How do you say Goodbye?

Two weeks ago, during what I thought would be a routine telepsychiatry appointment, Monalisa told me something I wasn’t prepared to hear.

Our next appointment would be our last.

We were reviewing how the medications were doing. A recent increase in Effexor had helped resolve a brief resurgence of depressive symptoms that had begun to interfere with my quality of life. Because of the dose change, we had returned to meeting every couple of weeks.

We talked about life more broadly—how the boys were doing, how work was going, and how things felt surprisingly stable for now, even with a major move to Chicago looming a few months down the road.

Typically, our appointments are in the morning, with Marina joining the call remotely from work. That morning was different. She was home, sitting next to me at the kitchen table.

It felt like a small but meaningful change of pace. We were able to laugh together, talk together, and smile at each other as we shared how our lives were going with Monalisa. For once, everything felt calm and connected.

Just before the appointment was scheduled to end, Monalisa said she had something difficult to share. She told me it was never easy to say this to any client—especially not to me, given how much we had worked through together—but she was leaving her psychiatric practice.

Our next appointment would be our last.

The words landed like a physical blow. It felt as though all the air had been forced out of my chest at once. Heat spread through my sternum, sharp and burning. Tears started immediately, before I could even process what she had said. I couldn’t speak. I couldn’t look up. Marina sat beside me, silent, steady, squeezing my hand while I stared at the floor and tried to breathe.

I thought immediately of my first appointment at her office. The hard chairs in the waiting room. Sitting beside Marina. Unable to sit still. Tugging at the hem of my sweatshirt. The impatience of the front office staff. The physical exam. The waiting.

I was convinced I was in the wrong place—that this was another provider who wouldn’t work, another false start. That I would keep bouncing from appointment to appointment, still trapped in the same pit of depression, anxiety, panic, and sickness, with no idea how long it would last.

Then we were shown back to Monalisa’s office.

The carpet was unusually thick, muting our footsteps. The hallway felt quiet in a way I couldn’t quite explain, almost like sound was absorbed instead of echoed. Her office was small and bright, with a few minimalist sculptures, a calendar, and a Mac desktop set neatly in the corner of her desk. I noticed she used an ergonomic mouse and remember thinking that someone who paid attention to details like that might actually pay attention to me.

The chairs were soft and comfortable. The medical assistant slid the barn-style door closed behind us. The room became still.

Monalisa asked, “So tell me why you’re here. What’s been going on?”

And I cried. I tried to say everything at once—the Vraylar, the anxiety, the panic attacks, the syncope, the inability to drive, the depression, the blank spaces in my memory. Marina filled in the gaps when I couldn’t. Monalisa stopped us only a few times for clarification. Mostly, she just listened. She nodded. She understood.

Since that first appointment—through medication changes, therapy, and countless in-person and virtual visits—Monalisa has been the psychiatric half of my psychiatrist-therapist team, alongside Michelle, that carried me through the darkest period of my life.

She made space for me. She took the time to understand me. She welcomed Marina into our appointments without hesitation. She answered emails at all hours and responded quickly when something felt wrong. She adjusted medications between visits without delay, always working with me to find the sweet spot—the exact right combination and dose that allowed me to become myself again.

Because of her, I was able to return to being a husband, a father, a captain, a human.

How do I say goodbye to Monalisa? How do I start over with someone new after everything we worked through together? Especially knowing that in just a few months, with our move to Chicago, I’ll have to say goodbye all over again?

What could I possibly do to thank someone who pulled me back from the edge—who helped give me my life back, my family back, my mind back—who made it possible for me to keep doing the work I needed to do?

The thought that there will be more goodbyes someday is something I’m not ready to face yet.

I engraved a small keepsake for her on my laser engraver. A token. A trinket. Something tangible to give when there aren’t words big enough.

I don’t know what it will mean to her. Maybe she’ll keep it in a drawer. Maybe it will end up in a box with dozens of others, indistinguishable from the rest, part of a long career spent helping people through their worst moments. Maybe I won’t stand out at all.

I’ve been in EMS for nearly twenty years, and I know how this works. There are patients who blur together, and then there are a few who stay with you forever. I don’t know which one I am to her. I don’t know if I mattered in that way.

I don’t know what happens next. I don’t know if the next psychiatrist will be a good fit, or if starting over will feel like progress or loss.

What I do know is that I am here. I am alive. I am present with my family. I am doing the work. None of that would be true without Monalisa—and without Michelle—walking with me through the worst parts of my life and helping me find my way back.

Someday, I may find the right way to honor that. For now, all I can do is say goodbye.