After dinner I got introduced to Meal Processing. One girl handed out a sheet of paper with a list of numbers from one to ten rating our hunger and fullness levels going into the meal and leaving it. I immediately circled a ten (meaning Thanksgiving dinner full and about to burst). I had not felt hunger going into the meal and left with more discomfort than from my last big binge. However, dinner did not conclude a day of meals at the center. Oh no. From their nutritional standpoint, the refeeding process required patients to eat three meals and three snacks each day. That night our snack consisted of two blueberry muffins and a glass of two percent milk. I knew by the creamy taste it wasn’t low-fat or nonfat. I felt poisoned. No sane person eats muffins right before going to bed.
My nutritionist told me we were eating no more than seventeen hundred calories a day, but one girl had heard we were eating around four thousand, and I more readily believed this. Anorexics and bulimics memorize, calculate, and recalculate the calories of every food on the planet. I may have struggled in astrophysics but I sure knew fruit from vegetable and the caloric contents of breakfast, lunch, and dinner entrées. Seventeen hundred calories? Yeah, maybe at breakfast, where biscuits, gravy, and sausage patties were piled in front of us. Coming from California, I wasn’t familiar with this kind of southern food. While my mind shouted, “Purge, purge, purge!” my body had to take it in, all of it. Each bite felt like a glob of fat and cholesterol, with no relief in texture or taste.
Some rich meals have safety valves; an omelet may be cheesy but at least you have the option of substituting fruit for potatoes and leaving out buttery toast. Fried chicken can be served sliced over a fresh salad with lots of veggies to dilute the grease-covered poultry. Even desserts like cake can be made less filling when served without frosting and instead with a little fruit compote. But there were no substitutes at the center. It’s not that all the food was necessarily bad or grossly rich, it’s more that because we were required to finish every crumb I felt disgusted and positively stuffed to my breaking point. As a longtime bulimic I had many occasions following a meal where I could feel my food creeping up into my throat, wanting so desperately for me to grab my toothbrush and stick it down to gag myself and release my meal. One night after eating spicy enchilada pie, I couldn’t help but bend over the toilet hours after dinner, in my room, and release the globs of food creeping up my throat. I did it only once and kept it a secret.
Some days it was the quantity more than the quality that got us. The portions so severely surpassed normal that I felt as if we had walked into the Cheesecake Factory, especially on “dessert challenge” days. After a meal of large pulled-pork sandwiches, with potato salad on the side, the “challenge” was Key lime cheesecake. Every girl there stared at the bathroom after that meal, wanting so desperately to make a mad dash and puke. At Meal Processing everyone came out of the meal at ten and felt incredibly disgusted.
The nurses always watched me, as I tried to find ways to revert back to ED behavior. We had turkey wraps for lunch one day and, as had been customary for me, I started to peel apart the tortilla to eat mainly turkey and lettuce. The nurse who sat with us that day scolded me, “You can’t do that, Lisa. You have to eat it whole.” I wanted to fling back, “Fuck you! I’ll eat this damn wrap how I want to.” Instead I slowly chewed and swallowed, wondering how this could possibly help. There was one nurse, however, that I was incredibly fond of and I think she felt the same about me. I feel like she saw the real me—not simply an eating disorder—and she always encouraged and cheered me on at the table, telling me to eat slowly and that it was okay, that I was okay. When she sat at my table I didn’t mind eating so much; she had such a kind face that made it much easier to tolerate whatever it was we were eating. One other nurse also helped me feel a little more comfortable, by asking about school and my boyfriend. She must have seen how desperate I was, always near tears. Some of the patients also helped distract me from the meal with conversation.
We were allowed to omit three foods from our menus but those three foods had to be very specific and could not be from the same food group. For example, I did not eat beef or pork, yet I could only omit one of these and it could not be all beef or pork preparations; I could chose hamburger or steak. But my nutritionist actually made an exception for me since I was very adamant about my dislike of beef. I also was not allowed to eliminate a fat addition such as oil or butter. I remember feeling so overwhelmed when trying to make this list of only three. I chose beef and nuts, but I don’t remember the third food. All I remember is that I regretted it and wished I had said pasta or bread. I was however able to have soymilk instead of regular, so I was saved from a glass of creamy cow’s milk at our nighttime snacks. And since I suffer from acid reflux, my nutritionist allowed me to omit spicy foods as well.
