Don’t Dwell On It

Therefore the Master
Acts without doing anything
And teaches without saying anything.
Things arise and she lets them come;
Things disappear and she lets them go.
She has but doesn’t possess,
Acts but doesn’t expect.
When her work is done, she forgets it.
That is why it lasts forever.

The door is opened and a woman asks for permission to talk to me. She needs an appointment for her mother because she believes her mother needs help. I am somehow surprised because she insists that I should see her mother but I give her the appointment anyway. However, my curiosity wins and, before she leaves, I ask her:

– Why me? Why do you want me to see your mother? Why not somebody else?

– Because you are a very good doctor.

– But how can you know that I am a good doctor since we never met before?

– Both my mother and I know you are a good doctor. My father told us you are.

I smile. He must be one of my patients who now sends his family to me.

– Is your father my patient?

– He was.

I look puzzled at her. She continues:

– He was your patient for a very brief moment.

– Really? And what happened to him?

– He died.

Everything becomes more and more complicated. According to what I know, I haven’t lost any patients yet. At least not here at this workplace, since I’m employed for less than a year. The woman continues however with the explanation.

– My father was not your patient here at your office. You saw him once while he was in the oncology department. You came by his bed and you talked nicely to him. He knew that he is going to die soon, but what you said and the medicines you gave to him helped him a lot during his last moments. He told us that, if we need a psychiatrist after his death, we should come and search for you in the hospital. Then he died one month after you saw him… Now my mother needs some help with her grief. So… here I am! Some of the staff in the hospital tried to stop me from seeing you but I persevered and I finally found you.

My surprise is quite big. I know that some people want to get rid of me in the hospital, but this is quite common when your values do not align with the established values. However, it is for the first time that I’m getting an appointment from… the afterlife. Normally, living people sometimes recommend me; being recommended by dead people is something new for me… but at least this counterbalances my situation in a quite surrealistic (and mystical) way…

I am often called on the oncology department to see people who are about to die. It is something I do with a particularly heavy heart, since my existence was traumatized in a definitive way years ago when, in a couple of months, a friend of mine, younger then me, agonized and died before my eyes. That experience (covered in my Romanian language book, Zbucium) changed me forever. My illusions collapsed. I saw that nobody cares about us and we are literally left alone in a cynical world. No God answered to my (and our) prayers. The void was obvious. It was then that I learned that there are no guarantees in life, in the real life. Since those moments I live without defensive mechanisms when it’s about death and dieing. I no longer form attachments the way I did before. I know that I can lose everything, at any moment, without warning. Nothing is controllable. And the only God there is… is the one acting from inside me and through me…

So, when I go to the oncology department, I encounter not only horrible memories of helplessness and hopelessness, but also my own mortality. I want to run and I know I can’t because my role of psychiatrist forbids this. So I basically have to talk with people who are condemned to die soon. Well… theoretically… sooner than me. Because… practically… nobody knows who dies first.

I have two distinct feelings when talking with someone who is going to die: fear and curiosity. People on oncology are generally brave; they are much more courageous than a political leader or a wealthy guy who believes he’s God on Earth. But the patient’s fear can be felt through transfer. Many are highly defensive and I never tear down their protective walls because they would probably scream in horror. This is contrary to what I like to do in normal psychotherapy, where I enjoy breaking walls of denials or illusions. In oncology I preserve the inner walls and I encourage people to live fully what is left of their time, as if they’d live forever. I don’t know how I do this; I simply do it. Despite the fact that I am notoriously known for not being able to inspire hope in my general interactions with people. The second feeling I experience is a bizarre form of curiosity: I look at the patient in front of me, knowing that he or she is going to die, and I wonder what are they going to see before me in the afterlife, who are they going to meet and how is going to be the moment of death for them. Is it going to be painful? Are they going to detach from their bodies and see themselves from the exterior? Are they going to understand, at that particular moment of the Great Passage, those things that were hidden from them during their lifetime? Is it really something after death or we just fall in a state of nonbeing? I look at them and I am somehow envious (and fascinated) that they are going to find out what is beyond death before me…

One typical aspect of the psy interventions in oncology is that everything happens ‘now’, in the present moment. There is no future and the past doesn’t matter. You do or you don’t do it and you only have one chance. Period. Nobody cares and time is limited, if not unknown. The questions are direct and the answers I give tend to be direct and practical. Both the patient and I can’t pretend there isn’t “an elephant in the room”, and that elephant is disease, suffering and death. So the usual psychological games are rarely played. And probably this kind of dialogue – free from pretending that everything is or will be fine – was so much appreciated by the father of the woman who came to my office. Fairness and realism about life and about his situation.

You probably noticed the quote at the beginning of this text. It’s from Tao Te Ching. It is one of my favorites and contains several attitudes I aim to attain. Although I still actively teach and I still get angry when I see abuse or lack of love, I learned that I don’t truly possess anything and I learned to be so detached that I “forget” what I do or say to my patients; when my work is done, I don’t dwell too much on what I did and I prefer to move on, not exerting any true ownership on what I did. Why that? Well, particularly in oncology, you can’t really build something since time is limited and you’re actually building “sand castles”. To put it in a different way, how much does it help what you say to a person if that person dies within a couple of days? You can’t keep your psychological intervention – the proof of your psychotherapeutic mastery – as some sort of a trophy to be seen and appreciated by others. Before you know, the patient is dead. So, there is no place for pride or satisfaction. At the practical level, you do nothing, as the patient dies anyway, and moreover, he dies fast. What you do is valid only for the present moment; it is valid only… now. So, what matters most is at an emotional level: how the patient feels during and after the interaction with you, or what he discovers rationally following the discussion, rational aspects that are, again, irrelevant, but aspects that might help the patient make peace with his soul or with the others, the benefit being, again, purely emotional. For me, as a rational-pragmatic being, the entire situation projects me well away from my comfort zone.

The story of this unusual appointment has taught me something new: sometimes, even if you might think that what you talk with a dieing patient is unpractical and it is a waste of time, it can actually turn practical, in the form of a continued relationship with his family who might need your help with their bereavement. That’s one thing. Another thing is that human interaction, even if it happens near the moment of death, matters emotionally; otherwise the patient wouldn’t have sent his family to me. Our discussion must have had some sort of effect on him. And a third thing: dealing with dieing patients teaches us something that could be resumed like this: live everything now, don’t be too serious about building “cheap” stuff, and… don’t dwell too much on anything, as you take nothing with you anyway and nothing lasts. When your work is done, “forget it”. Don’t show off. It’s useless. You don’t matter that much.

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