understanding (n.)

My last few posts have been a little heavy in the way that a ton of bricks is a little heavy.  I promise I will work in some lighter posts soon.

But.

I have had a client since the very first week of internship back in September -- Mary seems as good a name as any other.  Over the past 9 months, Mary and I have met weekly for life review therapy and we have formed a very, very close professional relationship.  She is an amazing woman, old-old, who has lead a full life of discovery, adventure, family and reconciliation.

She is the client I have that is the most ready to pass away.  And by that, I mean just that.  She is ready.  She has spoken often about how she is ready to go and how she is humbled and profoundly grateful for the life she has lead.  For her, dying is part of living.  She is not fearful.  She is just old.  And ready.  

The past few weeks we have been going through her scrapbooks and her stories have made me tear up a little.  In fact, when I have my field supervision, both my field supervisor and I have cried openly when speaking about this incredible woman and her passion, fire and spirit.  We have also cried openly about the incredible teaching experience working with Mary has been for me as a graduate counseling student.

I'm tearing now.

I asked my field supervisor last week if she had any ideas about how I should structure our last sessions.  I stated that it would be difficult for me, but that I had had a profoundly enriching student experience, for which I was grateful.  My field supervisor pointed out I was talking about the worker/client relationship, but that I wasn't talking, necessarily, about how I was feeling about the relationship ending.  She was right.  I am grateful, and.  And Mary and I have grown close.  I don't have a desire to continue visiting with her, really.  She's met all of her goals and I'm confident she would have had the tools necessary to face the relatively brief time she has left.  And I know, based on her feedback, that she would have been able to look back on this therapeutic relationship and be able to pull out how strongly I believe in her and how competent I believe she is.  It's been such a positive experience.  But it's been one filled with so much meaning.  I feel overwhelmed at how moving it has been.  And that is a difficult thing to process through emotionally.  I have a feeling.  I have many feelings.  I'm still sorting through them.

I'm past tearing now.

Why am I telling you all of these personal things about this client?

Mary and I, technically, have two more sessions on the books.  We have started to wrap.  She is physically tired, has worked hard to ensure her children know she loves them, has several health issues, and she's at the point where she will welcome death in the most positive, peaceful way imaginable.

I arrived at internship today to find out that Mary was in the skilled nursing facility after being discharged from the hospital yesterday, and,  she is now on Hospice.  (Seems fast, but sometimes these things move fast.)  When my field supervisor first told me this, I immediately smiled broadly, laughed, and said, "Blessed Be.  This is exactly what she wanted."

I went to visit Mary this afternoon in skilled and it is clear that she doesn't have much time left.  When I woke her up gently, she smiled and said softly, "Oh, it's Lisa.  You came to visit me!"  And she laughed.

Then she said quietly, but joyfully, and this is almost ver batim -- as close as it's going to get -- I've been thinking about it all afternoon -- "Lisa, you've been a dear, dear friend to me.  I've so enjoyed you and your visits.  Thank you.  Thank you for coming to visit me.  I think I'm on my way out and I'm too tired to visit now.  So tired.  But thank you for coming to say goodbye.  Now you kiss me on my forehead, dear."

I willingly obliged and that's when my tears started flowing.  I told her, "Mary, you have taught me so much about living and aging and dying."  (And then I mentioned some specific things we talked about in session I won't mention here).  "And I'm crying right now because I'm so happy for you."

To which she closed her eyes, sleepily responded, "I know, dear!  Isn't it wonderful!" and fell back asleep.

I told her to enjoy this journey, watched her sleeping form for a minute, and then walked to my field supervisor's office, tears streaming.  I asked her if this ever went away -- the tearing and how emotional I felt -- and she said, "Not if you form this kind of bond.  I've kissed many foreheads in my years here, and if you're comfortable enough to do that, you celebrate the journey and grieve the loss."

Mary, I don't think I'm going to have a chance to give you the closure letter I've written to you.  And that's more than ok.    Part of your generativity has been talking about my school and my role as a student, so you must know how grateful, how truly, truly, truly grateful, I am to have worked with you.  My professional and personal selves have been fundamentally changed by the person you are and time we spent together and I will look back at this time in my life with incredible tenderness and fond memories.

Rest well, dear heart. This is a life well lived.

-- Rudyard Kipling


Two nights ago, my dear, usually unflappable, impeccably professional Shoes called me, quite audibly agitated, to tell me that  there had been a gang homicide in the Vineyard Town (the town in which he still lives).  It is, unbelievably, the first gang related homicide (the numbers of assaults and riots number much higher) in the small community of 31,000 people.


