Pdoc's got a brain tumor and T's mom is sick

Background 1: in January my pdoc discovered he had a brain tumor. He was gone for several months. Two weeks ago I saw him for the first time since January and he looks like hell--wt loss and hair loss from the chemo (which is ongoing), a long and ragged scar on the top of his head from the surgery.

Background 2: I was hospitalized for most of March because my depression got really god-awful. During that time t suggested that maybe I ought to find a different treatment team for a variety of reasons (I've written about this in the past). I had a lot of feelings about that (which I have also written about ad nauseam). Because we could't find any local therapists who would take my insurance, I've been doing a trial period of this program at a local psych hospital. If I were to do it, it'd be a year of weekly group and individual psychotherapy, along with a prescriber. It has been going okay--I don't hate it. I still wasn't sure if I felt ready to terminate with T (and/or if I felt ready to pause with her for a year while I did this program) but she and I were continuing to talk about it.

What happened today:
This morning at work I glanced at my phone and saw that my T's office had tried to call me three times. The fourth time they called I picked up and the secretary said, "T's going to be out for a month on medical leave so your appointment next week is cancelled." That threw me for a loop. I looked closer at my phone and saw that my T left me a message asking me to call her, so I did.

When she answered, she said, "I wanted to let you know that I'm going to be out for a while on family medical leave." She paused and asked uncertainly, "do you want me to tell you... " and I said, "just tell me." She took a breath and said quickly, "so, several years ago my mom was diagnosed with an aggressive breast cancer. She was treated and was stable for a while but it's come back." I think I heard her sob. "So I'm going back to [the country where she was born and where her parents still live] to take care of things for a while." I said, "oh, [t]. How awful. I'm so sorry." She went on, "I told them I'd be out for a month because I had to give a time frame, but I'm not really sure how long I'll be. I feel horrible because you've already had all this uncertainty and disruption with [pdoc] being out for so long, and now I'm going to be out too." My heart broke for her--I'm not a therapist but I am a doctor, someone who takes care of patients, and I know how gut-wrenching it is to not be able to be there for them. In typical fashion, she asked, "do you want to talk about this, how this affects you?" I said, "[t], it's okay. I'll manage." She pushed forward and said, "given that [pdoc] is still not full time and I'm going to be out for at least a month, I think it makes sense for you to just go ahead and do the year-long program." I agreed. "This isn't necessarily goodbye. The program is only for a year, and you and I could work together when it's finished if you'd like." I agreed with that too. "I want to let you know it's been an honor to work with you. I'll call the program and let them know what's happened, and I'll call [pdoc] to get him to set up a sooner appointment with you. I just feel terrible that you're experiencing a sudden disruption again." I said, "[t], I of all people know that terrible things happen sometimes. I'll be okay. And it could be worse--at least I've got this great offer lined up." [That was kind of a joke since she and I have been talking about how I'm not totally certain I want to do the year-long program.] She laughed ruefully. "Okay. I'll call you when I'm back so we can touch base." I said, "I'd like that, thank you." And I said again, "[t], I'm so sorry." She thanked me. I think I heard her sob again. And we hung up.

I know this is therapy and that the therapeutic relationship is unique, that it is not my job to take care of my t. But also she is human and so am I. And in the moment on the phone with her, all I felt was this very visceral sensation of my heart breaking, my heart reaching out to her.

The loss and disorientation hit me later--a few minutes after we hung up I went down to the call room and sat on the floor for a few minutes to get myself grounded before going back to the wards to manage my own patients (none of whom speak English this week, incidentally--makes for long days b/c with the interpreters, everything is said twice so every conversation takes at least twice as long).

I'm not really sure why she told me what was going on. Maybe she told all her patients. Or maybe she felt obligated to tell me because of what happened with pdoc, or because this means I'm not going to see her for at least a year, if ever again. Or maybe just because we work within the same small-ish hospital system and gossip is rampant so she figured I'd find out anyway--I heard about pdoc's brain tumor not b/c he told me but b/c my psych friends let it slip.

Regardless, I'll be glad to see pdoc in the next week or two--at work (with my pager on, God only knowing what new crisis could pop up at any moment), over the phone, with T audibly upset, I was not in any kind of place to process my feelings with her. But I do have feelings about this. So pdoc and I will have to have a chat.

