Hope and Other Luxuries

by Clare B. Dunkle

  Rough stone walls had risen out of my mind and obliterated the sunlight. I was looking down a gloomy hallway in a bleak, dismal old house, half castle and half barn. The scent of stale air rose from dank, unopened places. It made me want to hold my breath.

  Shadows congregated in this dim hallway, and dust, and cobwebs, until I found myself squinting to see. As my eyes adjusted to the gloom, I could make out a figure standing in the shadows: a gray-faced girl in a ragged black dress.

  This girl had been the very first of all this story’s ghosts. Her life had ended long before she came into my world. Everything that had made her human had fallen away. She had lost her fears and her joys. She had lost her eyes.

  This poor little once-upon-a-time human had never shocked me, not even the very first time I saw her. But, no matter how many times I studied the empty black circles in her gray face, I never stopped feeling sad.

  At the moment, I was rereading her grim story with great care, matching the image the words raised in my mind with the image the way it had looked when I had first dreamed it. If the words were wrong, they would form a fuzzy double exposure, and the image and the feelings it raised wouldn’t come into focus. But if the words were right, I could read the story just the way my readers would, and I would see exactly what I was supposed to see. Then my mind wouldn’t have to work to bring the image to life. The words would do it for me.

  She stood very still in the dusky passage where the light was poorest. Like me, she wore the black dress that proclaimed her a maid of the house, but where mine was new, hers was spoiled by mildew and smears of clay. Thin hair, dripping with muddy water, fell to her shoulders in limp, stringy ropes. This was my companion of the night before—and she was dead.

  I could see it all: the long, limp, wet hair and the mildew-spotted black dress. But wait a minute—was that right? Mildew was black, wasn’t it?

  Could mildew be white? Or was it always black? Could mildew show up on a black dress?

  Probably. Possibly. I didn’t know. And I didn’t want to wait for a copyeditor to ask. I clicked away from the Word file I was reading, pulled up Google, and typed mildew into the search box.

  The phone rang: a double interruption. The eyeless ghost flickered and grew faint. I grabbed the phone with my free hand as I scrolled through the Google results, willing the ghost to stay where she was.

  “Hello,” I said, scanning. This stuff was all about mildew in houses. But there, at least the Wikipedia article mentioned clothing.

  “Hello, this is Dr. Petras. I have your daughter Elena here.”

  Dr. Petras? Right, the child psychiatrist with the silly, droopy mustache. I had dropped Elena off at the hospital two hours ago, and she had intended to walk upstairs to her appointment after she did some volunteering. He must be calling to confirm that she wouldn’t be coming back to see him. Maybe he needed to talk about her prescription.

  Did Elena still need that Zoloft? Her feelings about Valerie weren’t as raw now as they’d been a few months ago.

  At the thought of Valerie, the eyeless ghost standing in front of me changed. Now my absent daughter stood in her place. Long hair, pale oval face, black eye shadow, ragged black clothes. The impression in my mind—the wistful sadness—remained the same.

  But it’s getting better, I reminded her.You sent me an email just yesterday. You’re crazy about Clint, your new boyfriend, you told me. You wrote to say that you love me.

  Meanwhile, in my ear, Dr. Petras had charged ahead. His voice was stern, like a reprimand from the boss. After listening for a few seconds, I realized that I wasn’t sure what he was talking about. Ghost in the room, ghost in the Word file, ghost in my family circle—I couldn’t break free from it all quickly enough for him.

  “I’m sorry,” I blurted into the flow of stern words, “but what is this about?”

  “Your daughter has anorexia nervosa.”

  Anorexia nervosa?

  What?

  The shadow of the lost Valerie slipped away like a raindrop. Headlines lit up in my mind. Somewhere in there was Karen Carpenter’s strong, expressive voice, half laughing, half crying, saying she had the blues.

  “Anorexia?” I heard myself say stupidly. “My daughter? You mean . . . Elena? You do mean that daughter, don’t you?”

  But . . . she’s the one who’s completely normal! I thought.

