Part Four

Though we travel the world over to find the beautiful, we must carry it with us, or we find it not.

—Ralph Waldo Emerson 

Chapter 46 The Bees

A minute before Charlotte's appointment, I get a text from my mother. Please call me. She doesn't normally send texts like this, so I dial her cell. She answers on the first ring.

"Don't be alarmed," she says, which always means that something alarming has happened. "But Dad's in the hospital."

My hand tenses on the phone.

"He's fine," she says quickly. Fine people aren't admitted to the hospital, I think. "What happened?" I ask.

Well, she says, they don't know yet. She explains that my father was eating lunch when he said he didn't feel well. Then he started shaking and had trouble breathing, and now they're at the hospital. It looks like he has an infection but they don't know if it's related to his heart or something else. He's fine, she keeps repeating. He'll be fine. I think she says this as much for herself as for me. We both want—need—my father to be fine.

"Really," she says, "he's fine. Here, see for yourself." I hear her mumble something to my father as she hands him the phone.

"I'm fine," he says by way of hello, but I can hear his labored breathing. He tells me the same story about having lunch and not feeling well, leaving out the shaking and difficulty-breathing parts. He'll probably be out by tomorrow, he says, once the antibiotics kick in, though when my mom gets back on the phone, we wonder whether it's something more serious. (Later that night, when I go to the hospital, I'll see that my father looks pregnant—his abdomen filled with fluid—and that he's on several different IV antibiotics because a serious bacterial infection has spread throughout his body. He will be hospitalized for a week, the fluid around his lungs aspirated, his heart rate stabilized.)

But right now, getting off the phone with my parents, I realize that I'm twelve minutes late for Charlotte's appointment. I try to shift focus as I head to the waiting room.

Charlotte jumps up from her seat when I open the door. "Oh, phew!" she says. "I thought maybe I had the wrong time, but this is always my time, and then I thought I had the wrong day, but no, it's Monday"—she holds up her phone to show me the date—"so then I thought maybe, I don't know, but here you are."

This all comes out as one long sentence. "Anyway, hi," she says, moving past me into my office.

This may seem surprising, but when therapists are late, many patients are shaken. Though we try to avoid this, every therapist I know has let a patient down this way. And when we do, it can bring up old experiences of distrust or abandonment, leaving patients feeling anything from discombobulated to enraged.

In my office, I explain that I was on an urgent phone call and apologize for the delay.

"It's fine," Charlotte says nonchalantly, but she seems out of sorts. Or maybe I am, after the call with my father. I'm fine, he had said. Just like Charlotte says it's fine. Are they both really fine? Charlotte fidgets in her chair, twirling her hair, looking around the room. I try to help her locate herself by meeting her eyes, but they're darting from the window to a picture on the wall to the pillow she always keeps on her lap. One leg is crossed over the other, and she's rapidly kicking that leg in the air.

"I wonder what it was like for you, not knowing where I was," I say, remembering how, a few months ago, I'd been in the same position, sitting in Wendell's waiting room and wondering where he was. Killing time on my phone, I noticed that he was four minutes late, then eight. After ten minutes, the thought crossed my mind that maybe he'd been in an accident or fallen ill and was at this moment in the emergency room.

I debated whether to call and leave a message (to say what, I'm not sure. Hi, it's Lori. I'm sitting in your waiting room. Are you in there, on the other side of the door, writing chart notes? Eating a snack? Have you forgotten me? Or are you dying?). And just as I was thinking about how I'd need to find a new therapist, in no small part to process my old therapist's death, the door to Wendell's office opened. Out walked a middle-aged couple, the man saying "Thank you" to Wendell and the woman smiling tightly. A first session, I speculated. Or the disclosure of an affair. Those sessions tend to run over.

I breezed past Wendell and took my place perpendicular to him.

"It's fine," I said when he apologized for the delay. "Really," I continued, "my sessions go over sometimes too. It's fine."

Wendell looked at me, his right eyebrow raised. I raised my eyebrows back, trying to preserve my dignity. Me, get all worked up because my therapist was late? C'mon. I burst out laughing, and then some tears escaped. We both knew how relieved I was to see him and how important he had become to me. Those ten minutes of waiting and wondering were definitely not "fine."

And now—with a forced smile on her face, her leg jerking like she's having a seizure—Charlotte is reiterating how fine it was to wait for me.

I ask Charlotte what she thought had happened when I wasn't there.

"I wasn't worried," she says, even though I said nothing about worry. Then something catches my eye through the large wall-to-wall window.

Flying in dizzyingly fast circles a few feet behind the right side of Charlotte's head are a couple of very kinetic bumblebees. I've never seen bees out my window, several stories high, and these two look like they're hopped up on amphetamines. Maybe it's a bee mating dance, I think. But then a few more fly into view, and within seconds, I see a swarm of bees buzzing in circles, the only thing separating us from them being a huge sheet of glass. Some are starting to land on the window and crawl around.

"So, you're going to kill me," Charlotte begins, apparently unaware of the bees. "But, um, I'm going to take a break from therapy."

I look away from the bees and back to Charlotte. I'm not expecting this today, and it takes a moment for what she just said to register, especially because there's so much movement in my peripheral vision and I can't help but follow it. Now there are hundreds of bees, so many that my office has become darker, the bees pressed up against the windowpanes and blocking out the light like a cloud. Where are they coming from?

The room is so dark that Charlotte now notices. She turns her head in the direction of the window and we sit there, saying nothing, staring at the bees. I wonder if she'll be upset by the sight of them, but instead she seems mesmerized.

My colleague Mike used to see a family with a teenage girl at the same time I saw a couple. Every week about twenty minutes in, this couple and I would hear an eruption from Mike's office, the teenager screaming at her parents, storming out, slamming the door; the couple yelling after her to come back; her yelling "No!" and then Mike coaxing her back, calming everyone down. The first few times this happened, I thought it would be upsetting for the couple in my office, but it turned out it made them feel better. At least that's not us, they thought.

I'd hated the disturbance, though—it always broke my focus. And in the same way, I'm hating these bees. I think about my dad in the hospital, ten blocks away. Are these bees a sign, an omen?