This is very long now. Thanks if you've read to the end.

oh chihirochild.... i don't even know what to say... other than my heart goes out to you and I'm so sorry this is all happening. sending you safe hugs and strength and all kinds of good wishes. this must be just so difficult.

Wow, you handled this so well. I am really sorry, though, that you keep getting the s**t end of the stick this year, especially after your pdoc tried to get you to rely on him instead of family (if I've got that right).

You did handle that so well. I can understand that in that moment you were there with her as a fellow human being in pain and that later that loss hits home for you. It is a massive loss.
Take care of yourself.

Hugs...that sounds so difficult. And like you're handling it as well as could possibly be expected...

I am sorry to hear this. It sounds very rough for all.

Thanks, all. This is definitely rough.

You do have that right (good memory), and it made his sudden absence 10x worse. Now that he's back I suppose he and I ought to talk about that but given all that's going on I dunno if we'll get to it.

This is so sad- almost like vicarious trauma in a role reversal. I am so sorry.

It sounds very difficult, many hugs to you Chirochild

Oh no, chihirochild, I'm so so sorry, this must be just so painful, overwhelming, hard and disappointing!

I’m so sorry I’m sending gentle hugs

Sending you gentle hugs You are handeling this much better then i would. Please keep posting here we are here for you anytime

It’s funny... it seems like when I turned off my feelings at work the other day, they got locked out of my conscious experience. But of course you can only lock the strong man in the parlor for so long—I keep waking up at night feeling bereft, keep having these awful dreams that I can’t remember. And I’m incredibly irritable.

Seems like the thing to do is a) get some freaking sleep (I’m on a looooong string of long shifts) b) unearth the locked-up feels so that they quit holding me hostage from my unconscious. But I’m a little afraid that once I dredge then up, I won’t be able to handle them.

This sucks.

I'm sure this is no comfort, but I love the way you wrote about what this is like for you. I've got my own version of the strong man in the parlor and I think the dreams and the irritation are a natural function of grief and loss. My T was out on medical leave for a few months a couple of years ago, after I'd noticed he lost a ton of weight and his skin actually looked gray. He didn't have cancer (my spouse died from it) but something else wrong with his digestive system that needed surgery. He came back and seems fine now.

It was a loss to not see him in those months, so maybe I get a little of how you feel. It was easier when I admitted it was really tough to be without him, let myself talk to that man in the parlor when it was safe. It took a lot more energy to lock it away than deal with it, when I started to allow myself to do it.

And now I can’t sleep again. The one good thing about being in the hospital for a month is that they sent me home on sleep meds that worked. But they apparently stop working under duress.

One theme of my therapy with these folks has been, “trust us, we’re here for you.” But I’m butting up against the reality that nobody can make that kind of promise, no matter how noble their intentions.

And pdoc being sick and t’s mom being sick reminds me painfully of my parents’ mortality. And that scares me more than anything else I can think of. I’m afraid to discuss it with pdoc, though, because he is still getting chemotherapy for f***’s sake—seems like asking him to discuss how his illness and mortality remind me of my parents’ mortality is just cruel. Yes I know it’s not my role to take care of him... but it just seems beyond what can be expected of a professional.

Maybe one reason I’m feeling sensitive to his needs as a provider is because I’m under such strain myself over the last few weeks... had to tell a man he had cancer, which always sucks (in the ED, via an interpreter that kept cutting in and out, with the ED nurse manager tapping her foot because she wanted him out of the ED because they were busy), had this patient where I kept saying to my attending “I’m really concerned that he has an infection in his belly,” to which she literally scoffed... but I was right and he does have a ****ing infection in his belly and it might kill him (though if we’d started antibiotics last week like I had suggested, he wouldn’t be nearly so sick now)... these situations break my heart and make me SO MAD and then when a patient yells at me because their toast is cold or refuses some necessary test as a ploy to get more narcs or benzos, I am just not interested in dealing with it. I am working so so hard and having people get mad at me for things that are not my job or try to manipulate me to get more drugs makes me want to say “f*** it all.”

So I suppose I imagine that when my pdoc manages to drag himself to the office between chemo sessions, he might not be interested in how his struggle for his life is affecting me. He might want to deal with his existential terror in private.

