Because Caitlin spoke quickly—she was articulate and funny—it took me a while to see the fragility beneath her armored self. Her story was a difficult one: David, her husband of ten years (together for nearly twenty), had just been diagnosed with terminal liver cancer. At their last hospital appointment she had pushed the doctors to give her some idea of his life expectancy, and was told he had between nine and eighteen months to live. David had chosen to know the bare minimum, but privately Caitlin needed more information; the part of her that was feisty and strong said, “I’m sailing this ship; I need to know what I’m dealing with,” though she cried as she told me this. Theirs was a complicated relationship that had been affected by his addiction to alcohol, but she still loved him.

Her greatest concern was for their two young children, Kitty, nine, and Joby, six. She hadn’t told them their father was dying. The overriding feeling that emanated from her was one of fear, great wafts of it: fear of the unknown, fear of survival, fear about whether she/they could cope, fear about money, fear for her children, and, of course, fear about David’s dying. Caitlin was all at sea. She felt naturally protective of her children, who were very young; she had already been telling them white lies to cover up David’s drinking. She was worried he would suddenly drop dead and she wouldn’t have any time to prepare them. I asked her what she thought they knew. She said, “Nothing.” I told her that was unlikely, because children are smart; they sense immediately when something is wrong, even if they don’t know exactly what it is. And, in fact, she later mentioned that they had said, “Daddy is like Daddy but smaller.”

We discussed whether David would be involved in the conversations, and she was clear that he wouldn’t be. We agreed that she should start by asking her children what they knew about their father’s illness. I told her that over time they would need to be told the truth—not all at once, but in bite-size chunks. Her answers to their questions needed to be literal and factual; what children don’t know they make up, and what they make up can be more frightening than the truth. If they were told the truth, they would trust her, and that trust would be the foundation of the support they would need during this incredibly difficult and frightening process.

In a later session Caitlin told me about how she had broken the news of David’s impending death to her children. She explained to them that “Daddy is very sick, and doctors can usually make people better, but Daddy is very, very sick now and this time the doctors can’t make him better.” They didn’t cry at first, but when she asked them what they were worried about, she cried, and then they all cried. She’d shown them it was okay to cry, and good to do it together. They’d had lots of questions. Was he going to die? Were they going to die? Caitlin was honest and gentle with them. She said, “Daddy will die when his body stops working; we don’t know exactly when that will be, but I’ll always tell you the truth.” Then they got on with their usual routine of dinner and bath and stories, with extra hugs, which soothed them. It had been a heartbreaking conversation, one of many they would have over the weeks that followed, but, difficult as it was, she had managed it with great courage.

I was confident I would be able to build a relationship with Caitlin. She was like a revved-up motor, and she needed to be able to trust enough to slow down and to feel safe. Safe had been the key recurring word in many of our sessions. She needed a reliable, consistent person who would listen to her with care, and not be overwhelmed by her story—someone who could give her the necessary tools to structure and then manage her very real fears. She loved her husband but also hated him at the same time for everything he had put them through—his drinking she described as “dripping poison onto our family”—and she felt that his dying would damage them irrevocably forever.

Caitlin carried her anxiety about in a whirlwind of agitation. She would fly into my room speaking incredibly quickly, as if the faster she spoke the more she could stave off the pain, like someone leaping between hot coals. She knew of very few ways to calm herself when she became anxious, which only intensified the distress attached to her grief. She often spoke about her mother, whom she saw regularly and loved deeply. But what soon became clear to me was that her mother’s parenting had been erratic; like David, she was an alcoholic, and this inevitably meant Caitlin couldn’t trust her. Caitlin told me about experiences she’d had around the age of ten: her mother would often be late to collect her from school, and Caitlin would be forced to hide behind the bus shelter, hot with shame and overcome by a desolate feeling of loneliness that would never leave her. These episodes revealed the roots of her sense of abandonment and how the lens through which she saw the world had been formed, her first thought in any stressful situation being “I’ll be left alone.” Shame and fear were recurring words in our sessions. But she loved her mother and would vacillate between deep, warm love and painful anger. My interpretation of these emotions—which she didn’t agree with—was that she had the “magical thinking” of a child, hoping that her affection might control her mother’s drinking bouts. She believed that if she was good, her mother would also be good, and that if her mother was drunk, it was because Caitlin was bad. Of course Caitlin ultimately came away with a fixed idea of her own badness.

