Chapter 22 Jail

"Hmm," Wendell says after I make my book confession well into our session. It's taken me a while to get up the courage to tell him.

For two weeks I've moved over to position B planning to confess all, but once we're face-to-face, catty-corner on the couches, I stall. I talk about my son's teacher (pregnant), my dad's health (poor), a dream (freaky), chocolate (a tangent, I'll admit), my emerging forehead wrinkles (not a tangent, surprisingly), and the meaning of life (mine). Wendell tries to focus me, but I'm skating so quickly from one thing to the next that I outmaneuver him. Or so I think.

Out of the blue, Wendell yawns. It's a fake yawn, a strategic one, a big, dramatic, gaping yawn. It's a yawn that says, Until you tell me what's really on your mind, you'll stay stuck exactly where you are. Then he sits back and studies me.

"I have something to tell you," I say.

He looks at me like No shit.

And out comes the entire story in one fell swoop.

"Hmm," he says again. "So you don't want to write this book."

I nod.

"And if you don't turn in the book, there will be serious financial and professional repercussions?"

"Right." I shrug as if to say, See how screwed I am? "If I'd just done the parenting book," I say, "I wouldn't be in this situation." It's the refrain I've been repeating to myself daily—sometimes hourly—for the past few years.

Wendell does his shrug-smile-wait routine.

"I know." I sigh. "I made a colossal, irrevocable mistake." I feel the panic well up again.

"That's not what I'm thinking," he says.

"Then, what?"

He starts singing. "‘Half my life is over, oh yeah. Half my life has passed me by.'"

I roll my eyes, but he keeps going. It's a bluesy tune and I'm trying to place it. Etta James? B. B. King?

"‘I wish I could go back, change the past. Have more years, to get it right . . .'"

And then I realize it's not a famous song. It's Wendell Bronson, impromptu lyricist. His lyrics are awful, but he surprises me with his strong, resonant voice.

The song goes on, and he's getting really into it. Tapping his feet. Snapping his fingers. If we were out in the world, I'd think he was a nerdy guy in a cardigan, but in here, it's his confidence and spontaneity that strike me, his willingness to be fully himself, entirely unconcerned that he'll come across as foolish or unprofessional. I can't imagine doing this in front of my patients.

"‘'Cause half my life is o-o-o-o-over.'" He arrives at the finale, complete with jazz hands.

Wendell stops singing and looks at me seriously. I want to tell him that he's being annoying, that he's trivializing what is realistically and practically an anxiety-provoking problem. But before I can say that, I feel a heavy sadness descend, seemingly out of nowhere. His tune is going through my head.

"It's like that Mary Oliver poem," I say to Wendell. "‘What is it you plan to do with your one wild and precious life?' I thought I knew what I planned to do, but now everything has changed. I was going to be with Boyfriend. I was going to write what mattered to me. I never expected—"

"—to be in this situation." Wendell gives me a look. Here we go again. We're like an old married couple by now, finishing each other's sentences.

But then Wendell is silent, and it doesn't seem like the intentional kind of silence I'm used to. It occurs to me that maybe Wendell is stumped, the way I sometimes get stumped in sessions when my patients are stuck and I get stuck too. He's tried yawning and singing and redirecting me and asking important questions. But still, I'm back to where I usually go—the saga of my losses.

"I was just thinking about what you want in here," he says. "How do you think I can help you?"

I'm thrown by his question. I don't know if he's enlisting my help as a fellow therapist or asking me as his patient. Either way, I'm not sure; what do I want from therapy?

"I don't know," I say, but as soon as I say it, I'm scared. Maybe Wendell can't help me. Maybe nothing can. Maybe I just have to learn to live with my choices.

"I think I can help," he says, "but maybe not in the way you imagine. I can't bring your boyfriend back, and I can't give you a redo. And now you're in this book situation and you want me to save you from that too. And I can't do that either."

I let out a snort at how preposterous this is. "I don't want you to save me," I say. "I'm a head of household, not a damsel in distress."

He locks his eyes on mine. I look away.

"Nobody is going to save you," he says quietly.

"But I don't want to be saved!" I insist, though this time part of me wonders, Wait, do I? On some level, don't we all? I think about how people come to therapy expecting to feel better, but what does better really mean?

There's a magnet that somebody stuck on the refrigerator in our office's kitchen: PEACE. IT DOES NOT MEAN TO BE IN A PLACE WHERE THERE IS NO NOISE, TROUBLE, OR HARD WORK. IT MEANS TO BE IN THE MIDST OF THOSE THINGS AND STILL BE CALM IN YOUR HEART. We can help patients find peace, but maybe a different kind than they imagined they'd find when they started treatment. As the late psychotherapist John Weakland famously said, "Before successful therapy, it's the same damn thing over and over. After successful therapy, it's one damn thing after another."

I know that therapy won't make all my problems disappear, prevent new ones from developing, or ensure that I'll always act from a place of enlightenment. Therapists don't perform personality transplants; they just help to take the sharp edges off. A patient may become less reactive or critical, more open and able to let people in. In other words, therapy is about understanding the self that you are. But part of getting to know yourself is to unknow yourself—to let go of the limiting stories you've told yourself about who you are so that you aren't trapped by them, so you can live your life and not the story you've been telling yourself about your life.

But how to help people do this is another matter.

I go through the problem again in my mind. Must write book to have roof over head. Turned down opportunity to write book that would have put roof over head for years to come. Can't seem to write stupid book about stupid topic that's making me miserable. Will force myself to write stupid miserable happiness book. Have tried to force myself to write stupid miserable happiness book but end up on Facebook, feeling envious of all the people who manage to have their shit together.

I remember a quote from Einstein: "No problem can be solved from the same level of consciousness that created it." I've always felt that made sense, but, like most of us, I also believe that I should be able to think my way out of my problem by going over and over how I thought myself into it.

"I just see no way out of this," I say. "And I don't just mean the book. I mean the whole this—everything that's happened."

Wendell leans back, uncrosses and recrosses his legs, then closes his eyes, something he does when he seems to be gathering his thoughts.

When he opens his eyes again, we sit there for a while, saying nothing, two therapists comfortable together in a long silence. I lean back and luxuriate in it, and I think about how I wish everyone could do this more in daily life, simply be together with no phones, laptops, TVs, or idle chitchat. Just presence. Sitting like this makes me feel relaxed and energized at the same time.

Finally, Wendell speaks up.

"I'm reminded," he begins, "of a famous cartoon. It's of a prisoner, shaking the bars, desperately trying to get out—but to his right and left, it's open, no bars."

He pauses, allowing the image to sink in.

