. What do you want?" She was like, "No, but blah-blah-blah." I was just like, "Jersey, you're not going to meet someone who is super-emotionally mature who is also really young, so stick closer to your own age." I'm like [...] (inaudible at 00:14:50).

THERAPIST: If that's what you want.

CLIENT: Yeah. You want a serious relationship. You're probably not going to get it from this person, especially if you want to engage in a lot of high-level communication. [00:15:07] I also worry about that a little bit. I think you need to stop dating guys in their early 20s all the time. [...] (inaudible at 00:15:25) she's just not having relationships with them, and yet it's hard. If she lived closer I would just go over there every day or evening and be like, "Okay. What's up?" It's just I can't. I've just been feeling so stressed out about my own life that I find it hard to have the energy and space to do any of it. [00:16:02] (pause) Normally she has friends help cook her meals three days. I've done that several times and this time I was like, "I can't really give myself. I'm sorry." I don't know. One of the ways I deal with anxiety or worried about friends is giving them food.

THERAPIST: Right. It's probably pretty nice for her, too.

CLIENT: Yeah. And it's also hard because of what she expected isn't what she got, so she's feeling very much like, "I don't know what I want. I'm sorry." [00:16:59] The thing that she said that she wanted for typical post-surgery, it turns out she doesn't want. She's been through a lot of surgeries in her life.

THERAPIST: Yeah. [Like what you said in terms of people around her?] (ph?)

CLIENT: Yeah. And so she has a lot more than she ever has and that's stressing her out, obviously, and I'm stressed about it, too. I don't know. (sighs) I was feeling very super stressed and cranky. Thursday and Friday I was just in a bad mood and I was like, "Oh, right. Maybe it's just my friend having major surgery. Huh. Oh, right. It didn't go well. That might be why I'm so upset and have a headache." [00:18:08]

THERAPIST: [...] (inaudible at 00:18:12). That could be it, but it's not the most straightforward.

CLIENT: What I usually do is I end up tensing all my muscles and not paying attention. (chuckles)

THERAPIST: I see.

CLIENT: Then my shoulders really hurt and my neck hurts. Then eventually I'm usually like, "Oh, right. I've been tensing all my muscles, clenching my jaw." Also I don't want to eat, which also makes me headachy.

THERAPIST: Sure.

CLIENT: Which is also weird for me. I think it's partially the Wellbutrin and partially just... [00:19:01]

THERAPIST: Did you change the dose or...?

CLIENT: She upped my dose a year and a half ago and ever since then I [...] (inaudible at 00:19:12). When I'm stressed out I don't like to eat, so that [...]. (pause) Then I'm also having a week of really minor squabbles about how stuff that are making me feel really irritated and that, more than – like it feels out of proportion. [00:20:05] Like the cable was out, so I called and was on the phone with them forever. I made an appointment. Everything started working and I canceled it and then I thought I shouldn't have canceled it because what if it stops working? And then it stopped working six hours later so she was giving me shit about canceling the appointment. I made a new one for the next day, but I had therapy and I wanted to go to work out. You shouldn't try to schedule things when I'm not there. Ashby basically doesn't want to wait for the cable person either tomorrow night or Wednesday night, which is frustrating because she's been very insistent on wanting new equipment. [00:21:01]

[...] (inaudible at 00:21:03)

CLIENT: I've been more neutral on it, so there is that. And then Friday she's like, "Order this pizza for me from this place." You get this special crust. I was like, "Okay." So I ordered it and she was like, "It's the wrong crust. I mean, it's going to be fine. It's fine. It's just that you ordered the wrong one." That really pissed me off. She flipped out because our landlord came on Friday to replace our windows and she was like, "This place is so horrible and messy our landlord is going to think we're horrible people," and then had me clear a space in front of the windows where we had boxes piled. [00:22:04] So she flipped out about that. I don't know. Ordering a pizza is not that big a thing. We order food for each other sometimes. If we get the wrong thing, that's fine. I was just really pissed, in part because she was sort of being like, "You got the wrong one, but no, it's fine." But also couldn't tell me what the right one was. She was like, "It's the hand one." No, it says hand-tossed. She said, "But it's the wrong one." Eventually it came out that it's hand-made. I don't know. (pause) [00:23:14] The other thing is that when Ashby calls, she basically starts really pissed and goes from there. I don't like it when she does that and I'm around. [...] (inaudible at 00:23:29) She bitched at me for staying on the phone with Customer Service. She said something to me and I was like, "You know, I was on the phone for 90 minutes." She was like, "I never do that." Shut up.

