A Strange Condition

Tuesday brought the tragic news that my most successful patient was decompensating. He had gone off his meds, lost his job, and was spiraling into psychosis. I felt awful, defeated, and sad. A wise woman once told me: "Man up, you cry-baby pussy. Things are only going to get worse." I soon learned just how wise she is.

Yesterday I rather surprisingly learned that one of my patients had died. Disbelief gave way to tears, and I spent the next forty minutes curled up in the corner of an empty office. I can feel the loss, it is raw and true and powerful, but it is almost wholly unfathomable, even to me. It is hard to explain a loss of a relationship that is so hard to explain to begin with. When a patient accepts services, I (ideally) get to know their hopes and their pasts, I deal with their doctors and pharmacists and families. I learn some of their secrets, and they hide vast facets of their lives from me. I know them better than some family members, but there's a twist of one-sidedness: my patients are supposed to be able to trust me, but they never really know me, because true involvement could affect the professional, clinical relationship. So what is a patient supposed to mean to me? Are they projects for the psychiatrically-inclined? Friends held at arm's length? Clients that I know way too well? I don't know. I know that my patient was old and didn't take care of her medical or mental conditions; she was sweet at heart with a stubborn streak; it took months to build rapport with her, and when I did, I found that beneath a blunted affect and a dirty, fetid exterior was a quietly funny woman who had more problems than karma should allow.

I saw her about thirteen days ago, she was feisty and made me laugh. When I took her home, I waited for her to tell me "Don't do anything I wouldn't do," or "Stay out of trouble," before she slowly tottered off to her asshole husband and much-loved, flea-bitten dog (her baby, as she told me many times). I had no reason to believe it was the last time I would ever see her. She was in my calendar for weeks to come, she was part of my routine. If I saw her written in, it was obviously Every Other Thursday. Now she's a series of eraser marks.

I spent Wednesday mired in a numb, hollow kind of feeling. I don't know if this is how case managers usually feel, or if this is how I should feel. Without preconceptions to guide my grief, I suppose it is a sincere kind of mourning. I can't say I will miss providing her services (mostly 'cause of the smell), but I miss her.