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****** ****
Specialist Nurse Day Care
Eating Disorder Service
18 January 2012
From my psychiatrist
Dear Dr *********,
Diagnosis: Anorexia nervosa (restrictive sub-type)
Medication: Nil
Weight: 35.3kg
BMI: 12.6
Level of Medical Risk: High
I just wanted to update you on Lydia’s progress since her referral to our service. You will have received details of the assessment carried out by ****** ***, senior dietitian, on 12 December 2011. I have met with Lydia twice now, the first time on 11 January 2012 and again on 16 January 2012. She is really struggling to make changes to her eating pattern and continues to insist on following a vegan, gluten-free diet. Physically she is very frail. She was just about able to do the SUSS test and struggled to get up from squatting, but did not lose her balance. Her temperature was 36.2°C though she was peripherally cool to touch with some redness of her fingers, but no edema. She had an enlarged appearance of her parotid glands bilaterally and was chewing gum vigorously.
I understand that she has been seeing a private psychologist, *** ***** at Dorking, for CBT on and off since last summer and she reports finding this helpful. Unfortunately, however, her weight is continuing to slip down without evidence of stabilisation at all. I have spoken with her about the various options, including:
1) Her attending day care.
2) Her being referred for voluntary inpatient admission.
3) Her being referred for admission as an involuntary patient under a section of the Mental Health Act.
She was not keen on any of these options and insists that she is able to improve her health herself, despite evidence of the last few months being to the contrary. Lydia allowed her mother to join us at our last appointment. Mum expressed a significant level of concern about her daughter’s state of health. Mother reports finding it difficult to support Lydia to eat as Lydia refuses to eat what her mother makes, even if it is gluten-free and vegan. Mum is surprised at the level of continued weight loss, though she did go on to disclose that Lydia had gone to Brighton on a train at the weekend to get a tattoo, and increased activity may have contributed to the weight loss. Mum also expressed concern about Lydia’s drinking – she is drinking a glass of wine at night – and also her level of smoking – Lydia has picked up the habit of smoking and has told her mother that she can only eat if she is allowed to have a cigarette afterwards.
Following further discussion about the options open to Lydia, she is amenable to attending day care preparation appointments, though she believes that she is going to be able to stabilise her weight loss and show that she can gain weight as an outpatient over the next two weeks, and that actual admission for day care will therefore not be necessary. She is aware that if she is unable to halt the weight loss, then the level of medical risk may be such that inpatient hospital admission is unavoidable.
I will keep you informed of her progress.
Yours sincerely,
Dr ***** **
Consultant Psychiatrist
This was the copy of the letter I received following one of my worst appointments. I was so delicate that I was barely able to walk. A healthy BMI is between 20 and 25, 18 and below is considered underweight, 16 and below prompts diagnosis of anorexia. Mine was just 12. A MCBT therapist told me that the lowest BMI he had ever worked with was 16 (which is still way under healthy). I was in an extremely dangerous place, and death was a definite risk. My heart could just stop pumping at any minute, and though I was aware of this it really didn’t scare me. At this particular appointment, I should have been sectioned under the Mental Health Act. I have always been extremely persuasive, even as a child, and somehow managed to wangle my way out of it, promising that I would improve and that hospitalisation was not an option. Mother was distraught at the thought of me being sectioned … It stays with you forever, compromising future career opportunities, and preventing you from travelling freely to places like America. I was outraged that they thought I was mad. I was much cleverer than all of them put together. They were all older than me, but I had seen and experienced so much that I believed I had a higher knowledge of the world. I could see things in different ways to everyone, in ways that I could not explain and they would not be able to understand even if they tried. They were stupid, and I hated them for classing me as ‘psychotic’. This is a word that was often used to describe me when I was attempting to explain my logical theories to the Eating Disorders Unit. Maybe they were just idiots and couldn’t understand me because my level of intelligence and perception was miles above theirs. To be accused of being mad is something else. To be told you are going to die is okay, if the facts add up and the sum is realistic. But to be told you are mad? How can you measure madness? Everyone is different, and everyone thinks differently, therefore I find judging madness a little like judging art. My mind was an abstract work of art, a collage of colours and ideas. Their minds were like textbooks – boring, structured and unimaginative. In the car home after this appointment, my mother cried silent tears and I stared out of the window blankly. I didn’t want to see her cry, especially not because of me. Halfway home the song ‘Up’ by James Morrison came on the radio. It was pouring with rain and we were driving down the gloomy motorway. The lyrics of the song hit both of us, and we both knew it. The song to this day means so much to both my mother and me.