"All the prisoner has to do is walk around. But still, he frantically shakes the bars. That's most of us. We feel completely stuck, trapped in our emotional cells, but there's a way out—as long as we're willing to see it."

He lets that last part linger between us. As long as we're willing to see it. He gestures to an imaginary prison cell with his hand, inviting me to see it.

I look away, but I feel Wendell's eyes on me.

I sigh. Okay.

I close my eyes and take a breath. I start by picturing the prison, a tiny cell with drab beige walls. I picture the metal bars, thick and gray and rusty. I picture myself in an orange jumpsuit, furiously shaking those bars, pleading for release. I picture my life in this tiny cell with nothing but the pungent smell of urine and the prospect of a dismal, constrained future. I imagine screaming, "Get me out of here! Save me!" I envision myself frantically looking to my right, then to my left, then doing one hell of a double take. I notice my whole body respond; I feel lighter, like a thousand-pound weight has been lifted, as the realization hits me: You are your own jailer.

I open my eyes and glance at Wendell. He raises his right eyebrow as if to say, I know—you see. I saw you see.

"Keep looking," he whispers.

I close my eyes again. Now I'm walking around the bars and heading toward the exit, moving tentatively at first, but as I get closer to it, I start to run. Outside, I can feel my feet on the ground, the breeze on my skin, the sun's warmth on my face. I'm free! I run as fast as I can, then after a while I slow down and check behind me. No prison guards are giving chase. It occurs to me that there were no prison guards to begin with. Of course!

Most of us come to therapy feeling trapped—imprisoned by our thoughts, behaviors, marriages, jobs, fears, or past. Sometimes we imprison ourselves with a narrative of self-punishment. If we have a choice between believing one of two things, both of which we have evidence for—I'm unlovable, I'm lovable—often we choose the one that makes us feel bad. Why do we keep our radios tuned to the same static-ridden stations (the everyone's-life-is-better-than-mine station, the I-can't-trust-people station, the nothing-works-out-for-me station) instead of moving the dial up or down? Change the station. Walk around the bars. Who's stopping us but ourselves?

There is a way out—as long as we're willing to see it. A cartoon, of all things, has taught me the secret of life.

I open my eyes and smile, and Wendell smiles back. It's a conspiratorial smile, one that says, Don't be fooled. It may seem as though you've had an earth-shattering breakthrough, but this is just the beginning. I know full well what challenges lie ahead, and Wendell knows that I know, because we both know something else: freedom involves responsibility, and there's a part of most of us that finds responsibility frightening.

Might it feel safer to stay in jail? I picture the bars and the open sides again. A part of me lobbies to stay, another to go. I choose to go. But walking around the bars in my mind is different from walking around them in real life.

"Insight is the booby prize of therapy" is my favorite maxim of the trade, meaning that you can have all the insight in the world, but if you don't change when you're out in the world, the insight—and the therapy—is worthless. Insight allows you to ask yourself, Is this something that's being done to me or am I doing it to myself? The answer gives you choices, but it's up to you to make them.

"Are you ready to start talking about the fight you're in?" Wendell asks.

"You mean the fight with Boyfriend?" I begin. "Or with myself—"

"No, your fight with death," Wendell says.

For a second I'm confused, but then I flash to my dream about running into Boyfriend at the mall. Him: Did you ever write your book? Me: What book? Him: The book about your death.

Oh. My. God.

Typically therapists are several steps ahead of our patients—not because we're smarter or wiser but because we have the vantage point of being outside their lives. I'll say to a patient who has bought the ring but can't seem to find the right time to propose to his girlfriend, "I don't think you're sure you want to marry her," and he'll say, "What? Of course I am! I'm doing it this weekend!" And then he goes home and doesn't propose, because the weather was bad and he wanted to do it at the beach. We'll have the same dialogue for weeks, until one day he'll come back and say, "Maybe I don't want to marry her." Many people who say, "No, that's not me," find themselves a week or a month or a year later saying, "Yeah, actually, that's me."

I have a feeling that Wendell has been storing up this question, waiting for just the right moment to float it out there. Therapists are always weighing the balance between forming a trusting alliance and getting to the real work so the patient doesn't have to continue suffering. From the outset, we move both slowly and quickly, slowing the content down, speeding up the relationship, planting seeds strategically along the way. As in nature, if you plant the seeds too early, they won't sprout. If you plant too late, they might make progress, but you've missed the most fertile ground. If you plant at just the right time, though, they'll soak up the nutrients and grow. Our work is an intricate dance between support and confrontation.

Wendell asks about my fight with death at exactly the right moment—but for more reasons than he could possibly know.

Chapter 23 Trader Joe's

It's a busy Saturday morning at Trader Joe's, and I'm scanning the lines to see which is shortest while my son darts off to look at the display of chocolate bars. Despite the chaos, the cashiers seem unfazed. A young guy whose arms are covered in tattoos rings a bell, and a bagger in leggings dances over and packs up a customer's groceries, jiving to the canned music. In the next aisle a hipster with a Mohawk calls for a price check, and at the end of the row, a pretty blond cashier juggles some oranges to amuse a toddler having a meltdown in her stroller.

It takes me a minute before I realize that the juggling cashier is my patient Julie. I haven't seen her new blond wig yet, though she had mentioned it in therapy.

"Too crazy?" she'd asked about the idea of being a blonde, holding me to my promise to tell her if she was going overboard. She'd asked the same thing about answering an ad for a singer in a local band, going on a game show, and signing up for a Buddhist retreat that required a full week of no talking. This was all before the miracle drug had worked its miracle on her tumors.

I'd enjoyed watching her stretch from the risk-averse stance she'd embraced all her life. She had always thought that achieving tenure would give her freedom, but now she was tasting a completely unexpected kind of freedom.

"Is this too off-the-wall?" she'd sometimes say before presenting a new idea to me. She was eager to veer from her mapped-out course, but not so far that she'd get lost. Yet nothing she proposed surprised me.

Then, finally, Julie had an idea that caught me off guard. She told me that at one point during those weeks when she believed she was about to die, she was waiting in line at Trader Joe's and found herself mesmerized by the cashiers. They seemed so themselves in the ways they interacted with their customers and one another, making conversation about the small daily things that are really the big things in people's lives—food, traffic, the weather. How different she imagined this job from her own, which she loved but which also came with a constant pressure to produce and publish, to position herself for advancement. With a shortened future, she imagined doing work where she could see tangible results in the moment—you pack groceries, you cheer up customers, you stock items. At the end of the day, you've done something concrete and useful.

Julie decided that if she had only, say, a year to live, she'd apply to be a weekend cashier at Trader Joe's. She knew she was idealizing the job. But she still wanted to experience that sense of purpose and community, of being a small part of lots of different people's lives—even if just for the time it took to ring up their groceries.