"I once thought about becoming a beekeeper," Charlotte says, breaking the silence, and this is less surprising to me than her sudden wish to leave. She finds terrifying situations thrilling—bungee jumping, skydiving, swimming with sharks. As she tells me about her beekeeper fantasy, I think that the metaphor is almost too neat: this job that would require her to wear head-to-toe protective clothing so she wouldn't get stung and would allow her to master the very creatures that might hurt her, harvesting their sweetness in the end. I can see the appeal of having that kind of control over danger, especially if you grew up feeling like you had none.

I can also imagine the appeal of saying you're leaving therapy if you were inexplicably left in the waiting room. Has Charlotte been planning to leave, or is this an impulsive reaction to the primal fear she felt a few minutes ago? I wonder if she's drinking again. Sometimes people drop out of therapy because it makes them feel accountable when they don't want to be. If they've started drinking or cheating again—if they've done or failed to do something that now causes them shame—they may prefer to hide from their therapists (and themselves). What they forget is that therapy is one of the safest of all places to bring your shame. But faced with lying by omission or confronting their shame, they may duck out altogether. Which, of course, solves nothing.

"I decided before I came in today," Charlotte says. "I feel like I'm doing well. I'm still sober, work is going fine, I'm not fighting as much with my mom, and I'm not seeing the Dude—I even blocked him on my phone." She pauses. "Are you mad?"

Am I mad? I'm certainly surprised—I thought she'd moved past her fear of being addicted to me—and I'm frustrated, which I admit to myself is a euphemism for mad. But underneath the anger is the fact that I worry for her, perhaps more than I should. I worry that until she has had practice being in a healthy relationship, until she can find more peace with her dad than bouncing between pretending he doesn't exist and becoming devastated when he shows up and inevitably disappears again, she'll struggle and miss out on much of what she wants. I want her to work through this in her twenties rather than her thirties; I don't want her to squander her time. I don't want her to one day panic, Half my life is over. And yet I also don't want to discourage her independence. Just as parents raise their kids to leave them one day, therapists work to lose patients, not retain them.

Still, something feels rushed about this decision and perhaps comfortably dangerous for her, like jumping out of a plane with no parachute.

People imagine they come to therapy to uncover something from the past and talk it through, but so much of what therapists do is work in the present, where we bring awareness to what's going on in people's heads and hearts in the day-to-day. Are they easily injured? Do they often feel blamed? Do they avoid eye contact? Do they fixate on seemingly insignificant anxieties? We take these insights and encourage patients to practice making use of them in the real world. Wendell once put it this way: "What people do in therapy is like shooting baskets against a backboard. It's necessary. But what they need to do then is go and play in an actual game."

The one time Charlotte got close to having a real relationship, about a year into her therapy, she abruptly stopped seeing this guy but refused to tell me why. Nor would she tell me why she didn't want to talk about it. I was less interested in what had happened than in what made this—of all the things she'd told me about herself—the Thing That Cannot Be Discussed. I wonder, today, if she's leaving because of that thing.

I remember how she'd wanted to hold on to this Thing—to say no to my request. "It's hard for me to say no," she explained, "so I'm practicing in here." I told her that regardless of whether she talked about the breakup, I thought it was equally hard for her to say yes. The inability to say no is largely about approval-seeking—people imagine that if they say no, they won't be loved by others. The inability to say yes, however—to intimacy, a job opportunity, an alcohol program—is more about lack of trust in oneself. Will I mess this up? Will this turn out badly? Isn't it safer to stay where I am?

But there's a twist. Sometimes what seems like setting a boundary—saying no—is actually a cop-out, an inverted way of avoiding saying yes. The challenge for Charlotte is to get past her fear and say yes—not just to therapy, but to herself.

I glance at the bees pressed up against the glass and think of my father again and how once, when I was complaining about the way a relative would try to make me feel guilty, my father quipped, "Just because she sends you guilt doesn't mean you have to accept delivery." I think about this with Charlotte: I don't want her to feel guilty for leaving, to feel that she has let me down. All I can do is let her know that I am here for her either way, share my perspective and hear hers, and set her free to do as she wishes.

"You know," I tell Charlotte as I watch some of the bees begin to disperse, "I agree that things are better in your life, and that you've worked hard to make that happen. I also have the sense that you're still struggling with getting close to people and that the parts of your life that might be related to this—your dad, the conversation about the guy that you don't want to have—feel too painful to talk about. By not talking about them, part of you might believe that you can still hold out hope that things might be different—and you wouldn't be alone in that way of thinking. Some people hope that therapy will help them find a way to be heard by whoever they feel wronged them, at which point those lovers or relatives will see the light and become the people they'd wished for all along. But it rarely happens like that. At some point, being a fulfilled adult means taking responsibility for the course of your own life and accepting the fact that now you're in charge of your choices. You have to move to the front seat and be the mommy dog driving the car."

Charlotte has been looking at her lap while I speak, but she sneaks a glance at me during that last part. The room is brighter now, and I notice that most of the bees have left. Just a few stragglers remain, some still on the glass, others circling each other before flying away.

"If you stay in therapy," I say softly, "you might have to let go of the hope for a better childhood—but that's only so that you can create a better adulthood."

Charlotte looks down for a long time, then says, "I know."

We sit together in the silence.

Finally she says, "I slept with my neighbor." She's talking about a guy in her apartment building who had been flirting with her but also said that he wasn't looking for anything serious. She'd decided she was only going to date men who were looking for a girlfriend. She wanted to stop dating emotional versions of her dad. She wanted to stop being like her mom. She wanted to start saying no to those things and yes to becoming neither parent but instead the person she has yet to discover.

"I figured if I left therapy, I could just keep sleeping with him," she says.

"You can do whatever you want," I say, "whether you're in therapy or not." I watch her hear what she already knows. Yes, she has given up drinking and the Dude and has begun to give up the fight with her mom too, but the stages of change are such that you don't drop all of your defenses at the same time. Instead, you release them in layers, moving closer and closer to the tender core: your sadness, your shame.