CBT notes
* I feel fat = A FEELING. NOT FACT.
* I am fat = A THOUGHT. NOT FACT.
I weigh 34kg today = FACT.
I require a weight of at least 52kg to be just normal = FACT.
I have not been able to sustain my weight gain = FACT.
I need professional help – day care = FACT.
18 January 2012
My blog post
Hello LIFE.
Each day could be a last day.
Fuck it.
Should be able to spend every single one the way I want to. Last night I went to see War Horse. Was it good? I do not know. Throughout the film so many things were concluded in my mind and I had an amazing epiphany. Like, as in I actually had to leave the cinema and go stand outside for five minutes just, like, smiling and trying not to faint. It was euphoric. Wasn’t sure whether or not to be this open on tumblr. But like I just said up there, Fuck it! Here are some of the things I wrote on my phone during the film …
Reached the lowest point
At severe risk
That’s been done now
You’ve done it now, now get better
Affecting about ten people in one night
For my parents
Do not want friends, friends of friends, friends’ parents – anyone – to need to worry
Upsetting everyone
Get better
Be determined
Get energy
Have life
Stop wasting precious time
Do it
Now let’s live
Too much more to life than this
This post again may not make much sense. But I suppose it’s not really meant to. I know what I mean. I MEAN I’m going to get better. I’ve flicked a switch in my head.
Tonight I am having curry.
Peace xo
20 January 2012
My blog post
Bit of a raw post but here goes …
It’s 5.30 a.m. I’m walking round and round the house, feeling very anxious. I’ve been awake for the past three hours. Worrying about breakfast. Not even that I’m going to struggle really, more I just don’t want it.
Just looked through my mum’s diary of the weeks and weeks and weeks ahead I’m gonna have at home doing nothing but focusing on this. And the amount of appointments, ergh. Fuck that, I should be at uni having fun. I wish this had never happened to me and my life hadn’t been taken over. It’s been two fucking days so far and it genuinely feels like it’s been two weeks’ worth of munching. Cos it’s so tir
ing physically and mentally. Like choosing what to have, when to have it, the anxiety of whether it’s the right decision, the decision-making itself (I’ve always been ridiculously indecisive), what’s normal, what will stabilise, what will gain, how fast will it gain. When will my legs not feel so weak any more, when will I experience hunger again? It’s all such a time-consuming process. That’s why I’m so sad it’s happened; because now I want to be better … getting better is going to take as much time, if not more, as getting this ill did.
I suppose the only thing to do is use this sadness as determination. No relapsing. Cos that’ll take away more of my life than has already been snatched away.
Why isn’t Neighbours on at 7 a.m.? I would not MIND an episode.
21 January 2012
My blog post
A heart rock my mum gave me yesterday. She said she got it for me because she loves me, and wants me to have a nice, strong, red, healthy heart again as soon as possible. Ha ha.
Need to thank some people. All of the support I have been receiving has been incredible, and I could not be more grateful. Every message I receive means so much, and I am so thankful I have such ridiculously understanding people in my life.
I’ve got to get better so I can give something back.
