Dream Me a River

http://www.nytimes.com/2016/05/24/opinion/dream-me-a-river.html

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MY schedule was packed with therapy patients back to back until 7 p.m. I wanted to make sure that everyone was seen and everything was taken care of before I left for vacation: medications refilled, phone calls returned, medical documentation completed. I was in a state of flow. Then I got a call from a former patient’s wife, informing me he had died. It stopped me.

Andrew had been an athletic and charismatic civil engineer in his early 40s, married with two young children. He came to see me for a drug addiction, which had started innocuously in his mid-30s with some occasional recreational use. Over the years his use increased until it consumed most of his life. A month before he came to see me, he had lost his job, and his wife was threatening divorce.

I started him on medication and he began attending an intensive outpatient treatment program. He stopped using, and within three weeks of treatment he accepted a job that would take him out of New York, to Maryland, half of the week. This meant he would be leaving his daily treatment program. I advised against this because it was so early in his recovery. He said he didn’t think it would be a problem: He would make sure to come to his weekly sessions and he would attend 12-step meetings. I felt very uneasy. My experience had been that this sort of thing was what led people to ease out of treatment into relapse. I shared my concerns. He nodded with a gentle smile. My words had no effect on him. I felt it in my core.

Eventually he started missing our sessions. Then one day he came in to tell me that it would be his last visit. He said that he was going to follow up with a new doctor who was a better fit for him.

It was five months after that visit when I received the call from his wife. Andrew, I learned, never followed up with the other doctor, and stopped every form of treatment. Soon he relapsed, and after months of secret drug use, he overdosed. I remembered the pleasant nod he gave me when I voiced my concerns. A profound heaviness descended over me. But as the day went on, I felt better, lifted by the patients who walked into my office to share their stories. It was the best medicine for me.

A few days later, as I rested on a beautiful beach on the southern coast of Brazil, Andrew came to mind like one of the many wispy low clouds blowing into the coast — a mystery, an unarticulated question. I again felt a heaviness. I knew doctors couldn’t save everyone. I had learned that a long time ago. I was sad about Andrew’s death, but I thought that I was at peace with it. Soon I would learn otherwise.

Later that day, a beautiful woman who looked to be in her early 60s started casually talking to me at the beach. She told me she was a spiritual healer and believed that we were all working through the traumas and ailments of our ancestors. She asked me what was my birth order. I told her I was the first born. “The father’s firstborn son comes into the world to work through the issues of his maternal grandfather,” she said. That struck me. My maternal grandfather died from complications of alcoholism when he was 49, before I was born. I had long been aware of the connection between my ending up in the field of addiction treatment and my having an alcoholic grandfather, but I had never felt its emotional resonance until that moment, with the memory of my deceased patient lingering.

After a long evening walk, I found the comfort of my bed and fell into a deep sleep. I dreamed I was in medical school again. I was in a small classroom, seated by a student I did not recognize. He reminded me of an elementary school classmate whose name was also Carlos. I could see in this student’s face that something was distressing him. I had to help him so I said assertively, “We are talking.”

We looked for an empty room so we could speak in private, but each room we found was filled. Eventually we found an empty classroom. As I started to walk in, another student began coming in with a group to do a project. I told her emphatically, “This room is mine.” They left without question. Then my classmate walked in and I followed. When I closed the door, the wall behind him disappeared and gave onto a savage river surrounded by thick tropical vegetation. The river brimmed with gray water rushing forth with relentless force. It looked like the river behind my maternal grandmother’s home in San Sebastián, Puerto Rico, except that this one was fuller and more ferocious.

As soon as the river appeared, the student threw himself in it. I jumped in terror to save him. I was able to wrap my arm around his dangling foot. I began screaming from the top of my lungs, “Ayúdenme, ayúdenme!” which means, “Help me, help me!” in Spanish. The more I screamed, the more he fought me. I could feel his foot slipping away. My screams woke me up. It took me a few moments to catch my breath and realize I was in my hotel in Brazil. I was mystified and shaken.

I eventually went back to sleep, but the dream stayed with me. I’ve thought about it every day since. It exposed a hidden grief for the loss of someone I was incapable of saving. That someone, most recently, was Andrew, yet the sorrow, I now realized, preceded his passing. Trying to cope with that old unconscious grief was no doubt what led me to treat addiction, and into psychiatry in the first place, the hope of having the power to change someone immutable. I thought about my mother, who had studied social work, motivated by her desire to help alcoholics like her father, whom she couldn’t stop from dying.

It was all becoming clear: My mother had transmitted to me unconsciously her desire to save her father and entrusted me also with taking on his pain — just as the spiritual healer said. The figure that jumped into the river represented not only Andrew and my grandfather, but also me. I had my own pain, which had led me into my own psychoanalysis years before. The dream suggested that I was afraid that the current of my powerful feelings would sweep me away the way it did Andrew and my grandfather.

The dream was a reminder that I can’t rescue anyone from his or her feelings, not myself or my patients. I can only learn to live with my own and be an instrument for my patients to do the same if they so choose.

Details have been altered to protect patient privacy.