When Patients Leave You

There is always an end. Sometimes it's happy, like a graduation, sometimes it's not, like believing you've failed. No matter how well you serve them, patients leave you behind. Some do so long before they are well and others require immediate removal from your practice. Departures are not to be taken lightly. How you let go of a patient may affect the future of that relationship and the reputation you build in your community. "Leaving" is transition. In Chinese astrology, the days between seasons is when the planets wobble and one must be careful to avoid extremes and negativity as they can magnify. You are between one form of relationship and another with every patient who leaves and the transition time must be handled with delicacy and artistry.

Early on in my practice, Jeffrey left because I suggested extending his course of treatment to address health problems that were plaguing him but for which he hadn't requested help. My teacher later told me to attend to only the problems patients come for. "The others you treat silently," he said. "That way they realize that your presence changes things they hadn't expected and they can decide on their own to stay with you."

I've had patients want to befriend me to avoid the ending. Others don't want to see me again because I remind them of a dark time in life, even if I helped them get out of it. A few depart because of mistakes I have made, leaving a needle in after closing the treatment or making comments they misunderstand or don't like. And occasionally, some one makes up reasons to go because they aren't quite ready to face the healing task in front of them.

A few call at Thanksgiving each year to share gratitude. Others reach out on birthdays or dates they find meaningful. I've' gotten letters explaining why it's over, like a romantic break-up. One man wrote me a song that he sang accompanied by a boom box. I hadn't scheduled the time to listen to a 57-year-old accountant sing his customized version of Frank Sinatra's "My Way," but I managed to find it. A few have instructed their families to send me invitations to their funerals, and many send birth announcements reflecting successful fertility treatment results.

Occasionally, patients will leave mentally before they have "left" physically. A treatment that worked brilliantly one week could have no results or even backfire the next if it's recipient has energetically "left" the healing relationship, though still returns to lie on my treatment table. Perhaps they heard of a new healer or technique and feel ready for a different adventure, even though this one may be serving them. Sometimes I am just a name on the long list of healers someone wants to try.

Maryanne, a woman in her 60s with an autoimmune disease that put her in a wheelchair, left by dying in my office. After a few months of work, she was feeling well enough to walk on her own around her house. This was her first improvement in over a decade of worsening disease. Her delight spilled all over her face and her husband's face and made the air in my waiting room sparkle. On this particular day, she also brought in a bad cough and a flushed face. Her husband, still beaming with the joy of her improvement, sat beside her, holding her hand as she lay on a treatment table waiting for me to come into the room. When I did, I noticed a quiet that was unusual, as if the silence was speaking. My fingers told me that all her pulses, except her liver position pulse, were gone. The liver pulse it the last to be silent as it is the organ from which the final aspect of the soul separates from the body, the concluding stop before heaven. I instantly began CPR (yes, we really do need to have that skill) but knew, because of her pulse profile, that success would be unlikely. Medics couldn't bring her back either. She had just slipped away holding her beloved's hand while anticipating that I would soon come in to help her feel better.

Instead of enjoying relief and gratitude as his health improved, Randall got irritated. The healthier he became physically, the more uncomfortable emotionally. Long before he was symptom free but far enough along in treatment to note obvious, sustained improvement, he stopped. I had no idea why as his hunt for healing had been lengthy and he appeared comfortable with me. His wife's exasperation was clear when she said, "He didn't leave because of something you did, Felice. As long as he doesn't have to admit he is still sick or that he needs to get better, he may come back to you for additional help. He hates to face difficulties. That's all."

Sometimes we learn more about a patient when they leave. Michelle had been dying of Lupus when we met. Two years of intense and consistent treatment later, her doctors were amazed at her turn around and she was functioning in the world again. Still, she was not ready to conclude our work and was frightened of symptoms returning. As the CEO of her own multi-million dollar a year company and the only wage earner in a childless marriage, Michelle knew she could well afford our work no matter how long it went on. Still, her husband Stan, a chronically unemployed and commercially unsuccessful artist, decided it was too expensive and that she should stop seeing me immediately. He was given the last word and authority on a matter of great importance to her, even though his wishes were in direct contrast to hers and, simply, nonsensical. I wondered if it strengthened Stan's sense of self to have his wife's lowered by disease. Her "leaving" my practice from his pressure helped me see the power structure in the marriage and her life and taught me a great deal about her.

For many years, I made too much of a patient leaving. I still do on occasion. I erroneously believe I should have more control over the closure of a healing process that I have shaped and put my heart to. Maybe I think a patient could improve further if he would stay with it. Or perhaps I think she is being swayed to follow advice that is ill informed or medically irrelevant. After all, I was in charge, at least somewhat, at one point. But no longer.

When "leaving" is about to take place, my only power is to say what I believe to be true for my patient clearly and simply, to show respect for their ability to choose and to offer support should they ever wish it from me. That's pretty much all you can do, too. It is a patient's option to receive from us or not. It is a patient's journey to leave us behind.