Hope and Other Luxuries: A Mother's Life With a Daughter's Anorexia

by Clare B. Dunkle

  It was like a family-wide slumber party.

  “Oh, wow! Thanks!” Clint said one afternoon when a plate of hot chocolate-chip cookies appeared at his elbow. I paused to look at the screen: a retro underwater world. I could see vividly colored art deco interior design, but fish were swimming by outside the windows.

  “What’s that?” I asked. “Oh! Watch out!” Because a creature, half human, half spider, had scuttled rapidly across the underwater ceiling.

  Clint hurled a fireball and followed up with shotgun blasts as the creature flitted rapidly to and fro. Finally, it fell to the floor. It wasn’t a spider, it was a thin man with hooks for hands. He was wearing an elaborate bunny-ear mask.

  Bunny ears? That tickled my imagination. Which genius had thought of that?

  “You don’t know BioShock?” Clint asked as his avatar strode over and robbed the creature’s corpse.

  This was more interesting than zombies or dragons. This game’s monsters reminded me of my goblins, and the setting was grimly beautiful: a kind of blood-spattered, poorly cleaned Titanic.

  “What’s it about?” I asked, sitting down and taking a chocolate-chip cookie.

  “It’s kind of complicated,” Clint said. “Here, I’ll start a new game.”

  Half an hour later, Joe was watching, too, and I was completely obsessed. “Does anybody want margaritas?” Joe offered as he polished off a cookie.

  And the Dunkle slumber party rolled on.

  Next afternoon, Valerie was changing Gemma on the floor while I picked up soda cans. Valerie never asked me to change a diaper. She was up with Gemma night after night for hours, and she never asked me to take a turn. I got to play with Gemma during the day, but I didn’t have to do the hard work.

  “Do you think Clint would like pizza?” I asked. “Yes? Then let’s have pizza tonight.”

  Valerie laughed. “You’re such a sucker, Mom. You spoil him. But hey, that’s okay, I like pizza, too.”

  Valerie was right that I was catering to Clint. I couldn’t help wanting to spoil him. Clint was very nice as well as smart and funny, and he and I liked the same kinds of monsters. Besides, he had worked hard to provide for his family. He had completed a year of college in his time off work, and in a few weeks, drill sergeants would be yelling in his face.

  Clint’s mother did everything she could to help Valerie, I thought as I dialed the phone for pizza. I’m standing in for her right now. I owe her a debt I can never repay. She’d want to know that her boy is enjoying himself.

  But a few days later, as I was driving Valerie, Clint, and Gemma home from my parents’ house through north Texas thunderstorms, a call came in on Valerie’s cell phone.

  “It’s your recruiter,” she said, handing the phone to Clint.

  He talked for a minute, quiet yeses and I understands. Then he handed the phone back to Valerie.

  “They’re not putting me in the April group,” he said. “They’re putting me through basic training in July.”

  This was a blow to Valerie and Clint. It meant another two and a half months added onto the time they would have to wait before they would be in a place of their own. I sneaked a glance at Valerie. She was in tears.

  “You know it’s fine with your father and me,” I said. “You three are no trouble. You’re the opposite of trouble.” And I thought about how nice it would be to have my family around me for another two months. My granddaughter would be sitting up and learning to crawl.

  “I’d better get a job,” Clint said thoughtfully.

  Valerie was silent for another minute. Then she gave a nod.

  “Okay, here’s what we do,” she said. “Clint, you go back to Georgia and ask your old boss there if he can pick you up on the payroll again for another few weeks. You know it doesn’t matter how many workers he’s hired since, he’ll take you back the minute he sees you.”

  “He never has enough guys he can count on,” Clint agreed.

  “Then I’ll drive out to pick you up in the middle of June,” Valerie said. “And your mom can visit with Gemma again.”

  Soberly, the two of them discussed the details while I changed lanes and watched through the watery windshield the parade of red taillights in front of me. Valerie’s stronger, I thought with pride. She really is a grownup now.

  “Okay,” Valerie concluded. “That’s what we’ll do. We’ve got a plan.”

