Paul in his kitchen when the phone rings. It is April asking to come in for a last session.
They start in silence. April complains that her hat itches and that it looks ridiculous. She says Daniel gave it to her. She let her mother tell him because she was afraid he wouldn't react. She tells Paul that the tests show that the mass behind her spine is shrinking. Paul says he is relieved for her and asks how she feels. She says she doesn't know.
Paul asks if she was surprised by the results. She asks if he is alone there, where are his children. He says they live with their mother. Then she tells him that Kyle and Sienna broke up and that he gave her a necklace to a wishbone. She is cynical about this, says it is too late because she is gone, that the girl he loved is gone, doesn't exist anymore even if she goes into remission because she will always have to tell people she has had cancer. She tells him she is repulsed by the idea of sex and thinks that part of her that wanted it is gone. Paul tells her that she is involved in recovering and desire will come back. She says he is right.
Paul asks about her message that this is her last session. She says she wants to stop. And Paul says she needs help during her recovery. He would like to schedule sessions with her parents and maybe with Daniel and she yells at him to stop and calls him an asshole and gets up and runs into the other room. She apologizes and he says it's not necessary. She challenges that and Paul tells her he's her therapist and she does not have to take care of his feelings.
They sit down again. Paul suggests she reacted so strongly because only a part of her wants to leave but another part wants to stay. She says what is the point because she could get worse. Her head is itching and she refuses to take off the hat. She says she dropped out of school last week. She says she'll never get a job as an architect because her work is shit. She said she only went to grad school to make her mother happy because she could know she had a plan. Her mother used to say a mother is only as happy as her least happy child and would look at Daniel, while April would think she was looking at the wrong child.
Paul asks why she didn't take a leave of absence. She says she won't go back. Paul says she is cutting ties not only with him but with everyone. She says she is 23 and had cancer so where can she go from there. Paul asks where she would go if she could go anywhere. She says back, back to her home. She says she is thinking of going from one organic farm to another getting room and board for her labor until she forgets everything.
She says she doesn't want to be the one who survives, because it is so hard. Paul asks if it was like that before she got sick. She says no, that before there was a path, steep and difficult but it was there. Paul tells her that her life's path was changed without her consent and it is so hard to handle. He tells her she will grow older, fall in love have children if she wants to. She says he doesn't know that. He tells her sometimes we have to act to make it so, that she can't see possibility now but that doesn't mean there is none. She is crying and fingering the necklace. She says she thinks she will be alone her whole life because she can't imagine loving anyone again.
She says she went to his web page. He wryly says it is empty and she says it isn't now. That there is a comment from Sophie, who has good things to say about him. He thanks her for telling him. April says he has really helped her. He says he didn't do that much, that she did the work. She insists that he let her thank him and then let her leave. he asks if she is sure because they have accomplished a lot. She says she came in with cancer and she is leaving with cancer. He says that all of her feelings are a good thing. She smiles and accepts what he says. He says if not with him, she needs to be talking with someone. She says, not him. She says not him because he is the guy who saved his life He asks if she would like him to refer her to another therapist. Se says maybe later but she wants to focus on getting well now. She scratches her had more. Paul gets up and goes to a drawer and brings back a leather hat which he says was his father's. She asks if she can try it on and he says yes. She tells him to look away and then she laughs -- the hat is a flight helmet and she loves it.
She gets up, thanks him and kisses his cheek. And then she leaves.
Another good session, though wistful. April is struggling with allowing hope to re-enter her life. She is willing to see that she may indeed need ongoing support. And she knows that what Paul was willing to do -- take her for chemo and call her mother -- was what she needed and that he contributed to saving her life. She is grateful to him but she feels she cannot continue working with him because he saved her life. I understood what she was saying on a visceral level but am finding it harder to put into words. I think this is her way of preserving the feelings and experiences she has had with him, preserving them against the destructive urges she is still experiencing -- in leaving school, in believing she cannot have love and a normal life. Leaving now allows her to continue to hold him as her savior and given what she tells Paul Sophie wrote about him -- and a nice way that was of updating us on her -- she sees him as someone able to help, it is not at all unlikely that she will return. She accepts the hat, which was Paul's father's and it is not hard to imagine her wanting to return it one day when she no longer needs it. But in taking it, she is taking Paul with her. Eventually she will call Paul, not for a referral to another therapist but to come back to work with him. Or maybe that is my wishful thinking.
And I suspect that this is better for both Paul and April. For April to give her time to be with what she has now and go on recovering and for Paul because he still wants to do too much with and for her, which he showed in his telling her about sessions they could have with her parents and her brother. That is Paul's agenda, an agenda he has to set aside in order to be able to meet her fully where she is and to receive her agenda. We cannot create a plan for our patients' lives because those are not our lives to live. The agenda must be the patient's because it is the patient who must live it.