Into that fault line a devastating tragedy struck when she was seventeen years old. Her beloved father, who had been a huge-hearted and successful man, became mentally ill, and hanged himself in the woods near their family home. His death came after a brief and unfathomably deep bout of depression. Caitlin said it had been like “carrying around a bottle of cyanide” in her stomach since his death. She told me that her father had been “a great man” whom she’d loved. As she was speaking, I could feel myself becoming fuzzy-headed; it was too much to take in. I told her this, and she cried. Something about my acknowledging how overwhelming it all was allowed her to acknowledge it as well. The raw shock of her father’s death had been vividly with her for decades; our time together allowed her to touch on it, but only for brief moments at a time. Although this submerged grief, which felt to me as if it had scorched her at a very deep level, was inevitably evoked by her approaching loss, now was not the time to deal with those wounds. It would destabilize her at a time when she would need all the resources she’d built up to work for her, in the face of David’s death and its myriad implications.

Caitlin was the youngest of a large professional Irish family with many close, open, and good friends. But with men she was different. She looked to men to validate her and to make her feel lovable; she believed she had to put on a show to please them, prioritizing their needs and, in the process, ignoring her own, with the result that she ended up feeling empty and used. At this point in her life, her man-obsession came in the form of Tim. Caitlin said that she loved David—he was kind to her, had chosen her above all others, and was the father of her children—but his drinking had made her lose respect for him. It had fractured the fragile trust between them, and her desire for him had drained away.

Tim was a fantasy figure who, she knew in her sensitive, intelligent mind, was totally unsuitable. Tim worked in marketing and was full of charm; he had recently separated from his second wife and was in financial and emotional turmoil, having to pay for three children in two homes as well as for his own apartment. Caitlin knew he was incapable of giving her what she needed, but no amount of “knowing” influenced her behavior: “I’m like a heat-seeking missile, constantly waiting to hear from him, planning when I can see him, rehearsing over and over in my mind the things I’ll say that will make him want me.” Her fantasy was that he would realize he was “madly in love” with her and make passionate declarations of love. There were two dialogues running concurrently in her head: the “I love you” one and the one where he would declare his love and she would tell him to “bugger off.” The reality, however, was harsh. When they did meet, he was unpredictable: sometimes charming and seductive, sexually drawing her in, and at others times quite dismissive. She would be anxious and needy, constantly hungry for his next text, checking her phone every minute, unable to concentrate until the message arrived. When it did, she would read and reread it, forensically trying to extract meanings that the actual words rarely conveyed. Disappointed, she was left hungry for another message. This pattern—in which she rejects him in the hope that he will chase her—is a common one in relationships; one person is shouting “go away” when what they really mean is “fight for me, come close to me, show me you want me.” It is also very commonly found between children and their parents.

Influenced by her Catholic beliefs and upbringing, Caitlin wanted a version of herself she could be proud of—but inextricable from this was her need to be desired. For Caitlin, Tim was a magnet, pulling her with insurmountable force toward him. He brought out aspects of her younger self, desperately longing for her mother’s attention; Tim’s inconsistency mirrored her mother’s, and her sense of being a bad person, not worthy of being loved, remained in her.

Caitlin would speak while looking at the floor, and then look up sideways, checking that I was still there, worried that I would be judging her. She later said that it was in these moments that she finally felt someone was seeing her for who she was, warts and all. She didn’t feel she was being criticized, and this freedom from judgment enabled our relationship to grow. At the point I mentioned an assessment, to see how we were doing, she broke down. “Oh, you’re going to leave me as well, are you?” she snapped, and then cried. She thought that this was my way of ending our sessions. I explained that our ending wasn’t something that I would impose on her; we were both in charge of it, and we would agree on it together. It was important to let her know that I wasn’t going to repeat the pattern established by her father and husband and suddenly disappear from her life. The emotional armor with which Caitlin had girded herself as a young child was like a coat of varnish, as impermeable as it was invisible. It prevented her from taking in and retaining positive feelings and blocked the very nurture she needed most. In fact, she drew away from real, authentic loving, although it was ostensibly what she had always been seeking. As a result of our work and the care she received, she very slowly began to believe that she was lovable.

However, Caitlin’s obsession with Tim couldn’t just be dismissed; at the same time, I was aware that it was acting as a kind of anesthetic, numbing the pain of David’s approaching death. It was also a way of relinquishing her sense of self. I needed to ensure that the Tim drama did not divert me away from her fear of being abandoned, which was the key to her continuing damaging behavior. If she could find a way of soothing her internal agitated child, rather than hurling that poor child into his weak and insecure arms, she would be better protected. In effect, I was seeking a way to help her take care of herself. The metaphor she used to describe herself was a pint of Guinness: she showed everyone the frothy layer on top, but most of her was contained in the bubbling darkness below. We were able to look at the “darkness below” together. “Grief has hit my confidence bang in the gut,” she said. “It’s like walking around with no petrol in my tank; everything is harder than usual and feels doomed to fail. I’m angry all the time and I can’t see an end to it.” We discussed ways to cope, such as giving herself a manageable number of tasks during the day: doing comforting things like buying nice food and cooking for the family and eating well, all of which helped her to feel more in control.