"Maybe Trader Joe's can be part of my Holland," she mused.

I could feel myself push against the idea, and I sat for a minute, trying to understand why. It might have had something to do with a dilemma I'd been facing in treating Julie. If Julie hadn't had cancer, I'd try to help her look at the part of her that had felt inhibited for so long. She seemed to be opening the lid on aspects of herself that hadn't had space to breathe.

But with someone who's dying, did it make sense to do therapy or simply offer support? Should I treat Julie like a healthy patient in terms of more ambitious goals, or should I just offer comfort and not upset the apple cart? I wondered if Julie would ever have asked herself the questions about risk and safety and identity that had been hiding beneath her awareness had she not faced the terror of imminent death. And now that she had, how far should we delve into them?

These are questions we all deal with in a quieter way: How much do we want to know? How much is too much? And how much is too much when you're dying?

The Trader Joe's fantasy seemed to represent an escape of some sort—like a child saying, "I'm running away to Disneyland!"—and I wondered how this fantasy related to Julie's pre-cancer self. But mostly, I wondered if she could handle the job physically. The experimental treatment had added to her fatigue. She needed rest.

Her husband, she told me, thought she was insane.

"You have a limited time to live, and your dream is to work at Trader Joe's?" he'd asked.

"Why, what would you do if you only had a year or so to live?" Julie countered.

"I'd work less," he said, "not more."

As Julie told me about Matt's reaction, it occurred to me that he and I both seemed unsupportive, even though we wanted Julie to experience joy. Sure, there were some practical concerns, but could our hesitation also be that we were both, in a strange way, envious of Julie and her conviction to follow her dream, no matter how odd it sounded? Therapists tell their patients: Follow your envy—it shows you what you want. Did watching Julie's blossoming highlight the fact that we were too afraid to act on our own equivalents of working at Trader Joe's—and that we wanted Julie to remain like us, dreaming without doing, constrained by nothing more than the open bars on our prison cells?

Or maybe that was just me.

"Besides," Matt had said in his conversation with Julie, "don't you want to spend that time together?"

Julie said that of course she did. But she also wanted to work at Trader Joe's, and it became a kind of obsession. So she applied for a job there, and on the day that she learned she was tumor-free, she was offered a Saturday-morning shift.

In my office, Julie got out her cell phone and played both phone messages for me: one from her oncologist, one from a manager at Trader Joe's. She was grinning as if she'd won not just any lottery, but the Powerball of all Powerballs.

"I told them yes," she said after the Trader Joe's message ended. She explained that nobody knew if the tumors would come back, and she didn't want to just add things to her bucket list; she wanted to cross things off too.

"You have to pare it down," she said, "or else it's just a useless exercise in what could have been."

So here I am, standing in the market, and I'm not sure which checkout line to choose. I knew, of course, that Julie had started working at Trader Joe's, but I had no idea it was this Trader Joe's.

She hasn't seen me yet, and I can't help but watch her from afar. She rings the bell for a bagger, gets a child some stickers, laughs with a customer over something I can't hear. She's like the Queen of Cashiers, the party everyone wants to be at. People seem to know her and, not surprisingly, she's incredibly efficient, moving the line along quickly. I feel my eyes get wet and the next thing I know my son calls out, "Mom, over here!" and I see that he has negotiated his way into Julie's line.

I hesitate. After all, Julie might feel awkward ringing up her therapist. And, truth be told, I might feel awkward too. She knows so little about me that even displaying the contents of my shopping cart feels somehow too revealing. But mostly, I'm thinking about how Julie talks about the sadness she experiences whenever she sees her friends' kids while she and her husband are trying to find a way to become parents themselves. What will it be like for her to see me with my son?

"Over here!" I reply, gesturing for Zach to move to a different line.

"But this one's shorter!" he yells back, and of course it is, because Julie's so goddamned efficient, and that's when Julie looks over at my son and then follows his gaze to me.

Busted.

I smile. She smiles. I start to head to the other line, but Julie says, "Hey, lady, listen to the boy. This line's shorter!" I join Zach in Julie's line.

I try not to stare as we wait our turn, but I can't help it. I'm watching the real-life version of the vision she described in her therapy session—her dream literally come true. When Zach and I get to the register, Julie banters with us as she does with her other customers.

"Joe's O's," she says to my son. "A good breakfast."

"They're for my mom," he answers. "No offense, but I like Cheerios better."

Julie looks around to make sure nobody's in earshot, gives him a sly wink, and whispers, "Don't tell anyone, but me too."

They spend the rest of the time discussing the merits of the various chocolate bars my son selected. When we're all bagged up and rolling our cart away, Zach examines the stickers from Julie.

"I like that lady," he says.

"I do too," I say.

It isn't until half an hour later, as I'm unpacking the bags in my kitchen, that I see something scrawled on my credit card receipt.

I'm pregnant! it says.

Chapter 24 Hello, Family

Chart note, Rita:

Patient is a divorced woman who presents with depression. Expresses regret over what she believes to be "bad choices" and a life poorly lived. Reports that if her life doesn't improve in one year, she plans to "end it."

"I have something to show you," Rita says.

In the hallway between the waiting room and my office, she hands me her cell phone. Rita has never handed me her phone before, much less begun speaking to me before we're settled in my office with the door closed, so I'm surprised by the gesture. She indicates that I should take a look.

On her screen is a profile from the dating app called Bumble. Rita recently started using Bumble because, unlike more hookup-oriented apps like Tinder ("Revolting!" she said), Bumble allows only women to contact men. Coincidentally, my friend Jen had just seen an article about it and forwarded it to me with the message For whenever you're ready to date again. I'd texted back, Whenever isn't here yet.

I glance from the phone to Rita.

"Well?" she says expectantly as we enter my office.

"Well what?" I ask, handing her back the phone. I'm not sure what she's getting at.

"Well what?" she replies incredulously. "He's eighty-two! I'm no spring chicken, but please! I know what eighty looks like naked, and that gave me nightmares for a week. I'm sorry, but seventy-five is as far as I'll go. And don't try to talk me out of it!"

Rita, I should mention, is sixty-nine.

A few weeks ago, after months of encouragement, Rita had decided to try a dating app. After all, in her daily life, she wasn't encountering any single older men, much less those who met her requirements: intelligent, kind, financially stable ("I don't want anyone looking for a nurse and a purse"), and physically fit ("Somebody who can still get an erection in a timely manner"). Hair was optional, but teeth, she insisted, were not.

