Sunday, December 19, 2010

Pink Hats 16: A Little 'Couch' Time


"Howdy. You weren't visiting the twins, so I thought I'd find you here." Using the code Bob had given him, Chuck tried the doc's lounge. He stepped over to the counter and selected French Roast from the automated maker. "You want a refill?"

"Hey, Chuck. You done for the day?" asked Bob. He looked at his watch, 8:00 PM, and added, "For the evening? Yeah, thanks."

"Pretty much," Chuck said, knowing he was preaching to the choir. Bob was no stranger to late hours, especially since he'd started seeing the twins. "Unless you have anything going on I can help with, that is. You know me, glutton for punishment."

"Suits you well as a student -- within limits. It's easy for an overworked resident to take advantage of you without meaning to and you end up doing more than you should. Just be aware. It's like 'the road to hell is lined with good intentions.'"

"Thanks for the heads up. So, speaking of which, are you done with me?"

"More or less. Have a seat, there's something I'd like to bounce off you, something personal, if you'd be willing. A little informal couch time."

"Not at all. What's on your mind?" he asked, setting both cups on the table and falling into therapist mode. Asking a patient what was on their mind was one of his favorite open-ended questions for initiating conversation. With a new one, it might be, "How can I be of help?" Though Bob wasn't a patient, old habits die hard.

"To get right to the point, I'm thinking about adopting the twins. I've gone through my own list of reasons, my age, and so forth, but I'm wondering how it looks to someone like you, with your background. If I were to ask for 'psychological' impressions, what would you say?"

"I'd say it's interesting you should bring this up because it reminds me of a patient I worked with a few years ago. He was retired military, put in 30 years, had never married, and was thinking he'd like to have a family. Mid-fifties, had been careful with his money, bought a house in Denver, and gradually came to realize he'd lived primarily for himself most of his life. He wasn't depressed, he didn't appear to be compensating for guilt or avoiding grief. He wasn't trying to use kids to 'save a bad marriage,' as sometimes happens. He was simply a guy taking stock of his life and had been thinking for quite a while that he'd missed out on some important things along the way."

"So, you're saying he was having a mid-life crisis?"

"You could say that. I didn't because mid-life is always a time, for men at least, of reevaluation, thinking back-thinking ahead, getting in touch with feelings in ways they'd ignored for most of their career-building years. The idea of a 'crisis' is usually associated with an acute, precipitating event like a divorce or illness that forces a man to face up to his mortality. I didn't get any of that from him. Retirement can do it, of course, especially if a person doesn't prepare and has no specific ideas for using their time. This guy had opened a photo gallery in Lo-Do a year before I began seeing him -- Lo-Do is Denver's equivalent of Portland's Old Port -- and was happy, optimistic, and overall, doing quite well. Families would come in, he said, and he noticed how he felt when he saw them. He'd started working with Big Brothers, thinking doing something with one kid would help, but it wasn't enough. So, he thought maybe it's not too late to have some of his own.

"Sure, it's possible to interpret his desire as denial of mortality -- if he has kids, he won't get old. I was reluctant to do so because it seemed to me he was attempting to be more true to himself, to the person he might have been, to accept responsibility for himself as a man in mid-life, rather than pretend he was 22 once again, footloose and fancy-free."

"Women do it, have children on their own," Bob said, "and quite often, as a matter of fact. I have several patients of single mothers -- you've seen a couple of them -- who became pregnant by artificial insemination. Career-minded, they found themselves getting older, with no immediate prospects of a husband on the horizon, and besides, they didn't want to marry just to obtain a sperm-donor. Their biological clock was getting closer to midnight and they felt like it was now or never."

"Exactly. It's part of the 'changing face' of families we've been seeing in the last few years. Anyway, he and I spent a few sessions talking about alternatives, should he adopt an older child, did he want to deal with diapers, was there a love interest on the horizon. Then we got into what it all meant for him and of course, that's when things got really interesting. He had a sister with three kids and when they were younger, the two of them discussed who would be best suited to provide their parents with grandchildren and who would take on the role of being the hot-shot career person. She wanted a home and family, their dad was retired military, so it seemed natural for a son to follow in his footsteps.

"We talked about how that decision may have derailed any desires he may have had to procreate and how those were, apparently, resurfacing. Having done his duty for God, country, and his family of origin, now he wanted to live the rest of his life more on his own terms. In that sense, he hadn't been living for himself at all, as he initially believed, and instead, had lived for others, fulfilling expectations that weren't necessarily his. Opening a gallery rather than becoming a CEO of a Fortune 500 company was certainly a 'feminine' thing to do in terms of expressing beauty and creativity, and it showed how he was becoming increasingly open to the depth dimension within his own life. You might say he was doing 'soul work,' tapping into deeper levels of his psyche."