I felt as if I had no time ever to process my feelings because all we ever really did was eat. Every two hours at most we were eating, and not just small snacks here and there to stabilize blood sugar but real hard-core meals. We were also timed during snacks and meals and if we didn’t eat within the allotted time, or we left too much on our plates, out came the cup of Ensure. One time I opted for non-compliance instead of drinking the Ensure. I felt too full and angry to bother following whatever dumb rules they had laid out. I don’t remember how many noncompliances I received but I didn’t care. All that it really meant was that I couldn’t go on the morning walk, which was fifteen minutes of monitored walking at a moderate pace. The only other thing close to exercise was equine therapy. The brochure shows two women riding horses off into the sunset, but in my experience equine therapy was playing games, like trying to lure a horse into a rectangle shaped by ropes, not riding. On days we had equine therapy we were forced to guzzle down an entire bottle of Gatorade with breakfast. Do you know how much sugar is in a bottle of Gatorade? I found it dull and ultimately discouraging when the horse refused to follow my commands. As if standing in the blazing desert for more than five minutes wasn’t torture enough, attempting to rear a horse into a small, roped-off area over and over again proved my theory that I really was in hell.
When I was asked if I had any pain and I would say yes, in my stomach, the nurses would say, “You just need to eat more,” and I would say, “No, it’s because I am eating too much!” Every meeting I had with my therapist seemed to fall during snack time. She’d ask how I felt and I’d say I was overly full, I felt fat and gross and depressed, and then in would come my snack and she’d look at me like a naive child and say, “Crackers will help.” It is mean to say this, but I hated the fact that she was severely overweight and always talked about food. She claimed to have been a recovered bulimic, which said to me that in order to be recovered I had to be overweight. In fact, it seemed every member of the treatment facility was overweight, and I felt like that just did not fit the scene. How could a group of overweight women tell me how I should go about recovering? Is being overweight healthier than starving or purging? This whole setup focused too much on food rather than on feelings, and I wanted out as fast as possible. I wanted to work one-on-one with a nutritionist as I had four years earlier and work out my own food plan rather than being force-fed and lied to.
Many girls cried at meals, but I just felt numb and doped up on food. As much as I wanted to cry, the only emotion I ever really exhibited was anger and that got me in trouble, which made me angrier. How could they get mad at me for my feelings? I said I felt like I couldn’t deal with the amount of food and I did not see myself as thin. My therapist got angry with me. They fed us a ton of fiber and bran cereal to try to regulate our bowels. Yet that combined with the blazing dry heat failed miserably. Most girls went days or weeks without going to the bathroom. I went once the entire time I was there and it was nothing to write home about.
Some of our meals were actually quite delicious. Chicken salad served with sliced tomatoes, avocado, and sesame crackers made a perfect summer meal. We also had Asian-inspired marinated chicken and rice. However, the plea
sure of fresh grilled chicken was obliterated by a greasy, rich dessert of fried wonton skins and caramel ice cream. We ate peanut butter by the quarter cup, drank milk by the glass, and ate cereal by the cup.
