Maybe You Should Talk to Someone_A Therapist, HER Therapist, and Our Lives Revealed

by Lori Gottlieb

  One day ER’s writers called up a local emergency department with a medical question, and a physician named Joe happened to take the call. It seemed like kismet—in addition to his medical degree, he had a master’s in film production.

  When the writers learned of Joe’s background, they began to consult him regularly. Before long, they hired him as a technical adviser to block out the highly choreographed trauma-bay scenes, teach the actors how to pronounce medical terms, and make the procedures look as accurate as possible (flush out the syringe; wipe the skin with alcohol before starting an IV; hold the patient’s neck in this position when inserting a breathing tube). Of course, sometimes we skipped the surgical masks the characters should have worn, because everyone wanted to see George Clooney’s face.

  On set, Joe was a study in competence and calm, the same qualities that served him in a real ER. During breaks, he would talk about patients he’d seen recently, and I’d want to hear every detail. What stories! I thought. One day I asked Joe if I could visit him on the job—“Research,” I said—and he offered me access to his ER, where, in borrowed baggy scrubs, I followed him around during his shift.

  “The drunk drivers and gang shootings don’t start pouring in until dark,” he explained when I arrived on a Saturday afternoon and not much was going on. But soon we were rushing from room to room, patient to patient, as I tried to keep the names and charts and diagnoses straight. In the span of an hour, I watched Joe do a lumbar puncture, see inside a pregnant woman’s uterus, and hold the hand of a thirty-nine-year-old mother of twins as she was told that her migraine was really a brain tumor.

  “No, you see, we just wanted more migraine medicine” was her only response—denial that would soon give way to a rush of tears. Her husband excused himself to go to the restroom but vomited on the way. For a second I pictured this drama on TV—an ingrained instinct when your work is coming up with stories—but I had a sense that finding TV material wasn’t only what being here was about for me. And Joe sensed that, too. Week after week, I kept going back to the ER.

  “You seem more interested in what we’re doing here than in your day job,” Joe said one evening months later as we looked at an x-ray together and he showed me where the fracture was. Then, almost as an afterthought, he said, “You could still go to medical school, you know.”

  “Medical school?” I said. I looked at him like he was nuts. I was twenty-eight years old and had been a language major in college. It was true that in high school I’d competed in math and science tournaments, but outside of school, I’d always been drawn to words and stories. And now my work was a great job at NBC that I felt incredibly lucky to have.

  Even so, I kept sneaking away from tapings to go back to the ER—not just with Joe but with other doctors who let me shadow them too. I knew that my being there had gone from research to hobby, but so what? Didn’t everyone have hobbies? And, okay, sure, maybe spending my evenings in the ER had become the new equivalent of obsessively watching TV every night when I was restless in my film job. Again, so what? I certainly wasn’t about to give all this up and start over in medical school. Besides, I wasn’t bored by the work at NBC. I just felt that something real and big and meaningful was happening in the ER that couldn’t happen in the same way on television. And my hobby could fill in those blanks—that’s what hobbies were for.

  But sometimes I’d be standing in the ER, and, during a lull in the action, I’d realize how at home I felt, and more and more I wondered if Joe was onto something.

  Before long, my hobby led me out of the ER and into a neurosurgery suite. The case I’d been invited to see was that of a middle-aged man with a pituitary tumor that was likely benign but had to be removed to keep it from pressing on his cranial nerves. Gowned and masked and wearing running shoes for comfort, I stood over Mr. Sanchez, peering into his skull. After sawing through the bone (using a tool like something you’d buy at Home Depot), the surgeon and his team meticulously pulled aside layer after layer of fascia until they reached his naked brain.

  Finally, there it was, looking just like the images I’d seen in a book the night before, but as I stood there, my own brain inches from Mr. Sanchez’s, I felt a sense of awe. Everything that made this man himself—his personality, his memories, his experiences, his likes and dislikes, his loves and losses, his knowledge and abilities—was contained in this three-pound organ. You lose a leg or a kidney, you’re still you, but lose a part of your brain—literally, lose your mind—and who are you then?

  I had a perverse thought: I’ve gotten inside a person’s head! Hollywood tried to get into people’s heads all the time via market research and ads, but I was actually there, deep inside this man’s skull. I wondered if those slogans the network bombarded viewers with ever made it to their destinations: It’s Must See TV!

  As classical music played softly in the background and two neurosurgeons picked away at the tumor, carefully depositing pieces of it onto a metal tray, I thought of the frenetic sets in Hollywood with all of their commotion and commands.

  “Come on, people! Let’s go!” An actor would be rushed down a hallway on a stretcher, red liquid drenching his clothes, but then someone would turn the corner too quickly. “Shit!” the director would say. “Jesus, people, let’s get it right this time!” Burly men with cameras and lights would rush around in a frenzy, resetting the scene. I’d see a producer pop a pill—Tylenol or Xanax or Prozac?—and down it with sparkling water. “I’m gonna have a heart attack if we don’t get this shot today.” He’d sigh. “I swear, I’m gonna die.”