I gathered that David hadn’t been able to fulfill his potential professionally; loss of confidence closely coupled with his alcoholism had thwarted his talent. Now it was impossible for him to work. He was undergoing treatment—radiotherapy to reduce his symptoms—but it wasn’t going to prolong his life. He would be very tired for a few days afterward but then recover reasonably well. Although he wasn’t drinking, his pain-relieving drugs made him behave in much the same way as if he were drunk, which Caitlin found just as disturbing.

Caitlin told me they didn’t talk together about his dying; nor did he want to attend our sessions. He clearly wanted to live as long as possible for the children, and he intended to press on as if everything were going to be okay. Caitlin often spoke tearfully in a proud, reflective way of his ceaseless bravery, grace, and stoicism in the face of his terrifying illness. He was a wit, and the humor that had originally attracted Caitlin was now holding them together on their journey through hell, he used to say, “Thank God it’s not you who’s dying—you’d be a bloody NIGHTMARE!” One of the hardest aspects of the situation was the uncertainty, not knowing when he would die, and also the knowledge that afterward things wouldn’t be better but worse.

Caitlin and I saw each other for eighteen months before David died. She was the sole breadwinner, and working, caring for David, parenting, and managing her own inner turbulence all at the same time was incredibly stressful for her. She often felt agitated and saw no light, “only black fear.” But she found a way of living with it. The most fragile part of Caitlin always underestimated her resilience; she was much more robust than she would allow herself to believe. On some subconscious level she knew this, and denied it because she didn’t want to feel regret or guilt (her default emotions) after David’s death. She had made a promise to herself to be kind to David, not to get furiously angry with him, as she had in the past. She found ways to put right the difficulties of their relationship. She bought wonderful-smelling oils and rubbed them into his hands and feet; she stroked his cheek, and they had close, intimate hugs with real warmth—real love.

There were times she came to my office broken and needed to pour out all her struggles, and there were other times when she could only cry for David and the children. She rightly felt proud of what she had so far managed to achieve. She often didn’t sleep well, which made everything harder (it always does, and is common in grief), and we worked together to find ways to help her sleep better.

Occasionally she would stay out late partying, sometimes making reckless sexual choices, which led to days of despair and remorse. Often it was anger that kept her awake, many layers of anger: with David for being an alcoholic and how that had contributed to his illness; with herself for having chosen him as the father to her children; and at the situation as a whole, one that she was powerless to change. Her moods yo-yoed up and down: she had phases when she felt she could cope, and others when she felt full of fear. All this was accompanied by a nasty strain of self-loathing.

The question of whether David felt jealous of his wife because she wasn’t dying was never brought up by Caitlin. It is common for such difficult feelings to be avoided by the couple in an effort to protect each other. The reality of dying and the jealousy it can engender are understood yet also denied. Whether jealousy is voiced or not, it is nonetheless very likely to be present.

David’s deterioration was erratic. There were days when he had energy and could engage in family life: play with Joby and Kitty, go out to see his friends. On other days he’d be much weaker and spend most of his time on the sofa. The children would clamber around him while he made jokes, tickled them, hugged them; they’d sit and watch their favorite TV programs with him, curled up under the duvet. The last phase of his illness came very quickly, and, although it had been expected, it still came to Caitlin as a shock. His pain increased and he had trouble walking. They decided together with his doctor that the hospice would be the best place for him. It was a warm, safe place, where the children felt welcome and could run around. The wonderful nurses loved his jokes and took great care of him, in particular ensuring that he wasn’t in any pain. One of Caitlin’s most beautiful and also harrowing memories was his reading out the messages he had shakily written in books for his children.

I remember well the day he died. It was a warm spring day. I looked at my phone and there was a text saying, “David died peacefully this morning. He was holding my hand.” I phoned and asked Caitlin if the children had seen David’s dead body. She answered, “No,” and I suggested that she take photographs (bizarre as this sounds), as they would be very important to both her and the children later on.

The night before the funeral, Caitlin called me from the funeral parlor, her voice quiet and slow; she told me that they had all seen David looking peaceful, like alabaster. She had placed a love letter on his heart, and each child had placed a soft toy in the coffin and then kissed the casket. She sounded calm and steady, sweetly thanking me for my advice and saying that she felt a sense of “pride and completeness.” For Caitlin there was also an unbidden and unexpected sense of relief: what they had most feared had come, and they had survived intact. I felt, in turn, a surge of pride for her, for all of them.

Often the most we can do in the face of death is to be creatively alive. Caitlin was a creator and she was a force. She focused her energy on David’s funeral and, with his family, made it a tremendous tribute to his life, full of her love for him, and full of the love of his family and numerous friends. The crisis had brought the best of Caitlin to the fore—her deep capacity for love and loyalty to David and the children—and I could only admire and respect these immensely powerful qualities.

