I’ve searched for the hard copy everywhere. A twenty paged paper typed double space, almost exactly twenty years ago, before personal computers were a household or academic necessity. It must be in the storage bin somewhere, yellowing, with old journals, spiral notebooks and my collected graduate school syllabi.
I remember the grade written on top, I remember the professor, now deceased, who I wrote if for. I remember the main source cited: a small black leather bound book from the NYU library titled: Thanatology, the author forgotten. And I remember the boy, a client who was going to die, as we all will. And who somehow knew, although his mother could not bear to think of it or discuss it with him. A charming young boy who may have grown into a handsome young man, who, with luck and treatment advances, may still be with us, or who may be dead by now, but who is certainly still with me.
It was my first introduction to Death as an entity in the consultation room, although I have learned to recognize that specter as it lives and lurks in every treatment. There are those who specialize in bereavement, but the Psyche of every psychotherapist, every client, every human, has its own language to speak to the experience of death, dying, and grief.
Because I could not stop for Death,
He kindly stopped for me;
The carriage held but just ourselves
We slowly drove, he knew no haste,
And I had put away
My labor, and my leisure too,
For his civility.
We passed the school, where children strove
At recess, in the ring;
We passed the fields of gazing grain,
We passed the setting sun.
Or rather, he passed us;
The dews grew quivering and chill,
For only gossamer my gown,
My tippet only tulle.
We paused before a house that seemed
A swelling of the ground;
The roof was scarcely visible,
The cornice but a mound.
Since then ’tis centuries, and yet each
Feels shorter than the day
I first surmised the horses’ heads
Were toward eternity.
~ Emily Dickinson
He was six or seven, and small for his age, the size of a five year old – likely due to the the ultimately fatal illness that will one day kill him, if it hasn’t already. His mother was stiff, strained, overwhelmed, impatient and brittle. I suppose I would be too. In his short life he had multiple hospitalizations, emergency room visits, and surgeries. As soon as his mother left the room he raised his shirt up over his head to show me the large surgical scars on his little round tummy just north of his outie belly button. He was funny, smart and wild. Acting out in school, not sitting in his seat, joking, distracting other children, disrespectful of any parameters. I spent a great deal of our play therapy together using Virginia Axline’s recommended limit setting intervention:
“I know you want to do X…. but you can’t.” And laughing.
I was a second year social work intern, placed for the year in a child and family clinic. His mother doubted I could be of help to her. She found him unmanageable and increasingly resistant to the nightly medical interventions that he needed to surrender to in order to keep on living. She didn’t talk to him about his illness, or explain the painful, boring rituals she needed to perform on him at home. And she certainly never told him that she needed his help keeping death at bay, and that one day, they would be unsuccessful.
She didn’t play with him either. He performed and clowned and mugged and joked like the corniest Catskills comedian trying to make her smile. She pretended that she wasn’t interested, that it wasn’t funny, that she needed him to listen to her, not to crack wise. But I could tell she was terrified that if she laughed, and played, and got on the floor and enjoyed him – Grief when it arrived, would destroy her. Instead, she brought him to play with me, and strove to keep soft sounds out of her voice when she spoke. She needed to stay cross with him, her brows furrowed, her mouth pinched whenever possible.
And so the silly boy and I played together twice a week. He chased me around the room, holding a big green stuffed monster-man doll. If the doll caught me I was to be buried. The throw rug pulled over my face like a death-shroud. He found a toy bulldozer on the shelf and dug “graves” in small piles of playdough and had the molding clay “swallow up” the playskool “guys” one after another. And then he would have me dig them up, and we would bury them again. The doctor’s kit was in heavy rotation, and I would be instructed to lay on the floor, while he would “cut me open” from my heart to my belly, and take my insides out, and sew me shut again, sweetly covering my shirt with bandaids afterward. In between games, he would giggle and tickle, wise-crack and tease, and bounce and burp, and laugh and laugh.
At my parental guidance meetings with his mother, who refused her own psychotherapy, I would encourage her consider opening up conversation with him about his diagnosis. She did eventually tell him the name of his illness, and explain what was happening in his body that required so many trips to the doctor, so many operations, so many painful practices to keep him healthy.
His prognosis remained unthinkable, and unspeakable. Once, at a consultation I explained that much of his play seemed to be about mastering an innate awareness of their mutual fears. And wondered if she thought it might be hard for him to sit on top of these terrifying questions alone. She decided that I was threatening to tell him, if she didn’t, that he would eventually die and threatened to remove him from therapy entirely. And although it had never crossed my mind to be the one to inform him, and I promised that would never happen, I could suddenly imagine him asking me directly: “Am I going to die?” I began to rehearse a response: “That is a very important question. What do you think?” as I simultaneously prayed that my inner dialogue would never manifest.
In our final weeks together, before my internship ended, we planned our goodbyes together. Specific treats were requested for our final two weeks and a scheduled review of our favorite games. The green monster-man chase, the “burying and unburying” playdough game, and the operation game. And for the final session: something else. He wanted his mother to join us, and for me to teach her how to play all of our games.
At first she refused. I was good at playing she said, she was terrible. I explained that I was always a stand in, the person he really wanted to work this through with was her. She was the only one he really wanted to play with. She asked about the games, and I made no mention of the internal interpretations that I assigned to our play: He like to chased me with a stuffed animal, and then cover me up with a blanket. He liked to use a bulldozer to dig some little guys out of a mound of clay, and, just like the doctor who they saw so often, and who seemed to be a role model, he liked to pretend to perform surgery with a doctors kit, and listen to my breath with a toy stethoscope, and put bandaids on the ow-ie. She agreed. Uncomfortably, but she agreed.
When she came into the session, he was thrilled. And decided to help her out: “So that no one has to be embarrassed, we will play in the dark!” he announced, flipping the light switches, plunging my windowless office into utter blackness. He agreed, after adult protests to open the door a crack to let a sliver of yellow light in from the hall. “I’ve got the green monster-man!” he squealed as he chased her around the room. They resurrected the buried doll-guys, and I heard his mother giggling in the dark as he tickled her while performing a joyful, and unorthodox surgery.
They left together laughing, his hand in hers. And I shut the door. Breathing in deeply through my mouth, trying not to sob, when there was a sudden knock on the door.
The boy stood there: “Hey!” he said, “HIGH-FIVE! Awww, too slow!” and turned to walk back toward the clinic entrance, with his thumbs tucked under his back pack straps. After a few steps, he tossed the back pack aside, turned and ran at me full speed, and flew into my arms.
Twenty years later, I still remember the smell of his hair.
The smallest sprout shows there really is no death,
And if ever there was it led forward life, and does not wait at the end to arrest it,
And ceas’d the moment life appeared.
All goes onward and outward, nothing collapses,
And to die is different from what any one supposed, and luckier.
~ Walt Whitman, Leaves of Grass