Lessons from my dying therapist: care less, have fun – and accept the inevitable | Death and dying

My therapist told me she was dying the way someone else might admit to cancelling their gym membership. Oh no, she told me when I asked how her immunotherapy was going, she had stopped all that. She sounded regretful but not distressed. I was confused. I knew the tumours in her lungs were inoperable but I had understood the cancer was all but beaten. I’d asked how the treatment was going only to check she wasn’t suffering any nasty side-effects.

Actually, the chemotherapy hadn’t worked and the immunotherapy was somehow making things worse. She had been offered another treatment but that would mean losing her hair and she would rather not. So no, she had given everything up except the oxygen.

“Porca,” Sara said, summarising the situation in a succinct Italian expletive, and I slowly understood that one of my favourite people on Earth was dying.

“I love life but if it’s destiny, I don’t mind to die. I think it’s an injustice but I say, Sara, care less for once!

“I believe in a miracle. I want another year, maybe they’ll give me another few months, it doesn’t really matter. I’m feeling quite well actually!”

In fact, we had two months. Rather than cut down on our sessions she upped them, refusing to accept any additional payment, and miraculously this was somehow enough time for her to teach me how to live without her and how to die excellently.

“Dai, come on then, we’ve a lot to do. We need to close properly, and you need to have a baby before I die. Concentrate on making love!”

She was joking. Sort of.

“By the way, do you happen to know someone who can talk French with me? Someone nice and friendly. I need to practise my French for paradise.”

If the boundaries of a conventional client-therapist relationship sound as though they were blurred in her last weeks, they weren’t. At least, not unintentionally. Sara was unorthodox, certainly, but mostly she was cunning; she had a plan.

I found her in November 2018. I had been driving up a steep mountain road on a Greek island on holiday when I started to sweat profusely from my palms. I didn’t trust myself not to swerve over the edge. My whole body started to shake, then I couldn’t catch my breath, then I was going to black out, but there was nowhere to pull over. The roads were narrow and there was a precipitous drop inches from me, so I thought the safest solution was to drive at a crawl on the wrong side of the road, clinging to the mountainside. The trucks driving towards me in the same lane, horns blaring, swerving to avoid me, did not agree. When I finally reached flat land at the top, I stopped, got out and dropped to the ground, needing to press my belly to the earth like a snake. I abandoned the rental car and walked 35km to a port where I hitched a lift back to my Airbnb on a fishing boat. Then I Googled therapists.

One of the first results promising swift treatment for panic disorders was Sara Dryburgh, a clinical psychologist and psychotherapist with 30 years’ experience.

A few days after flying home, I am in the consultation room at her home in north London. A very tiny woman, maybe 50 or 60 years old, with a huge smile, red lips and excellent hair sits on the sofa opposite me, in glamorous silk shirt, covered in blankets. I am also covered in blankets and wearing the fluffy slippers with dog faces she has offered me. The room is messy, littered with open books, mostly on myth and philosophy, mostly Italian; postcards; stuffed toys and trinkets. It’s totally mad.

Sara Dryburgh in Verona in the late 1980s. Photograph: courtesy of Alastair Dryburgh

I tell her that my panic attacks had started when I was six and first understood that I was going to die. They have never really left, just shifted about. Since Greece, they have focused mostly on roads. Driving along any road with a drop, I can black out with terror.

“Yes, the panic is there to tell you something,” Sara says.

She doesn’t want to talk much more about why. She suggests instead that we try a guided meditation and uncomfortably, I agree. Surely reading a meditation from a book is something I can do without professional assistance. Still, I close my eyes and concentrate as she reads in her thick Italian accent. I miss every fifth word.

“You find yourself by a beautiful something. By the something you feel yourself very calm.”

I don’t know how, but it works. When we finish, I feel calmer than I can remember feeling. Or is it safer? In the course of the next three and a half years, I speak to her almost every week and my life changes completely for the calmer and the safer. I quit my job as an editor at the Guardian, move to Greece, and finally recover from a drawn-out, tumultuous breakup. We keep up our sessions by phone. Occasionally she speaks to me in Italian, refusing to accept that I can’t understand.

“Dai! Come on, it’s so easy. You’d learn it in a few weeks if you tried, and then you could read my Morelli!”

In clinical terms, Sara is a Jungian existentialist. Up there with Carl Jung, Aristotle and Melanie Klein is her all-time favourite Italian psychiatrist Raffaele Morelli. I can’t find any of his work in English, but Sara doesn’t see language as a barrier to anything.

“You know Morelli – nothing is just one thing,” she says, as if I’d read every word.

She had started her career as a child psychologist in Verona but her first job in adult psychotherapy was at St Thomas’ hospital in London where she proved to be an extremely effective talking therapist, despite not speaking a word of English. By the time we meet, she has developed her own unique vocabulary.

