Purge

by Nicole Johns

  We have to stop at Kwik Trip for more contraband Diet Coke and to change into our swimsuits. The two of us squeeze into the tiny bathroom, turn away from each other, and undress. Holly wears her favorite blue and green one-piece, and I wear my black and green two-piece. It goes against reason that I feel comfortable in my swimsuit, with my stomach and legs exposed, but I do. I feel that my body is proportional, and that I have nothing to be ashamed of. Besides, other than the hospital residents and staff, I know no one here.

  I have a picture from that day, taken by an anonymous sun-bather. Holly and I have shed our towels and are facing the water. Our arms are around each other’s waists and we appear apprehensive yet happy. When I get the film developed, Holly and I agree it is a flattering picture of both of us. It proves we are not the obese, cellulite-riddled women we think we are. I keep returning to the picture; it marks the beginning of acceptance for me—acceptance of my body, acceptance of myself—and the ability to finally just let go, even if only for a short while.

  We are tentatively hopeful on the day we go skinny-dipping. Holly has been in treatment for eight months, I for two and a half. We are learning to let go and accept ourselves, but what no one has told us is that the hardest part lies ahead, after treatment. Both of us will struggle and relapse. I will restrict and lose all the weight I gained at the EDC and then some. I will land back in the ER, dehydrated, orthostatic, and with a slow, erratic heartbeat. Holly will begin purging again, return to treatment, and end up on a feeding tube. But we don’t know this yet. We are convinced that we are almost there, that we have almost beaten our eating disorders.

  The water is cold from this rainy summer in southeast Wisconsin, but we swim out to the anchored rafts and clamber up the slick ladder. We lie side by side on the raft and sunbathe while talking intermittently about the other residents, staff, and our families back home. Holly is from a suburb of St. Paul, and she has been trying to convince me to return to the University of Minnesota in the fall so that we can go to school together.

  The sunlight gives my pale skin a light brown hue. I’ve spent most of my summer inside the over-air-conditioned EDC, so I don’t take this day at the lake for granted; I savor the warmth of the sunlight streaming over my skin. I will be sunburned, but I don’t care. For one afternoon I am a normal twenty-three-year-old sunbathing with a friend, not an eating-disordered patient rating my body image on a scale of one to ten.

  “Ready to jump back in? I’m getting hot,” says Holly.

  “Yeah, let’s do it,” I say.

  The coldness of the water shocks my warm skin and I bob to the surface, teeth chattering.

  “We’re far from shore; no one will notice if we take off our suits,” I say.

  “Okay. Can you imagine what Therapist Elaine and Dietitian Caroline would say if they knew we met up on pass and skinny-dipped?”

  “They wouldn’t know whether to congratulate us for doing something positive to improve our body image or yell at us for meeting up on pass,” I say.

  Holly begins the process of peeling off her bathing suit while I work on the strings on the top part of my two-piece. Eventually I give up and pull the top over my head, then slip off my bottoms easily.

  Our bodies are pale white, tinged with green from the water. We tread water and swim around, careful not to lose our grip on our suits.

  “This feels really freeing,” says Holly.

  “I told you it feels good.”

  We manage to slip back into our suits and swim to shore. When we are done swimming, we drive to Milwaukee for coffee, then split up. If we arrive back at the EDC at the same time, it will appear suspicious. So we stagger our returns, thinking no one will be the wiser. However, we are both sunburned and have Lake Labelle admission bracelets on. Staff figures it out.

  Therapist Elaine is annoyed, but Dietitian Caroline is proud of us for challenging our body-image issues, although she doesn’t condone skinny-dipping at a public beach. A few weeks later, the whole floor decides to go to Lake Labelle on an outing, but it isn’t the same. Sandra immediately starts swimming laps in an attempt to burn off the beef enchiladas she ate for dinner, Laura has a rape flashback, and the anorexics are in the water for only five minutes because their lack of body fat makes them more sensitive to the cold. RC Julia sits on the shore, dressed in long pants and a long-sleeved shirt on a blistering, eighty-five-degree day. It is apparent that we are from the EDC.