We both knew the 20 year old victim (also a gang member) and had worked with him professionally (it's public record).  In fact, almost all of my closest friends from the Vineyard Town are kid workers (addictions counselors, mentors, therapists, juvenile detention officers, juvenile probation officers and, of course, my own dear Juvenile Deputy Prosecuting Attorney) and we had all worked with him professionally.   In all honesty, this was a tough kid.  Challenging.  Defiant.  Angry.  And we cared about him deeply.  It's a situation in which all are true.


And we mourn his loss deeply.  More deeply than I know how to tell you.  We work as hard as we can.  We give as much as we can give (or as much as our resources allow us to).  And in the end, even though it's quite obviously nobody's fault, we all ask the same question:


Could I have done something differently?


We are all asking that question.  And we are all holding our breath to hear who the pd will arrest.  We want to believe it's not another juvenile.  We want to believe it's not somebody we've worked with.  And we know it's not a realistic expectation.


These kids - these "bad kids" - you wouldn't believe the challenges they face.  You wouldn't believe what's happened in their lives.  You wouldn't believe the community, contextual factors that contribute to their delinquency.    There are so many intersecting factors of race, class, privilege, and oppression that it is absolutely ludicrous to approach the issue from an "errant individual", middle class, Caucasian perspective and question why these kids aren't more pro-social, contributing members of society.   The public doesn't understand and it is ridiculously easy to demonize.  These kids did not wake up at 12 years old and make an informed decision to become gang members.


One thing I do regularly (that I should not do at all because it certainly doesn't contribute to my own mental well being) is read the public's comments on online news stories.  The following was posted yesterday from the Vineyard's Town paper (copied and pasted in full, including spelling errors - no edits):

@football stud: He did make a choice, and when you play with fire, you're going to get burnt. I just can't help but think that somewhere along the lines, someone realized that he was headed down the wrong path, and decided to turn a blind eye. Not all of us would do that, but I feel like many of these young kids are failed by their parents, teachers, neighbors, anyone that knows them and could see the red flags. Ulitmately, I hold the parents responsible for making sure that they don't get wrapped up in gangs, but we all know that many people that have children don't have them for the right reasons and don't take care of them. 

Red flags?  Dear heart, this was not an at-risk youth.  This was a youth drowning in more structural inequality, racism and delinquency than I care to address in a single posting.  Did we turn a blind eye to him?  Ask my juvenile detention officer friends who spent multiple nights with him, working with him on calming him down and listening from a place of non-judgmental inquiry.  Ask the probation officers who worked every angle they could to get him appropriate services.  This isn't blind.  This is doing as much as you can.  


But it may have been doing as much as we can too late.  As in, we need to build healthy communities sooner, because by the time the kids reach us, we're addressing some pretty deeply ingrained thoughts and beliefs.


For the first time in four years, I wish I was back in the Vineyard Town.  For the first time in four years, I feel something other than contempt for the community.  I'm not sure what it is, but I think it borders on tenderness and passion.


I may have been exaggerating when I said I would never return.  


Who knew?

"... I rambled."
       - Galway Kinnell, 1980



It's the time of the term when the sequestering is total, the rambling rampant.  This picture is largely ceremonial, because, well, really.  Whose workspace looks like this?  You should see the pile of peer reviewed articles I've got going in the next room.  I'm nose-deep in contextual family therapy, community forums, agency assessment ... But what can I say?

I love what I do.
I love where I'm at.

(Even though it makes me wistful of other people's places in life, as I so eloquently and maturely described in the previous post.)

This is the time of the term when there is no extra time and Shoes and I will next see each other on Memorial Day.    You didn't hear it from me, but a little bird (Ie:  his mom) called me to drop hints they may be ring shopping.  (They may kill each other in the process, but I can't help but find it incredibly endearing that my love is taking his mom to look at rings.)

Now, onward.  Forward. Upward.

I am told that when Shoes walked through the door of his brother's house last Friday night, the boys (6 and 3) came running up, took one look at Shoes, look past Shoes and said, "Where's Lisa?"

Lisa was stuck in a little bit of traffic North of Tacoma due to a MegaAccident, but got there an hour after Shoes.  And it was worth it.  Long hugs from the boys, discussions about Willy Wonka and Spiderman, and an offer from the oldest to unplant his mom's mother's day present so he could show me the roots.  He assured me they were super amazing. I told him I'd take his word for it.

