by Yara Zgheib
We stand there, two anorexics in horrid flowery patient robes, Emm’s tears soaking mine and hers. She cries herself to a stop, then silence. When she pulls back she is calm. Her voice is steady as she says,
Let me explain a few things to you, Anna.
There is nothing left of the despair that ransacked her minutes before. Emm the cruise director is back.
I understand what you’re going through. We all do, every girl here. And no, Matthias doesn’t, but that doesn’t mean that he is not suffering.
Her dispassionate tone clashes against the content of her words.
Matthias does not sleep at night because he is thinking of you. He worries about you in the morning, at work, on his way over here and when he leaves. He thinks about you when it’s cold and windy and snowing outside. He thinks of you at every meal. He thinks about you in every restaurant he goes to, poring over the menu for one item he thinks you might eat.
The more she talks, the more my heart hurts.
You have someone who worries about you. Do you understand how lucky you are? Every girl here watches him come here every damn night for you and wishes someone came for her. And if you think sending him away will protect him in some weird twisted way, it won’t. He’ll just worry about you more. He loves you and you’re hurting him. You have no right.
I am crying into my hands. He loves you and you’re hurting him. I remember Julia calling me one of the lucky ones. You have no right. I think of Valerie.
Sarah, missing her little boy. Emm, who has been here for four years.
You don’t have the right to send him away. You don’t have the right to give up. He’s asking you to eat. Eat, dammit! He loves you! You’re the luckiest girl here!
My eyes feel like they will burst. I look up at Emm. My voice is hoarse:
I do not know how.
In her business voice, she replies:
Well, you start by getting dressed. Vitals and weights, and then breakfast. Then keep going from there. Get that damn tube out of your nose. Get through your meals and snacks. And find a way to bring Matthias back.
I force my breaths calmer and longer and look at this girl saving my life.
Thank you, Emm.
Don’t thank me. Do it. Now let’s go downstairs. Come on, vitals and weights! We’re late.
In our patient robes, mine wrapped at the front, we go downstairs together.
70
I am not allowed coffee, and breakfast is infused, but I am out of bed, dressed, and downstairs. I wait in community space while the other girls eat. At eight thirty, they stand up and disperse. Direct Care clears the dishes from the breakfast table and then comes to me.
Your therapist wants to see you at nine, and your treatment team at nine thirty.
The other girls go on the morning walk. I remain on the couch.
The house is quiet, till the sound of a car pulling into the driveway. Doors opening, closing, a suitcase being wheeled to the front of the house.
It cannot be a new admission. Today is not Monday. The front door opens and in walks the sickest, thinnest girl I have ever seen.
What first strikes me is her suitcase; it looks very much like mine. Blue. Her worried husband, who looks a little like Matthias, carries it inside. She is dressed as I would be: in layers. She looks sick, cold, and old. I try not to stare, but her face stops me like a heart attack. Her eyes, her nose, the thin line where her lips are supposed to be.
Danielle?
Direct Care shakes both strangers’ hands. I hope she is gentle on hers. Even from a distance Danielle’s frail wrist looks ready to break.
Please have a seat. I will be with you as soon as I take Anna to her team.
Danielle jars me more than every book and article on anorexia I ever read. More than the numbers on the scale, those on my test results. More than all the other girls I met here. Perhaps it is the suitcase. Or her husband. Or that she looks like me.
Perhaps it is the blatant truth that this woman is dying. Bones and blue fingernails; this is anorexia. It is hideous. I cannot stop staring.
Something else is bothering me, but I cannot put my finger on what it is.
Then I do. Then my insides turn cold and there is no more air in the room.
Anna, are you ready?
Today is not Monday. Admissions are on Mondays. And yet Danielle is here.
Anna, did you hear me?
I understand what Danielle means.
Valerie is dead.
Anna!
71
Direct Care has to take me by the arm to the office with the gray suede couch. The force of her grasp brings some of the feeling back. The therapist is already inside, waiting for me. I do not sit down.
Valerie is dead.
I wait.
She does not correct me. I needed her to. I needed her to! I panic.
What the hell am I doing here? Valerie is dead. My words echo horribly in my ears. How can the therapist just sit there and watch me? Why can I not scream?
I cannot scream because there is no air. Only my face in the mirror. And Valerie’s. And Danielle’s. And the thought: We all look exactly the same.
Anorexia is the same story told every time by a different girl. Her name does not matter; mine used to be Anna but anorexia got rid of that. And my feelings, body, husband, life. My story will end as Valerie’s had.
Valerie is dead, and the therapist’s silence.
I collapse on the couch, sobbing.