She shakes her head. "I just don't want to wake up five years from now and never have had any kind of relationship," she says. "Five years from now, a lot of people my age won't be single anymore, and I'll be the girl who hooks up with a guy in the waiting room or her neighbor and then tells the story at a party like it's just another adventure. Like I don't even care."

"The cool girl," I say. "The one who has no needs or feelings and just goes with the flow. But you do have feelings."

"Yeah," she says. "Being the cool girl feels like shit." She's never admitted this before. She's taking off her beekeeper suit. "Is ‘like shit' a feeling?" she asks.

"It sure is," I say.

And so it begins, at last. Charlotte doesn't leave this time. Instead, she stays in therapy until she learns to drive her own car, navigating her way through the world more safely, looking both ways, making many wrong turns but finding her way back, always, to where she truly wants to go.

Chapter 47 Kenya

I'm getting a haircut and telling Cory my news about canceling my book contract with the publisher. I explain that now I might spend years repaying the publisher its money, and I might not be able to get another book contract after backing out of this one so late in the game, but I feel like an albatross has been removed from around my neck.

Cory nods. I see him check out his tattooed biceps in the mirror.

"You know what I did this morning?" he says.

"Hmm?" I say.

He combs out my front layers and checks that they're even. "I watched a documentary on Kenyans who can't get clean water," he says. "They're dying, and many of them are traumatized by war and sickness, and they're being thrown out of their homes and villages. They're wandering around just trying to find some water to drink that won't kill them. None of them go to therapy or owe their publishers money." He pauses. "Anyway, that's what I did this morning."

There's an awkward silence. Cory and I find each other's eyes in the mirror, and then, slowly, we begin to laugh.

We're both laughing at me, and I'm laughing too at the ways people rank their pain. I think about Julie. "At least I don't have cancer," she'd say, but that's also a phrase that healthy people use to minimize their own suffering. I remember how, initially, John's appointment was scheduled after Julie's and how I regularly made an effort to remember one of the most important lessons from my training: There's no hierarchy of pain. Suffering shouldn't be ranked, because pain is not a contest. Spouses often forget this, upping the ante on their suffering—I had the kids all day. My job is more demanding than yours. I'm lonelier than you are. Whose pain wins—or loses?

But pain is pain. I'd done this myself, too, apologizing to Wendell, embarrassed that I was making such a big deal about a breakup but not a divorce; apologizing for suffering from anxiety about the very real financial and professional consequences of an unmet book contract but that, nonetheless, were in no way as serious as the problems facing, well, the people in Kenya. I even apologized for talking about my health concerns—like when a patient noticed my tremor and I didn't know what to say—because, after all, how bad was my suffering if I didn't even have a diagnosis, much less a diagnosis that ranked high on the "acceptable problems to suffer from" scale? I had an unidentified condition. I didn't—knock on wood—have Parkinson's. I didn't—knock on wood—have cancer.

But Wendell told me that by diminishing my problems, I was judging myself and everyone else whose problems I had placed lower down on the hierarchy of pain. You can't get through your pain by diminishing it, he reminded me. You get through your pain by accepting it and figuring out what to do with it. You can't change what you're denying or minimizing. And, of course, often what seem like trivial worries are manifestations of deeper ones.

"You still doing Tinder therapy?" I ask Cory.

He rubs some product into my hair. "Hell, yeah," he says.

Chapter 48 Psychological Immune System

"Congratulations, you're not my mistress anymore," John says dryly as he walks in carrying a bag with our lunches.

I wonder if this is his way of saying goodbye. Has he decided to stop therapy right when we've just genuinely begun?

He walks to the couch and makes a show of silencing his cell phone before tossing it onto a chair. Then he opens the takeout bag and hands me my Chinese chicken salad. He reaches in again, pulls out some chopsticks, and holds them up: Want these? I nod: Thanks.

Once we're settled, he looks at me expectantly, tapping his foot.

"Well," he says, "don't you want to know why you're no longer my mistress?"

I look back at him: I'm not playing this game.

"Okay, fine." He sighs. "I'll tell you. You're not my mistress anymore because I came clean to Margo. She knows that I'm seeing you." He takes a bite of his salad, chews. "And you know what she did?" he continues.

I shake my head.

"She got mad! Why would you keep this a secret? How long has this been going on? What's her name? Who else knows? You'd think you and I were fucking or something, right?" John laughs to make sure I know how outlandish he considers that possibility.

"To her, it might feel like that," I say. "Margo feels left out of your life and now she's hearing that you've been sharing it with somebody else. She craves that closeness with you."

"Yeah," John says, and he seems lost in thought for a bit. He takes more bites of his salad, looks at the floor, then rubs his forehead as if whatever's going on in there is draining him. Finally he looks up.

"We talked about Gabe," he says quietly. And then he starts crying, a guttural wail, raw and wild, and I recognize it instantly. It's the sound I heard in the ER back in medical school from the parents of the drowned toddler. It's a love song to his beloved son.

I have a flash to another ER, on the night when my son was a year old and he had to be rushed by ambulance to the hospital after he spiked a fever of 104 and began seizing. By the time the paramedics arrived at my house, his body was limp, his eyes closed, and he was unresponsive to my voice. As I sit with John, I feel again in my body the terror of seeing my son lifeless, me on the gurney with him on my torso, the EMTs flanking us, the sirens a surreal soundtrack. I hear the sound of him howling for me as they strapped him into the x-ray contraption, forcing him to be still, his eyes open now, terrified, beseeching me to hold him as he squirmed violently to reach me. His screams, in their intensity, sounded much like John's wail now. Somewhere in the hospital's hallway, I remember seeing what looked like an unconscious child—or a dead one—being wheeled by. This could be us, I thought at that moment. This could be us by the morning. We could be leaving here like this too.

But it wasn't us. I got to go home with my beautiful boy.

"I'm sorry, I'm sorry, I'm so, so sorry," John is saying through his tears, and I don't know if he's apologizing to Gabe or Margo or his mother—or to me, for his outburst.