  Sandra, Holly, and I remove our swimsuits, but I am self-conscious now, as Sandra is thinner than I am. The outing goes further downhill when Holly jumps off the anchored raft and yells, “I’m a raging bulimic.” RC Julia isn’t amused, and she threatens to cancel the rest of the outing, which includes going to Cold Stone Creamery for a snack challenge.

  At Cold Stone I order a small Birthday Cake Remix, the same thing I get every time we go there. I sit outside with RC Julia, Holly, and Sandra, who keeps eating my ice cream. As I scoop the sugary ice cream into my mouth, I contemplate how my thighs touch at the top, how my upper arms are really too large these days, and how I think I saw a double chin when I looked in the mirror this morning.

  I could tell RC Julia that I’m struggling with urges. I could sit down in the office after we get back from Cold Stone and stay there until the urges pass. I could journal and break down the thoughts behind the urges. But I don’t. Instead, I deconstruct my body, part by part, flaw by flaw. And when we get back to the EDC, I sneak down the hall when no one is looking. Above the toilet is a list of reasons why I shouldn’t purge. I read over them, stick my finger down my throat, and heave until nothing but stomach acid comes up. No one hears me do this. I’ve perfected the art of the quiet purge.

  Afterward, I pace. I am jittery and red-eyed. Finally, I confess to RC Julia that I purged. She asks me why I didn’t come find her or someone else and talk about my urges. I want to tell her that the voice in my head, the voice of bulimia, is too loud and that there are no alternatives. I want to tell her how scared I am that I will never recover, that I will spend my life in a constant state of anxiety about calories, fat grams, exercise, and purging. But I don’t. I tell her I don’t know. And she tells me to keep fighting.

  Epilogue

  And now: it is easy to forget

  what I came for

  among so many who have always

  lived here . . .

  —FROM “DIVING INTO THE WRECK,” BY ADRIENNE RICH

  Holly abandoned me for the safety of bulimia the October after our summer at the EDC, but we began to drift apart long before then. It started after Holly discharged but while I was still at the EDC, living in the parallel world of treatment—back before those nights of drinking martinis at her house in the suburbs, before the revelry of homecoming weekend, before the very first day of school.

  “It was a slip,” she says.

  I lie stretched out on the EDC sofa in my pajamas, wrapped in my ivory afghan, contemplating what to say. In the RC office, RC Caroline is dispensing evening meds and telling the residents a story about her two-year-old son. Residents are sprawled on the dayroom furniture, watching television, knitting, and talking on their cell phones. The EDC environment is safe; we are protected from ourselves while we are here. Holly is in the real world, where no one checks up on you 24/7 and no one pulls your head out of the toilet. “Were you honest with your treatment team?” I ask.

  “Yes.”

  Holly has been in and out of treatment since she was fourteen. Some professionals consider her a chronic case. She has been to the EDC two times already, and she will go back again less than six months after her “slip.”

  “A slip is just a slip; it’s not a relapse,” I say.

  “I know. I’m not going to let this mess me up.”

  At first Holly does well; she doesn’t let the incident affect her recovery. Then she is hospitalized with a gastric motility disorder caused by her bulimia, which means her stomach does not digest food the way it’s supposed to. Instead, food sits in he
r stomach long after it should have been digested, and causes acid reflux and nausea. Holly has bout after bout of uncontrollable vomiting, which triggers her dormant bulimia.

  After Holly is discharged from the hospital, she begins purging. At first she tells me not to worry about it, it’s no big deal, she’s not doing it that often, but I see where this is headed. However, I can’t say much about Holly’s relapse without being a hypocrite, as my own motivation for recovery is dwindling. While I’m not purging, I’m just not eating. The urge to restrict is insidious. I cut back my meal plan a little bit at a time, until I’ve lost fifteen pounds and end up dehydrated, with low electrolytes, hooked up to a heart monitor in the emergency room. Any time I question Holly’s purging, she questions my lack of consumption.