The therapist sits quietly on the couch next to me. I can smell her peony perfume. Her name is Katherine. She wears summer dresses. She is human too.
I cry for a few minutes or a year, then the room and my feelings go mute. I let myself sink backward into the gray suede. I have no voice or tears or energy.
Katherine looks at the nothingness with me, then she sits up straight.
Valerie made a choice,
she says.
Not to have anorexia, but to die. You have a choice too.
Anorexia or Anna. Anorexia or Anna, except
It is too late. I no longer know how to live without anorexia. I do not know who I am without it.
Well, we can find out.
I am too tired. I tell her I am too tired.
Yes I know, Anna. Valerie was tired too. This is an exhausting disease. But you got out of bed, didn’t you? Why?
Because Emm made me.
Why else?
Because Matthias. Because Papa and Sophie. Because of what Julia said about me.
Why else?
Katherine repeats.
Because I have a reason: Matthias.
She nods and leans back next to me.
I do not have the right to give up. It is not fair to Valerie. Perhaps if she had had someone like Matthias she would still be alive.
She did not, and she is not, but I can still be. How had I told Matthias to leave? How had I gone to bed?
I have to bring Matthias back,
I tell Katherine. I have to fix this. If not for me, for Valerie, Emm, and every girl in that house, each one of them as deserving as I of a chance to live and be loved. I am not special. I am just lucky. The luckiest girl in the world. And happiness is a choice: I choose Matthias and Anna. I must bring Anna back.
My thoughts are interrupted by a knock on the door. It is already nine thirty. The rest of the team and Direct Care file in. They all sit down facing me.
I must speak before they do. I have no clue what to say, but the words come out to both their and my surprise:
I want to go on a date with Matthias.
Stunned silence. I clarify:
A therapeutic meal outing.
They exist in the patient manual.
They look at me like I am mad. I look at me the same way. This very meeting was convened because I had hidden cream cheese, refused to complete my meals, been intubated, run away, been returned, gone to sleep. I should be going nowhere but to a high-security psych ward. But I am not mad, not yet. I just h
ave to explain that to them.
Please, let me explain.
I look to the stony faces for help. From Katherine, a nod to proceed. That is all I need.
There is a girl outside with a suitcase like mine. Her husband brought them both here. She is dying. I can see it. I have never seen anything so clearly. She is dying and I do not want to die like her or Valerie.
My words are not coherent but are the best I can do. I continue:
I know I made a mess. I was tired and suffocating and I am still tired and suffocating. But I cannot lose Matthias and I do not want to die. Please give me another chance.
No reaction or response. Perhaps it is too late. I want to cry. I try one last time:
I want to go on a date with my husband, please.
And then, I wait.
72
Direct Care pulls a patient manual from the shelves over Katherine’s desk, bulky and identical to the one I was given on my first day. She opens it and flips through the sections to:
“The Stages of Residency at 17 Swann Street.”
I remember those. She begins:
“Stabilization Stage: Patients admitted at this stage may or may not recognize their eating disorder is a problem, and may or may not experience a desire for recovery.”
Not. Definitely not.
“During this stage the focus is on medical stabilization, nourishment, and hydration. Due to the intensive level of supervision necessary, patients at this stage are not eligible for therapeutic passes, outings, physical activity groups, or daily walks.”
In other words, hell. Girls rarely come here at Stabilization Stage, and if they do, rarely stay. They are often just too close to death to be outside a hospital ward.
Excuse me, Anna is at Stage One,
Katherine interrupts. Direct Care replies testily:
Yes, I was getting there.
She gets there:
“Stage One: Patients at this stage still require a high level of medical monitoring, but not one as extensive as that of patients at Stabilization Stage. During this time the focus is on medical stabilization, normalizing eating behaviors, developing adaptive coping resources, and establishing a collaborative working alliance with the treatment team.”
“Collaborative.” The operative word.
“Patients at Stage One may go on one therapeutic pass per week. Meals are not allowed on passes—”
Unless she is at Stage Two.
I look at Katherine, surprised but grateful; she is actually intervening for me. She reaches for the manual:
May I?
Direct Care hands it over to her. Katherine reads:
“Stage Two: Patients have decided that they are ready and willing to work for recovery. They collaborate with their treatment team to develop a course of action for their treatment.”
She pauses for a pointed look at me:
“Patients at this stage must be committed to exploring underlying issues that have contributed to the development of their disease. They must also present with increased honesty and accountability for their behaviors…”
I wince—
“… urges, and thoughts. They are allowed two meal passes per week.”