THERAPIST: I don't get it. She's not on the phone 90 minutes because she just gives up before then? Or she gets pissed? [00:24:09]

CLIENT: She refuses to do any of the troubleshooting.

THERAPIST: They're like, "Try turning it on and off and turning it back on again." She's like, "No."

CLIENT: She'll be like, "I already did that before. It's not working. Come out here and fix it." I'm like, "You could try. It might work and certainly not doing it definitely won't work." Yeah. (pause) [00:25:09] I talked to her about Jersey so she knows all this is happening. I guess part of me is like why are you picking at me now?

THERAPIST: Right, because you're really upset.

CLIENT: Yeah. This is sort of stressful and I'm upset. I don't know.

THERAPIST: I think you're helpless in all these situations – in distress and helpless. Not good. [00:25:55]

CLIENT: Right. Also, with Ashby I feel like if I ask her what she wants, the probability of me getting a clear answer is really low and the probability of her saying "it's all ruined" is pretty high, which makes me feel more almost like...

THERAPIST: Yeah, like you know it's going to be [stymied, any efforts to manage things.] (ph?)

CLIENT: Yeah, basically. I guess I really just don't trust a lot of Jersey's friends, is what it comes down to. [00:26:59] [...] (inaudible at 00:27:02) Jersey's previous friends about her surgeries as well in that a lot of people were really negative about her having her leg amputated. Even though from my point of view she would be in less pain, the prosthetic lets her stand and walk without her crutches. So fuck yeah, that's great. And because she's had leg pain and problems with uses crutches the entire time I've known her, friends of ours will just be [really invasive] (ph?) about medical things. Like have you tried blah-blah or suggest she do something to soup up her wheelchair which is awesome, except that she physically can't do that. [00:28:11] I mean one of the big things that we had talked about is that people don't trust that she can do things if she says she can. It can be a little harrowing from the outside to see like her carrying a full put of something or whatever, but she wants to do it. She'll kill you if you say that she's weak. And it's also a very good way to say "I can't do that." [00:29:01] Some of her rock-climbing friends were just not telling her about certain climbs because they thought she couldn't do them and she was really pissed, obviously. Her current housemates, she was like "We're going to plant a garden, but need assistance planting a garden." Two of them were like, "Well, it would just be too hard. We don't think you could do it." That's the other thing. (pause) I'm feeling pretty low about how she's doing right now. I feel sad about it. I know she's really emotionally wiped out and I don't want people treating her like she's helpless or that she can't do anything. [00:30:11] Or more to the point, not asking if she can but just assuming.

THERAPIST: Yeah, in a way they're making her helpless that way. She certainly can't do the climbs if nobody has told her about them.

CLIENT: Right. And she's a bad-ass climber in the rock-climbing gym and can walk – not always quickly, not always easily, but can do it. I don't know. When people do that I always think, "Have you met Jersey? Because I think if you were actually friends with her you would know don't do that." [00:31:06] I just want her to have some better friends. I want her rock-climbing friends to be less icky, which I don't think is going to happen because it's not. (pause) [00:31:57]

THERAPIST: A lot of the tension that you've been feeling is sort of trying to get a hold of yourself in a way. It sounds like it's pretty out of control.

CLIENT: I feel like I don't have a handle on stuff, like my life. I thought I knew how to – oh, I've done terrible times at school. And now I'm just like holy shit. What the fuck? This is really different than what I was expecting. And also I totally can't help her in the way I have before. [...] (inaudible at 00:32:50) is coming up this weekend and I just don't want people grabbing at me or at my attention, which people will. [00:33:03] I'm sort of like I wish there was a way to say to people that I'm at a neo-max. I'm sorry. Just go away. It's hard to do. Someone is coming that I find kind of annoying. She's kind of a friend. She is [...] (inaudible at 00:33:30) freaking out about it and wanting me to hold her hand and I'm really not up for it.

THERAPIST: Yeah, you do sound terribly upset about what's going on with Jersey.

CLIENT: Yeah. It's so frustrating. [00:34:00] Part of what is upsetting and frustrating is that she goes to the doctor and gets ignored a lot or they don't read her chart. She [...] (inaudible at 00:34:16) medication they give you. They're basically like, "Do you want morphine?" "Nope." "Do you want the [...] (inaudible at 00:34:27) to go to the limit?" "Nope. Read my chart." That's always so frustrating and her fear about getting the adjustment was if it's successful in the eyes of the surgeon she won't be able to get her leg amputated, even if it might not be successful for her. It seems like what has happened is that she's now in that state. [00:35:01] It's just so shitty. I was wondering if being poor and on Medicare might help. Fortunately it doesn't necessarily hurt, because she has a bunch of unusual conditions, not like "Oh, that's interesting."