“Don’t be a fascist! Always so extremist. You need to find a quotidianity,” she tells me.

Quotidianity is not a word, at least not an English one, but I understand immediately what she means. Equilibrium. Easiness. Normality.

“It’s sad, yes, but let’s find the good augit,” she suggests inevitably.

The good augit – also not a word – is the heart of Sara’s ideology. She created it, then embodied it. I had always heard it as some Italian variation of augur: that augurs well, there is an augit. It’s only when she’s dying that I finally ask her what she’s actually saying. Is it object?

“No! Not object. Augit. It means to be able to stay with the good bit of your life. To stay with the good augit is to find the good in an experience,” she says.

“If you don’t have this capacity to take the good augit, then you are trapped.”

Her dying is a crash test for the augit theory. I find myself walking through beautiful Athenian parks crying because I can’t focus on anything other than this feeling of crushing grief. There is an odd sensation of psychic bones being broken and reset. Sara understands this without me having to tell her.

“In this last period, I’ve never learned so much, it’s unbelievable. And you are doing the same. Maybe we are sharing because it’s like the both of us, in a different way of course, are being reborn,” she says.

“I will be reborn as an angel and you will be reborn as a different part of you.”

She has already given me several Lamy fountain pens, all with green ink, and packs of small black notebooks. Now she tells me she wants me to write about her. “Yes! I value myself. I think I did plenty, I deserve a good closure, or no? Write about Sara, ‘I never met somebody so mad, she is dying,’” she laughs. “I thought that, at my funeral – I will be dead – I want you to be there. It would be nice having you as a journalist.”

The absurdity of inviting someone to her own funeral makes her laugh so long and hard, it triggers a coughing fit, and she has to call me back. From this point on, I start to record all our sessions so that I can write about her more accurately, and Sara sets about heroically dying according to the good augit principle.

She has never learned so much, she says repeatedly and in awe. When I ask her what it is she has learned exactly, she always tells me a story about someone else.

In February, Sara is admitted to hospital with what I think is pneumonia. In fact, doctors have given her only a week or two to live. The room has a beautiful view over London, she tells me from her hospital bed, and all the nurses are kind and brilliant. One in particular fascinates her: she has three children but they live with her parents in Africa while she earns enough money to support them. Sara, a mother of three, sees this as superhuman.

“She is an excellent nurse, excellent. If I call her, she is able to forget everything and concentrate on the illness, yet at the same time, she is always thinking about these three children,” she wonders in amazement.

“I think there are periods in life when you can do things that are impossible. Morelli is right – in our mind there is not only negative, we have resources.”

The Italian physiotherapist who comes to treat her at home when she can no longer move easily is a genius. He knows instinctively that distracting her with stories from his childhood is the only way to help her through terrifying fits of breathlessness so he can work on her enough to get her diaphragm functioning again.

It doesn’t make sense to spend your last few months in mourning. I want a new bikini before I die – I’ll wear it in bed

Then there is the reflexologist, she tells me, who comes to see her every morning and makes her laugh. She is so talented, also a language teacher and a makeup artist, and so strong.

“Oh my lord, how can they do it? It’s a distraction, but I’m genuinely interested,” she says when I ask her how she can be so totally absorbed in the lives, problems and abilities of everyone else when her own is ending.

“It doesn’t make sense to spend the last few months of your life in mourning.”

She can no longer do most of the things that had always brought her joy – cycle to London Bridge, go to Vivaldi concerts at St Martin-in-the-Fields, visit the National Gallery, walk on Hampstead Heath – but dying hasn’t robbed her of pleasure.

“I’m treated as a queen! I have a massage on the feet, I have physiotherapy. If I knew I would be spoiled like this, I would have got ill before,” she cackles down the phone in mid-July, breathing audibly through her oxygen mask.

She loves delicious food, her middle son is a brilliant chef, but her body now refuses to digest it and she’s losing a lot of weight. She has the bikini body she always wanted. “You know Italian women, they need to be perfect. I couldn’t care less. I always bought these very small bikinis with this big stomach.

“I told my friend in Italy I need to have a few bikinis. She says, ‘But Sara, you don’t come to the sea!’ I told her, who cares? I need a new one – I will wear it in bed. I want to have it before I die.”

When Sara was four, she had pneumonia. Then she contracted rheumatic fever. Her uncles would wake up at 4am and take her to the sea, believing the water would strengthen her. Her sister had died with pneumonia aged two, and Sara attributes her own survival to the sea. It feels as though it might deliver her the same miracle again, if only she could reach it.

“Mamma, I do miss the sea,” she admits later in July when it’s 40C in north London.

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“I really believe in nature. We should treat nature well because we have more than one family; we are also all children of nature and the cosmos.”