  I manage to turn my relapse around, and by spring semester I’m eating enough to function and have started exercising. Then Holly goes back to the EDC in late January, and I’m left to fend for myself. Without Holly, I have no one who understands my struggle; I have no one to call when I need help. My non-eating-disordered friends grow frustrated and tell me I have to eat—I simply have to eat.

  One night in December, before Holly leaves for the EDC for her third round of treatment, I call her from Rainbow Foods on East Lake Street. I have been wandering around the grocery store, searching for something to eat for dinner. Every time I lift an item from the shelf, I glance at its caloric content and place it back on the shelf. Nothing is safe enough for me to eat, as I am in restriction mode. I call Holly in desperation; I need someone to tell me what to eat, and that it is okay to eat.

  “I’ve been wandering around Rainbow for the last hour, and I need you to tell me what to eat,” I say.

  “How about a Lean Cuisine?” Holly says.

  “That’s too much food,” I say.

  “Actually, that’s similar to your meal plan.”

  “I can’t do it. Please just tell me it’s okay to eat microwavable soup.”

  “Nicole, it’s perfectly fine to eat microwavable soup.”

  “Thanks. I’ll call you after I eat.”

  Because Holly has given me permission to eat, I rationalize that it must be okay. I am too ashamed to call my non-eating-disordered friends and ask them for help, and if I called my therapist every time I had an eating disorder quandary or crisis, I would be on the phone three-quarters of the day.

  Every day post-treatment presents a new challenge in my recovery from EDNOS. There are the bakeries I pass on my drive to school, there are the catered lunches for the Introduction to Creative Writing teaching assistants, there is the problem of eating a snack during the break in seminar, and then there is my ever-rising anxiety and panic before seminar, which I stifle by swallowing Xanax tablets with Diet Coke in a bathroom stall before seminar begins.

  Holly understands all of this.

  And then she leaves—she goes back to the safety of bulimia, then back to the safety of the EDC, with its regimentation and therapeutic schedule, and I am left to fend for myself in a world in which I have forgotten how to live.

  At the EDC, there are no doors to lock. You don’t have to remember to take the trash out on Tuesdays, to turn your headlights off, to pay the phone bill or do your homework. When I first left the EDC, I forgot to do those things and the world closed in on me in a screaming frenzy of demands. Less than two weeks after discharging from the EDC, I am back in Minneapolis, teaching, taking classes, and trying to readjust to the world. There was no transition time for me; unlike Holly, I did not have the opportunity to participate in a partial hospitalization program or an intensive outpatient program. I went from 24/7 therapy to one hour of therapy per week.

  In retrospect, why I relapsed in the fall is no mystery.

  My therapist wanted to send me back to treatment, but I refused. I was afraid I’d become a lifer, one of those women who are constantly caught in the revolving door of treatment.

  I can understand how Holly relapsed. I understand how, even though she had damaged her body irreparably, she kept engaging in bulimia. My understanding scares me. Other people don’t understand. And I don’t want to anymore.

  In January, when I begin spring semester, Holly begins the EDC program for the third time. We talk on the phone every night, but something is different. I don’t find Holly’s evasion of the EDC rules hilarious anymore. All I can see is that she is hurting herself by sneaking in contraband, going on spontaneous solo outings, and harassing staff.

  Holly tells me that the staff members always ask about me. I am in the habit of writing them letters about school and how I’m doing; she tells me they love my letters and are so proud of me for recovering. I imagine that the fact that I am succeeding and she is failing grates on her. There is an awkwardness between us.

  In February I win a fellowship to the Prague Summer Program, and that convinces me to recover fully. I am going to Prague and I’m going to enjoy it. I am not going to spend a month there with my head over the toilet, or passing out on cobblestone streets because I haven’t been eating.

  At the end of the month, I drive to Wisconsin and visit Holly. The EDC staff is happy to see that I am happy, healthy, and whole. Holly is sporting a nasogastric tube when I visit, a testament to the fact that she is not happy, healthy, and whole.

  We go to the mall, we go to Milwaukee, and we sit in the dayroom and talk (which is a bit trippy, since I’m an ex-resident). I cry when I leave.