"Chuck, you ought to be a psychiatrist. If you like pediatrics, do child-adolescent, you can still work with parents. As far as your patient's story is concerned, you're talking about me, whether you know it or not."

"I wasn't sure, but I had a feeling. Anyhow, to wrap this up, he eventually did go ahead and adopt. He started the process while we were working together and then I saw him at intervals over the remainder of the year to check-in on how things were going, do follow-up, and help him with the transition to fatherhood. I got a letter from him last week -- he writes every now and then -- with a photograph of him and the kids. He adopted a boy 5 and girl 3, brother and sister, whose parents were killed in Bosnia -- like I say, this was a few years ago. He went over, saw them in an orphanage, and brought them back to the States. They're in their early teens now and the three of them were on vacation in Honolulu. He said adopting was the best decision he ever made. Oh, he's also dating a woman who has two more -- only these are little, two or three, and he's thinking it may go to the altar. If it does, he said, he's ready to be a father for the second time."

"Let's go back to something you said earlier, about avoidance of grief. What's that about?"

"It's generally assumed women suffer more from infertility or the absence of children than men. The truth is, men suffer, too, though it may not show up until the middle years, 40s and 50s. At that point, it's usually an issue that may or may not get him into therapy. In any case, his options include, first, to actively mourn the loss of children and come to grips with his life as it is. I've worked with men who did this and came out on the other side with a renewed sense of purpose and satisfaction. Second, he can try to avoid mourning altogether and I'll see him when he needs an alcohol or drug detox admission or a script for an antidepressant and therapy. Generally, that's how it goes. The third is more complicated but it applies to the patient I described and I'm guessing it also applies to you, at least based on my observations."

"You've been observing me." It came as a bit of a shock, but he said it without offense.

The jig is up, Chuck thought, oh, what the hell, go ahead, tell him, the worst he can do is flunk you. "It's an occupational hazard. When you 'read people' for a living, you start doing it without thinking. But as a student, working with physicians or staff I'm unfamiliar with, it helps to develop my own sense of who they are and what's important to them. What they say, what they mean, and how they behave, can be very different.

"In your case, to be completely honest, I think you've probably done quite a bit of mourning, and I say that because men in mid-life who haven't, tend to lack a measure of emotional stability. They aren't centered, in other words; they don't really know themselves. You do, or you're working at it, which is the same thing. Furthermore, you haven't found that process to be completely satisfying, no matter how hard you've tried to convince yourself it ought to be. That's why you were standing out there in the middle of the road when a Mack truck came barreling along in the form of the twins. Desires like the one you're experiencing, that don't go away with the grief process, are ones we have to resolve in other ways. If we can't work them out by volunteering or being more involved with nieces, nephews, or children in the family, the choices get kind of obvious."

"Yeah, I think so, too. And that's what makes love not quite enough. I mean, it is up to a point, but I could love the twins without adopting them. Taking that step means I need to do it as much as I want to."

"And there's nothing 'wrong' with that. This is as much about you as it is the twins or anyone else you choose to involve. Clearly, you have a legitimate need to express your affection for them as their father, not merely as an altruistic bystander. Maybe you felt that way at first, maybe not, but you sure don't now. This is not something to take lightly or dismiss as self-interest. What it boils down to is, your 'inner father' is not going to be happy until you're doing what you believe you were meant to do.

"The need-to part is driving you forward, propelling you to deliberately think about the implications of your actions, how to be a good parent, and how to provide adequately for the twins. It makes you responsible. The want-to part is love; that's ultimately what makes the prospect seem worthwhile; it tells you this is the right thing to do and motivates you to give your best. Bringing those two together, as you have been doing, allows you to experience wholeness. The 'Bob' you were meant to be is the one you're becoming."

"Are you going to charge me for this?" Bob asked, cracking them both up. "Seriously, you ought to. And don't let anyone talk you out of being a psychiatrist, either, not even me. You can count on a hell of a recommendation from me when you apply for residency -- you are applying here, aren't you? I can help with that."

Bob heaved a huge sigh. It seemed to him like he'd done a lot of sighing lately. That's good, he thought, it means I'm feeling and feeling is better than not, any day of the week. "This is the right thing to do, for the girls and for me, and I believe, I hope, it is for someone else I'm thinking of involving. Talking about it tonight -- don't worry, I know you're my student, but this," he said, waving his hand across the space between them, "this is outside that relationship. We're both a little older, I think we can handle the differential. Anyhow, talking about it tonight, I'm even more convinced. Anything else, feels so lousy I don't even want to contemplate it." At Chuck's nod, he said, "I take it you agree, following my gut is better than going counter to it. Good. Thanks -- Doc." He smiled and got up, scraping his chair along the wooden floor.

"Anytime." Chuck said, smiling in return. "I'll send you my bill."


(Creative Commons image by pasukaru76 via Flickr)

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