Pretty bland post but I’m feeling very low in energy from being so overwhelmed with anxiety the past few days/nights. The thoughts are so energy consuming it’s ridiculous. For example, spending several hours of precious sleep time schizing whether it will be easier to have breakfast in pyjamas, or whether I should get dressed first. Reading that, it sounds fucking stupid. Ha ha. It’s far too evaluating. I need to be mindful. Trying to focus on the good is also exhausting. But it’s a vital element to all this. I am the biggest pessimist, so being positive is extra tiring. But it will be extra worth it when I have life again. Cloudy, cloudy post, but today I’ve got a cloudy head.
21 January 2012
Email from a friend
Hey Lydia,
I was just with my cousin and she mentioned that you’re not coming back to uni, and I wanted to just send you a wee mail to say that I’m sorry you won’t be back, but I’m glad that you are hopefully getting better and just taking some time at home! Don’t want this to come across like I’m speaking out of turn or anything. But I just wanted to let you know that I have been thinking about you and I really hope everything goes well for you, and good luck with all you do. Anyway. Take care. Hopefully speak again in the near future!
Love,
R xxx
21 January 2012
Email from a friend
Hey Lydia,
Hope you had a lovely Christmas … Heard you’re not coming back this semester. So sorry to hear that, hun; how are you getting on? I hope you get better as quickly as possible so we can see you again soon, babe! X x x x
24 January 2012
Email from a friend
Hey Lydia,
I know this is a bit random but I just thought I’d say I hope you get well soon xxx
27 January 2012
My blog post
I want my life back I want my life back I want my life back I want my life back I want my life back I want my life back I want my life back I want my life back I want my life back.
I’ve had everything snatched away from me and now I want it back.
My degree
My graduation
My final year at uni
My friends
My independence
Any form of freedom
My ability to concentrate
My driving licence
Happiness
Fertility
Energy
Relationships
Family
Time
Lifespan
Motivation
Everything
Taken. Over.
FUCK IT. FUCKING FUCKING FUCKING SICK OF IT.
Going to be better. Want it all back.
I love you sister. Xxo
29 January 2012
My blog post
Uninspired?
I’ve been significantly less inspired during this week. Days can seem like years. ‘Focusing on getting better’ could not make things more confusing if it tried. Mind fuck. When stuck at home 24/7 there is no satisfaction from doing anything.
29 January 2012
Email from a friend
Hey Lydia!
Just wanted to send you a quick message to wish you all the best with getting well again. I’ve been reading your blog and I think you’re doing amazingly! You’re such a good person; I know you’ll be fine in no time. Take care, darling.
Sending love and good wishes xxxx
30 January 2012
My blog post
The dietitian
I hate this woman – like, I absolutely hate her. I’m pretty easy going, and open minded to everyone. Though I’d say I am quite a good judge of character, I’d never judge anyone before I knew them. Because that is just closed-minded.
Hate is a very strong word. And I can honestly say there is nobody else I know that I actually hate. This woman, however. This condescending, evil bitch of a woman. The way everything she says, she does it in an irritating, patronising whisper, staring pitifully at me as if I am about to die. The way she nods as if she’s taking in what I’m saying, while she’s looking me up and down as I speak (again, looking like she’s about to burst into tears). The way she fucking makes me sit there for an hour and gives not one ounce of encouragement for the progress I feel I have made, but instead asks why I am chewing gum. WHY THE FUCK NOT? LIKE, WHAT THE FUCK? I am 20 years of age; I’m allowed to chew some gum if I want to. WHY DO YOU WEAR PURPLE EEEEEVERY TIME I FUCKING SEE YOU?? (Occasionally teal). (I did say this to her. She didn’t like it. She went bright red. And patronisingly whispered, ‘That’s not relevant now, Lydia, really, is it?’ followed by the nod and the sad expression.) Er … well, neither is the fact that I’ve got a piece of gum in my mouth. Who would want to spend 20 minutes talking about that? What a waste of my time.