THERAPIST: Does she work?

CLIENT: She can't.

THERAPIST: Because the pain is too distracting?

CLIENT: It's a combination of the pain is really difficult and she would need a bunch of accommodations, which – I mean she's worked at kind of low-level jobs and unless she was already working for them, they wouldn't hire her. [00:36:12]

THERAPIST: Right. Like if she had a lot of training in something, it might be easier to get those kinds of accommodations. I don't know. Maybe not.

CLIENT: Yeah, maybe. I feel like [...] (inaudible at 00:36:26) ADA or whatever, if she wheels in or crutches in, people would be like, "Oh, fuck that." They just don't want to deal with it or would make assumptions about her. She also has no education. She doesn't have a lot of technical skills. She has a lot of other skills, but [...] (inaudible at 00:36:49). (pause) She's just such an awesome, wonderful person. [00:37:01] It's so upsetting and frustrating. It's a combination of her body isn't working, and that sucks. But it's also a combination of her growing up. She grew up poor [...] (inaudible at 00:37:23) and got really shitty health care. Some of her medical problems were growing up with shitty health care. Then there are the surgeries that she finds less helpful. Nobody wants a knee replacement when they're 30 either. They have a life span. Her doctors are mostly like, "How about if we give you a bunch of pain medication?" [00:38:01] That will be great. She would prefer not to be sedated constantly. (pause) When she got [...] (inaudible at 00:38:17) it was so great to see her so much more mobile and in so much less pain. With this one I'm just really worried that she may be less mobile in a certain way. She's already [...] (inaudible at 00:38:33). (pause) I also find it hard to talk to people because a lot of people get caught up in the why would she want to amputate? Or 40-bazillion...

THERAPIST: Like technical questions.

CLIENT: Yeah. One of the big ones is why would she want to amputate? I don't know. Because she'd feel better.

THERAPIST: Yeah. And be more mobile.

CLIENT: Yeah. She'd be so much more mobile it would be ridiculous. I don't want to talk about that it's going to be an amputation or blah, blah. I want to talk about my friend.

THERAPIST: I see. [...] (inaudible at 00:39:38)

CLIENT: Or like I don't want to talk about the structural reasons why generational poverty exists or her lack of health care as a child. Those are also theoretically interesting discussions [...] (inaudible at 00:39:57) but I don't care.

THERAPIST: It didn't work out very well for her and she's really upset. It sounds like [...] (inaudible at 00:40:14) in a way that she is remarkably good at not being.

CLIENT: Usually she's bossing around the nurses and she's not. She hasn't even been able to get the leg immobilizer that she wants. And also the first few weeks post-surgery are really important and I totally can't. I'm not going to be able to see her.

THERAPIST: Where does she live?

CLIENT: She lives somewhere out of nowhere. [00:41:03] She has a car. Her roommate [...] (inaudible at 00:41:06) It's on the bus line sort of. [00:41:12] I can get there. I'm going away this weekend and two of her rock-climbing friends live near me. One of them gave me a ride [...] (inaudible at 00:41:30) and she was supposed to on Thursday. I kind of expected it.

THERAPIST: Where is the hospital?

CLIENT: GH. That's one of the weird things. She seemed like highly-skilled surgeon. It's not that.

THERAPIST: I was wondering how hard it would be to get where she is in the hospital.

CLIENT: Since it turns out that Chet isn't around this week, I'm totally going to take a long lunch tomorrow if she's still in the hospital and visit her. [00:42:08] I really wanted to today, but I didn't know he wasn't there, which is also why I'm really pissed about that. [...] (inaudible at 00:42:22) (long pause) [00:43:05] I've been having a horrible time sleeping, in part because of that. I think I got five hours last night. I need to eat. Unfortunately, nothing is really getting my mind – nothing is really getting my worry about her or me feeling like my own life is just like really overwhelming. Finishing packing is becoming a thing. [00:44:01]

THERAPIST: [...] (inaudible at 00:44:03)

CLIENT: Thursday morning. (pause)

[...] (inaudible at 00:44:16)

CLIENT: Do you have tomorrow's appointment?

THERAPIST: I was just thinking during the day you might have some more flexibility. CLIENT: Oh, yeah. (chuckles) Except that it's super busy and I can't. No, I would like to.

THERAPIST: We need to stop, but I will see you tomorrow.

CLIENT: Okay.

THERAPIST: [...] (inaudible at 00:44:57)

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