When I first met Joanna Hill eight years ago, she was thirty-four, diminutive, and had short brown, stylishly cut hair. A beautiful young woman who was funny, and had a kind-hearted soul, she and I both looked forward to our twice a week get togethers.
In the beginning, she talked about her stressful job as an insurance claims supervisor. Hired as a clerk after high school graduation, she worked her way up the ranks, and at twenty-seven, was in charge of a team of seven people.
After Hurricane Andrew (the most devastating natural disaster in U.S. history, until it was surpassed by Katrina thirteen years later,) hit south Florida in 1992, she was sent to the area to assess the damage.
She flew into Miami (which, though slightly damaged, was nothing compared to the hit suffered by the southern part of the county,) and lived for three weeks without electricity or water. “It was so intense,” she told me. “Every day, we, the other claims
adjusters and I, ventured into devastated Dade County to check the damage to homes and buildings, some of which were nothing more than piles of wood. Remember that game, 'Pick Up Stix?' That was what it looked like.
“It was hard to find your way around,” she said. “The street signs had all blown away and the roads were littered with broken trees. The destruction was indescribable. The Federal Government took forever to send assistance and the pain and suffering of the
residents was unimaginable.”
With little help and so much damage, Joanna found herself on the verge of a nervous breakdown. “How did you handle the stress?” I asked her.
“Lots of drugs and alcohol,” she replied coolly. I saw the far-off look in her eyes, and the tenseness in her shoulders and knew she was reliving the experience.
“Are you okay?’’ I was concerned for her well-being.
“I will be.’’ She lowered her head and I knew the conversation was over for now.
The next time we met, she told me that in the midst of all this horror, her mother called to say that her long-ailing father had died from cancer. “I wanted to fly home to California, but my boss told me I couldn’t go – not yet anyway. There was too much work to do, and no one to relieve me. Maybe in three weeks, he said, but not yet.
“I was overwhelmed with guilt. I loved my job; I wanted to be there to help those people; but I also wanted to be home with my mother and sisters.”
“So what happened?” I asked.
“I stayed in south Florida and had to miss the funeral. I felt so bad about that.”
Eventually, Joanna said, she was allowed to fly back to San Diego. But by that time, the funeral was over, and her father’s two brothers and younger sister had returned to their homes. Her older twin sisters, Victoria and Virginia had returned to Montana, so it was up her to deal with the aftermath of her father’s death, assisting her mother with cleaning out his personal effects, and reviewing the finances.
In the fall of 1993, her mother started showing the first signs of Alzheimer’s disease. Months later, Joanna gave up her apartment and moved in with her because of the elder woman's tendency to wander. It was in the spring of 1999, toward the end of this ordeal, that I met Joanna. Our relationship gave her an outlet for her frustrations, and a way to release her growing hatred of her mother and her situation.
"I feel trapped,” she said. “I don’t know how to help her.”
“Or yourself, for that matter.”
“Yeah, that too. I contacted the Alzheimer’s Association and they helped out some, but private care and resident facilities cost money, something neither she nor I had. I decided to quit my job to take care of her. That was a tough decision, but one I thought was right at the time.”
“That has to be rough.” I reached for her hands in a show of sympathy.
“It’s the toughest thing I’ve ever had to do. Sometimes I wonder how I’m ever going to survive. But I hired someone to come in to relieve me for a few hours a week so I have some time for myself, but basically I’m her caregiver twenty-four/seven.”
"You’ll survive. It may not seem like it now, but you will. How long has she been ill?”
“Almost seven years. Seven…very…long…years,” she said, drawing out the words.
“Do your sisters offer any assistance?”
I hit a sore note. She tightened her fists. Her breathing became fast and shallow. She set her jaw and narrowed her eyes, revealing the rage she had been keeping under control for all these years.
