ALL THE TIME WE HAVE
When your therapist dies, well, how does that make you feel?
BY DAVID RAKOFF
A literary agent I knew, his AIDS-related symptoms escalating daily, decided to retire from the business and make a graceful exit before his final reckoning. He called up his clients to tell them he was, in essence, dying, and one of his writers, her eardrums barely done trembling from the sound waves of the news, responded with an immediate and lachrymose, “But who’s going to represent me?” Would that this was even fractionally as aberrant as it is appalling. Many are the tears of bereavement that fall for no one but he who sheds them. I kept this cautionary tale in mind when I went to visit Del in the hospital.
Del had been my therapist. His efforts on my behalf were Herculean; he earned every dollar I paid him. I had been a chilly and resistant analysand from the start, although I stayed with him for ten years. I once admitted to a woman at a dinner party that I had never cried in therapy.
“Never?” she asked, astonished. “Your therapist is no good.”
“No, my therapist is very good, but I’m better,” I half-joked.
That I was ever able to extricate myself from my day job and become a writer was largely thanks to Del. The debt I owed him was unpayable. Even so, when I finally quit therapy, the thought that I might never see him again was only vaguely troubling. The very notion of post-treatment contact struck me as mildly inappropriate. Having grown up surrounded by psychiatrists, I lack that general curiosity people seem to have about shrinks — or their own shrinks, at least. From a very young age I can recall being out in public and seeing my father stop suddenly, or if we were sitting at a table in a restaurant, subtly turn his back and face us in an attempt not to be seen by a patient. Sometimes it was unavoidable, and an efficient hello might be exchanged, but we knew, my siblings and I — notwithstanding the eager smiles and eyes that raked over us like searchlights — that we would not be introduced. These were not social interactions, and any questions we might have had would emphatically not be entertained, although I can’t recall having any. Chalk it up to time and place: the 1960s and early ’70s in Canada, where a British reserve still overlay society. Things were different in New York, I have been told. The membrane between shrink and patient was more permeable. And from what I have seen, that still seems to be the case. Once, at a friend’s birthday party, her former psychiatrist got up and sang a Beatles song to all assembled. Putting aside the romantic declaration of the lyrics, “In my life, I’ve loved you more” (horrified italics my own), it just seemed improper.
I could never really get with the looser program. There were aspects of Del’s and my relationship that played out in the usual transferential manner — the craving for his approval, the briefest flashes of displaced anger on my part — but that classic desire for intimacy didn’t really come up for me. I didn’t hunger for details of Del. I was never moved to Google him (or as we used to call it back in 1989 when I started treatment, “look him up in the phone book”). I gleaned things about him over the years without trying: he was from Omaha; he had a Jewish father and had been raised in a Jewish household, but had seen fit to formally convert in adulthood (I translated the Hebrew of a rabbinical document he showed me); he had been a practicing Buddhist for years. I even once found myself marching behind him one year during Gay Pride (that was not a bombshell; I had gone looking for a gay therapist from the beginning). He looked back and smiled. There was no internal flutter, like when as a child I would see a beloved teacher beyond the confines of the classroom. I didn’t even take the opportunity to see who he was marching with. The moment seemed nothing more than ripe for a joke. “It’s my shrink,” I said to my friends. “Quick! Knock me to the ground and pee on me!”
Not long before we decided to terminate — no doubt exhausted by years of chilly resistance and scoping around for some last-ditch tactic to crack me wider than I’d theretofore allowed — Del started to employ that old reporter’s trick of disclosing things about himself in the hope that I might finally, monkey-like, proffer confessions of my own. With a defiant regularity, he began co-opting our conversations. He extolled the benefits of acupressure and how it cured a bowel obstruction he’d had (ick). He mentioned a recent trip to Cuba and how beautiful the men were, although “we figured they were mostly hustlers,” he added (I did not inquire who the “we” was). Once, when I was leaving, he even told me that my blue shirt was doing “wonderful” things for my eyes. All to no avail. Finally, he stopped me one day mid-rant about being broke: “David, I’m between a rock and hard place here. I hear and understand your anxiety about money, but we have something like seven sessions left and we have to at least talk about your leaving.”
Turning things around, I asked him what his feelings were about our ending things. “I’m incredibly angry,” he responded fondly. “How dare you? You should at least have to come and have coffee with me once a week.” I asked if he felt this way about most of his patients. “Not really,” he responded.
