Maybe You Should Talk to Someon - Lori Gottlieb Page 0,90

want to. I’m here if you change your mind and decide you want to come in next week to continue our conversation, even if it’s just one last time. My door is open to you. Bye for now.”

I make a note in John’s chart and then close it, but as I lean over the file cabinet, I decide not to move it into the Terminated Patients section today. I remember in medical school how hard it was for us students to accept that somebody had died and that there was nothing else we could do, to have to be the person to “call it”—to say aloud those dreaded words Time of death . . . I look at the clock—3:17.

Let’s give it one more week, I think. I’m not ready to call it just yet.

30

On the Clock

In my final year of graduate school, I was required to do a clinical traineeship. The traineeship is like a baby version of the three-thousand-hour internship that comes later and is required for licensure. By this point, I’d taken the necessary coursework, participated in classroom role-play simulations, and watched countless hours of videotape of renowned therapists conducting sessions. I’d also sat behind a one-way mirror and observed our most skilled professors in real-time therapy sessions.

Now it was time to get in a room with my own patients. Like most trainees in the field, I’d be doing this under supervision at a community clinic, much the way medical interns get their training in teaching hospitals.

On my first day, immediately after the orientation, my supervisor hands me a stack of charts and explains that the one on top will be my first case. The chart contains only basic information—name, birth date, address, phone number. The patient, Michelle, who is thirty and has listed her boyfriend as her emergency contact, will be arriving in an hour.

If it seems strange that this clinic is letting me, a person who has performed exactly zero hours of therapy, take on somebody’s treatment, it’s simply the way therapists are trained—by doing. Medical school was also a trial by fire; in medicine, students learned procedures by the “see one, do one, teach one” method. In other words, you watched a physician, say, palpate an abdomen, you palpated the next abdomen yourself, and then you taught another student how to palpate an abdomen. Presto! You’re deemed competent to palpate abdomens.

Therapy, though, felt different to me. I found performing a concrete task with specific steps, like palpating an abdomen or starting an IV, less nerve-racking than figuring out how to apply the numerous abstract psychological theories I’d studied over the past several years to the hundreds of possible scenarios that any one therapy patient might present.

Still, as I make my way to the waiting room to meet Michelle, I’m not terribly worried. This initial fifty-minute session is an intake, which means I’ll gather a history and establish some rapport with her. All I have to do is collect information using a specific set of questions as my guide, then I’ll bring those results to my supervisor so that we can formulate a treatment plan. I spent years as a journalist asking probing questions and establishing a comfort level with people I didn’t know.

How hard, I think, can this be?

Michelle is tall and too thin. Her clothes are rumpled, her hair unkempt, her skin pasty. Once we’re seated, I open by asking what brings her here, and she tells me that recently she has had trouble doing anything but cry.

Then, as if on cue, she starts crying. And by crying, I mean howling in the way one might if just informed that the person she loves most in the world has just died. There’s no warm-up, no wetness in her eyes that leads to a light drizzle and gradually a downpour. This is a level-four tsunami. Her entire body shakes, mucus drips from her nose, wheezy noises emanate from her throat, and, frankly, I’m not sure how she can breathe.

We’re thirty seconds in. This isn’t how the simulated intakes went at school.

Unless you’ve sat alone in a quiet room with a sobbing stranger, you don’t really know how simultaneously awkward and intimate it feels. To make matters weirder, I have no context for this outburst, because I haven’t gotten to the history part yet. I know nothing about this very distressed person sitting five feet away from me.

I’m not sure what to do or even where to look. If I look right at her, will