All of the above, he says. But mostly, he's sorry that he can't remember. He wanted to block out the unfathomable—the accident, the hospital, the moment he learned that Gabe had died—but he couldn't. What he'd give to forget hugging his son's dead body, Margo's brother pulling them both away, and John punching him, screaming, "I will not leave my son!" How he'd like to erase the scene of telling his daughter that her brother had died and of the family's arrival at the cemetery, Margo falling to the ground, unable to walk in—but those memories, unfortunately, remain vividly intact, the stuff of his waking nightmares.

What's fuzzier, he says, are the happy memories. Gabe in his twin bed in his Batman pajamas ("Snuggle me, Dada"). Rolling around in wrapping paper after opening his birthday presents. The way Gabe strode confidently into his preschool class like a big kid, only to turn around at the door and blow a furtive kiss. The sound of his voice. I love you to the moon and back. The smell of his head when John bent down to kiss him. The music of his giggle. His animated facial expressions. His favorite food or animal or color (Was it blue or "rainbow" before he died?). All of these memories feel, to John, as if they're fading into the distance—that he's losing the details of Gabe, much as he wants to hold on to them.

All parents forget these details about their kids as they grow, and they mourn that loss too. The difference is that as the past recedes in their memories, the present is right in front of them. For John, the loss of his memories brings him closer to the loss of Gabe. And so at night, John tells me, while Margo seethes, assuming that he's working or watching porn, he's hiding out with his laptop watching videos of Gabe, thinking about how these are the only videos he'll ever have of his son, just as the memories John has of Gabe are the only memories he'll ever have. There will be no more memories made. And while the memories might get blurry, the videos won't. John says that he's watched these videos hundreds of times and can no longer tell the difference between his actual memories and the videos. He watches obsessively, though, "to keep Gabe alive in my mind."

"Keeping him alive in your mind is your way of not abandoning him," I say.

John nods. He says that he pictures Gabe alive all the time—what he would look like, how tall he would be, what interests he'd have. He still sees the neighbor boys who were Gabe's friends as toddlers and imagines Gabe hanging out with them now in middle school, having crushes on girls, eventually shaving. He also imagines the possibility that Gabe would have gone through a phase of butting up against John, and when John hears other parents complain about their high-schoolers, he thinks about what a luxury it would be to have the chance to nag Gabe about his homework or find weed in his room or catch him doing any of the pain-in-the-ass things that teens tend to do. He'll never get to meet his son the way other parents meet their kids at different stages along the way, when they're the same people they've always been but both thrillingly and sadly different.

"What did you and Margo talk about?" I ask.

"When Margo was interrogating me about therapy," he says, "she wanted to know why. Why I was here. Was it about Gabe? Did I talk about Gabe? And I told her that I didn't come to therapy to talk about Gabe. I was just stressed out. But she wouldn't let it go. She was incredulous. ‘So you haven't talked about Gabe at all?' I told her that what I talked about was private. I mean, can't I talk about what I want in my own therapy? What is she, the therapy police?"

"Why do you suppose it's important to her that you talk about Gabe?"

He considers this. "I remember after Gabe died, Margo wanted me to talk about Gabe and I just couldn't. She didn't understand how I could go to barbecues and Lakers games and seem like a normal person, but that first year I was in shock. Numb. I told myself, Keep moving, don't stop. But the next year, when I woke up I'd want to die. I kept my game face on but I was bleeding internally, you know? I wanted to be strong for Margo and Gracie, and I had to keep a roof over our heads, so I couldn't let anyone see the bleeding.

"Then Margo wanted another baby, and I said, fuck it, okay. I mean, Jesus, I was in no shape to be a new father, but Margo was adamant that she didn't want Gracie to grow up alone. It wasn't just that we had lost a child. Gracie had lost her only sibling. And the house did seem different than it had when we had two kids running around. It didn't feel like a kid house anymore. The stillness was a reminder of what was missing."

John sits forward, puts the cover on his salad, tosses it across the room into the trash bin. Swish. It always goes right in. "Anyway," he says, "the pregnancy seemed to be good for Margo. It brought her back to life. But not me. I kept thinking that nobody could replace Gabe. Besides, what if I killed this one too?"

John told me that when he first heard that his mother had died, he was sure he had killed her. Before she'd left to go to rehearsal that night, he'd begged her to rush home so she'd be there in time to tuck him in. She must have died rushing home in her car, he thought. Of course, his father told him that she died while trying to push one of her students out of harm's way, but John was certain this was a cover story to protect his feelings. It wasn't until he saw the headline in the local paper—he had just learned to read—that he knew it was true, he hadn't killed his mother. But he also knew that she would have died for him in a heartbeat, just like he would have done for Gabe or Gracie and just as he would now for Ruby. But would he do it for Margo? He's not so sure. Would she do it for him? He's not sure either.

John pauses, then quips to break the tension. "Wow, this is getting heavy. I think I'll lie down." He stretches out on the couch, tries to fluff a pillow behind his head, and makes a disgruntled sound. ("What's this filled with, cardboard?" he once complained.)

"In a weird way," he continues, "I was worried I might love the new baby too much. Like I'd be betraying Gabe. I was so glad it wasn't another boy. I didn't think I could handle a baby boy without him reminding me of Gabe—what if he liked the same fire trucks that Gabe did? Everything would be an agonizing memory, and that would be unfair to the kid. I was so worried about this that I did research on when to have sex so you had the best chance of a girl—it was on the show."

I nod. It was in a subplot with a couple who were later written out, season three, I think. They were always having sex at the wrong time because one or the other of them couldn't control themselves and wait. I remember how funny it was. I had no sense of the pain that inspired it.

"The point," John says, "is that I didn't tell Margo. I just made sure to have sex only on the day that we'd have the best chance of a girl. Then I sweated it out until the ultrasound. When the OB said it looked like a girl, Margo and I both said, ‘Are you sure?' Margo wanted a boy because she loved raising a boy and we already had a girl, so she was disappointed that first night. ‘I'll never get to raise a boy again,' she said. But I was fucking ecstatic! I felt like I could be a better father to a girl, under the circumstances. And then, when Ruby was born, I thought I'd shit my pants. The second I saw her, I fell madly in love."

John's voice catches and he stops.

"What happened to your grief then?" I ask.

"Well, it got better at first—which, in a strange way, made me feel worse."

"Because the grief had connected you to Gabe?"

