I had planned to do a “one-year reflection” type of post this week, but an unexpected circumstance has been making it difficult to reflect back on the past year. That post will be slightly delayed.
It was a Thursday morning like any other. Swipe in, head to my office, check emails, grab charts for the day. As I grab the pile of green folders, the support staff coordinator says hi and shares some unsettling news.
“Hey, do you remember so-and-so? She died.”
So-and-so was a former client of mine who had been discharged, came back in for an intake, and discharged again a few weeks ago for lack of engagement.
“I don’t know.” The support staff coordinator stated that she had been checking insurances of people scheduled to see the therapists and doctors today. So-and-so was scheduled for a psychiatric evaluation, but as she had been discharged, she was informed that she would have to come in for an intake. Just in case she did not get the message, her insurance was run to determine coverage for a possible intake. At the bottom of the computer screen, the words “date of death precedes date of service” appeared in big red letters.
The therapeutic relationship is unlike any other. It’s professional and characterized by those boundaries, yet highly personal. As a therapist, you get let into the deepest parts of one’s identity and soul. You help someone navigate the messy, complicated, difficult parts of that person and process all that stuff with that person. It’s safe, but dangerous. One-sided, yet mutual. Confidential, private, intimate. You’re wrapped up in someone’s life for approximately one hour a week (maybe two, maybe one hour every other two weeks), and yet have no involvement with those 167 other hours.
I went into my co-worker’s office. “I just found out one of my former clients died.” We both sat for a couple seconds, not saying a word but knowing how jarring something like this could be. We talked for a few minutes, and I decided that I would take a walk to clear my head. On my way out, I found myself in my boss’s office. Door shuts, eyes well up, heart beats faster, voice shakes, internal heat rises. “I just found out one of my former clients died.” Start to cry in front of him, and add embarrassment to the multitude of emotions I’m feeling at this time.
When a client dies for a reason unknown to you, you begin to question everything. I have no idea when or how so-and-so passed. I looked back at those phone calls and recalled being irritated at the lack of engagement. When you realize that death may be the reason for the lack of engagement, guilt and confusion in yourself arises. So-and-so had some health problems, but there was also a past history of suicidal ideation. I’ll never know. I wondered if I could have done anything to prevent her passing. I’ll never know that either.
In between profusely apologizing for crying (which, in retrospect, is ridiculous – if you’re going to be able to cry in front of anyone, it’s going to be your boss at a mental health center who understands human emotional reactions) and blotting away mascara tears, I told my boss that I didn’t know what to do and how to proceed. We talked about legal and ethical boundaries that come with the territory. There are no next steps to take.
With a former client, the case is closed. There are few circumstances in which a therapist can break legal and ethical bounds of confidentiality. I can’t reach out to a family member. I can’t attend a memorial service or funeral. I can’t send a sympathy card or flowers. And I certainly can’t talk about details of so-and-so’s life to family members and friends. All of the traditional mourning activities that help one obtain some form of closure are off-limits to the therapist.
I manage to get through therapy sessions with two more clients. I vaguely share that I heard some news that affected me personally and that I may not be 100% today. They understand and empathize and I show them that I’m human. I take a walk and buy an overpriced smoothie to clear my head. I make feeble attempts to get my notes done and audit charts, knowing full well that my head is not there. At 2:15 PM, I decide to cancel my last appointments for the day and go home.
When a client or former client dies, you wonder what you missed. And then you realize that death isn’t about you – it’s something that eventually happens to all of us. But you also realize that despite only knowing this person in one context, regardless of how well you may know someone, you’re still grieving. You’re still thinking of that person, and that person’s family, and the value that one person’s life had. And you can’t go on pretending that it didn’t happen and that this person’s life didn’t mean anything to you.
But you can’t reach out and obtain that closure. You let time pass, mourn in the non-traditional sense, and take life for what it is in this moment.