  In the OR with Mr. Sanchez, there was no yelling, no one feeling as if a coronary was imminent. Even Mr. Sanchez, with his head sawed open, seemed less stressed out than the people on the set. As the surgical team worked, “Please” and “Thank you” peppered each request, and if it weren’t for the steady stream of blood dripping out of a man’s head and into a bag near my leg, I might have mistaken this place for fantasy. And in a way it was. It was at once more real than anything I had ever seen and also galaxies away from what I considered to be my actual life back in Hollywood, a place I had no intention of leaving.

  But months later, everything changed.

  I’m following an ER doctor in a county hospital on a Sunday. As we approach a curtain, he says, “Forty-five-year-old with complications from diabetes.” He pulls back the curtain and I see a woman lying on the table under a sheet. That’s when the smell hits my nostrils—an assault so vile I worry I might faint. I can’t identify the odor because I’ve never smelled anything this nauseating in my life. Has she defecated? Vomited?

  I see no signs of either, but the smell becomes so powerful that I feel the lunch I ate an hour ago rise into my throat, and I swallow hard to keep it down. I hope she can’t see how pale I must be or sense the queasiness taking over my gut. I’m thinking: Maybe it’s coming from the next bed over. Maybe if I move more to this side of the room, I won’t smell it so strongly. I concentrate on the woman’s face—watery eyes, reddish cheeks, bangs over her sweaty forehead. The doctor is asking her questions and I can’t understand how he manages to breathe. I’ve been trying to hold my breath this entire time, but I have to come up for air.

  Okay, I tell myself. Here goes.

  I take in some air and the smell seizes my body. Steadying myself against the wall, I look on as the doctor lifts the sheet covering the woman’s legs. Only there are no lower legs. Her diabetes has caused severe vasculitis, and all that remain are two stumps above the knees. One has gangrene, and I can’t decide if the sight of this infected stump, all black and moldy like a rotten fruit, is worse than its smell.

  The space is small, and I move closer to the woman’s head, as far away from the infected stump as possible, and that’s when something extraordinary happens. This woman takes my hand and smiles at me as if to say, I know this is hard to watch, but it’s okay. Even though I’m the one who should be holding her hand, even though she’s the one with the missing appendages an
d a massive infection, she’s reassuring me. And though this could make a great story line on ER, in that millisecond, I know I won’t be working on that show much longer.

  I am going to medical school.

  Maybe that’s an impulsive reason to change careers—the fact that this graceful stranger with a blackened stump is holding my hand as I try not to barf—but something is happening inside me that I’ve never felt at any of my Hollywood jobs. I still love TV, but there’s something about the real stories I’m experiencing in person that seduce me and make the imaginary ones feel thin. Friends is about community, but a fake one. ER is about life and death, but they’re fictional. Instead of taking these stories I witness and folding them back into my world at the network, I want real life—real people—to be my world.

  As I drive home from the hospital that day, I don’t know how or when this might happen or what kind of medical-school loans I can get or even if I can get in. I don’t know how many science classes I’ll have to take to meet the requirements and prepare for the MCAT or where to take those courses, since I graduated from college six years ago.

  But somehow, I decide, I’m going to make this happen, and I can’t do that while working sixty-hour weeks on Must See TV.

  12

  Welcome to Holland

  After Julie learned that she was dying, her best friend, Dara, wanting to be helpful, sent her the well-known essay “Welcome to Holland.” Written by Emily Perl Kingsley, the parent of a child with Down syndrome, it’s about the experience of having your life’s expectations turned upside down:

  When you’re going to have a baby, it’s like planning a fabulous vacation trip—to Italy. You buy a bunch of guide books and make your wonderful plans. The Coliseum. The Michelangelo David. The gondolas in Venice. You may learn some handy phrases in Italian. It’s all very exciting.

  After months of eager anticipation, the day finally arrives. You pack your bags and off you go. Several hours later, the plane lands. The flight attendant comes in and says, “Welcome to Holland.”

  “Holland?!?” you say. “What do you mean Holland?? I signed up for Italy! I’m supposed to be in Italy. All my life I’ve dreamed of going to Italy.”

  But there’s been a change in the flight plan. They’ve landed in Holland and there you must stay.

  The important thing is that they haven’t taken you to a horrible, disgusting, filthy place, full of pestilence, famine and disease. It’s just a different place.

  So you must go out and buy new guide books. And you must learn a whole new language. And you will meet a whole new group of people you would never have met.

  It’s just a different place. It’s slower-paced than Italy, less flashy than Italy. But after you’ve been there for a while and you catch your breath, you look around . . . and you begin to notice that Holland has windmills . . . and Holland has tulips. Holland even has Rembrandts.

  But everyone you know is busy coming and going from Italy . . . and they’re all bragging about what a wonderful time they had there. And for the rest of your life, you will say “Yes, that’s where I was supposed to go. That’s what I had planned.”

  And the pain of that will never, ever, ever, ever go away . . . because the loss of that dream is a very, very significant loss.

  But . . . if you spend your life mourning the fact that you didn’t get to Italy, you may never be free to enjoy the very special, the very lovely things . . . about Holland.