John looks surprised. "Not bad, Sherlock. Yeah. It was almost like my pain was evidence of my love for Gabe, and if it let up, it meant I was forgetting about him. That he didn't matter as much to me."

"That if you were happy, you couldn't also be sad."

"Exactly." He looks away. "I still feel that way."

"What if it's both?" I say. "What if your sadness—your grief—is what allowed you to love Ruby with so much joy when you first saw her?"

I remember a woman I treated whose husband had died. When she fell in love a year later—a love all the more sweet because of the loss of her husband—she worried that others would judge her. (So soon? Didn't you love your husband of thirty years?) In fact, her friends and family were excited for her. It wasn't their judgment she was hearing—it was her own. What if her happiness was an insult to her husband's memory? It took her a while to see that her happiness didn't diminish her love for her husband—it honored it.

John tells me he finds it ironic that Margo used to be the one who wanted to talk about Gabe and John couldn't; later, if John made a rare reference to Gabe, Margo would get upset. Would their family always be haunted by this tragedy? Would his marriage? "Maybe we remind each other of what happened—like our mere presence is some kind of sick memento," John says.

"What we need," he adds, looking up at me, "is some kind of closure."

Ah, closure. I know what John means, and yet I've always thought that "closure" was an illusion of sorts. Many people don't know that Elisabeth Kübler-Ross's familiar stages of grieving—denial, anger, bargaining, depression, acceptance—were conceived in the context of terminally ill patients learning to accept their own deaths. It wasn't until decades later that the model came to be used for the grieving process more generally. It's one thing to "accept" the end of your own life, as Julie is struggling to do. But for those who keep on living, the idea that they should be getting to acceptance might make them feel worse ("I should be past this by now"; "I don't know why I still cry at random times all these years later"). Besides, how can there be an endpoint to love and loss? Do we even want there to be? The price of loving so deeply is feeling so deeply—but it's also a gift, the gift of being alive. If we no longer feel, we should be grieving our own deaths.

The grief psychologist William Worden takes into account these questions by replacing stages with tasks of mourning. In his fourth task, the goal is to integrate the loss into your life and create an ongoing connection with the person who died while also finding a way to continue living.

But many people come to therapy seeking closure. Help me not to feel. What they eventually discover is that you can't mute one emotion without muting the others. You want to mute the pain? You'll also mute the joy.

"You're both so alone in your grief," I say. "And in your joy."

In our sessions, John had dropped occasional hints of his joy: his two girls; his dog, Rosie; writing a killer show; winning another Emmy; a boys' trip with his brothers. Sometimes, John says, he can't believe that he's capable of feeling joy. After Gabe died, he thought he'd never live through it. He'd go on, he figured, but like a ghost. And yet, just a week after Gabe's death, he and Gracie were playing together, and for a second—maybe two—he felt okay. He smiled and laughed with her, and the fact that he laughed amazed him. Just one week ago his son had died. Was that sound really coming from him?

I tell John about what's known as the psychological immune system. Just as your physiological immune system helps your body recover from physical attack, your brain helps you recover from psychological attack. A series of studies by the researcher Daniel Gilbert at Harvard found that in responding to challenging life events from the devastating (becoming handicapped, losing a loved one) to the difficult (a divorce, an illness), people do better than they anticipate. They believe that they'll never laugh again, but they do. They think they'll never love again, but they do. They go grocery shopping and see movies; they have sex and dance at weddings; they overeat on Thanksgiving and go on diets in the New Year—the day-to-day returns. John's reaction while playing with Grace wasn't unusual; it was the norm.

There's another related concept that I share with John: impermanence. Sometimes in their pain, people believe that the agony will last forever. But feelings are actually more like weather systems—they blow in and they blow out. Just because you feel sad this minute or this hour or this day doesn't mean you'll feel that way in ten minutes or this afternoon or next week. Everything you feel—anxiety, elation, anguish—blows in and out again. For John, on Gabe's birthday, on certain holidays, or simply running in the background, there will always be pain. Hearing a certain song in the car or having a fleeting memory might even plunge him into momentary despair. But another song, or another memory, might minutes or hours later bring intense joy.

Where, I wonder, is John's shared joy with Margo? I ask him what he imagines would have happened with Margo had the car crash not happened. What would their marriage be like today?

"Oh, for God's sake," he says, "now you think I can rewrite history?" He looks out the window, at the clock, at his sneakers, which he had slipped off when he lay down on the couch. Finally he looks at me.

"Actually, I think about that a lot lately," he says. "Sometimes I think about how we were a young family and my career was taking off and Margo was taking care of the kids and trying to run a business, and how we'd lost touch with each other, the way people do at that stage of life. I think about how things might have changed once both kids were in school and we were farther ahead in our careers. You know, life would normalize. But maybe it wouldn't have. I used to be so sure that she was the right person for me and I was the right person for her, but we make each other so unhappy, and I don't even remember when that started. Everything I do is wrong in her eyes. Maybe we would have been divorced by now. People say that marriages fall apart after a child's death, but maybe we stayed together because of what happened to Gabe." He laughs. "Maybe Gabe saved our marriage."

"Maybe," I say. "Or maybe you stayed together because you both want to rediscover the parts of yourselves that seemed to have died along with Gabe. Maybe you both believe you can find each other again—or for the first time."

I think about the family of the drowned toddler in the ER. What are they doing right now? Did they have another child? Their baby, the one whose diaper was being changed while their three-year-old ran outside and drowned, would now be in college. Maybe that couple is long divorced and living with their new spouses. Or maybe they're still together, stronger than ever, perhaps taking a hike on the scenic trails near their home on a peninsula south of San Francisco, reminiscing about the past, remembering their beloved daughter.

"It's funny," John says. "I guess we're finally both ready to talk about Gabe at the same time. And now that we are, I feel better. I mean, I also feel like shit, but it's okay, if you know what I mean. It's not as bad as I thought it would be."

"It's not as bad as it was not talking about Gabe," I suggest.

"Like I said, you're good, Sher—" We share a smile. He's stopped himself from calling me Sherlock, from using the caricature as a space keeper between us. Letting Gabe become more real in his life is allowing him to let others be more real too.