I needed to gain back some control and I knew that was not going to happen in that place. I felt horribly misled and trapped. I wanted to get treatment, just not in this intense of an environment. I needed to slow down, to work it out with someone who would let me go slow and ease back into the swing of eating normally and trying new items. When control is completely taken away from me, I freak out. I felt like no one listened to me, that that place was not the right fit for me. My parents, my boyfriend, they didn’t listen; the nurses, the other patients, even the sweet maid did not listen. I needed to escape back to my safety foods and the gym. I needed to be back in Santa Cruz and surround myself with organic produce and vegetarian options and my large salads with fat-free dressing. I wanted my large light-roast coffee, not one cup of bland decaf. I wanted mustard instead of mayonnaise and to pull apart my turkey wraps, to continue eliminating pork from my diet, eating only three times a day, and deciding my own portions. I did not want to be forced to eat dessert when my stomach shouted stop. I did not want nighttime snacks of muffins or bran cereal and a glass of soymilk. I wanted to wake up in the morning and go to the gym again and come home to my own prepared meals. I never wanted to eat biscuits and gravy again or pork sandwiches or BLTs. I wanted to choose how to prepare my own pizza without having to eat pepperoni. I wanted some sort of control back and I was not going to get it, and I knew I had to leave and find some other way of healing because that place and that treatment plan were not working for me or making me better.
sheila: Maybe this center’s twelve-step treatment plan was never going to work for Lisa or maybe she just didn’t give it a chance. I spoke with her therapist, the intake supervisor, the psychiatrist, and others, but from a distance I couldn’t tell whether this could be the right place, and Lisa’s resistance was normal. Lisa called several times a day to complain. Of course, it wasn’t meant to be fun. Could it really be as bad as she described? Then she said she’d walk away. We could have held the line and told her to stick with it or don’t come home, but we didn’t. After a week and a half, the day before we were to leave for Europe, she flew home, promising to contact the day program in our area. Scott and Jake would stay with her at our house. Our sisters would fly in if necessary. We had other family in the area, ready to pitch in. We had no idea we’d need them all.
Ned and I flew away, guilty yet grateful for a long, cramped trip through eight or nine time zones, sealed away from any news.
It came soon enough. Lisa called the ED day program near our house, but she sounded so bad that the intake person told her to have someone take her to the emergency room or they would send an ambulance. Lisa was admitted to the psychiatric ward at Stanford Hospital. It was a place that we had joked about, in a previous lifetime. Years earlier, when we knew the place only vaguely, we’d called it SMI, Stanford Mental Institute, as if you had to be very smart to go there. Big joke. Now my daughter was attending SMI.
My sister flew down from Seattle to stay at our house, and then Ned’s sister came from San Diego. Also there were Scott, Jake, our nephew and his wife, and my cousin Peggy, who had helped Lisa through the prom. We met my mom in Istanbul, where the cruise would start. She offered to fly home. If anybody flew home it should have been us. We felt like assholes, but we got on the ship.
We checked our email and called home. Elaine was making dinner for a full house, then they’d go to the hospital and visit Lisa. She told us Lisa seemed about the same. Doctors said it could take a while to find the right medication.
We had warned our friends that our stopover in Paris was doubtful, but when we changed our flight, the soonest we could get home was the following day. Part of us desperately needed to be with Lisa, our child. Part of us was incredibly relieved to have one glorious day in Paris with wonderful friends.
lisa: When I got home from Arizona, I immediately resumed my old habits. I tried to restrict my food and to exercise as much as possible, and I lost five pounds fairly quickly. With my parents gone on their trip around Europe and Scott at work, I was alone all day with my disease. To fill my loneliness I binged and purged. I’d been home a week when Scott found me in the garage covered in cake crumbs. He took me to the emergency room, and I was admitted to the psych ward. It was our second trip to the ER. Two days earlier I had been on the phone with the intake coordinator at El Camino Hospital’s day program for eating disorders, the place I had turned down when I chose residential treatment. This woman feared for my safety and urged me to admit myself overnight. We went to the ER but the thought of being in a hospital with patients who were severely mentally unstable was too much. I promised to take better care of myself. But every time Scott went to work and I was alone, I would binge and purge until I coughed up blood. I went into the garage freezer to chow down a chocolate cake, and as I was leaving to purge, Scott came home. He looked at me, and I looked at him and said, “I just want to die.” His only response was “Okay, get your stuff. Let’s go.” And I knew we were going back to the ER and this time I had to stay. In the car I told him I didn’t know how I was going to do it but I planned on ending my life, that I had nothing to live for, and that I promised to leave a note. He snapped, “Well, that’s great, that’s fucking great!” I did not blame him for his anger.