  “Welcome to Holland” made Julie furious. After all, there was nothing special or lovely about her cancer. But Dara, whose son had severe autism, said that Julie was missing the point. She agreed that Julie’s prognosis was devastating and unfair and a complete departure from how her life was supposed to go. But she didn’t want Julie to spend the time she had remaining—perhaps as long as ten years—missing out on what she might still have while alive: Her marriage. Her family. Her work. She could still have a version of those things in Holland.

  To which Julie thought, Screw you.

  And also, You’re right.

  Because Dara would know.

  I’d already heard about Dara from Julie, the same way I hear about all of my patients’ close friends. I knew from Julie that when Dara was at her wits’ end with worry and grief over her son’s endless hitting and head-banging, his tantrums, his inability to have a conversation or feed himself at four years old, his need for multiple weekly therapies that had taken over her life but also didn’t seem to be helping, Dara would call Julie, despondent.

  “Now, I’m embarrassed by this,” Julie said after she explained her initial anger toward Dara, “but when I saw what Dara was going through with her son, my biggest fear was to end up in her situation. I love her so much, and I also felt like any hope for the life she wanted had died.”

  “Like you feel now,” I said.

  Julie nodded.

  She told me that for a long while, Dara would say, “I didn’t sign up for this!” and catalog all the ways in which her life had been irrevocably changed. She and her husband would never have cuddles and carpools and reading stories before bed. They would never have a child who would grow into an independent adult. Dara would look at her husband, Julie said, and think, He’s an amazing father to our son, but she couldn’t help contemplate the amazing father he would have been to a child who could fully interact with him. She couldn’t help the sadness that would descend when she let herself think about the kinds of experiences they wouldn’t be able to have with their child, ever.

  Dara felt selfish and guilty for her sadness, because she wished most of all that her son’s life could be easier for his sake, that he could live a fulfilling life, one with friends and lovers and work. She felt enveloped by both pain and envy when she saw other moms playing with their four-year-olds at the park, knowing that in that situation, her son would likely lose control and be asked to leave. That her son would continue to be shunned as he grew older, and so would she. The looks she got from the other moms, the ones who had typical kids with typical problems, added to her sense of isolation.

  Dara phoned Julie often that year, each call more hopeless than the previous one. Depleted financially, emotionally, and practically, she and her husband decided not to add a sibling to the mix—how could they afford and have time for another, and what if that child also had autism? She’d already stopped working in order to manage their son’s life while her husband took on an extra job, and she didn’t know how to cope. Until one day she came across “Welcome to Holland” and realized that she would have to not only cope in this strange land but find joy there where she could. There were still pleasures to be had, if she could let them in.

  In Holland, Dara found friends who understood her family’s situation. She found ways to connect with her son, to enjoy him and love him for who he was and not focus on who he wasn’t. She found ways to stop obsessing about what she did and did not know about tuna and soy and chemicals in cosmetics during her pregnancy that might have harmed her developing baby. She got care for her son so that she could care for herself and do meaningful part-time work and have meaningful downtime too. She and her husband found each other and their marriage again while also struggling with the challenges they couldn’t change. Instead of sitting in their hotel room the whole trip, they decided to venture out and see the country.

  Now Dara was inviting Julie to do the same, to look at the tulips and Rembrandts. And after Julie’s anger about “Welcome to Holland” subsided, it occurred to her that there would always be somebody whose life seemed more—or less—enviable. Would Julie trade places with Dara now? Her first instinct: yes, in a heartbeat. Her second: maybe not. She’d come up with various scenarios: If she could have ten great years with a healthy child, would she take that over a longer life? Is it more difficult to be sick yourself or to have a child who is? She felt horrible even having these thoughts, but she couldn’t deny them either.

  “Do you think I’m a bad person?” she’d ask, and I’d assure her that e
veryone who comes to therapy worries that what they think or feel might not be “normal” or “good,” and yet it’s our honesty with ourselves that helps us make sense of our lives with all of their nuances and complexity. Repress those thoughts, and you’ll likely behave “badly.” Acknowledge them, and you’ll grow.

  In this way, Julie started to see that we’re all in Holland, because most people don’t have lives that go exactly as planned. Even if you’re lucky enough to be traveling to Italy, you might experience canceled flights and horrible weather. Or your spouse might have a fatal heart attack in the shower ten minutes after the two of you have glorious sex in a luxurious Rome hotel room during a trip to celebrate your anniversary, as happened to an acquaintance of mine.

  So Julie was going to Holland. She didn’t know how long her stay would be, but we were booking her trip for ten years and would change the itinerary as needed.

  Meanwhile, we’d work together to figure out what she wanted to do there.

  Julie had just one stipulation.

  “Will you promise to tell me if I’m doing something crazy? I mean, now that I’m going to die sooner than I ever imagined, I don’t have to be so . . . sensible, right? So if I’m going overboard, and things get a little over-the-top, you’ll tell me?”

  I said I would. Julie had spent her entire life being conscientious and responsible, doing everything by the book, and I couldn’t imagine what her version of over-the-top would look like. I figured if anything, it would be the equivalent of the goody-goody student who went a little crazy by having one too many beers at a party.

  But I’d forgotten that people are often at their most interesting when they’ve got a proverbial gun to their head.