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  • Writer's pictureTerry Pace

Playing Baseball in the Dark

Updated: Jun 20, 2020

By Terry M Pace

Here is a short essay about just one of thousands of examples of people I have known and worked with as a psychologist. I will share such stories from time to time. Whenever I do this, no one will be identified by name, exact age, exact locations or times or other identifiable information. Some of the details of each story will be modified to allow stories to be shared without even remote identification of individuals. Any similarities to people that might seem familiar are simply coincidental and based on common themes in people’s lives.

I will call the man who inspired this story, by the name of Mr. A. I was providing counseling for a man in his 70’s. He had been referred to me due to his doctor’s concern over how anxiety and grief were impacting Mr. A’s heart and lung health. When his appointment time came, I went to the waiting room to find a tall, very lean older gentleman, leaning over forward with his head almost between his knees trying to breath better. He wore working style clothes, jeans and a plaid western shirt. He was mostly bald with just a little hair on the sides of his small head. Mr. A greeted me with a smile. He apologized profusely for his not seeing me right away and for his very slow walk across the waiting room. He pushed his green oxygen tank with him and I soon discovered that he had required oxygen 24/7 for the past couple of years. When I adjusted the chairs in the room so his tank fit easily beside him, he again apologized and smiled at me, looking a little embarrassed. I recall his smile still; it was slow and soft and his eyes dilated a bit and his cheeks lifted, giving him a much more vigorous look, I thought perhaps more like the person he had been before his health deteriorated. This is something I knew we would need to discuss even before we spoke, as illness can cause a loss of agency and identity, thus reclaiming some of these losses is one thing that often helps folks not just feel better emotionally but actually find better functional-physiological health.

Mr. A had advanced congestive heart failure along with Chronic Obstructive Pulmonary Disease. In addition to his oxygen, he was on many medications for his heart and lungs. He also had diabetes and arthritis which required medications and care and had a history of coronary artery disease having received several stents to open up his coronary arteries.

Like many people, Mr. A was a little sheepish about telling his stories to someone he didn’t know and seeing a “shrink” was something he never thought he would do. But when asked to just tell me why he thought his doctors sent him to me and what he wanted to discuss, if anything, he easily began talking. He shared that he could not ever seem to relax, could not get some thoughts or worries off his mind, especially thoughts of his deceased wife and angry thoughts about his debts, lack of income and disability. He said he could not sleep well from these worries, so he thought that maybe his cardiologist was right and he needed my help. He also said he had tried for years to stop smoking and sometimes had some success but every time he got emotionally upset he smoked more (which is very common).

I reminded him of what I do and how it can help; that talking is another form of thinking and doing so in a place where one has time and can be honest often leads to less distress making it easier to sleep and reduce smoking. I discussed with him how that when we are supported with both compassion and objectivity it can be easier to share the difficult feelings that life challenges bring, and this sharing can often free ones’ mind and allow new ideas about ways to cope. Thus, lowering ones’ natural bodily response to stress and giving the body a little help against other illnesses, making it easier to breath and for the heart to work more efficiently. I also discussed confidentiality in psychotherapy and how I would communicate with his doctors with his permission to coordinate his care as needed, but no one else was privileged to his information beyond any legitimate legal proceedings or a risk of harm to self or others.

He asked about the financial side of seeing me and fortunately I was able to accept his Medicare payment for psychotherapy for anxiety and to waive his co-pay due to severe financial distress (otherwise he could not have afforded to see me or anyone in my profession). I explained he would owe nothing out of pocket, which is rare good news for any of us to hear. I shared how his feelings were very normal and most folks were unsure how talking helps or if it might mean you are crazy. To this he smiled brightly and agreed. I then said that it’s okay anyway cause I’ve also done some crazy things in my life And I also have had times of depression and anxiety. His smile turned to a laugh. His goodness and decency showed though his distress. From these few moments, I knew I liked him very much and hoped I could help him.

As I got to know Mr. A, he shared that he had worked all his life as a self-employed carpenter which meant he had no health insurance. Medical bills began to pile up in his mid 50’s as his wife became ill with cancer and needed many difficult and expensive treatments and hospitalizations. By the time he was 65, he was broke and bankrupt. In the several years prior to turning 65 and qualifying for Medicare, his own health deteriorated. And here came more medical bills again so he avoided seeking medical care as much as he could, waiting until he became so ill he often needed hospitalization. Of course, he could not afford many of his medication’s ether. So, he became sicker and sicker. He could no longer afford their home and moved into a small travel trailer on a relative’s property. He could no longer work and became fully disabled and unable to live without 24 -hour Oxygen therapy. He did receive social security disability after three applications and several years of fighting for it. But, his disability payments of around $1200 a month were not even enough to afford basic living costs and this plus his Medicare were his only income and resources. After turning 70, his wife had died and he was so broke that he could not afford to have her buried in her home state, thus had to choose to have her cremated and hoped to one day return her ashes to her home. He cried in telling this story and it took several sessions to be able to talk about his wife and her death and all the accompanying indignities he had experienced though these times.