And that's what we did.  We visited. We ate.  We passed around the babies at the Birthday Party.  Shoes and I lounged lots on Sunday and had conversations like:

Shoes, "Lady Gaga's a dude."
Me,"Huh?"
Shoes, "Lady Gaga.  It's a dude."
Me, "I don't think she's a man."
Shoes, "He is.  He's a man."

And conversations like:

Shoes, "I HATE the University of Washington!"
Me, "But you're an alumn."
Shoes, "I'm an alumn of Washington State!"
Me, "And UW."
Shoes, "Not UW."
Me, "You went to law school there."
Shoes, "I.  Am.  A.  Washington.  State.  Alumn."
Me, "And a Husky.  And it was a top 25 law school when you went there."
Shoes, "I HATE the University of Washington!"

And conversations like,

Shoes, "Bear and I are going to Boulder this fall for a Pac 12 game."
Me, "Huh?  What?  You're going to Boulder for a Packer's game?  I don't think that's right."
Shoes, "No.  We're going to a Pac 12 game.  You're not invited."
Me, "No surprise.  It's like the Adam Karl Poker Game.  I get it.  It's the next big thing."
Shoes, "There's one other Next Big Thing that's going to happen this summer before that."
Me, "Promises, promises."
Shoes, "Let's go camping this summer, too.  Camping would be fun."  Pause.  "I'm pretty sure Lady Gaga's a dude."

You know.  The kind of conversations that go nowhere and say nothing but you have them repeatedly anyway.

It was a good weekend.
Shoes knows lots of lovely people.
It was truly my pleasure to be with them.
Anybody want to solve the Lady Gaga debate?

This is mean.  And it's mean because I'm jealous.  I'm going to be mean right now because some days I would like to be at home all day getting caught up on all the things that pile up at a house if you're single or married or have kids:  laundry, dishes, floors, vacuuming, grocery shopping, windows, bills, switching out pictures in picture frames, organizing papers, emptying out mice traps (right.  probably will call someone to come do that one.)

But I can't do any of those things right now because I'm swamped in macro level community based projects (love, love, love raising $500.00 in 3 weeks.  That's a lie. I don't at all.  PTSD from Church Fundraisers) and gerontology theory and dueling gracefully with the GSSW over my registration rights as a 3 year student (long story).  I'm just tired and cranky and ready for the summer.

And mean.  And jealous of those who have already figured out their adult life and don't wake up at 3 in the morning randomly worrying about how to get 3 cases of bottled water to the GSSW when my entire macro project team works at least 3/4 time and there is no extra time.

(I'm about to be transparent about my meanness.  Hold on.)

There is no extra time.  None.

So I get jealous when I see what people are doing on Facebook all day long and it sounds so much better than what I'm doing (which makes no sense because I do love what I'm doing on many levels) and that manifests itself in thoughts such as, "What?  How are people on Facebook  that much?  And why are they telling me about every little thing they're doing?"  Which REALLY doesn't make sense because I am the one READING it.  And I know lots of people who have writing careers where they're at the computers all day and the FB is part of being on the computer.  Not really thinking about that here.  I have often harbored mean, terrible thoughts about parodying these constant FB updates, but in a super special, SW way.  Using lots of exclamation points, because, of course, using exclamation points is super appropriate when working with the dying.  Such as:

8:00 am:  OMG!  Another day at internship!  LOVE THESE OLD PEOPLE!
9:00 am:  FELLOW GSSW's:  Any ideas where I can get a free DSM??
10:00 am:  Just had supervision - can't believe this year is almost over!
11:00 am:  Lisa likes "God" and "Humanistic Politics" and "Don't show the pictures of Bin Laden"
12:00:  Lunch - I am SO hungry!  Choices, choices.  Do I eat the food from the retirement cafe or the free food the facility gives us?
1:00:  Lisa is attending "May 1st Worker's Right March in the Park Blocks"!!
2:00:  Lisa started playing Sim Social Work Services.  Build your own service agencies and clients -- see which clients thrive!
3:00:  OMG.  Group today went soooooo good!
4:00:  So tired.  Yawn.  Almost done with this day.  2 more individual sessions left and then I'm outta here!
6:00:  Lisa started playing Public Policy Trivia with a score of 5000!  Create an account and play with her!
7:00:  Just went for a 4 mile run and I'm STARVING!  What to eat for dinner??
8:00:  Decided on the chicken and salad - can't be too healthy, LOL!!
9:00:  Another long night of reading, writing and research ahead - Socioemotional Selectivity Theory and Gerotranscendance, here I come!
12:00:  Sooooo tired.  Goodnight everybody!!!

