One foot in front of the other is up to you

O

ver the years, I’ve spent a lot of time with Rabbi Naftoly Bier, my rosh kollel from Boston, and can honestly say I’ve never seen him get angry. I’ve watched this even-tempered talmid chacham deal with frustrating community crises, people who had treated each other without human decency, and even observed him respond gracefully to someone who came to him with an agenda to incite a community scandal. I’ve personally been upset on his behalf, but never saw the tiniest bit of anger in him.

Except once. Someone had double-parked outside of the kollel and was blocking one of the avreichim who was now late for picking up his kids from daycare.

“Don’t they understand that this is geneivah?” he said, more upset than angry. “They’re stealing the father’s time waiting to get to the babysitter, they’re stealing the babysitter’s time, and they’re stealing the children’s time with their father!”

In my practice I experience a similar feeling when my patients show up late. Most of my colleagues who run private practices have a standardized way of dealing with this problem: You get 50 minutes no matter what, even if you were caught in a tornado. Show up 17 minutes late and your appointment is reduced by 33%. Don’t show up at all and you get the bill anyway, unless you cancelled two business-days in advance.

And it makes sense most of the time. Showing up late or blowing off an appointment is geneivah when the professional’s livelihood depends on the visit taking place. But that’s not the only consideration.

Yaffa was a single woman in her late twenties with a history of panic attacks. She had an initial assessment with a social worker and was then referred to me. This particular social worker was a respected colleague and I was looking forward to meeting the patient. The treatment for panic attacks is one of my strongest clinical experiences: a working combination of psychoeducation, cognitive-behavioral therapy, and relaxation exercises with or without psychopharmacology (depending on the situation and the patient’s preferences, of course).

But Yaffa didn’t show up for her appointment, and 15 minutes after it had started, I called her to make sure that everything was alright.

“I’m so sorry, Dr. Freedman,” she said. “I totally forgot.”

“That’s okay,” I responded. “We’re only human beings and can’t be expected to be perfect.” It was the truth. Sometimes these things happen.

“Can I reschedule for Thursday?” she asked.

“Of course,” I told her. And we did.

But come Thursday, Yaffa was nowhere to be found, and 15 minutes into the appointment I decided I should call her again.

“Oy, vey!” said Yaffa. “I can’t believe I forgot again.”

“I hear you, Yaffa. But if it’s really important for you to fix this problem, then the first step is showing up for your appointments.”

“I know. I’m so sorry again, I promise I’ll come on time, I’ll even be early next time,” she said.

As she sounded sincere and I wanted to provide high-quality treatment for my colleague’s patient, I offered to reschedule her a final time.

But then came the chazakah. And 15 minutes into our appointment I was forced to call Yaffa, as she hadn’t arrived.

“I’m so sorry, Dr. Freedman. I’m just stuck in traffic. The traffic into the city is awful. I feel terrible,” said Yaffa.

I also felt terrible. I was trying to judge her favorably but it was becoming difficult. This would be three cancelled appointments in a row and there wasn’t that much I could do.

“Can I reschedule again?” Yaffa asked.

“I don’t know, Yaffa. You have a chazakah for missing our appointments now. And you should know that this is basically geneivah because you’ve wasted three hours of my time.”

“I’ll pay you for your time,” Yaffa said.

“Well, I appreciate the offer. But truth be told, that’s not even the issue. The issue is that I have people waiting up to a month or more to see me for an intake appointment. You didn’t just steal my time, you stole their time. And not just once, but three times.”

“Dr. Freedman, I’m really sorry….”

She did sound sorry. And I was trying to think about Rabbi Bier. Would he forgive her? Would he give her a fourth chance? I’d have to call him later to ask, but right now I needed a solution. And then Hashem sent me a sign. I’d just received a message from my next patient that he wasn’t feeling well and wouldn’t be able to make it for our appointment, which was scheduled directly after Yaffa’s.

I took a deep breath and thanked Hashem for his amazing kindness in showing me what I felt must be a very clear message.

“Yaffa,” I told her. “I had a cancellation, and my next patient won’t be coming in. If you’d like to get through that traffic and daven that Hashem saves you a parking spot near my office, then I’d be happy to see you when you get here.”

“Really, Dr. Freedman? I’d be tremendously grateful and again I’m so sorry.”

A few minutes later, Yaffa walked in. And I wanted to set the record straight right off the bat. “Yaffa, I don’t think that you did anything egregious or deplorable by missing the appointments. This stuff happens sometimes.”

“I appreciate it, I really do,” she answered. “I mean, I’m here to get treatment for my panic attacks, and all that’s happened so far is that I feel I’m getting one trying to be here on time for this appointment.”

“I understand completely. So let’s relax and take some deep breaths for a bit.” When things seemed calm enough, I decided I’d use this whole experience as a teaching moment for her about the work we’d be doing moving forward.

“Yaffa,” I said. “We are about to embark on a journey whose destination is to cure your panic attacks. I’ve been a tour guide on this road for lots of folks, and having done it for a while, I can tell you that without a doubt, the most important factor here is the patient himself.”

“What do you mean, Dr. Freedman?” Yaffa asked.

“I mean that you’ll get what you put into our work together. I’m going to be providing you with a lot of skills and exercises to target your symptoms, but in the end you’ll be the one who will have to put one foot in front of another.”

“And that starts by showing up for my appointment, I guess.”

“Bingo. Now let’s get started.”

Originally featured in Mishpacha, Issue 700. Jacob L. Freedman is a psychiatrist and business consultant based in Israel. When he’s not busy with his patients, Dr. Freedman can be found learning Torah in The Old City or hiking the hills outside of Jerusalem.  Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.