Her beliefs are more ancient Greek than flower child, and they help me. Dying becomes less terrifying when it’s less a brutal cessation of being and more a return to some original state with your meta-family: Mother Gaia, Father Uranus and Grandma Chaos. I find the idea reassuring, particularly if Sara is floating about in there somewhere.

The last photograph taken of therapist Sara Dryburgh, five days before she diedThe last photograph taken of Sara Dryburgh, five days before she died. Photograph: courtesy of Alastair Dryburgh

It’s about this time that I start hugging trees. I do it in the park near my house when I’m sure no other park walkers can see me. It’s a connectivity thing and it also helps. Maybe parts of Sara or me will be tree someday. I don’t tell anyone but her.

“You’re very clever to find parents in nature,” she congratulates me. “Your father is probably a tree, a birch or something similar.”

She bursts into song, offering in four perfect lines an animist’s answer to death anxiety: “Phoebe’s the sun / Phoebe’s the sea / Phoebe’s Phoebe / And is like a tree.”

For Sara, it’s the sea with its endless horizon that connects her to the infinite, the divine, the cosmos. It’s why her reliance on oxygen tanks is so difficult. She can no longer travel farther than an hour from home without panicking that her supply will run out. She will never see the sea again.

As the summer’s heatwave rolls on, she isn’t able to leave her third floor flat and breathing has become more difficult. One night, she almost dies. “At this moment, I really wanted from the heart the sea when it’s in a tempest, a rough sea. I have a friend who is teaching art and I just said to her, ‘Do you mind to send to me some rough sea?’ She sent me so many. Now I have the sea tempesta everywhere, it’s amazing!”

Somehow, for her, a symbol can fill any lack. She surrounds herself with paintings of the sea and fresh-cut roses. “I’m getting fixated on roses. I’m a rose fascist, I can’t have any other flower around me,” she tells me. “I only realised today it’s because the rose belongs to Italy. Also in England, there are roses everywhere, so in this moment when I can’t go to Italy, they are my roots.”

In early August, I fly back from Greece to see her. She looks thin but beautiful, full of energy, dragging her oxygen tank behind her like a bunch of balloons. I bring her pink roses and a wooden carving of a saint from Athens. The Greek Orthodox are very specific and the lady in the shop had recommended Savvas, a saint who specialises in miracles for people with lung cancer. Sara is delighted and we prop him up against the vase of roses, next to pictures of her sons, so she can see him from her chair.

She has a present for me, too: a pair of her silver starfish earrings.

“Just keep it. I want you to have something, for heredity,” she insists when I try to refuse. “Che bella, and they represent the sea.”

We talk a bit about her childhood and she tells me that, in the past few weeks, she’s been comforted by her sister.

“I contact her symbolically. She died but I have her inside myself,” she says with a shrug.

We finish the session by finding three good augits. Afterwards, she asks me to help her organise the presents she wants to send back to the little seaside town in Tuscany where she spent almost every summer. She won’t make it back again. A woman there had a miscarriage and local busybodies have been gossiping, saying it’s because she went out dancing that she lost the baby. Sara’s furious.

“What can I do? She doesn’t need a psychotherapist, so I got her all the girly bits. What does it take me? A few minutes, nothing.”

I am ready for everything because I have an excellent life. I adore my clients. I did an excellent job

But she’s also bought presents for everyone in the town – books, toys, candles. I survey the haul, it looks like Santa’s sled, and tell her that she’s been very generous.

“Believe me if you’re generous it comes back,” she tells me. “Look at me! It comes back in so many things, unbelievable.”

I’ve been worrying for weeks about saying goodbye. What if it’s the last time I see her? It will be too painful. But when it comes to it, I feel warm and happy as I usually do after an hour in her company. I’m convinced she has longer than the doctors are allowing. They don’t know her. She has the sea, Saint Savvas, the cosmos. She’ll die when she’s ready.

“When do I see you next?” she asks as I head out the door, and I tell her I’ll be back in London in September.

“That’s nice,” she says. “I’m better. I think I will be alive. Go and enjoy, have a nice time. You can’t do things without risk!”

Over the next two weeks, our sessions are disrupted because I’m travelling, having a nice time. When we speak again, I’m back in Greece and Sara sounds frail. She doesn’t seem to be sleeping much any more but she’s been using the time alone at night to think and write. She studied philosophy before psychiatry and has composed poetry since she was a child. She has written her rules for a good life and asks if she can read them out to me. The effort is audible.

1 Balance: not putting all your effort into just one thing like professional success or accumulating wealth.
2 Honesty: being honest with yourself; not accepting comfortable lies.
3 Cherishing relationships with people who matter to you. Accepting that some people will never like you.
4 Developing your life to make best use of your own unique talents and attributes even when the result is not what society values the most.
5 Knowing when to give up on a lost cause. Accepting the inevitable with dignity.
6 Consider reading Marcus Aurelius’s Meditations and Edith Hall’s Aristotle’s Way.