Before the eighty-year-old, there had been a same-age gentleman who was not so gentle. They had gone out to dinner, and the night before what was supposed to be their second date, Rita had texted him the recipe and photo of a dish he said he wanted to try. Mmmm, he texted back. Sounds delicious. Rita was about to respond, but then another Mmmm popped up, followed by You're killing me here . . . , followed by If you don't stop, I won't be able to stand up, followed a minute later by Sorry, I was texting my daughter about my bad back.

"Bad back, my eye, the pervert!" Rita exclaimed. "He was doing who knows what with who knows who, and he certainly wasn't talking about my salmon dish!" There was no second date, and no dates at all until she met the eighty-year-old.

Rita had come to me at the beginning of spring. At our very first session, she was so depressed that when she gave me an account of her situation, it seemed as if she were reading an obituary. The final line had been written, and her life, she believed, was a tragedy. Thrice-divorced and the mother of four troubled adults (due to her own bad mothering, she explained), grandchildless and living alone, retired from a job she disliked, Rita saw no reason to get up in the morning.

Her list of mistakes was long: choosing the wrong husbands, failing to put her children's needs above her own (including not protecting them from their alcoholic father), not using her skills in a professionally fulfilling way, not making an effort when she was younger to form a community. She had numbed herself with denial for as long as that worked. Recently, it had lost its efficacy. Even painting—the one activity she enjoyed and excelled at—barely held her interest.

Now her seventieth birthday was coming up and she had struck a deal with herself to make her life better by then or stop living it.

"I think I'm beyond help," she concluded. "But I want to give it one last try, just to be certain."

No pressure, I thought. While suicidal thoughts—known as suicidal ideation—are commonplace with depression, most people respond to treatment and never act on those hopeless impulses. In fact, it's as patients begin to get better that the risk for suicide increases. During this short window, they're no longer so depressed that eating or dressing seem like monumental efforts but they're still in enough pain to want to end it all—a dangerous mix of residual distress and newfound energy. But once the depression lifts and suicidal thoughts subside, a new window opens. That's when the person can make changes that improve life significantly over the long term.

Whenever suicide comes up—either because the patient or the therapist broaches the topic (bringing it up does not, as some worry, "plant" the idea in a person's head), the therapist has to assess the situation. Does the patient have a concrete plan? Is there a means to carry out the plan (a gun in the house, a spouse out of town)? Have there been previous attempts? Are there particular risk factors (lack of social support or being male; men commit suicide three times more often than women)? Often people talk about suicide not because they want to be dead but because they want to end their pain. If they can just find a way to do that, they very much want to be alive. We make the best assessment we can, and as long as there's no imminent danger, we monitor the situation closely and work with the depression. If the person is set on suicide, though, there are a series of steps to take right away.

Rita was telling me that she would kill herself, but she was very clear that she would wait out the year and not do anything before her seventieth birthday. She wanted change, not death—as it was, she was already dead inside. For now, suicide wasn't my concern.

What was concerning to me, though, was Rita's age.

I'm ashamed to admit this, but at first I worried that I might secretly agree with Rita's grim perspective. Maybe she really was beyond help—or at least beyond the kind of help she wanted. A therapist is supposed to be a container for the hope that a depressed person can't yet hold, and I wasn't seeing much hope here. Typically I see possibility because the people who are depressed have something to keep them going—it might be a job that gets them out of bed (even if they don't love that particular job), a network of friends (just one or two people they can talk to), or contact with some family members (problematic but present). Having children in the house or a beloved pet or religious faith can also protect against suicide.

But most notably, the depressed people I saw were younger. More malleable. Their lives might seem bleak now, but they had time to turn things around and create something new.

Rita, however, seemed like a cautionary tale: a senior citizen, utterly alone, lacking in purpose and full of regret. By her account, she had never truly been loved by anybody. The only child of older and distant parents, she had messed up her own children so badly that none of them spoke to her, and she had no friends or relatives or social life. Her father had been dead for decades, and her mother had died at ninety after suffering for years with Alzheimer's.

She looked me in the eye and presented me with a challenge. Realistically, she asked, what could change at this late date?

About a year earlier, I'd gotten a call from a well-respected psychiatrist in his late seventies. He asked if I would see his patient, a woman in her thirties who was considering freezing her eggs while she continued to look for a partner. He thought that this woman might benefit from consultation with me because, he said, he didn't know enough about the dating and baby-making landscape for today's thirty-somethings. Now I knew how he felt. I wasn't sure that I fully understood the aging landscape for today's senior citizens.

I'd learned in my training about the unique challenges faced by older adults, and yet this age group gets short shrift when it comes to mental-health services. For some, therapy is a foreign concept, like TiVo, and besides, their generation grew up largely believing that they could "get through it" (whatever "it" was) on their own. Others, living on retirement savings and seeking help at low-cost clinics, don't feel comfortable seeing the twenty-something therapy interns who predominantly staff them. Before long, these patients drop out. Still other older people assume that what they're feeling is a normal part of aging and don't realize that treatment might help. The result is that many therapists see relatively few seniors in their practices.

At the same time, old age is a proportionately larger percentage of the average person's life than it used to be. Unlike the sixty-year-olds of a few generations ago, the sixty-year-olds of today are often at the top of their games in terms of skill, knowledge, and experience, but they're still pushed out professionally for younger employees. The average life expectancy in the United States now hovers around eighty, and it's becoming common to live into one's nineties, so what happens to these sixty-year-olds' identities during the decades they still have left? With aging comes the potential to accrue many losses: health, family, friends, work, and purpose.

But Rita, I realized, wasn't experiencing loss primarily as a result of aging. Instead, as she aged, she was becoming aware of the losses she had been living with her entire life. Here she was, wanting a second chance, a chance she was giving herself only a year to realize. As she saw it, she had lost so much that she had nothing left to lose.

That part I agreed with too—mostly. She could still lose her health and beauty. Tall and slim, with large green eyes and high cheekbones, her thick naturally red hair flecked with just a few strands of gray, Rita was genetically blessed with the complexion of a forty-year-old. (Terrified of living as long as her mother had and running out of retirement funds, she refused to pay for what she called "modern beauty expenses," her euphemism for Botox.) She also attended an exercise class at the Y every morning, "just to have a reason to get out of bed." Her physician, who had sent her to me, said that she was "one of the healthiest people her age I've seen."

But in every other way, Rita seemed dead, lifeless. Even her movements were listless, like the way she sauntered to the sofa in slow motion, a sign of depression known as psychomotor retardation. (This slowing down of coordinated efforts between the brain and the body might also explain why I kept missing the tissue box in Wendell's office.)

Often at the beginning of therapy, I'll ask patients to recount the past twenty-four hours in as much detail as possible. In this way I get a good sense of the current situation—their level of connectedness and sense of belonging, how their lives are peopled, what their responsibilities and stressors are, how peaceful or volatile their relationships might be, and how they choose to spend their time. It turns out that most of us aren't aware of how we actually spend our time or what we really do all day until we break it down hour by hour and say it out loud.