  A woman came walking through my memory. Her pelvic bones were sharp points under a green minidress. Her knees and elbows looked like knots, and her rough skin sagged into hollow places and dipped from neck bone to shoulders. That memory blurred into another one: a ratty horse with hipbones jutting under its hide. “Bonny’s thirty,” a voice drawled over the image of the horse. “She can’t keep flesh on anymore.”

  Was that anorexia? What was anorexia? Wasn’t Elena normal?

  Dr. Petras had taken off again while I was caught up in my own confused thoughts. His tone was hard—almost rude. More than the words, the tone captivated me now. What could it mean?

  “Anorexia nervosa,” I repeated, pulling out the one thing I felt sure of so far. “Okay.”

  Because it was okay, wasn’t it? Wasn’t it always good to put the right words to something? If they were the right words, that is—and the skinny-horse woman loomed in front of me again. But that didn’t make sense. Elena didn’t look a thing like that horse and that woman. She had an adorable figure. For heaven’s sake, her bras were a bigger cup size than mine!

  “So—anorexia nervosa,” I ventured again. “Are you sure?”

  “This is very serious!” Dr. Petras said in answer. He sounded as if I was confirming his worst suspicions.

  Suspicions about what?

  Was Elena all right? Had something happened?

  Anxiety surged through me, the anxiety that I had lived with every day—every minute!—for a solid year. The anxiety that was just now—just these last few weeks—beginning to go away. And the gray-faced ghost that was really my missing daughter drifted back into the room. She stared at me mutely. Accusingly.

  Without eyes.

  Muscles tightened in the back of my neck and sent fingers of tension crawling down to my shoulder blades—the tension that I had once thought would never let me go, the tension that had just started to release—just a little. And the warm, drowsy room, the blissfully unconscious cats, the almost-finished manuscript—the entire day, in fact, began to wobble in my grasp.

  I could feel it shift. I could feel it start to slide down—

  Dr. Petras said, “I’m putting Elena in the hospital, starting right now. I want you in my office in fifteen minutes!”

  And the sunny day smashed into pieces.

  CHAPTER NINE

  There we were, half an hour later, gathered together in Dr. Petras’s office: Elena, Joe, and I. Joe had been in the middle of a series of meetings, and the stress showed on his face. Even without the crazy commander, his workdays were still long and hectic. It was obvious that Elena didn’t want to be there, either. This appointment I had asked her to attend as a courtesy had turned into a disaster.

  And me? I was doing my best to be a logical, reasonable person. I had a firm belief that psychological sessions were useful things, and I was well aware that I had kept Elena from canceling this one. I had no desire to hate Dr. Petras, either. That wasn’t a logical, reasonable feeling to feel.

  But when I looked at my daughter’s face, I had to struggle not to hate somebody.

  Elena looked as if she were undergoing a prisoner interrogation. She was staring past us at the far wall, her face carefully and completely blank. After everything we had endured over the course of the last year—after things had started to get better!—the sight of that expressionless mask on Elena’s face made me want to stand up and scream.

  Absolutely nothing about this enforced surprise office visit was pleasant. It had ripped all three of us out of our routines. It had brought back tensions we had just shaken off, and it had raised memories we had just started to
forget. In fact, the situation was so dramatic that it felt like a deliberate manipulation. And I don’t like being manipulated.

  “I’m admitting Elena to the hospital today,” Dr. Petras announced. “She has anorexia nervosa.”

  Again, I found myself overwhelmed by a feeling of indignation. Just like that—out of the blue—he was deciding care for our daughter. What about discussing options first? What about explaining this surprise diagnosis?

  “Do you think you have anorexia nervosa?” I asked Elena.

  Her answer was an angry, explosive “No!”

  For several reasons, this situation was hitting me at a weak point. Or maybe—

  Maybe it was hitting me at a very strong one.

  When I was a small child, around two or three, I was very close to my father. He worked nights back then, and he babysat me while my mother worked on her PhD and taught classes. I have precious memories of those long-ago days, of my father saying to me, “Well, fussbudget, what are we going to do today?” I even remember the sight of my own white diapers flapping on the clothesline.