“Those bitches?” she laughed, her voice a mixture of bitterness and sarcasm. “They tell me how sorry they are that mom is going through this, and how it’s only going to get worse. But do they offer me any sympathy? Do they ever offer to come here and give me any relief? No. They’re too busy with their own lives on their expansive ranches, taking care of their own families. I’m the single sister so why shouldn’t I take care of mom, right?”
“Well, you’re doing what you have to and you should be proud of that.”
“Yeah, I am. But you know,” she said, her voice softening, “as hard as it is, I’m glad I’m doing it. My mom means the world to me. I’m her baby and we’ve always been very close.”
One day later that summer, as we sat in the park looking out on the lake filled with ducks, geese, and cranes, she said, “I used to be a happy-go-lucky girl. I used to party with my friends, shop, and go to concerts. Now look at me.”
I had noticed a change in the few months I’d known her. Her large brown eyes had lost their youthful excitement. Crows’ feet now stretched across her face. Her skin had
lost its luster. She was bitter and disenchanted with the world, and especially with her sisters.
“Have you talked to them?” I asked.
“Yeah, but it’s the same old thing. 'I’m too busy. I don't have time. The kids need me.' It’s never going to change,” she told me, her voice filled with the anger she harbored. “But talking to you helps. Thanks for being such a good friend, Dana,” she said, patting my arm and smiling.
“You’re welcome. But you have to let go of the anger, Joanna. If you don’t, it will destroy you,” I told her. “You have to accept your sisters for who they are, and remember that you’re doing the best you can.”
In May 2000, her mother passed away, and I saw another drastic change in her appearance. Her graying hair desperately needed to be cut and colored. There were new deep grooves in her face that extended from her nose to the corners of her mouth, making it look like she was perpetually scowling.
Instead of a new outlook I had hoped would come with her newfound freedom from responsibilities, she looked old and tired. Our conversations centered mostly on her bitterness about what she considered was a wasted life.
“You told me you used to be a party-girl; you used to shop, hang out with your girlfriends, go to concerts,” I said. “Why not do those things again? You’re still young, you’re how old now?”
“That’s still young. You have your whole life ahead of you. Your mom’s gone; you have no responsibilities. Get out, meet people, do things,” I was trying to encourage her to get back to the job of living.
“Yeah, okay,” she replied, but I could see my words were falling on deaf ears.
Then one beautiful fall day, that all changed. We were sitting on a bench outside my office, enjoying lunch and the changing foliage, listening to the chirping birds, in an area landscaped with palm trees and waterfalls. Joanna liked being outdoors, looking at nature’s finest, having seen its worst. The sun was shining and so was she. Her eyes sparkled, and the color was back in her cheeks. And she had been to the beauty
salon - her hair was stylishly cut again, and the gray that had started to spring up, was now discreetly covered.
“What’s going on?” I asked. “You look ecstatic.”
“I am,” she said, a wide grin lighting up her face.
“Why? What's happened?”
“I met a guy.”
“Really? That’s great. What’s his name? Tell me about him.”
“His name is Alex. He’s forty-two, tall – maybe six-two - has black hair, graying at the temples, steel blue eyes and a fantastic body from working out every day at the gym. And,” she said, looking around to make sure she couldn’t be overheard, “buns of
I laughed. “That’s wonderful. What does he do?” I really was happy for her. She deserved something good in her life.
“He’s a lawyer; he’s rich. And he loves me.”
“That’s great Joanna. When are you seeing him again?”
“Tonight. I invited him over for dinner. I’m making lasagna, and a green salad with Caesar’s dressing. And I’m serving a bottle of merlot wine. He told me that’s his
“Sounds wonderful. When did you meet him?”
“Oh? Why didn’t you tell me about him before?”
“I wanted to keep it a secret,” she answered, lowering her head as if embarrassed over keeping this information from me.
“Why? If I’m your friend, why not tell me?”
“ ’Cause,” she replied. She rubbed her bottom lip with her index finger, a nervous habit she had recently developed.
“ ’Cause why?”
“ ’Cause I didn’t want you to know,” she said, her voice relaying the annoyance she was feeling at my questions.