John sits up and starts fidgeting; our session is about to end. As he slips on his sneakers and stands to retrieve his phone, I think back to his earlier comment about telling Margo he came to therapy due to stress and how often he's told me the same thing.

"John," I say, "do you really think you came here because of stress?"

"What are you, an idiot?" he says, a twinkle in his eye. "I came here to talk about Margo and Gabe. Boy, are you dim sometimes."

When he leaves, there's no wad of cash at the door for his "hooker." "You can bill me," he says. "No more skulking around. We're legit now."

Chapter 49 Counseling Versus Therapy

"Are you asking for counseling or therapy?" Wendell says at today's session after I tell him that I have a professional question. He knows I'll understand the distinction because he's offered professional guidance twice before. Do I want advice (counseling) or self-understanding (therapy)?

The first time I asked Wendell such a question, I'd been talking about my frustration with people choosing the quick fix over the deeper work of psychotherapy. As a relatively new therapist, I was curious how someone more seasoned—specifically Wendell—dealt with this. It was one thing to hear what older colleagues had to say, but from time to time, I couldn't help but wonder how Wendell handled the frustrations of the profession.

I doubted he would answer my question directly—he would more likely express empathy for my predicament. In fact, I knew I was putting him in the classic Catch-22 position in which therapists often find themselves: I want empathy, but if you give it to me, I'll feel angry and hopeless, because empathy alone won't solve my very real problem, so what good are you anyway? I was thinking that he might even say something about this Catch-22 (because the best way to defuse an emotional land mine is to expose it).

Instead, he looked at me and asked, "Would you like a practical suggestion?"

I wasn't sure I'd heard him correctly. A practical suggestion? Are you kidding me? My therapist was going to give me a concrete piece of advice?

I moved closer.

"My father was a businessman," Wendell began quietly. At that time, I hadn't yet fessed up to my Google-binge, so I nodded, pretending this information was new. He told me that when he was starting out, his father suggested that he make an offer to prospective patients: They could try a session, and if they chose not to continue to work with Wendell after that, the session would be free. Since many people were nervous about starting therapy, this risk-free session would give them the opportunity to see what therapy was about and how Wendell might help them.

I tried to picture Wendell having this conversation with his father. I imagined the pleasure his father might have gotten from finally giving professional advice to his gentler son. His suggestion wasn't groundbreaking in the world of business, but therapists don't often think of what we do as a business. And yet we do run small businesses, and Wendell's father must have realized that his son, despite leaving the family's company, had actually become a businessman after all. Maybe he took great joy in having that connection with his son. And maybe it meant a lot to Wendell, which is why he was willing to pass this wisdom along to other therapists like me.

In any event, his father was smart. As soon as I implemented this offer, my practice filled up.

But his second piece of counseling—which I not only asked for, but pushed for—flopped. While I was grappling with my happiness-book dilemma, I kept agitating for Wendell to tell me what to do. I pushed so hard and so often that finally, Wendell (who, of course, had no knowledge of the publishing business) gave in near the end of one session. "Well, I don't know what else there is to say about this," he replied to my eighty-seventh query on that topic. "It sounds like you'll just have to find a way to write this so that you can write what you want next time." Then he patted his legs twice and stood, signaling our time was up.

Sometimes a therapist will deliberately "prescribe the problem" or symptom that the patient wants to resolve. A young man who keeps putting off finding a job might be told in therapy that he can't look for a job; a woman who won't initiate sex with her partner might be told not to initiate it for a month. This strategy, in which the therapist instructs patients not to do what they're already not doing, is called a paradoxical intervention. Given the ethical considerations involved, a therapist has to be well trained on how and when to use paradoxical directives, but the idea behind them is that if patients believe that a behavior or symptom is beyond their control, then making it voluntary, something they can choose whether or not to do, calls that belief into question. Once patients realize that they're choosing a behavior, they can examine the secondary gains—the unconscious benefits it offers (avoidance, rebellion, a cry for help).

But Wendell hadn't been doing that. He was just reacting to my endless complaints. If I came in upset because my agent once more insisted that nothing could be done and that I had to write this book or I'd never get another book contract, Wendell would question why I couldn't get a second opinion—or another agent—and I would explain that I couldn't approach other agents because I had nothing to offer them other than the mess I was currently in. Wendell and I had some version of this conversation often, and finally I convinced both of us that there was just one way out: to keep writing. So I trudged on, now blaming not just myself but also him for my predicament. Of course, I didn't realize I was blaming Wendell, but my resentment surfaced the week after I emailed my editor and told her I wouldn't be finishing the book. I'd been edgy all session, unable to share this milestone with him.

"Are you angry with me?" Wendell asked, picking up on my vibe, and suddenly it hit me: Yes! I was furious with him, I replied. And, I added, guess what—I had canceled my book contract, finances and consequences be damned! I was walking around those prison bars! Especially given my mysterious medical condition and its debilitating fatigue, I wanted to be sure that I was using the "good" time I had in a meaningful way. Julie had once said that she finally understood the meaning of the phrase "living on borrowed time": our lives are literally on loan to us. Despite what we think in our youth, none of us have all that much time. Like Julie, I told Wendell, I was starting to strip my life down to its essentials rather than sleepwalking my way through it, so who was he to tell me to hunker down and write this book? All therapists make mistakes, but when it happened with Wendell, I felt irrationally betrayed.

When I finished talking, he looked at me thoughtfully. He didn't get defensive, though he could have. He simply apologized. He'd failed, he said, to see something important that was going on between us. In trying to convince him how trapped I was, I left him feeling trapped as well, imprisoned by my perceived imprisonment. And in his frustration, like me in mine, he'd taken the easiest way out: Fine, you're screwed—write the damn book.

"The counseling I want today is about a patient," I say now.

I tell Wendell that I have a patient whose wife sees him, Wendell, and that every time I come here, I think about whether she's the woman I've seen leaving his office. I tell him that I know he can't say anything about a patient to me, but still I wonder if she's mentioned the name of her husband's therapist—me—to him. And how should we handle this coincidence? As a patient, I can say whatever I want about any aspect of my life, but I don't want to cloud his patient's therapy with my private knowledge of her husband.