(Sigh. Should you happen to be possessed of a certain verbal acuity coupled with a relentless, hair-trigger humor and surface cheer spackled over a chronic melancholia and loneliness — a grotesquely caricatured version of your deepest Self, which you trot out at the slightest provocation for endearing and glib comic effect, thus rendering you the kind of fellow who is beloved by all yet loved by none, all of it to distract, however fleetingly, from the cold and dead-faced truth that with each passing year you face the unavoidable certainty of a solitary future in which you will perish one day while vainly attempting the Heimlich maneuver on yourself over the back of a kitchen chair — then this confirmation that you have triumphed again and managed to gull yet another mark, except this time it was the one person you’d hoped might be immune to your ever-creakier, puddle-shallow, sideshow-barker variation on “adorable,” even though you’d been launching this campaign weekly with single-minded concentration from day one … well, it conjures up feelings that are best described as mixed, to say the least.)
At the end of our last session, I stood up to leave and put out my hand. “No way,” he said, and pulled me into an embrace. We hugged good-bye. In our ten years of acquaintance, it was the first and only time we ever touched. Bills, breath mints, money had all passed between us in hermetic and sanitary non-contact. I was shocked to find that he was shorter than me.
There is that archetypal moment in a women’s picture where a title card reading “Three Years Later” comes up and then you see the main characters — a little wiser, with incipient crow’s-feet, their hair a little duller, perhaps, their clothes most definitely better — meeting across a table at 21 or the Algonquin where they muse ruefully and bring each other up to date on all that’s happened since they’d last seen each other and all of their dreams had come true (or did they?). I wrote and dedicated a book to Del, and I mailed him a copy, but I had already heard through the grapevine that a virulent and aggressive colon cancer had forced him to close up his practice, seemingly within a matter of a few short weeks. He was very moved by my dedication, but he begged my indulgence; he had little energy or focus for reading. He was already in hospice care at Beth Israel, although he sounded positively cheery on the phone. He would love a visit. I asked if I could bring anything, and without hesitation he asked for two Budweisers, a Big Mac, a large fries, and a Diet Pepsi. His last hurrah. I was reminded of the only true fight we ever had.
Del had once asked if he could eat during a session. I didn’t care: I saw him at the end of the day; he didn’t have a moment to himself. His supper was a Tupperware container full of unhulled grains and some dark, leafy greens. If a Janis Ian song could be food, this was it: a sad and earnest colonic scouring pad of a meal. This was around 1991, a time during which I was spending a good amount of my time shuttling back and forth among New York’s AIDS wards visiting sick friends. I made numerous shopping trips to Integral Yoga Natural Foods on 13th Street, where I would root around in the bins of grimy vegetables for exactly these ingredients for one friend who was piebald purple with Kaposi’s lesions. I asked Del if everything was all right with his health.
He didn’t mind that I asked such a question, but he took issue with the way I asked it. I thought I had invested my voice with a calm assurance and a let’s-not-worry-until-there’s-something-to-worry-about unflappability. To his ears, I had sounded clipped, harsh, and unforgiving. I had always appreciated my own oncologist’s English stoicism and distaste for sowing false hopes — a man who, when I asked him at the age of twenty-two if my impending chemotherapy would have side effects, responded with a bright-eyed, “Oh yes. It’s profoundly nauseating. You’ll be vomiting within half an hour.” Or my New York GP, whose bedside manner was borderline actionable and hilarious — he would say during every rectal exam, “Bet this takes you back.”
As I recall, Del and I reached a chilly détente, each acknowledging the other’s different verbal style, but neither of us giving an inch.
McDonald’s bag in hand (I would have brought him a Cuban hustler if he had asked me), I arrived at Del’s room on a sweltering summer day. He was on the phone. More metastases than man, tipping the scale at ninety pounds maximum, he was sitting up in bed, his underpants gaping around the tops of his emaciated legs. I’d stopped being shocked by that kind of change in appearance. Perhaps years of having seen friends diminish to skeletal shadows of themselves had inured me. Or perhaps it had more to do with the very odd nature of our bond.