  Around the time I was four or five, my father had to take me to the doctor. He himself was sick with the flu, and I remember him shivering as he carried me to the car. I remember the sight of him huddling down in his chair as we waited in the waiting room.

  He had brought me to the doctor because I had a headache.

  Even back then, my headaches weren’t your standard “I have a headache” headaches. I would lie still in breathless agony with my hands clamped over my eyes. Every little sound sent jolts of electricity through my overwrought frame, and I thought my right eye was going to pop out of my head. The headaches came on with very little warning and lasted for hours. Sometimes, I ended up vomiting from the pain.

  On that day long ago, my pediatrician, Dr. McKinney, came smiling into the room. He examined me and listened to my father’s explanation. He was still smiling as he delivered his verdict.

  “It’s hypochondria,” he said. “Some children just want a little attention. Has anybody else in the family been sick?”

  And I could hear how upset my father was when he answered, “I’m sick!”

  “There! You see? She just wants to feel included.” And Dr. McKinney went smiling back out of the room.

  Preschoolers aren’t supposed to understand words like hypochondria, but I knew what that word meant. It meant that the doctor didn’t believe me. It meant that he thought I had lied—as if a small child really could lie about pain like that, lie about the need to stay perfectly still in a dark room, with tears leaking out of the corners of my eyes.

  “I do have a headache,” I said.

  My father didn’t answer. He was furious. I could feel his anger. As miserable as my father was, it must have been a special blow to feel that he had gotten himself out of the house for nothing.

  He didn’t speak to me on the car ride home.

  I remember the indignation in my father’s voice as he told my mother about it, how upset he was at the thought that I’d taken them in. But my mother disagreed. Headaches ran in her family, and my older brother had them, too. My father and mother ended up arguing about it, and that made a lasting impression. My father adored my mother. He hated to fight with her. In his mind, I had caused that fight.

  Maybe this all would have blown over if I could have stopped having the headaches. But that was something I couldn’t do. And every single time I had to drag myself off to bed, my father was sure I was trying to play him for a fool. He heckled me. “There she goes again!” he would say, as if I were a baby throwing a temper tantrum. And when my mother scolded him for it, his annoyance hardened into a grudge.

  Pretty soon, my father started picking on me for other things, like leaving the milk top open or standing too long at the refrigerator door. You have it easy, his stern eyes told me. Your mother coddles you. You don’t deserve her trust.

  And before long, my father and I weren’t close anymore.

  Throughout my childhood, as I spent days in pain, I felt the weight of my father’s angry disapproval and disbelief. Sickness became a shameful thing to me, a sign of weakness and bad character.

  Dr. McKinney continued to be my pediatrician, and every year or two, my mother would bring up my headaches again. “Sinus,” Dr. McKinney would say since I was older and in the same room, but his eyebrows would communicate something different. Hypochondria, they would convey with a knowing little smirk. But we mustn’t upset her, must we—hysterical little attention-seeking child.

  It was one more factor in my years of bitter isolation.

  When I was sixteen, I went to a general practitioner for the first time, and it took all of thirty seconds for him to diagnose me with classic migraine and to prescribe preventive medication that broke the cycle of pain I had been in since I was old enough to talk. As I grew up and made my way in the world, I won back my father’s respect, and he and I are once again close.

  But I have never forgotten the terrible price I paid thanks to a doctor’s hasty and incorrect diagnosis. I need facts from doctors now. They have to convince me that they know what they’re talking about.

  Dr. Petras already had one strike against him. His dramatic diagnosis of Valerie hadn’t been backed up by the other psychiatrists who had treated her. So, faced with a second dramatic diagnosis, I wanted a real medical consultation: explain yourself, give me your supporting evidence, and let’s talk about treatment options. That’s how my doctors and I had worked through what to do when I had had cancer. It seemed to me to be a perfectly logical approach.