I write them up, print them out and stick them on the wall next to my desk. I buy roses for my flat. I order a copy of Aristotle’s Way. When I next speak to Sara, it’s 16 August. She’s had a couple of difficult nights, she admits, but says she managed to get through them using mythology. “I’m incredible with myth, it’s Jung basically. I always go to Apollo. I decided to do a contract. I said, ‘Apollo, come on, give me a few months. I need to finish my clients properly.’ He hasn’t answered me yet what he wants back. What can I give back to Apollo? I need to think about it.”

I tell her I’m considering getting a tattoo of a rose because it reminds me of her, but she doesn’t like the idea at all. Why would I put myself through that sort of pain? I tell her that I love her.

“I think I represent a safe part and you have that inside you,” she tells me.

“I am ready for everything because I have an excellent life. I adore my clients. I did an excellent job. I really like my children and my husband. I couldn’t have more. Seriously! If I need to go, maybe it’s better that I’m the first because I have all this romantic theory to help me. I’m not worried about it at all, but I don’t want pain. This is it – I don’t want too much pain.”

She asks if we can speak for shorter periods but more often because talking for an hour is just too much. It’s Wednesday and we agree to talk again on Saturday. On Saturday morning, I receive a text from her number saying that she’s been taken ill. It doesn’t sound like her. It isn’t. Sara died on Friday morning.

Her memorial is held exactly one month after her death. It’s at the restaurant where her son is a chef. I wear the earrings she gave me, as I do when I want to feel close to her, and red lipstick because she would have liked it. Like almost everyone else, I’ve come with roses.

There is a board of pictures: Sara as a young girl looking adorably severe at her first communion; as a mother hugging her young sons; a toddler in the sea; a wife, her husband’s arm around her by a full rose bush. In front of the picture board is a spinning globe dotted with places she visited; her glasses; Savvas the Greek saint. I sit opposite the board next to an Italian woman. Like me, she is writing in a black notebook with a Lamy fountain pen with green ink. We notice and laugh.

Her husband and three sons speak. I wonder if they find it difficult facing a room of strangers in tears when they’re the ones who lost their wife and mother, but they are kind, curious and generous. They talk about Sara with a frank emotional intelligence that’s breathtaking. Her eldest son admits he had been having a hard time accepting that she was going to die. “I told Dad I was feeling very bad and he said, quite rightly, ‘You realise your mother has been sitting in a chair for two months doing nothing but scheming to make sure you’re going to be all right, so trust her.’ And I do. She was sneaky.”

Her middle son tells us they were all with her when she died.

“The nurse was administering the end-of-life care, all the drugs that meant Mum could have a peaceful end, comforting Mum, saying, ‘You’re doing really well, Sara, really well, that’s good, good, good.’ The last thing Mum did was to turn around and with great effort say, ‘I’m not doing good, I’m doing excellent.’

“That was her outlook. To look all the crappy stuff in the face and be like, nah, you’re all right. I see you’re there but I’m choosing to enjoy this more than I’m meant to. That ability to sing and dance no matter how shitty the situation and decide: no, I refuse to have a bad time here. I’m going to look at life and find it beautiful even if it sucks, and it really sucks at times. We should all remember that. We can all live excellently, not just fine.”

Her husband tells Sara’s clients that she has made arrangements for all of us who wanted to continue with another therapist, but repeats for us what he had told his son:

“If you feel lost, I would urge you to consider that she took great care in her last few months when she knew the end was near to prepare everyone, whether they were patients, friends, family. If you want her monument, look inside you.”

Back in Greece, I go to an island with some friends. I want very badly to be near the sea and Ikaria is one of the few Greek islands with proper waves. I want to learn to surf. It’s only on the drive from the ferry to the hotel that I realise the island is basically one huge mountain lined by terrifying cliffs. I consider getting straight back on the 12-hour ferry to Athens. I’ve never seen roads like them, not one bend without a dizzying drop to certain death. It’s fine, I tell myself, sweaty palmed. I’ll stick to surfing and hiking, writing and drinking.

On the second day, I sprain my ankle. If I want to do anything for the next week beyond sitting at the hotel bar, deathly cliff roads will be unavoidable. I’ve been listening to the recordings of my sessions with Sara. Her voice is clear in my head, or it’s my voice, I’m not sure.

“Dai, come on,” it says. “Fuck it, care less for once. Have fun!”

The road leading to a secret beach we’ve been told about is a dirt track edged by a sheer rock face that plunges to the sea. My friend negotiates it carefully and I peer out of the passenger seat window over the edge. I’m ready for the cold sweat, the hyperventilation, the blackout. It doesn’t come. At the bottom, we find one of the most beautiful coves any of us have ever seen. I hobble towards the water, nothing but tree-lined cliffs and a deep blue horizon in front of me. The sea tempesta, I think. It is a very good augit.


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