Here's how Rita's days went: Get up early ("Menopause ruined my sleep"), drive to the Y. Come home, eat breakfast while watching Good Morning America. Paint or nap. Eat lunch while reading the paper. Paint or nap. Heat up frozen dinner ("It's too much trouble cooking for one"), sit on her building's stoop ("I like to look at the babies and puppies that people walk at dusk"), watch "junk" on TV, fall asleep.

Rita seemed to have almost no contact with other human beings. Many days, she talked to nobody. But what struck me most about her life wasn't just how solitary it was, but how nearly everything she said or did conjured for me an image of death. As Andrew Solomon wrote in The Noonday Demon: "The opposite of depression isn't happiness, but vitality."

Vitality. Yes, Rita had had lifelong depression and a complicated history, but I wasn't sure that her past should be our initial focus. Even if she hadn't given herself a one-year deadline, there was another deadline that neither of us could change: mortality. As with Julie, I wondered what the goal should be in treating her. Did she just need somebody to talk to, to ease the pain and loneliness, or was she willing to understand her role in creating it? It was also the question I was struggling with in Wendell's office: What should be accepted and what should be changed in my own life? But I was more than two decades younger than Rita. Was it too late for her to redeem herself—is it ever too late for that? And what degree of emotional discomfort would she be willing to endure to find out? I thought about how regret can go one of two ways: it can either shackle you to the past or serve as an engine for change.

Rita said that she wanted her life to improve by her seventieth birthday. Instead of dredging up the past seven decades, I thought, maybe we should start with trying to inject her life with a little vitality—now.

"Companionship?" Rita says today after I tell her that I won't try to talk her out of finding companionship with men under seventy-five. "Oh, honey, please don't be so naive—I want more than companionship. I'm not dead yet. Even I know how to order something on the internet from the privacy of my apartment."

It takes me a minute to connect the dots: She buys vibrators? Good for her!

"Do you know," Rita adds, "how long it's been since I've been touched?"

Rita goes on to describe how disheartening she finds the dating scene—and in this regard, at least, she's not alone. It's the most common refrain I hear from single women of all ages: Dating sucks.

Marriage, though, hasn't been much better for her. She'd met the man who would be husband number one when she was twenty years old, eager to escape her dreary home. She commuted to college each day and went from "dying of boredom and silence" to "a world of interesting ideas and people." But she also had to hold down a job, and while she sat in a real estate agent's office typing up mind-numbing correspondence after class, she missed out on the social life she craved.

Enter Richard, a charming, sophisticated upperclassman in her English seminar with whom she had deep conversations and who swept her off her feet and into the life she wanted—until their first child was born a couple of years later. That's when Richard started working longer hours and drinking; soon, Rita was just as bored and lonely as she had been in her childhood home. After four kids, countless fights, and too many drunken episodes during which Richard struck both her and their children, Rita wanted out.

But how? What could she do? She had dropped out of college; how would she support herself and the kids? With Richard, the kids had clothes and food and good schools and friends. What could she, by herself, offer them? In many ways, Rita felt like a child herself, helpless. Soon Richard wasn't the only one who drank.

It wasn't until a particularly terrifying incident that Rita screwed up the courage to leave, but by then her children were well into their teens and the family was a shambles.

She married husband number two five years later. Edward was Richard's opposite: a kind and caring widower who'd recently lost his wife. After her divorce at age thirty-nine, Rita had returned to tedious secretarial work (her only marketable skill, despite her keen intelligence and artistic talent). Edward was a client of the insurance agent Rita worked for. They married six months after they met, but Edward was still grieving his wife's death, and Rita felt envious of his love for her. They argued constantly. The marriage lasted two years and then Edward called it quits. Husband number three left his wife for Rita, and five years later, he left Rita for someone else.

Each time, Rita was shocked to find herself alone, but her history didn't surprise me. We marry our unfinished business.

For the next decade, Rita steered clear of dating. Not that she met men anyway, holed up in her apartment or aerobicizing at the Y. Then came the recent reality of an eighty-year-old's body—so withered and saggy compared to the body of her last husband, who had been only fifty-five at the time of their divorce. Rita had met Mr. Saggy, as she called him, through the dating app, and "because I wanted to be touched," she said, "I thought I could give it a try." He had looked young for his age, she explained ("more like seventy") and handsome—in clothing, that is.

After they had sex, she told me, he had wanted to cuddle but she'd escaped to the bathroom, where she discovered "an entire pharmacy of medications," including Viagra. Finding the whole scene "revolting" (Rita found many things revolting), she waited until her date was fast asleep ("His snores sounded as revolting as his orgasm"), and took a taxi home.

"Never again," she says now.

I try to imagine sleeping with an eighty-year-old and wonder if most elderly people are put off by their partners' bodies. Is it jarring only to those who haven't been with an older body before? Do people who have been together fifty years not notice because they acclimate to the gradual changes over time?

I remember reading a news story in which a couple, married for more than sixty years, was asked for tips on happy marriages. After the usual advice about communication and compromise, the husband added that oral sex was still in their repertoire. Naturally, this story spread like wildfire online, and most of the commenters were disgusted. Given the public's visceral reactions to aging bodies, it's no wonder old people don't get touched much.

But it's a deep human need. It's well documented that touch is important for well-being throughout our lifetimes. Touch can lower blood pressure and stress levels, boost moods and immune systems. Babies can die from lack of touch, and so can adults (adults who are touched regularly live longer). There's even a term for this condition: skin hunger.

Rita tells me that she splurges on pedicures not because it matters if her toenails are painted ("Who's going to see them?"), but because the only human touch she gets is from a woman named Connie. Connie has been doing her toes for years and doesn't speak a lick of English. But her foot massages, Rita says, "are heaven."

When she got divorced for the third time, Rita didn't know how to live without being touched even for a week. She'd get antsy, she says. Then it was a month. Then years turned to a decade. She doesn't like to spend the money on a pedicure nobody will see, but what choice does she have? The pedicures are a necessity because she'll go crazy with no human contact at all.

"It's like going to a prostitute, paying to be touched," Rita says.

Like John does with me, I think—I'm his emotional hooker.

"The point," Rita is saying about the eighty-year-old, "is that I thought it would feel good to be touched by a man again, but I think I'll just stick with my pedicures."

I tell her that the choices aren't necessarily limited to either Connie or an eighty-year-old, but Rita shoots me a look and I know what she's thinking.

"I don't know who you'll meet," I concede. "But maybe you'll be touched—both physically and emotionally—by somebody you care about and who cares about you. Maybe you'll be touched in an entirely new way, one that's more satisfying than your other relationships have been."

