On the Death of My Patient

Yesterday afternoon I found out that a¬† young man that I knew quite well had died. Bobby (not his real name) had been an individual patient of mine, off and on, from 2010 through most of 2016. I’ve spent much of the last 24 hours thinking on him.

Bobby was referred to me by another therapist. That therapist started treating him when he was 17 and saw him for several years. Bobby was a very bright kid from a good family. He used substances a little bit, had a penchant for minor crimes, and often used his wit to lessen his consequences. In his early 20s, he discovered crack cocaine and his life spiraled downward. Within two years, the drugs had severely impacted the functionality of his brain. Bobby’s sharp mind had been permanently dulled. His therapist thought he should see a drug expert, but also found it brutally difficult to see Bobby in his newly diminished capacity.

I met with Bobby and his parents  during our first session. It was clear that they were kind and loving and desperate for their son. They were frustrated too. Bobby would put together a month or two of living substance free, and then would spectacularly relapse and sell his things (he went through several laptops). Bobby had been seeing a psychiatrist and was on a heavy regimen of a variety of medications. He had also begun to experience a bit of religious psychosis. Despite all of this, Bobby was able to get and maintain good part time jobs that paid well. We worked out a plan.

Bobby and I met weekly. Because of his mental state, he no longer had any friends that he hung out with. I tried to get him to reach out and engage with others, but he had little desire to and perhaps not much ability. Every session, he would ask me a very painful question: “When will my brain heal?” Despite doing significant damage to his cognitive functions, he was aware of the fact that he was changed. I refused to lie to him. I told him that he may have done permanent damage to his brain, but that we wouldn’t know for sure until he had a few years clean from drugs and allowed it to heal if it could. This would register, but he always asked me the same question the next week. It was heartbreaking.

Bobby had a kind heart. We would talk about the needs of other people. He had vast empathy for not only his family, but strangers. He eventually put together 11 months clean. He was saving money, occasionally attending 12-step meetings, and was slowly repairing his relationship with his parents. Then he disappeared for a few days. His Mom tracked him down in a dumpy motel. He expressed remorse and got clean again. He was 30 credits or so shy of a degree, so he went back to school part time (and worked part time too). He relapsed after a little more than a year. His parents cut him off and after a few months of a vagabond lifestyle, he checked himself into one of the indigent treatment centers in NJ. He got out after six months and called me up. He said he had no money but wanted to see me. I had folded up my private individual practice in order to focus on all of my other work, but I felt a deep obligation to Bobby. He offered to pay a small fee once he got a job and I agreed.

We met off and on over the next two years. We worked on a plan for meetings, exercise, family communication, work, school and in a few other areas. He would often cancel for one reason or another, and eventually I figured the best way to get him to keep his appointments was to meet him outside of his apartment. Occasionally he still cancelled. The last time I saw him was in the summer.

When I found out he died, I was not surprised but it still jolted me. My first thought was “I should have done more.” That was also my first thought when my friend Frazer overdosed and died in 2002. Then I thought about his Mom. And his Dad. And his other family members. I called his Mom an hour after I found out. I hadn’t spoken with her in three years. She told me that he had been home for the holidays and died in his sleep. She said he went peacefully. And then she started to cry. Heavily. I told her that there are no adequate words of comfort. I told her I mourned with her. I also said that I knew hundreds of parents that had lost their children, and that I would like to put her in touch with them, if and when she was ready. She thanked me and told me how much Bobby liked me. Even in this moment of ultimate despair, she was trying to soften the blow for someone else.

I’ve worked with a lot of people that have since died. Some were students, but most were clients that were in some kind of rehab or outpatient group. A man who was very dear to me died from complications around his relapse and liver cancer four years ago. That was awful (I still carry around the prayer card from his funeral). I’ve trained and supervised many therapists who have lost a patient. They always grieve the loss, and they often beat themselves up for missing something or not doing it differently. I tell them that working in mental health and addiction is brutal, and that death is horribly common aspect of our work. I tell them that it is a reminder of how limited our powers are.

When a patient was sent to prison in 2004, my first real supervisor told me that I couldn’t wear the successes and failures of my clients, because I was (a) not that powerful or responsible and (b) that I would burn out. He told me I had to focus on the process. It was my duty to listen, to educate, to inform them about resources, to model healthy communication and behavior, and to provide honest and forthright feedback. I have shared that story with every counseling student and supervisee since then. I did all of those things for Bobby. And he still died. I spent hundreds of hours with Bobby talking about the most intimate aspects of his life and mind. I liked him. I hoped and rooted for him. And now I mourn him.