I left it at that and the next time I saw her I asked her how it went.
“I don’t want to talk about it,” she replied. She rubbed her lip, then lowered her head.
“ ’Cause I don’t. Let’s talk about something else.”
That was Joanna. She had to be in control of the conversation. I learned a long time ago that if I just let her run with the ball, she would, but she despised being directed.
Over the next three months, she told me more about Alex. One day, as we sat in the park, which was becoming her favorite spot to meet, she said, “Guess what? We got married over the weekend.” Her face beamed and I could see she was truly happy, perhaps for the first time in several years.
“That’s great,” I said. “But isn’t it a little sudden?”
“No, it’s not sudden at all. He loves me. Why can’t you be happy for me?”
“I am happy for you. I just hate to see you rushing into anything.”
“I’m not. We’re in love and just want to be together,” she said defensively.
“Well then, I think it’s wonderful. Congratulations,” I said and hugged her.
Over the next year, I watched helplessly as she turned back into an old lady. Now approaching her mid-forties, she seemed to have aged twenty years. Her normally straight posture was hunched over, and her once beautiful, sparkling brown eyes had turned dull and lifeless. She had gained about twenty-five pounds and her once shiny and luxurious hair now hung in her eyes, dirty and uncombed.
“What’s going on with you,” I asked.
“Alex left me,” she said.
“Oh hon, I’m so sorry to hear that. What happened?” I hurt for her. I had truly wanted her to find happiness.
“He just decided he didn’t want to be married to me anymore. He walked out and took the kids with him.”
“Kids? What kids?" I asked, shocked at this revelation.
“You know, Jason and Meredith. He's five and she's three.” The look in her eyes scared me. I thought she was losing touch with reality.
“What are you talking about, Joanna? You don’t have kids.”
“Sure I do. I told you about them,” she said getting angry with me. “Here, I’ll show you their picture.” She opened her pocketbook and pulled out her wallet. She flipped it open to a photograph. Yes, I’d seen it before – in wallets for sale in the department
“Oh, yes. I remember now,” I said. I had to tread carefully. I didn't want her to disassociate completely.
Joanna started crying, the first tears I’d seen from her in a long time. “What am I going to do, Dana? My life is nothing without my kids,” she wailed.
I put my arms around her, holding and rocking her as she continued to cry.
The next time I saw her, a couple of weeks later due to personal events that happened in my own life, she looked different. Her hair had been cut and styled and she had lost a few pounds.
“Hi, Joanna. I must say you look better than you did the last time I saw you.”
“Where were you? I missed you,” she said. But her voice was monotone, her eyes vacant. What was she thinking, I wondered.
“I’m sorry. I had to go out of town for a couple of weeks to take care of some things. What’s been happening?”
“I’ve decided to become a writer.”
“That’s fabulous,” I said. “What kind of stuff do you want to write?”
“Children’s books. For Jason and Meredith. So when I see them again I have something to read them. Wouldn’t that just be so cool?”
“Yes, it would.”
Over the course of the next year, Joanna said she had written three books. “They haven’t been published yet, but I’m working on it,” she told me. Her appearance had started to improve, and I was glad she had found something that made her happy.
Then one day, what I feared most happened. Her emotions out of control, she wandered into the middle of the street, sat down, and cried. She was taken to a hospital where she underwent a psych evaluation.
I'm Dr. Dana Lindsay. Joanna Hill is my patient, and this has been her story. Everything following the death of her mother occurred only in her mind. There never was an Alex; there never were any children, and she has never written a single word. She had fabricated these stories. Once she had given up the frenzy of an important job (that part was real,) she needed the excitement of a lover, and the pain of losing him and her imaginary children, just to be able to wake up every day and face what she considered her dull and boring life.
I determined she had had a psychotic breakdown and she was committed to a mental institution. Psychotherapy has helped, and with time, I think she will be able to again take her place in society, which is all any therapist can hope for. I know Joanna is tough; now I have to help her realize it.