Hugs if you want them. You're a good person.

I saw pdoc yesterday, the first time I've had any kind of psych care in two weeks. How did we address the unexpected absence/premature termination of my t plus all of this recent crap with my mother in 40 minutes? (Shocker: we didn't.)

We talked for a while about how I've been feeling since t's departure. I told him it has been a mix of disorientation, sadness, anger. (I don't feel angry with her for leaving to take care of her mother, but I do feel angry with the situation--the whole year of therapy with these two has been a total s*** show. First off, it was nearly impossible to find a therapist when I moved to this town in June--despite starting the search four months before moving here, I didn't actually meet pdoc until I'd been here for about a month, and then he was on vacation for six weeks so our second meeting didn't happen until I'd been here for nearly three months. Initially I was supposed to see pdoc for both meds and therapy but then after we met the second time he finally bothered to call my prior providers, decided he couldn't deal with me alone, and brought in T and she became my primary therapist (pdoc stayed on for meds and occasional therapy). But then T and I had mismatched Christmas vacation schedules so I just saw T for about a month. And then 4-5 weeks after T came back from vacation, pdoc left suddenly b/c of the brain tumor (this was like mid-Feb). I was hospitalized for all of March, during which time T said she wanted me to transition my care to someone who could see me more often... but then in April she was like "actually I couldn't find anyone else who would see you twice a week and take your insurance, so do you want to keep working with me after all?" Pdoc returned to work part time mid-May, but he's still getting chemo and looks like hell. And then at the very beginning of June, T left the country to deal with her ill mother.)

He asked me if I wanted to explore the sadness I was feeling. I told him I wasn't sure--in part because I'm always a little afraid that once I start feeling something it will overwhelm me and pitch me into a spiral of depression, in part because I'm going to stop working with him in a month or two so what the f*** is the point? He encouraged me to try anyway. I tried a little. It made me feel dizzy.

It's interesting, he seems less sure of himself than he was before he got sick. Before he left, he had this tendency to, like, close his eyes and get this serious look on his face as if he was trying to read my mind and say things like "I can feel your sadness" or whatever. But yesterday he said, "the longing is there. I can feel it." I said "I don't know if it's there anymore. It got smacked upside the face and fled for its life. Or maybe it's just buried." And instead of insisting that he was right, he said, "it being there makes it all make sense." I asked what he meant, and instead of insisting that it was there and redirecting me towards my internal experience he said, "I don't know what I mean, exactly" and gave me a sheepish grin. (For any fellow nerds, it reminds me of an episode of Star Trek in which the ship's counselor, who has special empathic abilities, briefly loses her ability to feel other people's emotions and has to figure out whether or not she can still work as a counselor.) I wonder if the brain tumor was causing delusions of grandeur. Or maybe being so seriously ill (contemplating life's fragility, his own fragility) and/or having the experience of being on the other side of the white coat has affected his arrogance.

Not directly related: I keep having this fantasy that when T found out that her mother was sick (and/or was at work making arrangements so she could be gone for at least a month), she went to tell pdoc in person. I imagine she walked into his office, looking distraught, and closed the door behind her. I imagine that she told him what was happening and started to cry, that he got up and put his arms around her. I'm not sure why this fantasy is comforting to me. I think it is some combination of wanting to be able to comfort T (it makes me sad to see/hear her distress) but I can't because I'm her therapy patient... wanting to be comforted myself... or maybe my unconscious is just trying to put a finer point on this weird lil therapeutic Oedipal triangle the three of us find ourselves in.

Interestingly, I also have this fantasy that at my last session with pdoc or T, they will try to hug me. And I will startle back as if burned, saying, "no, no. Please don't. This is what I've been asking from you for so long, and now that we're done working together you offer this to me? It will hurt too much, to have a glimpse into what I wanted but you wouldn't give. Just don't."

This whole business makes my heart hurt. Yesterday I didn't have to go back to work after I saw pdoc so I went back home and closed the blinds and curled up in a soft blanket and felt the ache in my chest. It is different from being stuck in bed with the depression--that feels much more intense, more hopeless/restless, sharper. But still, the being-in-bed thing scares me a little because I don't want it to somehow become stuck-in-bed-with-the-depression. I can feel it around the edges, the scary sickness that swallows me up. I don't know how to keep it at bay, if I even have that ability.