As she had loved him in life, boy oh boy she missed him in death. “He hadn’t by any means been the perfect husband, but he was MINE,” she said. Now she was alone. In their bed she was distressed by the empty space of his absence; she would bury her sobbing face in his last-worn T-shirt to smell him. But there had been something clean and clear about his death: there were no regrets between them; they had cared deeply for each other and for their children; and his cruel illness had finally righted their wrongs with dignity.

Caitlin’s pain hit her powerfully six weeks after David’s death, when the numbness had begun to fade. It came in great blasts of loss, and left her blown away and exhausted. She cried. She had taken a photograph of David after he died, and she said, “In death he looked smoother, round, beige”; it made her cry to remember. She was able to miss him because she could throw away the “crappy bits of the past”: “I wish I could smell that greasy neck I used to tell him off for, revolting, but smooth and comforting.”

Sometimes she would resist feeling the pain and act out in harmful ways, such as nonstop partying or fighting with colleagues. Sex is a natural survival mechanism for all of us, and one that she went for. Caitlin had lost intimacy, and she was doing all she could to claw it back. At its most basic, sex is about creating life, the very opposite of death. She craved it, but she rarely had a good experience; often she felt used afterward, because her priority was always to give to the man, and then she wasn’t satisfied. She had one friend with whom sex and friendship worked better; enjoyed on the go between work and home, it resembled what my parents’ generation referred to as cinq à sept. The sex was more satisfying and not at all complicated, which she liked; but always lurking in her shadows was Tim. On the edges of availability, he was full of promises that came to nothing. He had helped her with the wording of David’s service program. She was grateful for that—but then he was unable to give her the attention she craved, hollowing out further the hole she was struggling to avoid. Yet she was still able to use the strategies that she knew from experience worked: taking the children to the park, buying and cooking nice food, listening to meditation tapes at night, reading her favorite books. She became disciplined enough to leave her phone outside her bedroom, to stop herself from manically looking for Tim. Most importantly, she would regularly meet the friends who really loved her, laugh with them and cry with them.

We talked a lot about Joby, “my boy,” and Kitty, “my girl.” They were doing well, both instinctively gravitating toward David’s brothers, who would come and play soccer with them or take them for days out. They missed David’s hugs, and small things could easily upset them enough to cause meltdowns. Caitlin resisted the temptation to break their basic rules of bedtime and manners, for we had discussed their need for boundaries to keep them safe and stable. At night they would light “Daddy’s candle” and often tell a funny or sweet story about him. She could see David in them: “Joby holds himself in a way that is like his daddy, little tics and things”—what she called “nature, nurture, and Nietzsche.” She remembered that she used to tell David off for holding his knife the wrong way around, and Kitty now held her knife just as David had, but Caitlin never corrected her. She used to tell David not to pile the scrambled egg too high on the toast, and as the kids did it now they would say cheekily, “Daddy did it.” These were touchstones that would later enable them to find their father within themselves. Scrambled-egg touchstones.

Sometimes the fierceness of Caitlin’s love for her children frightened her. It reminded her of her mother: “One minute she’d be sweetness and light, and the next she’d turn into a rage like a Hokusai wave.” She had a vivid memory of cozily eating toast with her mother in her parents’ bed; the next minute her mother was on the rampage, screaming about the untidiness of the house. Caitlin remembered: “I was sobbing, purple-faced, because I was wearing all the clothes I’d put on to get them out of the way. She’d gone mad; the bile that came out of her mouth! I’m never going to do that.” This awareness would prevent the wave crashing out of her and turning into violence. Caitlin could breathe, or count to a hundred; she could tell her children to go to their rooms, knowing that she needed space so as not to harm them. She developed strategies that allowed her to change, to become the person she wanted to be.

We both recognized she was back on track about eighteen months after David’s death, because she was coping well with everyday life: sleeping better, having times of happiness. Increasing the time between sessions was a conscious, and joint, decision, one that was made in order to see how she managed with fewer meetings. She knew there would be times when she was “lurchy”—out of control and scared. But she also knew that her work was going well, her children were thriving at school, and she had finally detached herself romantically from Tim, though he was still a friend. She had a new man, not perfect in every way but someone whom she called “a gentleman.” He was kind, reliable, and sexy. They had a good time when they saw each other.

I liken the image of Caitlin’s life that I hold in my mind to a mosaic, the sort you might see in a Roman villa: some tiles might be scuffed or cracked, and some might be really broken. Others are untouched and show a perfect picture. Caitlin’s capacity to give and receive love is what unifies these fragile but precious tiles. David’s dying had split parts of the mosaic, but Caitlin’s generosity and natural exuberance still make the image as a whole shine brightly in the darkness.