  A plan. She sounds like me, I thought. That’s the first thing I do, too: set up a plan.

  But my own plans were about to change.

  The next day, I got a call from Emily, Elena’s therapist at Clove House. The last month had been quiet, and what little we had heard had felt like good news. But this new phone call shook me up considerably.

  “Your insurance company wants to move Elena into day therapy,” she said. “They won’t continue to pay for residential care. Elena’s finally putting on weight, but her negative feelings are intensifying. She’s not ready for this. We’re afraid she may try to harm herself.”

  Harm herself? What did that mean? What did they think she would do? And a horrible memory heaved itself up from the darkest, gloomiest corner of my mind: Valerie, coming down the stairs, humming softly, and her hands . . . What was wrong with her hands? . . .

  “I . . . Okay,” I stammered. “But what—what can I do?”

  Emily’s voice was carefully neutral. “We need to know if you’ll pay the difference between day therapy and residential care.”

  “That’s three hundred dollars a day!”

  “Can you do it?”

  My brain spun.

  Three hundred times seven. Twenty-one hundred dollars. Over two thousand dollars a week!

  “I don’t know,” I heard myself say out loud. “Maybe—but not for very long.”

  “Mrs. Dunkle, we need a definite answer. Her residential care stops today.”

  Today?!

  Why do they always need these answers today? I thought frantically. Can’t they plan at all?

  “Okay,” I said. “For . . . a week.”

  A week! Twenty-one hundred dollars!

  I hung up and called Lynn, the brisk nurse who was Elena’s liaison—the one who worked for the dark side now.

  “Please understand, we do want what’s best for your daughter,” Lynn told me. “But she’s been in residential care for a month and a half. She should be ready to move to full-day therapy now.”

  “Her care team says she’s not ready,” I said. “They’re concerned that she’ll hurt herself. Twelve unsupervised hours a day is a huge risk.”

  “We need to try it,” Lynn said. “Six weeks in the hospital is a very long time. If your daughter isn’t willing to make progress by now, there’s not much anybody can do.”

  I felt the cold realism of this statement. It was practical. It made sense. And it sent panic coursing through me—panic so profound that it was all I could do to keep holding the phone. I felt as if I were sliding into a pit. I wanted to strike out, to claw the walls, to struggle free.

  Because . . . what if the treatment didn’t work?

  I had never even considered that it might not work.

  A plan. A plan! I would fight this decision. That steadied me and filled me with courage. It was good, in that moment, to have something to fight.

  “Lynn, I have to go over your head,” I said. “I’m calling Washington, DC. As long as the insurance company is standing between Elena’s treatment team and the care they say she needs, I have to fight you any way I can.”

  “Of course you do!” Lynn said, and she meant that sincerely. “Mrs. Dunkle, I wish you the best of luck.”

  I spent hours on the phone that day and the next. Against the maze of bewildering phone lines in Washington, DC, I used every trick I had learned. I was pleasant. I was appealingly helpless. I let people rescue me. I used my storytelling skills to bring to life the tale of my tragic, desperately ill daughter.

  “Please help me,” I would beg each new person who came on the l
ine. “I know I’m not calling the right number, but it’s the only number I have. My daughter’s doctors think her life is in danger.”

  Time after time, friendly voices reassured me, told me what they knew, and gave out phone numbers that weren’t public. “When he asks, just tell him Leticia gave you this extension. I’m praying for you and your daughter.”

  For five anxious days, Joe and I had to pay the three hundred dollars a day that kept Elena safe in residential care. But by the time those five days were up, my phone calls had paid off. Another psychiatrist at the insurance company reviewed her case and okayed residential care yet again.

  But the handwriting was on the wall. Day therapy was coming. It wouldn’t mean two thousand dollars a week, but it did mean a fifty-dollar copay each day—probably for months. That meant fifteen hundred dollars a month. And then, there would be the cost of an overnight stay somewhere, and possibly a rental car, too.

  Over coffee that weekend, Joe and I discussed strategies.