  Holly calls me a few weeks later and tells me she wants to die, and I don’t know what to say. I think about how many friends I’ve taken to the emergency room since college, how many of them wanted to die, and how I never know what to say in the face of all that pain, because anything said in that moment sounds trite. All I can do is listen to her ragged breathing and sobs and tell her it will be okay.

  In May, when I drive home to Pennsylvania, Holly is still at the EDC, so I stop in Wisconsin to visit her. Staff tells me I should come back to the EDC as a motivational speaker because I’m doing so well. I tell them I can’t do that while Holly is there; it would be a big slap in the face. Holly and I say goodbye for the summer.

  I call her from Prague. She sounds so happy to hear my voice, and while I’m excited to talk to her, I’m not as excited as I thought I’d be. In Prague, I’ve remembered how to live. I haven’t weighed myself for a month, I haven’t counted calories, and I haven’t declared any foods off-limits. For the first time in a long time, I am genuinely happy. I take only one Xanax the whole month.

  In August, when I return to Minnesota, Holly is hospitalized in the Mayo Clinic because she can’t keep any food down, even if she wants to. She gets a nasojejunal feeding tube.1 She gets sicker in September. She spends the whole month of October in the hospital after a failed surgery. Now she has two tubes, one in her stomach and one in her jejunum. I drive down to the Mayo Clinic and find Holly high on pain medication, a shell of herself.

  When Holly returns home, I visit her. We watch America’s Next Top Model. Cans of feeding-tube formula sit on her kitchen counter, along with a suction device that attaches to the tube jutting out of her stomach. Dark circles ring her eyes, and walking is a struggle. One day, I spend the afternoon with Holly while her parents go to work. They don’t have any more vacation days left. We spend the day watching television and napping. Holly sobs as she packs her surgery wound with sterile gauze. After she has injected narcotic pain medication into her tube, I lie beside her on the bed until she falls into a drugged sleep.

  On Halloween, Holly’s dad calls to tell me that she has to have emergency surgery to clean out an infection that her feeding tubes have caused in her abdomen, and that her surgeon has warned her family that she might not live. After I hang up the phone, I start sobbing uncontrollably. I drive to a local park and sit among the leaves, crying because I am so scared I could lose Holly.

  Holly is septic, and when the surgeons open her abdomen, they remove a liter of pus. For the next three weeks, she clings to life in the ICU. I visit he
r every day.

  The first day is the hardest. At the hospital reception desk, I am asked if I am a relative or a friend, and I lie and say I’m her sister. I ride the elevator up to the ICU and think about everything that has happened since I met Holly. I think back to that summer day at Lake Labelle when we skinny-dipped, and about how much things have changed for both of us over the course of a year.

  Holly’s parents, sisters, and grandparents are all crammed into her ICU room. Her dad shouts in an overly excited voice, “Hey, Holly! Nicole’s here!” I set my bag on the floor and walk gingerly over to her hospital bed. Holly is hooked up to more tubes than I can count, and she has the light blue pallor of the dying. Her pupils are dilated and her hair is plastered to her forehead in a sweaty tangle. I am scared to touch her.

  “Nicole, I knew you would come,” she says.

  She drifts back into unconsciousness, and I hold her bloated hand. Her mom tells me that Holly is on three different IV antibiotics to try to kill her infection, and that her organs are failing. Her heart beats an arhythmic thirty beats per minute, her oxygen levels are low, her kidneys are shutting down, and she’s alternating between high fevers and abnormally low temperatures. Her brain swells and she has massive seizures. Her prognosis is not good.

  The worst day is when Holly is almost comatose, and has her head thrown back and mouth open, with the feeding tube hanging out her nose. She looks like Terry Schiavo.

  For the next three weeks, I jump whenever my phone rings, scared that it might be Holly’s parents calling to tell me she’s died.

  I cry in my car when I listen to the Dixie Chicks and all the songs we used to listen to at the EDC. I develop a routine: I go to school, then go to the ICU afterward. I grade creative writing projects while sitting with Holly, occasionally holding her hand, giving her sips of water, and telling her where she is when she startles awake.