She also undoes every single thing I say. Tells me I am in a psychotic state and that nothing I say when I am talking about why I want to get better makes any sense. WHEN IT DOES. She snatches my inspiration from me every time I see her and makes me feel completely rubbish and unmotivated.
Next time I see her I will say to her, ‘You are the least encouraging and the most patronising beast of a woman I have ever met. The only ounce of inspiration I gained from you and your sessions was to get stronger so that I could ATTACK YOU. And burn your hideous purple attire.’
I was too close to saying this today but there was a medical student sat in my appointment. So although I was still fairly rude to her, I thought I’d save this for next time …
I HAD BETTER GET STRONGER FOR THEN.
31 January 2012
Email from a friend
Hey sweetie, the girls mentioned you aren’t coming back to uni. I really hope you get better soon and I’ll be thinking of you, xxxxx
1 February 2012
A letter from me to my parents
Dear Mum and Dad,
I am so so, so, so, so sorry for all the stress I have put you under, and the worry I have put you through. You are the best parents anyone could ever wish for and it makes me sad to think what I have put you through. You deserve a lot better. You, Matthew and Pascale are the reason I managed to find the courage to seek help in the first place. I couldn’t get better for myself. That wasn’t an option. But for all of you I try my best to be as brave and strong as I can be every single day …
This is much more difficult than you will ever understand; but it is for all of you that I persevere.
Every day seems like the length of a year. I spend most of it thinking or crying (usually both). And every night is almost as long (waking up feeling sick with anxiety, and sweating so much I have to get changed). The best word to describe how I feel, I think, is ‘humiliated’. It’s
embarrassing waking up sweating and having a big agony stomach and being 20 and feeling like a lazy worthless slob. It’s humiliating living off your hard-earned money like this; it’s humiliating crying like a big out-of-control baby, having to leave meals early, hurting my family, having a life as sad as mine has become.
I am writing this to you because I am trying desperately not to push you away. I’ve lost my life, some friends, a boyfriend, my graduation, my freedom, my drive. Sometimes I stand and look at myself and wonder how on earth I went from being 20 at uni to back at home living like when I was 12. It makes me feel stupid. Like a complete failure. I also wonder where the hell my life is going. I have lost all sense of worth. I don’t have any ambitions. I don’t know what I want at all. I don’t really know who I am any more. I feel completely broken. I’m trying so hard to be fixed. And when I shout and scream I don’t mean it. I’m just frustrated because I’m trying to be fixed for YOU, not for me. So when you get frustrated at me or try to help me it hurts because I am already trying my best just for you.
I’m terrified, anxious, depressed, lost, confused and more than anything heartbroken at the state of my life.
I am aware I’ve got a lot of issues and I am sad about this because I’ve never wanted to disappoint either of you.
Thank you for standing by me even though I’ve let you down so badly. And sorry about this stupid letter but you’re all I’ve got left so I can’t shut you out completely.
I love you so much and will never, ever be able to describe how sorry I am to you.
Lydia xo
9 February 2012
From the Eating Disorder Service, NHS
Dear Dr *******,
Thank you for your letter dated 4 February 2012, which Lydia hand delivered to me here at the Eating Disorder Service clinic. Lydia has given me permission to discuss her treatment in our service with you, and with her consent I will arrange for you to be copied into correspondence to her GP.
Lydia is a very ill young woman and given the severity of her anorexia and her very low BMI score our treatment approach would include the prioritisation of weight restoration over psychological therapy at the start of treatment. This is because in our experience people at a very low BMI and very low weight often lack the cognitive ability to make use of psychological therapy. It would also be my preference for Lydia to have all treatment for her eating disorder be delivered within one service in order to reduce the likelihood of splitting and also to ensure regular communication of risk and a multi-disciplinary approach to the treatment and management of Lydia’s eating difficulties. Lydia can access psychological support and therapy from within our service, though currently she insists on continuing to see you privately and she apparently values quite highly the work you are doing together.