We returned to the Stanford ER and they had to place me in the lookout room, a place for suicidal patients that had a security guard at the door. I was allowed to have one visitor at a time. The guard sat and read as I lay on the bed staring at the blank walls. He told me I looked too young and innocent to be this sad, and he prayed that I would get better. We talked for a little while about activities I used to like and my boyfriend, and then he brought me a magazine. I told him I was only twenty-two and wanted to die. He said there are too many people in the world who would be distraught if I died. I wanted to believe him.
After hours of waiting I was brought upstairs in a wheelchair. A nurse asked me routine questions and made sure I would not hurt myself. She took my vitals including weight (ninety-eight pounds), and we put together a standard schedule and treatment plan. My aunt had flown in to take care of me and to her surprise ended up sitting with me in a hospital room. From my room in the psychiatric wing, located right by the entrance to the ER, we heard sirens and saw panic. My room was also located next to the nurses’ station, making it nearly impossible to sleep at night. They gave me earplugs. I covered my eyes with my blanket, but every hour or so a nurse came in to check on me and shined a flashlight in my face. Most of the night, I followed the slow tick of my clock. Early in the morning a lab attendant came in to draw blood, finding it difficult to locate my veins as I squirmed. An hour later a nurse came in to take my blood pressure, heart rate, and weight. We started a weight curve with where I was and where I needed to be. My doctor explained they hoped to see a steady incline. I always went down. Unlike inpatient treatment centers for eating disorders, the hospital let me know my weight each day. I wanted it to go down.
Meals were at 8:00 a.m., noon, and 6:00 p.m. I had extreme difficulty choosing items on the menu, but my dietitian, Johanna, patiently sat with me as we tried to figure it out. I just wanted fruit and nonfat yogurt. The hospital did not have nonfat yogurt and she said I couldn’t have it anyway because I needed to gain weight. She required me to have soymilk with each meal to get more calcium, in addition to calcium supplements. Many meals I ate mainly vegetables or just the chicken off my salad. Unlike at the treatment center, no one watched me eat. I circled how much I ate on my menus so Johanna could monitor my weight and caloric intake. She said they hoped I was getting at least eighteen hundred calories a day, but I wasn’t—not even close. One of the interns, Jennifer, often sat with me at breakfast and asked me why I wasn’t eating. I told her it all looked like binge food to me and she asked me why it was a binge food, an
d I said, “It just is.” I wouldn’t let myself have french toast, scrambled eggs, or potatoes. Most days I had oatmeal, a banana, and cholesterol-free eggs. They kept opening Ensure shakes. Johanna explained that I was not getting nearly enough calories and needed the Ensure shakes. But I saw them as a one-way ticket to fat land.
In the hospital I felt no relief and no healing. I felt like a helpless mental patient when in reality I was incredibly sick, lonely, exhausted, confused, scared, and longing for someone to talk to. The doctors barely had any time to listen to my thoughts and feelings nor did it seem they even cared when they did lend an ear for two seconds here and there.
sheila: Our nephew had set up a hospital meeting for Ned and me the day we got home from Europe. Seeing Lisa in a hospital gown, disheveled, hardly speaking, we could only say to ourselves, “She’ll get better.” We agreed to the suggestion of a new medication, and thus began the torture familiar to patients with mental illness and their families. The medication may not work, or may have terrible side effects, but in any case it’ll be at least a few weeks before you know. Meanwhile, Lisa was having delusions and decided she wanted to leave the hospital. She was put on a seventy-two-hour-hold.
In California, a person who is demonstrably a danger to herself or others, or gravely ill, can be held involuntarily for three days if authorized by a physician or police officer. The patient has the right to contest the hold. One afternoon I got a call from the patients’ rights advocate, who reported that Lisa had filed a petition to overturn her involuntary hospitalization. The advocate said the mediator who considered these petitions would decide based on Lisa’s ability to feed, clothe, and care for herself. Then she asked me, “Does she have a place to go?”
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