“Hi David,” he said, handing me the phone to return to its cradle (those words always had an avuncular, almost regretful, falling intonation). “You look good. Actually, I take that back. You look fine, but there’s a slight reserve, a kind of sadness there.” I gave him a No shit, Sherlock look, which made him laugh. I poured his Pepsi into a small cup and stirred it to remove the gas. He slowly unwrapped the hamburger, taking a tiny bite and chewing it for a few seconds before discreetly spitting it out into a napkin. His interest in the food was gestural at best. He could no longer digest solids; his systems were breaking down. He was to be fitted that day with a PIC line, a tube that’s threaded up a vein in the arm until it reaches the larger veins near the heart, for the efficient delivery of medication and fluids. All of these were signs that he was “getting closer,” as he put it. “And I have to deal with that emotionally,” he said.
For the next three hours, I fell into my preferred hospital room role, bustling around, picking things up, replacing the ice in the pitcher, deadheading the flowers. He catnapped, and we talked. He expressed some mild regret — what can only have been the merest tip of a veritable ship-obliterating iceberg — that he hadn’t traveled more. “California! I went there and thought, ‘This is marvelous! One really needs a month here to explore this place properly.’” He had desperately wanted to go to Italy, but had delayed two critical weeks, after which he was too sick to go. “But I saw Tibet,” he said. (As a resentful twentysomething, filled with rage, I had constructed an angry fantasy about this man getting rich off my dollars, financing country houses and trips abroad with monied abandon while I scraped together my pennies so that every week I might dredge up feelings I’d rather have kept tamped down.)
Later in the afternoon — I don’t recall how it came up (I certainly didn’t ask) — he mentioned that he was planning on being cremated. “A friend of mine knows a place in Florida where Krishnamurti might once have been, so I’m going to have some of my ashes scattered there.” As for the rest of him, the implication was that whatever was left over after this panhandle hegira didn’t really concern him.
Where Krishnamurti might have been? There was something so utterly bleak about this disposal, being cast into an apathetic wind in a place whose significance was little more than a matter of conjecture. The relinquishing of craving and thereby achieving detachment is perhaps the noblest of the Four Noble Truths, I know, but I wanted nothing so much as to take him in my arms and moor him to the here and now. This all felt like some obstinate standing on principle on his part: the spiteful child taking leave of a world that didn’t care about him enough. Del would have said I was projecting (as would anyone, frankly). I didn’t know anything about his life to justify this conclusion, but I wished that I could turn to those closest to him and say, “Talk some sense into him. Tell him how much we love him.” That I might have told him as much myself only occurs to me now.
A nurse came to check his diminishing vitals, along with someone from his temple who was going to say some prayers. They drew the curtains around him, and I stepped out into hallway.
When I had told friends that my therapist was dying, the response was uniformly solicitous. “That must be very intense for you,” people would say. It was. I suppose. Del was an unbelievably good egg. His being under fifty-five seemed doubly unjust, and he had quite literally saved my life to boot. But given my decade’s worth of egocentric monologue, would I be grieving a man or the imminent demise of a reliquary of my deepest pains, most artful observations, and wittiest bons mots? Was I mourning the cancellation of The David Show (“Who’s going to represent me?”)? I didn’t feel entitled to that particular hue of despond.
Outside Del’s hospital room, I listened to the low chanting of sutras. There was a framed copy of the New York State Patients’ Bill of Rights posted on the wall. It was written in English and Spanish, and also Yiddish. Rosetta-stoning with the English translation above, I read through the Yiddish text. In about five years’ time, I thought, this version would no longer be relevant, even at a place like Beth Israel. An era was passing. After about thirty minutes, Del’s friend came out to tell me he had fallen asleep. I went home. I would not see him again.
A day or two later, I had the following dream just before waking: a phone call from Del. “Hi, David. I’m much better, and in fact we’re to meet for dinner at seven just around the corner. The head of oncology will be there, too.” And suddenly there he is, only now he is a small boy, no older than six, fresh from a bath, his black hair wet and combed (between Del and myself, only one of us had dark hair, and it wasn’t Del). Wearing light blue pajamas, he climbs onto my lap. “Look,” he whispers, unbuttoning the jacket. The pale skin of his chest is marred by something: a tattoo, or a wound, or a scarification. Whichever it is, it is clear this injury is a devotional mark. A bruise of allegiance that he would carry forever. &