"This is the counseling you want?" Wendell asks.

I nod. Given the earlier fiasco, I imagine he's being extra-careful in how he responds.

"What can I tell you that will be useful to you?" he asks.

I think about this. He can't answer my question about whether Margo has the appointment before mine or even say if he's aware that we're talking about Margo. He can't tell me if the fact that I see his patient's husband is new information or if he's known all along. He can't tell me what Margo may or may not have said about me. And I know if I were ever to say anything about John, Wendell would handle it professionally and we'd talk about it in the moment. Maybe I want his advice on whether I did the right thing by telling him about the situation.

"Do you ever wonder if I'm a good therapist?" I ask instead. "I mean, given all you've seen in here?" I remember my earlier "Do you like me?," but this time I'm asking something different. Then I was saying, Do you love me as a child, love my neshama? Now I'm saying, Can you picture me as an adult, as a competent grownup? Of course, Wendell has never seen me do therapy, has never supervised my work. How can he have any opinion at all on the matter? I start to say this but Wendell stops me.

"I know you are," he says.

At first I don't understand. He knows I'm a good therapist? Based on wha—oh! So Margo thinks things are getting better with John.

Wendell smiles. I smile. We both know what he can't tell me.

"I have one more question," I say. "Given the situation, how do we lessen the awkwardness?"

"Maybe you just did," he says.

And he's right. In couples therapy, therapists talk about the difference between privacy (spaces in people's psyches that everyone needs in healthy relationships) and secrecy (which stems from shame and tends to be corrosive). Carl Jung called secrets "psychic poison," and after all of the secrets I've kept from Wendell, it feels good to have this final secret out in the open.

I don't ask for counseling again because the truth is that Wendell has been counseling me from day one, in the sense that therapy is a profession you learn by doing—not just the work of being a therapist, but also the work of being a patient. It's a dual apprenticeship, which is why there's a saying that therapists can take their patients only as far as they've gone in their own inner lives. (There's much debate about this idea—like my colleagues, I've seen patients reach heights I can only aspire to. But still, it's no surprise that as I heal inside, I'm also becoming more adept at healing others.)

On a practical level, too, I've taken Wendell's lessons straight to my office.

"I'm reminded of a cartoon of a prisoner, shaking the bars . . ." I said to John early on, in a Hail Mary attempt to help him see that the "idiot" he was talking about that day wasn't his jailer after all.

When I got to the punch line—the bars are open on each side—John smiled for a second in what seemed like recognition but then batted it back at me. "Oh, give me a break," he said, rolling his eyes. "Do other patients actually fall for this?" But he was the outlier. The intervention has worked beautifully with everyone else.

Still, the most important skill I've learned from Wendell is how to remain strategic while also bringing my personality into the room. Would I kick a patient to make a point? Probably not. Would I sing? I'm not sure. But I might not have yelled "Fuck!" with Julie had I not seen Wendell be so utterly himself with me. In internships, therapists learn how to do therapy by the book, mastering the fundamentals the way you have to master scales when learning to play piano. For both, once you know the basics, you can skillfully improvise. Wendell's rule isn't as simple as "There are no rules." There are rules, and we're trained to adhere to them for a reason. But he has shown me that when rules are bent with thoughtful intention, it broadens the definition of what effective treatment can be.

Wendell and I don't talk about John or Margo again, but a few weeks later, as I settle into my chair in the waiting room, Wendell's door opens and I hear a male voice. "So this time next Wednesday?"

"Yes, see you then," replies Wendell, then his door clicks shut.

Past the screen, a guy in a suit slips out the door to the hall. Interesting, I think. Maybe the woman before me ended her therapy, or maybe she was Margo, and Wendell engineered the switch to protect my privacy in case Margo eventually figured it out. I don't ask, though, because it doesn't matter anymore.

Wendell was right: The awkwardness had disappeared. The secret was out, the psychic poison diluted.

I'd gotten all the counseling—or was it therapy?—I needed.

Chapter 50 Deathzilla

It's ten minutes before Julie's session, and I'm mainlining pretzels in our suite's kitchen. I don't know when our last session will be. If she's late, I think the worst. Should I check on her between sessions or let her call if she needs me (knowing she has trouble asking for help)? Should therapists' boundaries be different—looser—with terminally ill patients?

The first time I saw Julie at Trader Joe's, I'd been reluctant to get in her line, but every time after that, if I happened to be there when she was, Julie would wave me over and I'd happily go. If my son was with me, he'd get an extra sheet of stickers and a high five. And when Julie wasn't there anymore, he noticed.

"Where's Julie?" he asked, scanning the counters for her as we approached the checkout. It wasn't that I wouldn't talk about death with him—a close childhood friend of mine had died of cancer a few years before, and I had told Zach the truth about her illness. But because of confidentiality, I couldn't reveal more about Julie. One question would lead to another, to lines I couldn't cross.

"Maybe she changed days," I said, as if I knew her only as the clerk at Trader Joe's. "Or maybe she got another job."

"She wouldn't get another job," Zach said. "She loved her job!" I was struck by his response: even a young child could tell.

Without Julie there anymore, we've been going in Emma's line—the woman who offered to carry Julie's baby. Emma also gives him extra stickers.

But back at my office, waiting for Julie to arrive, I ask the same question Zach did: "Where's Julie?"

There's a word we use for the end of therapy: termination. I've always found it to be oddly harsh-sounding for what's ideally a warm, bittersweet, and moving experience, much like a graduation. Generally, when the therapy is coming to an end, the work moves toward its final stage, which is saying goodbye. In those sessions, the patient and I consolidate the changes made by talking about "process and progress." What was helpful in getting to where the person is today? What wasn't? What has she learned about herself—her strengths, her challenges, her internal scripts and narratives—and what coping strategies and healthier ways of being can she take with her when she leaves? Underlying all this, of course, is how do we say goodbye?

In our daily lives, many of us don't have the experience of meaningful goodbyes, and sometimes we don't get goodbyes at all. The termination process allows someone who has spent a great deal of time working through a significant life issue to do more than simply leave with some version of "Well, thanks again—see ya!" Research shows that people tend to remember experiences based on how they end, and termination is a powerful phase in therapy because it gives them the experience of a positive conclusion in what might have been a lifetime of negative, unresolved, or empty endings.