This weekend I'm going taking a day to drive with Shoes up to Seattle for one year olds' birthday party (we committed to this awhile ago and I have been purposefully structuring my coursework for the past few weeks to be gone for an entire day and a half).  I will not think about how mean I am.  I will not think about theory.  I will worry only slightly about the cases of water that need to get to the school next Friday.  I will play with Shoes' nephews and will enthusiastically listen to fantastic stories about dinosaurs and Pokemon.  I will pretend that that is my real life and I have already graduated.  I am thankful for school.  And.  I am ready for 2012.

... because that is the way life is.
                         Bernardo Bertolucci

We started talking about endings with clients at the beginning of Spring Term in class.  All of us graduate students see the end of our first internship year coming, and all of us have people we're working with it will be difficult to say goodbye to.

On the flip side, in all honesty, we all have people it will be less difficult to say goodbye to.

I brought this up with my on-going clients Week One of Spring Term (the last week in March).  Primarily, I started the ending phase that early (11 weeks before it happens) because of the mild, age related cognitive impairment my on-going clients happen to share.  Forgetfulness is common.  My youngest is 87 years old.

There was another reason, though.   Erik Erikson characterized the last part of a human being's life - the last part of lifespan development -- as one in which the elderly person ideally reaches ego integrity -- "a fundamental acceptance of his or her own life, regardless of how good or bad it has been, and looks back and feels satisfied with the past" (Tornstam, 1999, p. 11).  Part of this acceptance, then, is generativity.  As I come to terms with my life and I examine it now, what am I giving back?  What are my contributions now?  What mark am I leaving?

 I started the ending process so early to ensure that my on-going clients understand that while I have been providing counseling to them, they have been enriching my life beyond measure.  This is part of their generativity. It will take me years to sort this out - what exactly this year with them has meant and how it has changed me.

It will take longer than the time they have left to live.

Here are some of the bigger lessons:

From my field supervisor:
"You stop doubting yourself.  You see people and you understand people and it's time for you to stop being so timid when you present your assessments. Next year you'll be an advanced clinical student, so say what you have to say with the grace I know you already have.  That time is now."

From On-going Client One:
"You go on and you tell them that being old is something they need to think about now.  You tell people what it's like because people need to come to terms with that before it surprises them.  Old age isn't what it used to be, but old age isn't something to be afraid of."

"Stay out of the pool hall."

"Cause enough mischief to keep things interesting."

From On-going Client Two:
"When you get as old as I am, you should reach the point where you're able to live harmoniously with your family.  That's the only thing that matters."  (Research has, indeed, shown this to be a primary goal of the aging population [Carstensen, Fung, & Charles, 2003]).

"Only marry your boyfriend if you know you can handle the aging process with him."

From On-going Client Three:
"I have told my story about my WWII battalion to as many people as I could have.   Soon, my story is only going to live in the people who have heard it.  Tell it.  Tell them about the 442nd.  Tell them how we're just now being recognized for our work."  (Obviously, I only tell you now as it is his wish for me to do so.)

"You listen too good.  I tell you too many things, but that's ok. When you leave here, you be sure to listen to people just like you're listening to me now."

From On-going Client Four:
{and this is difficult for me, personally, to write; on-going client four is dying.  there is little talking now.  there is just companionship.}


"That boyfriend of yours?  You tell him that he has a good woman and that he would be foolish for him to not marry you.  You tell him that."

This is the advice for newly married couples:  "Be careful!  No getting pregnant right away and she should keep her trim figure!"

"Don't dye your hair back to brunette.  Stay blond.  Stay fun."

(Why so much talk about my boyfriend?  Because that was the first question they all asked me:  are you married?  All they really know is that he exists, and anybody working with the elderly understands there's a teensy bit more self disclosure than when you work with other demographics.  


It was how they were taking care of me.  It was part of what they wanted to teach me.  And they did.  And they are.)

References

Carstesen, L., Fung, H., & Charles, S. (2003).  Socioemotional selectivity theory and the regulation of emotion in the second half of life.  Motivation and Emotion, 27(2), 103-123.

Tornstam, L. (1999). Transcendence in later life.  Generations, 23, 10-14.