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SUDDENLY, IN JULY OF 1978, I FACED a life-threatening illness requiring major surgery and prolonged debilitating treatments. My surgeon ordered me to resume work promptly, seeing anxiety and self-preoccupation as stressful. He was convinced that stress interferes with the immune system, this the mysterious but decisive factor in survival. He viewed work as a life-saving distraction. Thus, I was transformed from an ebullient junior colleague to a fatigued, pale, despondent individual as I fought to keep my spirits above the waters of self-absorbed despair. If the ideal therapist serves as a secure container for the projected affects of the patient, I guiltily thought of myself as more a collander or saturated sponge than a container. So, I returned to work at Chestnut Lodge, partly as a therapist, partly as a patient on an occupational therapy assignment. My patients became part of my metaphoric treatment team, giving to this work their best and very effective efforts, replete with the expected ambivalences. It was as if they too had been drafted to fight at the front lines of a confrontation with death. I wish to convey, through a series of vignettes, something about this phase of the work, and then to offer a few comments.
Initially, the staff tried to spare my patients the news, but it became clear some patients already knew. For example, among my initial visitors to the hospital was an intrusive 26-year-old borderline woman who had left the Lodge a few months earlier against medical advice. She appeared at the hospital soon after I'd left the intensive care unit. So, the six administrators of my six patients met with each of them, informing them of the situation as they each understood it. Interim therapists were assigned.