  Whenever I feel threatened or emotional, I reach for logic. It calms me down. I work those “If the German in the blue house plays the clarinet, who owns the fox?” puzzles for fun, and I turn to logic in moments of argument or stress.

  At that moment, I felt very emotional and, on behalf of my family, quite threatened. This doctor whom I barely knew had called us all into this sudden meeting to announce a drastic course of action. He had put Joe and me at a distinct disadvantage: we had had almost no time to educate ourselves and prepare to participate in such an important decision. I had taken five minutes to do a couple of quick Internet searches, but that was all I’d had time for.

  “So, if I understand you,” I said now, “you’re basing this diagnosis of anorexia nervosa on three monthly weigh-ins.”

  “She’s underweight,” Dr. Petras confirmed.

  “But what else supports the idea that she has anorexia?”

  “She lost eight pounds in one month,” he said.

  “But she gained four pounds in one month, too,” I pointed out, “from the first month to the second month. Both of those first weights were within the normal range. Isn’t anorexia nervosa a chronic condition? How chronic can it be if she was at normal weight two months out of the three?”

  If Dr. Petras had attempted to educate us, I wouldn’t have felt so emotional. But his manner was very stern—almost hostile. I felt that he was keeping things from Joe and me and deliberately saying as little as possible. But why? We were Elena’s caregivers. We had to be involved.

  “She lost eight pounds in one month!” he snapped. “Doesn’t that mean anything to you?”

  “Of course it does!” I said. And really, why was I even having to say that? “But I’m still not getting from there to anorexia nervosa. There could be a serious medical issue behind weight loss like that. Don’t you need to rule out physical factors first? Have you contacted Family Practice to schedule blood work?”

  And I thought of my cancer. It had triggered weight loss.

  “No, I haven’t scheduled blood work,” he said. “I know what she has.”

  But how? How could he know what she had before he ruled out medical factors? Was this another Dr. McKinney, reaching for that “hysterical child” diagnosis?

  Logic . . . I told myself.

  I started over.

  “If I understand you,” I said, “you’re not saying that Elena told you she
hates to eat. In fact, you haven’t told us that you’ve learned anything about her eating habits. Has she told you she’s been trying to diet?”

  “She lost eight pounds in one month. Of course she’s trying to diet.”

  “And she told you that,” I said.

  But Dr. Petras didn’t answer.

  “So,” I said after a minute, “she didn’t tell you that.”

  He gave a shrug. “Well, it’s obvious.”

  Was it really obvious that Elena was on a diet? Did this man know how hard it was for that girl—and for her family members, too—to manage to hold on to weight? Did he take her family’s naturally high metabolism into account? Or did he just assume she had been dieting because we women, all we want to do is diet, right?

  How I hated that hysterical female crap!

  Logic . . . Logic . . . This isn’t helping . . .

  “What about the Zoloft you put her on?” I asked. “She’s been on it for two months, and you increased the dose last month. Could it have caused her weight to vary? Could it have caused this sudden weight loss?”

  “No, it couldn’t,” Dr. Petras said.

  Yes, it absolutely could. Loss of appetite and weight loss are common side effects of Zoloft, especially in children and adolescents. It isn’t unusual for Zoloft to cause a child to lose more than 7 percent of his or her body weight. But I didn’t know this then. I hadn’t had time to educate myself.

  “Look, I’m not going to argue with you,” Dr. Petras continued. “Your daughter has anorexia nervosa. I’m putting her in the hospital until she gains weight. And that’s how it’s going to be!”

  I felt completely bewildered. I hadn’t realized we were having an argument. Silly me, I thought we were consulting together to try to determine the best medical course of action to help one of the three most important people in my life. But it felt as if Dr. Petras had deliberately forced me into a position that would allow him to say this.

  Could he actually put Elena into the hospital, even without our permission? I wasn’t sure. Our status in Germany, connected to a military base overseas, did put us into a somewhat vulnerable position. Overseas military doctors have greater latitude than civilian doctors do back home. It could be that Dr. Petras was within his rights to do this, and he certainly acted as if he was.