I'm expecting a click of the tongue, which I've come to recognize as Rita's version of an eye roll, but she goes quiet, her green eyes filling with tears.

"Let me tell you a story," she says, fishing out a crumpled, used-looking tissue from the depths of her purse, even though a fresh box sits right beside her on the end table. "There's a family in the apartment across from mine," she begins. "Moved in about a year ago. New to town, saving up for a house. Two small children. The husband works from home and plays with the kids in the courtyard, hoisting them onto his shoulders and giving them piggyback rides and tossing a ball with them. All the things I never had."

She reaches into her purse for more tissues, can't find any, and dabs her eyes with the one she's just blown her nose into. I always wonder why she doesn't take a clean tissue from the box a few inches from her.

"Anyway," she says, "every day around five p.m., the mother comes home from work. And every day the same thing happens."

Rita chokes up here, stops. More nose-blowing and eye dabbing. Take the damn tissues! I want to scream. This pained woman, whom nobody talks to or touches, won't even let herself have a clean tissue. Rita squeezes what's left of the snot ball in her hand, wipes her eyes, and takes a breath.

"Every day," she continues, "the mother unlocks the front door, opens it up, and calls out, ‘Hello, family!' That's how she greets them: ‘Hello, family!'"

Her voice falters and she takes a minute to compose herself. The children, Rita explains, come running, squealing with joy, and her husband gives her a big, excited kiss. Rita tells me that she watches all this through the peephole that she secretly had enlarged for spying purposes. ("Don't judge," she says.)

"And do you know what I do?" she asks. "I know it's horribly ungenerous, but I seethe with anger." She's sobbing now. "There's never been a ‘Hello, family!' for me."

I try to imagine the kind of family Rita might fashion for herself at this point in her life—perhaps with a partner or a rapprochement with her adult children. But I wonder about other possibilities too—what she might do with her passion for art or how she might form some new friendships. I think about the abandonment she experienced as a child and the trauma her own children experienced. How all of them must feel so ripped off and full of resentment that none of them can see what's actually there and what kind of lives they might still be able to create. And how for a while, I haven't been able to see it for Rita either.

I walk over to the tissue box, hand it to Rita, then sit down next to her on the couch.

"Thank you," she says. "Where did those come from?"

"They've been there all along," I say. But instead of taking a fresh tissue, she continues to wipe her face with the snot ball.

In the car on the way home, I call Jen. I know she's probably also in the car driving home.

When she picks up, I say, "Please tell me that I won't still be dating in retirement."

She laughs. "I don't know. I might be dating in retirement. People used to hang it up once their spouses died. Now they date." I hear the blare of horns before she continues. "And there are so many divorced people out there too."

"Are you trying to tell me you're having marital problems?"

"Yes."

"He's farting again?"

"Yes."

It's their ongoing joke. Jen has warned her husband that she's moving into the next room at night if he keeps eating dairy, but he loves dairy and she loves him, so she never moves.

I pull into the driveway and tell Jen I have to go. I park the car and unlock the front door to our house, where my son is being cared for by his babysitter, Cesar. Technically, Cesar works for us, but really, he's like an older brother to my son and a second son to me. We're close with his parents and sibling and his multitude of cousins, and I've watched him grow up through the years into the college student he is now, taking care of my son as he grows too.

I open the door and yell, "Hello, family!"

Zach shouts from his room, "Hey, Mom!" Cesar takes off an earbud and calls out from the kitchen, where he's preparing dinner, "Hey!"

Nobody runs up excitedly to greet me, nobody squeals with delight, but I don't feel deprived the way Rita does—just the opposite. I go to my bedroom to change into sweatpants, and when I come back out, we all start talking at once, sharing our days, teasing one another, vying for airtime, putting plates on the table and pouring the drinks. The boys bicker over setting the table and race to get the bigger portions. Hello, family.

I once told Wendell that I'm a terrible decision maker, that often what I think I want doesn't turn out the way I'd imagined. But there were two notable exceptions, and both proved to be the best decisions of my life. In each case, I was nearly forty.

One was my decision to have a baby.

The other was my decision to become a therapist.

Chapter 25 The UPS Guy

The year Zach was born, I began acting inappropriately with my UPS delivery guy.

I don't mean that I tried to seduce him (it's hard to be seductive with milk stains on your T-shirt). I mean that whenever he delivered a package—which was often, given the need for baby supplies—I would try to detain him with conversation simply because I craved adult company. I'd strain to make small talk about the weather, a news headline, even the weight of a package ("Wow, who knew diapers were so heavy! Do you have kids?") while the UPS driver fake-smiled and nodded as he not-so-subtly backed away from me to the safety of his truck.

At the time I was working from home as a writer, which meant that all day, I sat alone in my pajamas at a computer when I wasn't feeding, changing, bouncing, or otherwise engaging with an adorable but demanding ten-pound human with a talent for screaming like a banshee. Basically, I interacted with what I called, in my darkest moments, "a gastrointestinal tract with lungs." Before having a baby, I'd relished the freedom of a non-office job. But now I longed to get dressed every day and be in the company of verbal grownups.

It was during this perfect storm of isolation and plummeting estrogen that I started to wonder if I'd made a mistake by leaving medical school. Journalism suited me well—I got to cover hundreds of topics for dozens of publications, and they all revolved around a common thread that fascinated me: the human psyche. I didn't want to stop writing, but now, while reeking of spit-up in the middle of the night, I reconsidered the possibility of a dual career. If I became a psychiatrist, I reasoned, I could interact with people in a meaningful way, helping them to be happier, but I could also have the flexibility to write and spend time with my family.

I sat on the idea for a few weeks, until one spring morning I called up my former dean at Stanford and floated my plan by her. A renowned researcher, she was also the med-school version of a camp mom—warm, wise, intuitive. I had run her mother-daughter book group when I was in medical school and knew her well. I was sure that after I explained my thought process, she would be supportive of my plan.

Instead she said: "Why would you do that?"

And then: "Besides, psychiatrists don't make people happy!"

I remembered the old medical-school quip: "Psychiatrists don't make people happy—prescriptions do!" Suddenly sobered, I knew what she meant. It wasn't that she didn't respect psychiatrists; it was that psychiatry today tends to be more about the nuances of medication and neurotransmitters than the subtleties of people's life stories—all of which she knew I knew.

Anyway, she asked, did I really want to do three years of residency with a toddler? Did I want to spend time with my son before he started kindergarten? Did I remember talking with her as a medical student about my desire to have more substantial relationships with patients than the contemporary medical model afforded?