  “You bought that pricey BMW because it was a great deal in Germany,” I pointed out. “But it’s a hassle to look after here in Texas, and you end up borrowing my car all the time because the Bimmer won’t transport your bicycle. Maybe it’s time to sell it.”

  Was it fair for me to suggest this? I’m not that sentimental about cars. But what did the BMW mean to Joe? Did he see it as a symbol of success? Was it a reward for his years of hard, steady work as an engineer? Did the sight of it in the garage give him a mental lift to tackle the daily grind?

  I don’t know. My husband is practical and straightforward. He doesn’t tell me these sorts of things.

  What I do know is that he didn’t hesitate.

  “You’re right,” he said. “See what you can get for it.”

  Three days later, I had exactly the deal I wanted, and it was a deal on—of course!—another Elantra. But it was the newest model, and it had leather seats. I owed my poor husband that much, at least.

  Joe picked me up at the end of his workday, and we headed to the dealership to sign the final papers. Halfway there, my cell phone rang. I answered it through the Bluetooth connection in the dashboard, and Elena’s angry voice reverberated through the car.

  “I’m leaving today! There’s nothing you can do to stop me!”

  My heart sank.

  “Hello?” I said. “Elena, what’s going on?”

  “Mrs. Dunkle,” a smooth feminine voice answered, “this is Dr. Greene, Elena’s psychiatrist.”

  “Yes, hello, Dr. Greene,” I said. “I remember you.”

  “I’ve got Emily, your daughter’s therapist, here with me,” Dr. Greene continued, “and we’re having a conference with Elena. She’s very upset. She wants to talk to her parents.”

  “Yes, go ahead,” Joe said. “We’re both here.”

  “Your daughter wants a PEG tube,” Dr. Greene said. “That’s a tube that goes straight through the abdominal wall. We aren’t sure it’s a good idea, and your insurance won’t pay for it. If we schedule it, will you pay for it yourselves?”

  Joe and I exchanged startled glances. He was driving down a three-lane access road through rush-hour traffic. It wasn’t the best place for absorbing fine details.

  “Wait,” Joe said. “You don’t think an operation’s a good idea. But you want us to pay for it?”

  “We just need to know if you’re willing.”

  A tube through the side of the abdominal wall. My imagination dredged up a photo I had seen in a science book of a man who was fed through a flap in his stomach. Doctors had experimented on him for years, putting things into his stomach and taking them out to look at them. My own stomach felt fluttery at the thought.

  “I need that operation,” Elena said. “They want me to eat five thousand calories a day. Five thousand healthy calories—that’s plates and plates of food! My stomach can’t process it all!”

  “It is true,” Dr. Greene agreed, “that the amount of food is hard on your daughter’s system. But her metabolism is so high that unfortunately, it’s necessary.”

  Joe took a right turn. Now he was on a five-lane feeder street: two lanes each way and a turn lane in the middle. Cars and people and big flashy signs were everywhere, crowding in and demanding attention. My stomach lurched and rolled from the motion and the mental images. I shaded my eyes with my hand and tried to be sensible.

  “I’m still not getting this,” I said. “Isn’t the amount of calories going into the stomach the same?”

  “It’s different with a tube,” Elena said. “With a tube, I won’t notice. It can get spread out over twenty-four hours.”

  “When you were in the hospital before,” Joe said, “you had a tube that ran down your nose for that.”

  My imagination found that image and showed it to me: my daughter lying absolutely still and silent in the ICU, the beeping of the machines, the chilly air . . .

  “We’ve tried the nose tube,” Elena’s therapist said. She sounded harassed and unhappy. “A nose tube doesn’t work for your daughter.”

  “How is that possible?” Joe asked. “Why wouldn’t it work?”

  For a few seconds, none of the three invisible parties spoke. Then Dr. Greene’s smooth voice answered. “Elena’s gag reflex is very sensitive. She’s conditioned it with years of purging.”

  I blinked. A silver minivan came blasting out of a gas station and almost took my door off. Joe swerved.