Julie and I have been preparing for another kind of termination, though. We both know that her therapy won't end until she dies; I made her that promise. And our process lately has consisted of more and more silence, not because we're avoiding saying something, but because this is how we're facing each other most honestly. Our silences are rich, our emotions swirling in the air. But the silences are also about her declining state. She has less energy, and talking can take a toll. Jarringly, Julie looks healthy, if thin, on the outside, which is why so many people have trouble believing that she's dying. Sometimes I do too. And in a way, our silences serve another purpose: They give us the illusion of stopping time. For fifty blissful minutes, we're both granted a respite from the outside world. She feels safe here, she told me, not having to worry about people worrying about her, having their own feelings.

"But I have feelings about you too," I said the day that Julie brought this up.

She thought about this for a second and then said simply, "I know."

"Would you like to know what they are?" I asked.

Julie smiled. "I know that too." And then we went back to silence.

Of course, between the silences, Julie and I have also been talking. Recently, she said she was thinking about time travel. She'd heard a radio show about it and shared a quote she loved, a description of the past as "a vast encyclopedia of calamities you can still fix." She'd memorized it, she said, because it made her laugh. And then it made her cry. Because she'll never live long enough to have this list of calamities that other people acquire by the time they reach old age—relationships they'd want to mend, career paths they'd want to take, mistakes that they'd go back and "get right" this time.

Instead, Julie has been time-traveling to the past to relive parts of her life that she's enjoyed: birthday parties as a child, vacations with her grandparents, her first crush, her first publication, her first conversation with Matt, one that lasted until dawn and still hasn't ended. But even if she were healthy, she said, she'd never want to travel to the future. She wouldn't want to know the plot of the movie, to hear the spoilers.

"The future is hope," Julie said. "But where's the hope if you already know what happens? What are you living for then? What are you striving for?"

I immediately thought of a difference between Julie and Rita, between young and old, but flip-flopped. Julie, who was young, had no future but was happy with her past. Rita, who was old, had a future but was plagued by her past.

It was that day that Julie fell asleep in session for the first time. She dozed off for a few minutes, and when she woke up and realized what had happened, she made a joke, out of embarrassment, about how I must have been time-traveling while she was sleeping, wishing I were someplace else.

I told her I wasn't. I was remembering hearing what must have been the same show she'd heard on the radio, and I was thinking about an observation made at the end of that segment—that we're all time-traveling into the future and at exactly the same rate: sixty minutes per hour.

"Then I guess we're fellow time travelers in here," Julie said.

"We are," I said. "Even when you're resting."

Another time Julie broke our silence to tell me that Matt thought she was being a Deathzilla—going crazy with the death-party planning, the way some brides become over-the-top Bridezillas with their weddings. She'd even hired a party planner to help carry out her funeral-party vision ("It's my day, after all!"), and despite his initial discomfort, Matt was now fully onboard.

"We planned a wedding together and now we're planning a funeral together," Julie said, and it has been, she told me, one of the most intimate experiences of their lives, full of deep love and deep pain and gallows humor. When I asked what she wanted that day to be like, first she said, "Well, I'd rather not be dead that day," but failing that, she didn't want it to be all "sugarcoated" and "cheery." She liked the idea of a "celebration of life," which the party planner told her was all the rage nowadays, but she didn't like the message that came with it.

"It's a funeral, for God's sake," she said. "All these people in my cancer group say, ‘I want people to celebrate! I don't want people to be sad at my funeral.' And I'm like, ‘Why the fuck not? You died!'"

"You want to have touched people and for them to be affected by your death," I said. "And for those people to remember you, to keep you in mind."

Julie told me that she wanted people to keep her in mind the way she keeps me in mind between sessions.

"I'll be driving, and I'll panic about something, but then I'll hear your voice," she explained. "I'll remember something you said."

I thought about how I did this with Wendell—how I'd internalized his lines of questioning, his way of reframing situations, his voice. This is such a universal experience that one litmus test of whether a patient is ready for termination is whether she carries around the therapist's voice in her head, applying it to situations and essentially eliminating the need for the therapy. "I started to get depressed," a patient might report near the end of treatment, "but then I thought of what you said last month." I've had entire conversations in my head with Wendell, and Julie has done the same with me.

"This might sound crazy," Julie said, "but I know that I'll hear your voice after I die—that I'll hear you wherever I am."

Julie had told me that she'd begun thinking about the afterlife, a concept she insisted that she didn't completely believe in but nonetheless contemplated, "just in case." Would she be alone? Afraid? Everyone she loved was still alive—her husband, her parents, her grandparents, her sister, her nephew and niece. Who would keep her company there? And then she realized two things: first, that her babies from her miscarriages might be there, wherever "there" was, and second, that she was coming to believe that she would hear, in some unknowable spiritual way, the voices of those she loved.

"I would never say this if I weren't dying," she said shyly, "but I include you in those I love. I know you're my therapist, so I hope you don't think it's creepy, but when I tell people that I love my therapist, I really mean I love my therapist."

Though I'd come to love many patients over the years, I'd never used those words with any of them. In training, we're taught to be careful with our words to avoid misinterpretations. There are many ways to convey to patients how deeply we've come to care about them without getting into dicey territory. Saying "I love you" isn't one of those ways. But Julie had said she loved me, and I wasn't going to stand on professional ceremony and reply with a watered-down response.

"I love you too, Julie," I said to her that day. She smiled, then closed her eyes and dozed off again.

Now, as I stand in the kitchen waiting for Julie, I think about that conversation and about the ways I know that I'll hear her voice too, long after she's gone, especially at certain times, like while shopping at Trader Joe's or folding laundry and seeing that pajama top with NAMAST'AY IN BED in the pile. I'm saving that top not to remember Boyfriend anymore, but to remember Julie.

I'm still munching on pretzels when my green light goes on. I pop one more into my mouth, rinse my hands, and breathe a sigh of relief.

Julie's early today. She's alive.