Then—just as I imagined my former dean shaking her head on the other end of the phone, just when I wished I could turn back time so that this conversation had never happened—she said something that would change the course of my life: "You should go to graduate school and get a degree in clinical psychology." By going the clinical psychology route, she said, I could work with people in the way I'd always talked about—the appointments would be fifty minutes instead of fifteen, and the work would be deeper and longer term.

I got chills. People often use that expression loosely, but I actually did get chills, goose bumps and all. It was shocking how right this felt, as if my life's plan had finally been revealed. In journalism, I thought, I could tell people's stories, but I wasn't changing their stories. As a therapist, I could help people change their stories. And with this dual career, I could have the perfect combination.

"Being a therapist is going to require a blend of the cognitive and the creative," the dean continued. "There's an artistry in combining the two. What could be a better mix of your abilities and interests?"

Not long after that conversation, I sat in a room with college seniors and took the GRE, the graduate-school version of the SAT. I applied to a local graduate program, and over the next few years, I worked toward my degree. And I continued to write, hearing stories and sharing them, while learning to help people change as my life changed too.

During this time, my son began to talk and walk, and the UPS guy's deliveries gradually evolved from diapers to Legos. "Oh, the Jedi Starfighter!" I'd say. "Are you a Star Wars fan?" And when I was finally ready to graduate, I told the UPS guy the news.

For the first time, he didn't try to run for his truck. Instead, he leaned over and hugged me.

"Congratulations!" he said, his arms wrapped around my back. "Wow, you did all that already, and with a kid too? I'm proud of you."

I stood there, shocked and moved, embracing my UPS guy. When we finally let go, he told me that he had news too: He wouldn't be on my route anymore. Like me, he'd decided to go back to school. And to save on rent, he needed to move in with his family, who lived a few hours away. He wanted to become a contractor.

"Congratulations to you!" I said, throwing my arms around him. "I'm proud of you too."

We probably looked odd ("That must have been some package!" I imagined the neighbors murmuring), but we stayed that way for what felt like a long time, delighted by how far we'd both come.

"I'm Sam, by the way," he said, after we finished hugging.

"I'm Lori, by the way," I said. He'd always called me "Ma'am" before.

"I know." He gestured with his chin to the package with my name on the address label.

We both laughed.

"Well, Sam, I'll be rooting for you," I said.

"Thanks," he replied. "I'll need it."

I shook my head. "I have a feeling you'll do just fine, but I'll root for you anyway."

Then Sam asked for my signature one last time and left, giving me a thumbs-up from the driver's seat as he pulled away in his big brown truck.

A couple of years later, I received a business card from Sam. I saved your address, he wrote on a Post-it attached to the card. If you have any friends who need my services, I would appreciate the business. I was midway through my internship, and I placed his card in my drawer for later, knowing exactly when I'd use it.

The bookshelves in my office?

Built by Sam.

Chapter 26 Embarrassing Public Encounters

Early in our relationship, Boyfriend and I were standing in line at the frozen-yogurt place when one of my therapy patients walked in.

"Wow, hi!" Keisha said, taking her place in line behind us. "It's so funny running into you here." She turned to her right. "This is Luke."

Luke, who was thirtyish and attractive like Keisha, smiled and shook my hand. Although we'd never met, I knew exactly who he was. I knew that Luke was the boyfriend who had recently cheated on Keisha and that she'd figured this out because he'd been unable to get an erection with her. Each time he cheated, the same thing happened. ("His guilt," she once said, "is in his penis.")

I also knew that Keisha was preparing to leave him. She'd come to understand what had drawn her to him in the first place and wanted to be more intentional about choosing a trustworthy partner. In our last session, she had said that she planned to break up with him this weekend. It was now Saturday. Had she decided to stay with him, I wondered, or was she going to break it off on Sunday so that she'd have the structure of Monday's workday to help her stay the course? She'd told me that she wanted to tell Luke in a public place so that he wouldn't make a scene and beg her to stay, which he'd done when she attempted the conversation at her apartment twice before. She didn't want to cave again just because he said all the right things to convince her to change her mind.

In the yogurt line, Boyfriend was standing next to me expectantly, waiting to be introduced. I hadn't yet explained to him that if I see therapy patients outside the office, in order to protect their privacy, I won't acknowledge them if they don't acknowledge me first. It could be upsetting, for instance, if I said hello to a patient and the person accompanying her asked, "Who's that?," leaving the patient in the awkward position of having to hedge or explain on the spot. What if I were to say hello to a patient who was with a coworker or boss or who was on a first date?

Even if patients said hello to me first, I didn't introduce them to whomever I was with. That would also be breaking confidentiality—unless I were to lie when asked about how I know the patient.

So Boyfriend was looking at me, and Luke was looking at Boyfriend, and Keisha glanced at my hand, which Boyfriend was holding.

Unbeknownst to Boyfriend, I'd already run into a patient while he and I were together. A few days before, the husband in a couple I was seeing walked by us on the street. Without stopping, he said hi, I said hi back, and we both kept going in opposite directions.

"Who was that?" Boyfriend had asked then.

"Oh, just somebody I know through work," I said casually. Never mind that I knew more about his sexual fantasies than I knew about Boyfriend's.

At the yogurt place that Saturday night, I smiled at Keisha and Luke, then turned around to face the counter. The line was long, and Boyfriend took the hint and made small talk with me about yogurt flavors as I tried to tune out Luke's voice while he excitedly discussed vacation plans with Keisha. He was trying to pin down dates, and Keisha was being cagey, and Luke asked if she'd rather go next month, and Keisha asked if they could talk about it later and changed the subject.

I cringed for both of them.

After Boyfriend and I got our yogurts, I led him to a far table by the exit and took a seat with my back to the rest of the crowded room so that Keisha and I could both have our space.

A few minutes later, Luke stormed past our table and out the door, Keisha trailing behind him. Through the glass walls, we could see Keisha making apologetic gestures to Luke and then Luke getting in his car and driving away, nearly running Keisha over.

Boyfriend seemed to be putting it all together. "So that's how you know her." He joked that dating a therapist was like dating a CIA agent.

I laughed and said that being a therapist sometimes felt more like having an affair with your entire caseload, past and present, simultaneously. We're always pretending not to know the people we know most intimately.

But often it's therapists who feel uncomfortable when our outside worlds collide. After all, we've seen our patients' real lives. They haven't seen ours. Outside of our offices, we're like Z-list celebrities, meaning that hardly anyone knows who we are, but for those few who do, a sighting is significant.

Here are some things you can't do in public as a therapist: Cry to a friend in a restaurant; argue with your spouse; hit the building's elevator button relentlessly like it's a morphine pump. If you're in a rush on your way into the office, you can't honk at the slow car blocking the entrance to the parking garage in case your patient sees (or because the person you're honking at might be your patient).