She does not read on and into Stage Three. Too far away, too surreal. But she does look at me and ask:
Do you think you’re ready for Stage Two?
Have I decided that I am ready and willing to work for recovery? Can I be honest and accountable? Do I want to collaborate?
Well—
The nutritionist protests:
She has a feeding tube in!
She and I exchange dirty looks. The psychiatrist asks her:
How’s her weight?
She shows him my chart.
Hmm …
Katherine addresses me:
Anna, you have not answered my question.
No I am not ready, but I can only go forward from here … or to a hospital ward.
I want to try, I have to. I have to bring Matthias back.
No further questions. I am told:
Anna, you may go now, thank you. Direct Care will take you back to community space while the team makes a decision.
Neither Danielle nor her husband is in community space when I return. I conclude he probably left and she is probably in orientation. The rest of the girls are out on the morning walk. I have some time to waste. I decide to write Danielle a welcome letter, like the one Valerie had written me.
Short, signed, and folded. I slip it in my pocket to give to her when she returns. It’s what we do here. The girls return, the mailman, and preparations for midmorning snack.
I do not see Danielle in the morning, or as we cross the lawn for lunch. After it I ask Direct Care about her. She says:
She had to leave. Don’t worry: she’s stable now.
73
Treatment Plan Update—June 10, 2016
Weight: 89 lbs.
BMI: 15.3
Summary:
Treatment team has approved patient transition to Stage Two of residential treatment, with reservations by team nutritionist.
In light of low patient weight, behavior and mood, and the continued need for feeding by means of nasogastric tube, treatment team acknowledges the precocity of this transition. However, it highlights that this transition is exceptional and probationary, approved with the main purpose of allowing patient to go on a therapeutic meal outing with her spouse.
Treatment team feels reasonably confident that the benefits of the therapeutic meal outing outweigh potential risks of noncompliance and relapse at Stage Two. Maintenance of Stage Two status is contingent upon patient’s full compliance with her assigned meal plan, all treatment activities, and the team’s instructions.
Date, location, and meal plan of the therapeutic meal outing will be determined by the nutritionist. Nasogastric feeding tube will remain in place as a precautionary measure. Failure to complete any meal or snack prior to the outing will result in the immediate revocation of the permission.
Residential treatment remains necessary.
Treatment Objectives:
Complete a meal with spouse without resorting to eating-disorder behaviors or necessitating nasogastric feeding tube.
Alleviate symptoms of depression and motivate patient to resume work toward recovery.
Resume normal nutrition, restore weight. If needed, ensure nutrition through nasogastric tube feeding.
Monitor vitals. Monitor labs. Follow hormone levels.
Target caloric value: Maintain and secure at 2,700 calories until reevaluation.
74
I will have the pizza margherita,
Anna told the waiter.
I knew it!
Matthias triumphed.
Of course you will, you unpredictable one.
To his teasing, she deftly responded,
Do not be too cocky, mon ami.
And to the waiter:
The gentleman, I believe, will have the tartuffo. Extra mushroom and truffle oil.
Matthias laughed and topped the order with two glasses of the house red.
It was Friday night, one of their earlier dates, but he had already known her forever. He was also beginning to suspect that he was in love with her.
We’re in a rut!
he lamented.
Boring!
she exclaimed, her mouth twitching mischievously.
Before we know it, we will be finishing one another’s sentences.
Drinking our coffee the same way!
he added.
Ah non! Never!
she gasped.
You drown yours in cream and sugar!
And yours is disgustingly black!
They both laughed. He reached for her hand across the table and looked at her. She was beautiful.
I like knowing these little things about you,
she admitted shyly.
I like knowing what side of the bed you sleep on and the way you smell in the morning. How you like
your eggs and fold your socks.
He was in love with her.
I like knowing that about you too.
The wine and pizzas arrived.
So tell me, Matthias, why do you cut off the crust?
It’s a useless filler; I’d rather save the space for more mushrooms,
he said.
The crust is my favorite part,
she answered.
Really? Ha! You can have all of mine.
He put the first piece onto her plate. She bit off the end and smiled:
Merci! But what will I give you in return?
Hmm, let me think, olives?
The waiter had placed a small bowl of green ones on the table.
C’est parfait! I hate olives. You can always have mine.
And you can always have my crust.
Now we really are boring!
she laughed.
I love you,
he replied, leaned over the table and kissed her, pizza on their lips and all.
75
It was a tradition: Friday nights were our date nights, even after we were married. Tired or not, we dressed nicely and went out to places with wine lists and dim lights. Those outings, of course, had grown more sporadic as my food repertoire had narrowed. Till they had become nonexistent. And then I had come here.