  “Years of—I’m sorry, we’re on the road here,” he said. “Years of doing what?”

  Purging. Purging is vomiting, I thought. But Elena doesn’t do that.

  It was the one thing Dr. Costello had felt confident telling me during the Summer from Hell. Elena wasn’t bulimic. She didn’t purge. Over and over, I had heard her confident denial as one doctor after another had asked her about it. “Look at my teeth,” she would say. And they would look at her white, undamaged teeth, and they would nod in agreement. No purging. My daughter didn’t purge.

  But Dr. Greene’s voice was steady.

  “Your daughter has been purging her meals for years, on a daily basis. Her gag reflex is so sensitive that it responds to the slightest pressure. We’ve tried it repeatedly, but she can’t keep a nose tube down.”

  Can’t keep a tube down. My imagination played with that—played with nerves in the back of my throat. My own gag reflex gave a heave in answer.

  Joe pulled into a parking lot and stopped the car. It was that big chain toy store, a place with some of the most unnatural, grotesque childhood companions on the planet. In years past, I used to walk in there and feel as if I were trapped inside a can of soda. I used to joke that if I died in one of its aisles, no one would even bother to move my body.

  A PEG tube. A hole in the side of the stomach. An unnatural, grotesque misuse of the body. Major surgery, against doctors’ advice and on our nickel—just to keep from having to eat.

  “No,” I heard myself say. “We won’t pay for a PEG tube.”

  Elena’s voice filled the car again, bitter and furious. I could hear the loss of control in her voice that the medications had brought on, the loud tone and sloppy speech. Was this helping my daughter? Was she becoming more truly herself?

  The further Elena went into treatment, the less I understood who she was. The tragic details of the rape and the miscarriage had made me feel closer to her. But in this moment, sick at heart and sick to my stomach, I had never felt so far away.

  Who was this resentful stranger who hurled insults and vomited up food? How did my bright, nervous, imaginative child turn into this bony, bullying wraith?

  Joe began speaking quiet sentences into the hectic torrent of words, stepping-stones to help us find our way. “I know this is hard,” he said. “It’s causing you great stress. But you can do this, Elena. I believe in you.”

  Little by little, Elena began to calm down. That allowed Emily to intervene. Over the course of the next few minutes, she and Dr. Greene talked Elena into trying again.

&nb
sp; Shouldn’t this make me happy? Shouldn’t I be grateful to Joe for jumping in and being an effective, positive parent? Why should it leave me with such anger?

  Oh, sure, she’ll calm down for him! She always listens to her father. But who’s been there for her? Who’s lost sleep over her? And she treats me like I’m the enemy!

  Joe and I said our good-byes to them, and he pulled out into traffic again. In silence, we drove to the dealership.

  “I was beginning to worry!” the manager joked when we walked in.

  I could feel the wrongness of my smile. It stretched my lips like rubber, but it didn’t reach my eyes. Joe was the one who answered and reached out to shake the manager’s hand.

  As I watched my husband sign away his beautiful white BMW, my anger melted into guilt.

  What’s wrong with me? Don’t I want my husband to be a good parent? Isn’t it good that the two of them have a rapport?

  We drove home in the new car. Its attractive interior appealed to me, and Joe seemed to enjoy it, too. Leather seats and a top-of-the-line trim package, for just the price I had wanted—I had practically stolen this car! And Gemma was awake when we got home. I hugged her warm, soft little body in my arms and walked up and down with her, singing the alphabet song.

  I always sang Gemma the alphabet song. I wanted to condition her for life. My hope was that whenever she heard it, she would feel a little happier and a little more loved, even if she didn’t know the reason why.

  Meanwhile, Valerie was setting out plates and pouring drinks. Pizza again—I wasn’t much of a cook these days.

  “Let’s have a salad, too,” I said, feeling guilty. “We’ve got salad fixings, right?”

  Valerie opened the fridge. “I think we’ve got a bag around here somewhere.”

  She scooped preshredded lettuce into bowls while I told her about the phone call. “Vomiting food!” I said. “It’s like I don’t even know her anymore.”