Fixer Upper of Fragile Beings

In my work, one of my areas of interest is working with folks who have life-threatening illnesses. With some clients, this means that I walk with them as they approach death.

We face the changes they experience in their bodies and minds together, making the process less lonely and validating the loss they are living with. Here is an example of a situation I found myself in with one of the clients I have had who is struggling to maintain dignity and independence in addition to grappling with the reality of his approaching death.

Vignette

He does not live in a fixer-upper. His apartment has already been fixed up. Three apartments have been turned into one large and lavish home. We are making appointments for the coming week. I can see that he has only written one in the datebook he refers to as the Bible, but there are two appointments he should note, not one. He has asked me to come to see him twice weekly now. I know that if I do not check the book, the second visit will be forgotten. The golden leather-bound daily calendar he keeps in the front pocket of his Burberry walker holds the schedule of the meetings with doctors and caregivers and friends that he would not remember otherwise.

I cannot say what I really want to say. I do not want to hurt him. He waves me away when I ask him if I can check the holy pages.“ I’ve got it, I’ve got it,” he reassures me.

I linger for a second in that place of knowing I should say more but holding it in. Sometimes this is a good practice, but often, what is left unsaid is essential. I swallow my words and smile and tell him that I will see him next week.

He is the only client I visit at home. He cannot get around by himself anymore. Two years with stage four lung cancer is a long time. The doctors injure him regularly by reminding him that he has been kept alive for a much longer time than they ever expected him to live for. He tells me this fact often and expresses how tasteless and cruel this is. He lives braced for the impending reality; his death. This unsavoury fact lurks over his life like an unwelcome thief trespassing onto his property.

I try to make it more palatable for him.

“ We all have reservations at the same restaurant, ” I tell him.“ Yeah, but I’m not hungry yet !” he jokes and we laugh together.

Over and over again he tells me how the demolition of the life he once had, has left him bored and lonely. Friends who once envied him for his connections to the rich and famous have now exiled him to the land of the almost dead. He can no longer offer them favours and so, the phone does not ring as often as it once did.

The day arrives for the appointment I worry he has not recorded. I enter the narrow garage where I need to ask the concierge to let me into each time I arrive. I am not a tenant so I do not have regular access. As usual, I park the car and deliver my key to the front desk. When I leave I will reclaim it and sign out. There is a record of my visit.

Up I go into the elevator in the art deco building where Dashiell Hammett once lived and wrote. I ring the bell that his son repaired for him when it stopped working. There is no answer.

What I knew could possibly happen has occurred.

I call him on his cell phone and he tells me I am not in the book. He is certain that I am not in the appointment book and that I must have gotten confused about the day and time.

It is not me who is confused, I want to say, but don’t. The next time I visit, the time that was written in the bible, we talk about the missed appointment. Slowly I recreate the scene when I did not say what I wanted to say because I did not want to add another injury to his already sensitive sense of self.

“ You don’t have to worry about hurting me,” he says with tears in his eyes. I know he says this not because he welcomes more injury, but because I am one of the only people who is concerned about caring for the fragile being he has now become.

Gloria Saltzman works as a psychotherapist in private practice in San Francisco. As part of the staff at Sinai Memorial Chapel, she offers mourner care counselling. She has been published in Pharos, New Poetry and prose from Paris 2004, Tikkun online, The SF Chronicle, Jewish Journal; an online blog, and She's Got This, an anthology of essays by the Write on Mamas.

She has read in Litcrawl, part of the SF Litquake festival.