However, when I saw him it had been several years since his wife had died and he not only could not afford this trip to bury her ashes as she had wished, but could no longer make such a trip himself Due to his health. He was heart-sick. Both I and his cardiologist felt certain that the level of stress and depression from the losses, but equally from the devastating debts and lack of basic life options had hastened the progress of his illness via central nervous system stress effects. Psychotherapy was difficult as his problems were so deep and intractable, but I enjoyed seeing him every visit. He had a sweetness and humility that made him easily likable and respectable for me.

Our therapy time was mainly about grief, acceptance of life’s burdens and unfairness, support for daily self-care such as remembering medications and getting better sleep as well as reducing if not eliminating his long habit of smoking (that he acquired while serving our country in the military), and an effort to affirm and remember his life loves, joy and dignity.

One session will always be memorable for me, I asked him if he would like to talk more about his youth as we had never really gone into much detail from that far back into his life. He smiled so grandly and laughed and proceeded to tell me several stories of growing up on a farm on the edge of a very small town in central Texas in the 1940’s. He shared one story so vivid I can still picture him as a teenager. He said on summer nights when all the stores closed and the farmers all came in from their fields, in those days adults mostly went to bed when the sun went down. He told how that was then the best time for him and his teen-aged friends.

On those dark soft summer nights, he and a small group of his friends would sneak down to the local baseball field and play night baseball. He said they would sometimes sneak around town just for the fun of not getting caught when the local sheriff made his rounds. He told of watching the fire-flies so thick they almost lit up the field and of the dark star- lite skies amidst the grandeur of the milky-way. He relished in telling me of the thrill of trying to catch a fly ball in center field in the dark! Despite his breathing difficulty, he laughed a deep belly laugh and said he felt better than he had in years.

We talked over his grief (his wife), his anger (money and the lack of health care), his regrets (smoking), his successes (and he had many in his strong work history and his love for family) and his happy memories. We worked equally on reactivating his happy memories as we did on understanding or expelling his harsh memories. When he felt especially upset (sadness, worry or anger) he was to spend 5 minutes thinking of a happy memory. This was enjoyable to him and gave him a sense of permission to day-dream and not feel guilty from wasting time!

After a couple of months of weekly therapy with me, his doctor sent a note to me sharing that Mr. A’s lungs looked better and his blood pressure and blood sugars were better than they had been in some years. He also noted that Mr. A had only had one ER visit over the two months since starting to see me, as compared to an average of 2 visits per month over the previous year. This is an example of one way quality mental health care is an over- all cost saver in healthcare. If an average ER visit is $1,000 (it's probably more) and the cost of weekly psychotherapy is about $100 then saving three ER visits and having 8 sessions of psychotherapy is a two month savings of $2,200. Mr. A and I all felt that his psychotherapy was helping him to feel and thus be better. I’m glad I could be there and he came my way. I’m thankful for his doctor who understood the links of stress and grief to health.

But I am so sad at the burdens we as a society had placed on Mr. A from the lack of health insurance and thus medical debt from his own and his wife’s illnesses. Though Medicare helped this dear man during the time I saw him, it was really too late to make a big difference in his health and life outcome. Had he received care for his wife and then himself in a timely manner without having to file bankruptcy and lose all his assets then it’s possible this story could have been different. He may have cared for and then buried his wife with dignity and his grief may have had a way to be managed easier for him. With less burden from unresolved grief and less worry and anger over medical bills that he could not avoid, his stress might be lower, and thus the chemical balances of his body may have remained healthier. Maybe with less stress and more regular medical care he might have been successful at smoking cessation, which would have enabled better cardio and pulmonary functioning for him.

He was a dear soul and I am thankful for being a small part of his life and that he will always be an important part of my life and lessons I’ve learned.

PS: After many inquiries, I found a fund for emergency medical or funeral expenses related to the loss of a loved one and though this was a delayed loss I was able to appeal the medical necessity for some assistance. This took considerable time that many clinicians just do not have. These modest funds helped Mr. A to make connection with a funeral service where his wife was from and to mail them her ashes for burial. This was not the ideal way of burial without him being there in person, but it was a relief that she was finally “home.” I hope for a day that folks can rely on the goodness of all of us in society to pay for taxes that target needed health and death related services; that no one has to choose between their own health care and funeral expenses for a deceased spouse. Human dignity demands it and we have the ability to do these things if we can find the will.

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