Sometimes when a patient asks for a ‘change in meds’ I look at their chart, thick as a brick, and wonder what on earth to do given all we have done already. I tell the patient to hold on until I do a chart review. This usually involves a weekend afternoon when I reread the chart from beginning to present. As I do this I draw onto a single piece of paper a timeline of what meds were done and what happened, looking for patterns and ‘forks in the road’ where we tried “A” instead of “B”. It’s tedious work but it always gest me to see the forest for the trees and what is the logical next step. It never fails to come up with ideas. I place the paper in the ‘chart review’ folder. I pull them out when a patient with one has an appointment to add to it when changes are made.

I have another folder. When a long time patient with a chart review stops coming in I take the paper out of the ‘active’ folder and put it in the ‘inactive’ one. Sometimes patients disappear for years only to return and I move theirs back into the ‘active’ folder. However the majority of the inactive folder stay there. Some I know why: they have moved away or have died. The majority I don’t know why they didn’t return.

Whenever I open the inactive folder to place or retrieve a review I see the all names of the ones therein and remember them. Of the ones who have died there is no point in holding onto their reviews; they ain’t coming back. However I don’t throw them away. It is like a cemetery that I visit and see their grave stones.

The active patients know I have a chart review but the ones in the inactive file (dead or otherwise) do not. It doesn’t do the deceased any good that I still think about them from time to time. It does me some good I suppose. One of the premises of Jungian psychology is any encounter of the analyst with an analysand causes both to alter. I’ve learned and grown from these interactions. Sometimes I’ve suffered for it. I never know how much (if any) I effected them and their psyches. Some patients have been very trying if not hurtful to me but there were lessons learned and the suffering therefore has some meaning. I feel honored I was part of their lives, even if only for a little while.

In another drawer it a third folder, an older ‘patient cemetery’ of some patients I had back in the 90s when I had a pokey private practice in Chicago. Who knows what happened to them. I know the outcome of one of them: he killed himself. Afterwards his family tried to sue me. I hold onto this one’s chart review somewhat out of a sense of regret of what I could have done. His spirit lives on this way to remind me what I may have done wrong (if anything).

Every once in a while I think to throw out the chart review of the deceased and the ones I know are not coming back. But I hold onto them.

Most of us won’t be remembered past a few generations; it is nice to know someone remembers us for a little while.