If you're a respected child psychologist, like a colleague of mine, you don't want to be standing in the bakery when your four-year-old has a meltdown about not getting another cookie, culminating with the ear-piercing proclamation "YOU'RE THE WORST MOM EVER!" while your six-year-old patient and her mother look on, aghast. Nor, as happened to me, do you want to run into a former patient in the bra section of a department store as the salesperson announces loudly, "Good news, ma'am! I was able to find the Miracle Bra in the thirty-four A."

When you're making a restroom run between sessions, it's best to avoid the stall adjacent to your next patient, especially if either of you is taking a malodorous dump. And if you use the pharmacy across the street from your office, you don't want to be seen in the aisles buying condoms, tampons, constipation aids, adult diapers, creams for yeast infections and hemorrhoids, or prescriptions for STDs or mental disorders.

One day, while feeling flu-like and weak, I went to the CVS across from my office to pick up a prescription. The pharmacist handed me what was supposed to be an antibiotic, but when I looked at the label, I saw it was an antidepressant. A few weeks earlier, a rheumatologist had prescribed the antidepressant off-label for fibromyalgia, which she thought might explain some lingering fatigue, but then we decided I should hold off due to its potential side effects. I never picked up that prescription, and the rheumatologist canceled it; nevertheless, for some reason, it still sat in the computer, and every time I got a medication, the pharmacist would bring out the antidepressant and announce its name loudly while I prayed that none of my patients were in line behind me.

Often when patients see our humanity, they leave us.

Soon after John began seeing me, I ran into him at a Lakers game. It was halftime, and my son and I were waiting to buy a jersey.

"Jesus Christ," I heard somebody mutter, and I followed the voice and spotted John ahead of us in the line next to ours. He was with another man and two girls who looked to be around John's older daughter's age, ten. A dad-daughter outing, I figured. John was complaining to his friend about the couple in front of them who were taking a while to make their purchase—they kept losing track of which sizes the cashier had said were sold out.

"Oh, for God's sake," John said to the couple, his booming voice catching the attention of everyone around us. "They're out of the black Kobe in all sizes but the small—which is clearly not your size—and they only have the white Kobe in a kid's size, which is also clearly not your size. But it is the size of these girls here who came to watch a Lakers game, which is starting up in"—here he made a great show of holding up his watch—"four minutes."

"Chill, buddy," the guy in the couple said to John.

"Chill?" John said. "Maybe you're too chill. Maybe you should think about the fact that halftime is fifteen minutes and there's a sizable crowd behind you. Let's see, twenty people, fifteen minutes, less than a minute per person—Oh shit, maybe I shouldn't be so chill!"

He flashed his gleaming smile at the guy, and that's when John noticed me looking at him. He froze, stunned to see his mistress-hooker-therapist standing there, the one whom he didn't want his wife or, probably, his friend or daughter to know about.

We both looked away, ignoring each other.

But after my son and I made our purchase, as we were running hand in hand back to our seats, I noticed John watching us from afar, an inscrutable expression on his face.

Sometimes when I see people out in the world, particularly the first time it happens, I ask back in session what the experience was like for them. Some therapists wait for their patients to bring it up, but often, not mentioning it makes it bigger, the elephant in the room, and acknowledging the encounter feels like a relief. So the following week in therapy, I asked John what it was like to see me at the Lakers game.

"What the fuck kind of question is that?" John said. He let out a sigh, followed by a groan. "Do you know how many people were at the game?"

"A lot," I said, "but sometimes it's strange seeing your therapist outside of the office. Or seeing their children."

I'd been thinking about the look on John's face as he watched me run off with Zach. I privately wondered what it was like for him to see a mother hand in hand with her son, given the loss of his own mother when he was a boy.

"You know what it was like seeing my therapist and her kid?" John asked. "It was upsetting."

I was surprised that John was willing to share his reaction. "How so?"

"Your son got the last Kobe jersey in my daughter's size."

"Oh?"

"Yeah, so that was upsetting."

I waited to see if he'd say more, if he'd stop with the jokes. We were both quiet for a bit. Then John began counting. "One Mississippi, two Mississippi, three Mississippi . . ." He shot me an exasperated look. "How long are we going to sit here saying nothing?"

I understood his frustration. In movies, therapist silences have become a cliché, but it's only in silence that people can truly hear themselves. Talking can keep people in their heads and safely away from their emotions. Being silent is like emptying the trash. When you stop tossing junk into the void—words, words, and more words—something important rises to the surface. And when the silence is a shared experience, it can be a gold mine for thoughts and feelings that the patient didn't even know existed. It's no wonder that I spent an entire session with Wendell saying virtually nothing and simply crying. Even great joy is sometimes best expressed through silence, as when a patient comes in after landing a hard-won promotion or getting engaged and can't find the words to express the magnitude of what she's feeling. So we sit in silence together, beaming.

"I'm listening for whatever you have to say," I told John.

"Fine," he said. "In that case, I have a question for you."

"Mmm?"

"What was it like for you to see me?"

Nobody had ever asked me that before. I thought for a minute about my reaction and how I would convey it to John. I remembered my irritation with the way he was talking to that couple at the front of the line and also my guilt at silently cheering him on. I, too, wanted to get back in the stadium before the second half started. I also remembered, when I was back at my seat, glancing down and noticing that John and his group were sitting courtside. I saw his daughter showing him something on his phone, and as they were looking at it together, he put his arm around her and they laughed and laughed, and I was so touched that I couldn't take my eyes off them. I wanted to share that with him.

"Well," I began, "it was—"

"Oh, Jesus, I was kidding!" John interrupted. "Obviously I don't care what it was like for you. That's my point. It was a Lakers game! We were there to see the Lakers."

"Okay."

"Okay what?"

"Okay, you don't care."

"Damn right, I don't." I saw that look on John's face again, the one I noticed when he was watching me run with Zach. No matter how I tried to engage with John that day—by helping him to slow down and notice his feelings, by talking about his experience with me in the room, by sharing some of my experience in our conversation—he remained closed off.

It wasn't until he was leaving that he turned back to me from the hallway and said, "Cute kid, by the way. Your son. The way he held your hand. Boys don't always do that."

I waited for the punch line. Instead, he looked me right in the eye and said, almost pensively, "Enjoy it while it lasts."

I stood there for a second. Enjoy it while it lasts.

I wondered if he was thinking about his daughter—maybe she'd outgrown letting John hold her hand in public. But he'd also said, "Boys don't always do that." What did he know about raising boys, being the father of two girls?

It was about him and his mother, I decided. I tucked away the exchange for when he'd be ready to talk about her.