The isolation of the office is shattered; the patient has allowed someone from his or her life to enter. And I have the privilege of witnessing the person across from me interacting spontaneously with that world.
Most patients handle calls with a quick apology; then they switch off their phones, surprised they had forgotten to do so before coming in. Some screen their calls, always available to selected callers.
Others do not make anything at all of interruptions and answer every time their theme song sounds. Even their brief conversations can be revealing. “I’m seeing my shrink.” “I’m with Doc S.” Who knew they had pet names for me? To one family, I’m “The Big B” (though I stand 5-feet-2 in heels.)
A mother receives a call from her teenage daughter. One theme of our sessions has been how to deal with the daughter’s “demanding behavior.” The volume is up; I hear both sides. The daughter is insistent about something trivial; mother is endlessly patient, even solicitous. Now I see that this child hasn’t been getting consistent feedback that her behavior is problematic. Guilt has driven my patient to conceal her anger. She is surprised to learn from me how successful she has become at this deception and how counterproductive it is.
When another patient’s husband calls to learn the results of her medical tests, I sense his tenderness; this counterbalances my knowledge of their sexual difficulties.
A calliope blares from the coat pocket of another patient, a young man. “I bet a hundred dollars it’s my sister!” he says. Clearly she calls him a lot, and he kind of loves it. Oddly, he rarely mentions her in therapy. Now I learn why. He had been afraid to disrupt the sweetness of his sibling relationship by uncovering its competitive core.
I am witness to another patient, a physician, juggling a potpourri of calls: colleague needs urgent consultation; child wants sleep-over; spouse craves takeout; nurses worry about wound infections, fevers, bleeding. I really get the stress involved in ceaselessly shifting from matters of trivial consequence to those with life and death stakes.
Sometimes patients hand me their phones to hear their messages. We play them and discuss whether we discern the same nuanced implications between the lines.
And patients show me those little glowing screens with photos of pets and progeny, apartments they might rent, last week’s rash (for diagnosis and for empathy). I see messes that have become the focus of family fights: the kid’s room with wet towels piled atop clean clothes; the cluttered dining room table that hasn’t allowed for dinner parties.
In trying to grasp the infinite complexity of an individual’s mind, it helps to narrow the focus by closing out the world and creating a place of privacy. But, for understanding the context — the life a patient inhabits outside the office — it helps to let in some of the sights and sounds. The pictures are worth a thousand words; so are the voices.