Couch is a series about psychotherapy.

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Isabella left a package for each of her children to open after her death. Her youngest was only 5 months old, and the other three were ages 2, 4 and 7. She had always wanted a big family, and when she learned, after the birth of her third child, that she carried BRCA1, the so-called breast cancer gene, she and her husband decided to rush to have their last child. Then she would have the surgery that she believed would save her life, a double mastectomy.

But it was too late. Only a month after the baby was born, Isabella was found to have ovarian cancer, and several months after that she passed away.

Naomi, my patient, grabbed a tissue from the box on the little table next to the couch. She had been in therapy with me for six years and I knew her friends pretty well. I especially knew Isabella, who had been her best friend since childhood.

It isn’t unusual for therapists to feel that they know intimately their patients’ friends, lovers and family. In some ways, we get attached to these people, their stories, their successes and struggles. We accompany them at once closely and from far away, as if they are favorite characters in a beloved book.

Isabella was one of these people for me. She was Naomi’s “sister,” as they used to call each other. When her cancer was diagnosed I, too, was shaken and upset, and when she died I silently grieved.

Naomi told me that Isabella had read online about a woman who, when she learned she was going to die, prepared several years’ worth of dinners for her family. “For a few weeks that woman cooked every day,” Naomi said, “packed it all in boxes and labeled them with dates. She stored it all in a big freezer.” Naomi took a deep breath and continued: “Isabella read that to me, and said she regretted that she was never a good cook. ‘Can you believe I might force them to eat my cooking for years?’”

They had laughed at that together. Then Isabella shared with Naomi her idea of leaving something for her children: a big blue box containing letters and gifts for important events she would miss. She was the tooth fairy, leaving a present under the pillow. There were good luck notes for the first day of school, gifts and letters for birthdays and graduations. “Thinking about it makes me miss them so much already,” Isabella had told Naomi, in tears. And in my office, Naomi cried at the memory.

I fought to hold back tears of my own.

That evening, after Naomi left my office, I had a strong urge to rush home and hug my own kids, to hold them tight and not let them go. I remembered that feeling from when they were babies, how I used to hurry back, imagining our reunion — their smiles, their smells.

Instead, I ended up wandering. I walked aimlessly around the Bowery neighborhood in Manhattan, back and forth on the same route I take every day from my home to my office. I found myself gazing at a group of young people waiting outside for a table at a trendy new restaurant. I could see only purity, innocence, naïveté. “They all look so happy, so glamorous,” I thought to myself, “as if they have never lost anyone, never felt devastated or realized that cancer is waiting around the corner for all of us, unaware that we might lose everything we love.” I tried to hide my tears and look happy, fearless, beautiful.

“Isabella always said she wanted to die beautiful,” Naomi had told me. “And she was worried about the way she looked when people came to the hospital to visit her. ‘I don’t think a secret lover will come visit you in the middle of the night,’ I joked with her. ‘And besides, you always look gorgeous.’”

Naomi had looked at me and then added, “Can you believe it really happened? I lost Isabella. She will never come back.”

Oddly, I felt that I had lost something as well. But mine was an unusual, unrecognized loss. I grieved for a woman I had never really known, and no one could see or acknowledge my pain. I was alone with it.

I was glad that Naomi was my last patient on Tuesday evenings. The Bowery is never peaceful, and its hectic rhythm allowed my thoughts to flow freely. I walked home, listening to the familiar hum of the city, like the white noise machine in my office, which, when I am alone, helps me to feel and to daydream.

The next day it was raining. Every morning, as I walk to my office, looking at all the garbage bags on the street corners, I listen to the voice mail messages on my work phone. That morning, I held an umbrella in one hand while trying to put the other hand close to my ear.

I rarely accept new patients these days, but something about one message struck me as unusual. I listened to it again. “I need to grieve but I don’t know how,” the caller said. Intrigued, I called him back and we set up an appointment.

Into my office walked a man in his mid-40s. “Hi,” I said, referring to him by his first name. He smiled. I looked at his face and tried to find a sign of his loss.

“The woman I loved died,” he explained, after he had settled into the couch. “I need to speak with someone.”

I nodded, and he continued: “Her death was sudden. From cancer. One day she was here, and the next day she was gone.”

He lifted his head and looked into my eyes. “She left me many notes,” he went on, “a box filled with love letters. I’m not sure why she thought that might help. It only makes it worse.”

“She left you a box of letters?” My voice was too loud.

“A big blue box,” he said. “That’s just who Isabella was.”

“Isabella?” I heard myself say.

“I mean, the woman I was with,” he clarified. “We were lovers for many years.”

He, too, was married, which meant that he had been forced to mourn her death in secret. This had been difficult. “She was the love of my life,” he explained, “but strangely, ever since she died, sometimes I find myself thinking I just made her up, that she never actually existed. Do you know what I mean?”

He looked at me, and I could see the tears in his eyes — and feel tears building up in my own.

“Yes, love needs a witness,” I said. “I know exactly what you mean.”

Galit Atlas, a faculty member in the postdoctoral program in psychotherapy and psychoanalysis at New York University, is the author of “The Enigma of Desire: Sex, Longing, and Belonging in Psychoanalysis.”

Details have been altered to protect patient privacy.