HI. You said, in part, "It's interesting, he seems less sure of himself than he was before he got sick. Before he left, he had this tendency to, like, close his eyes and get this serious look on his face as if he was trying to read my mind and say things like "I can feel your sadness" or whatever. But yesterday he said, "the longing is there. I can feel it." I said "I don't know if it's there anymore. It got smacked upside the face and fled for its life. Or maybe it's just buried." And instead of insisting that he was right, he said, "it being there makes it all make sense." I asked what he meant, and instead of insisting that it was there and redirecting me towards my internal experience he said, "I don't know what I mean, exactly" and gave me a sheepish grin. (For any fellow nerds, it reminds me of an episode of Star Trek in which the ship's counselor, who has special empathic abilities, briefly loses her ability to feel other people's emotions and has to figure out whether or not she can still work as a counselor.) I wonder if the brain tumor was causing delusions of grandeur. Or maybe being so seriously ill (contemplating life's fragility, his own fragility) and/or having the experience of being on the other side of the white coat has affected his arrogance."

I would seriously consider finding a new psychiatrist. It sounds like his brain cancer IS affecting his ability to be the psychiatrist he used to be. If he doesn't sound like himself, that might be because he isn't, anymore. Good luck.

I am switching psychiatrists—the new program I’m enrolling in comes with a prescriber.

I know you have some misgivings about the new program, but maybe it will be good to get a fresh start. It sounds like your current team never quite got off the ground. Will this program last the whole time your T is gone? Or is it still too up in the air to know for sure when she gets back?

The program is a year-long commitment, can't do more or less than 12 months. It starts in mid-July, I think. (I'm still in the required 8-week psychoeducation course they make you do before you can officially start.) Not sure if I'll return to T and/or pdoc when it's finished or if I'll find another team.

The program doesn't allow patients to have other therapists/psychiatrists/groups/what-have-you while you're in it, but I get the sense that given the circumstances they might make an exception for a single termination session with T when she gets back. (She didn't offer this herself but when I spoke with pdoc yesterday he said that she was quite flustered when she called and just didn't think to mention it explicitly, that seeing her once more to tie things up as best we can would be reasonable. He said he'd been in touch with her, she thought she'd be back by the end of the month but still wasn't sure.)

I went to the psychoeducation group this morning. It was so f**ing ridiculous--I got there an hour early without realizing it and then was super frustrated when I couldn't find the group. It was just the last straw (like, "I have to go to this group I hate for this diagnosis I don't think I have because the people who were supposed to be treating me have fallen the f*** apart, and I've cancelled my morning patients and dragged my *** to this stupid hospital in this stupid town and now I can't even find the g****** idiots I hate leading the stupid group I don't want to be in that's treating the mental illness that is destroying my life even though I work so so hard to keep it at bay.") (This was on top of some intense work-related frustration... several especially inane and infuriating interactions with my patients' insurance companies and a major scheduling f***up--two months ago I said I needed this Wednesday mornings off this week and next, and it was approved by the chief residents and the program director... but instead the administrative people cancelled all of my patients today AND tomorrow, and failed to cancel my patients next Wednesday morning. The administrative staff who run the clinic where I are f**ing idiots.)

Anyway. I sat in the lobby and cried for like 45 minutes, figuring I'd wait until the group got out and explain to the group leader that I really had made an effort but just couldn't find the group. Then I saw one of the other group members at like 10:50 and he was like "lol doc we start at 11am, not 10am" and then I felt really extra-stupid. But I think the crying was actually a good thing. I hardly ever cry. At least I felt some of the things, instead of them lurking around in my unconscious and keeping me awake at night.

After the group, I asked the MSW guy if there was any possibility of having some supportive therapy prior to the program officially starting given that my treatment team has sort of disintegrated. He was empathetic, I guess, but said he didn't think there was a way to make that work but he would ask. I kind of suspected that would be the answer but I'm just feeling so awful and pdoc is going on vacation and I'm not scheduled to see him until mid-July at which point I guess that'll be our last meeting?

I hate this.