Sandra is my first patient of the morning.
![Figure](https://www.cmaj.ca/content/cmaj/166/6/786.1/F1.medium.gif)
Figure. Photo by: Art Explosion
We start at 7:00 a.m. She has never missed a session. She is always on time. She stares at me like an owl and I wonder what she is thinking. She has a very serious stare right now and she is frowning at me and her two brown eyes grow darker and larger. I have a falling sensation, and the room seems jittery. It is a horrible dark falling inside of me and I hate the way it makes me feel.
“You weren't listening to me,” Sandra says.
“You didn't say anything,” I reply.
She stares back at me. Her eyes are burning with rage.
“It doesn't matter if I didn't say anything,” she says. “You weren't listening.”
“Oh?”
“No, you weren't.”
I feel the room tremble and the air grow still.
“Actually, I was listening to you. I was looking at you,” I say.
“No, you weren't looking at me. Your eyes were half closed.”
“My eyes were closed?” This is very serious, I think.
We have a running battle, Sandra and I. It is like a series of small skirmishes, insurrections, counterattacks. I try to plot my answer. Yet what do I say?
She waits for me.
“You think your eyes were open, but they were closed. Maybe half closed. And you were not moving. You were like a statue, like a piece of wood. No, stone! You were stone. You sit there like this piece of stone and you are half asleep.”
“I realize that is your experience,” I say, “and I know it is very important. But we try to understand how you feel — ”
“Feel? No, no, no,” Sandra says, cutting me off. Her face is sharp as steel. It's too bad; her face is really quite beautiful and sensitive and likely once was tender, but now it is twisted and I think she truly hates me.
“This is it, Dr. R. I've tried with you, believe me.”
“We are both trying,” I say. “But sometimes it gets very hard.”
“I don't think this is good for me. You always seem so tired and I know you are unable to listen —”
“Listen?” I say. “You said that you wanted to work on your —”
“I'm fed up. I'm absolutely fed up. I don't have to put up with your fatigue and your lousy excuses, and I don't think I can ever get closer to you. I've wasted two years coming here and I don't think I've got anywhere.”
“Well —”
“I haven't.”
“You are letting me know how enraged you feel and how fed up you are with me. And that is what you are able to show me here — anger, frustration, dissatisfaction — but at the same time, you know, I am listening to you. I am watching you and we are working on this together.”
“Well, maybe,” she says. “Or maybe not.”
I look at my watch. It is early in the morning and snow is falling. Outside the wind is blowing against the window. It is growing lighter.
Ronald Ruskin Psychiatrist Toronto, Ont.