Brave Girl Eating (6 page)

But of course, she is.

Jamie arrives in time to hear the doctor in charge of the ICU tell the nurse, “Get an NG tube.”

“A
what
?” I say.

The doc looks up, his eyes impatient. “A feeding tube,” he says, drawing the word out as if he thinks I can't hear him. And maybe I can't. “It goes up her nose and into her stomach,” he adds briskly. “We'll feed her that way if she won't eat.”

“No, Mommy!” cries Kitty from the bed. “Not the tube! I want to be able to taste my food!”

It is a moment of the highest imaginable absurdity. I want to say, “But you're not eating anything now!” Later, I understand her reaction. The need to eat is hardwired into our brains and bodies. Anorexia can keep a person from eating, but it can't turn aside that primal force. Hunger denied expresses itself in other ways—in Kitty's case, in the compulsion to taste and savor every shred of food she consumed.

I bargain with the doctor. “Give her an hour,” I beg. “If she eats something in an hour she doesn't need the tube.”

The doctor raises an eyebrow. Clearly, he thinks I'm a deluded and interfering mother. Clearly, he doesn't believe Kitty will eat. But reluctantly he agrees that if she downs a whole protein milk shake in the next thirty minutes, and
then
eats a plate of spaghetti an hour later, he will hold off on the tube. For tonight.

The ICU nurse, who is the kindest person I have ever met, brings a chocolate protein milk shake and a straw. She helps Kitty sit up, arranges the pillows behind her, pulls a tray over, and puts the milk shake on it. Kitty reaches for the milk shake, holds it in one hand, lifts the straw to her lips. She's crying silently now, tears slipping over the sharp cliffs of her cheekbones. Her hands tremble. Her whole body trembles. For five minutes, ten minutes, fifteen minutes she sits, holding the milk shake and crying, while Jamie and I murmur encouragingly.

I have fed this child from the moment she was born. I have fed her not just with food but with love. The thought of a nurse, even this one, pushing a bolus into her stomach through a tube makes me want to vomit. I try to arrange my face into a neutral expression. I try to be ready for the sight of the rubber tube threaded up my daughter's nose and down her throat.

But Kitty eats. One shaky, terrified bite at a time, crying steadily, she consumes the shake. Between bites she talks out loud to herself. She seems beyond caring that we can hear, or maybe she's so deep in her own nightmare that she doesn't know we're here. “Come on, Kitty, you can do it,” she says. “You don't want to go back to that scary place.” Jamie and I are crying now too, as we understand for the first time exactly how courageous our daughter is. Each time she lifts the spoon to her lips, her whole body shaking, she is jumping out of a plane at thirty thousand feet. Without a parachute.

Thirty minutes later exactly, Kitty finishes the milk shake. And
an hour later she eats the plate of spaghetti, one agonized bite at a time. The nurses praise her extravagantly, rubbing her hands, her back. It's more than Kitty's eaten in days. Afterward she falls asleep. Jamie goes home to collect Emma from the friends who have been taking care of her. I sit in a chair beside Kitty's bed, exhausted but unable to sleep. Every time I start to nod off, Kitty's sunken, terrified eyes rise up before me. Seeing the shape of her ulna revealed against the white hospital sheet feels strangely pornographic, like seeing part of someone's brain pulsing and exposed. It's a reminder of my daughter's vulnerability, and it feels unbearable, because there is nothing I can do to protect her from the thing that is eating away at her. And how ironic—she's being eaten alive, literally, by the fear of eating.

There is no privacy in the ICU; a glass wall separates us from the rest of the unit. I see the nurses filling out charts at the station, doctors hurrying back and forth. I see other parents with bloodshot eyes and ravaged faces. As night falls I sit, and I watch, and I wait for whatever will come next.

Five days later, Kitty
is discharged from the hospital. I'm anxious about bringing her home, because as awful as the hospital has been, at least we weren't alone with the anorexia there. It wasn't just Jamie and me at the kitchen table, locked in mortal combat with our starving daughter. Kitty's eating about a thousand calories a day now—not much, nowhere near enough, but probably twice as much as she was eating before the hospital. What will happen now that we're going home again?

On our way home we stop for groceries, the first of the nearly
daily shopping runs we'll make over the next year. Kitty rests in the car with Jamie while I blow through the store at top speed. Just last week I wished I could shop without Kitty's intrusive presence.
Be careful what you wish for.

As I steer the cart through the produce section, I'm reminded in a curious way of what it feels like to begin a diet: the special preparatory shopping trip, the sense of hopefulness undercut with past experiences of failure. The sense of wiping the slate clean. The feeling that this time, things will be different.

Will they, though? I want to believe Kitty's hospitalization will change things, though I don't, yet, understand how. I can't see my way from where we've been to where we need to go. And I'm a person who needs to be able to see the path ahead, to see what I'm up against and what I have to do, no matter how tough. Right now, not only is there no clear path, there's no suggestion of one—just a seemingly infinite slog through the darkness that has swallowed up our daughter.

If she was ill with something else—if she had diabetes, or pneumonia, or strep—her doctors would prescribe medicine, bed rest, fluids, and we would give her all those things. But this—this is like battling a many-headed monster in the dark. It's like fighting darkness itself, a darkness that is inside my daughter, that's somehow part of her. To fight
it
feels like fighting
her
.

Dr. Beth has explained to us that we need to increase Kitty's calories by about three hundred every couple of days. And that's why I'm here, to prepare for the battles that are coming. I rip up my shopping list and any concept of a budget and speed-walk down the aisles, piling the cart with cookies, Muenster cheese, alfredo sauce, ranch dressing, buttery crackers, ice cream, potato chips, candy bars—all the foods Kitty used to love. Before anorexia, I didn't buy
much processed, packaged food. I was a conscientious and health-conscious mother in twenty-first-century America, where we all understand the words
healthy food
to mean
low-fat, low-calorie food, and not too much of it
. Standing in front of the Pepperidge Farm display now, I have the sense that the world as I know it is tipping, elongating, growing as strange as an image in a funhouse mirror. I grab an armful of Milanos and keep going.

At the far end of the store I stop at the shelves of high-protein and high-calorie supplements, which Kitty drank in the hospital with every meal. I tried one once; they taste nasty, a revolting cocktail of chemicals and artificial flavors. But each Ensure Plus packs 350 calories, more than a quarter of Kitty's daily requirement right now, and Kitty has perfected a way to drink it: she holds her nose and pours it down in less than five seconds. I load the cart with chocolate-flavored Ensure Plus and move on.

Kitty's asleep in the backseat when we get home. As a toddler, the only way we could get her to nap was to drive her around until her eyes slid shut and her head drooped. Then we'd carry her into the house, car seat and all, tiptoeing so as not to wake her. Now Jamie unbuckles her seat belt, scoops her into his arms, and carries her upstairs to her room. He looks at me, and I know what he's thinking: it's been years since he could lift her this easily.

I call the friends who are keeping Emma today to let them know we're home and to talk to Emma, who says she's been invited for dinner and wants to stay. Over the last few weeks, she's found ways to avoid all of us as much as possible, and I don't blame her. Emma's world has been turned upside down. She's watched her sister suffer and starve and her parents morph from reasonably functional adults into obsessed, irritable wrecks. I wonder if we should send her to stay with my sister for a while, to get her out of the house. Not yet,
I think. If things get really bad. Then I laugh to myself. How much worse can they get?

I tell Emma of course, we'll pick her up later, and then I take my time putting away the groceries. I stow the Ensure in the basement pantry, tucking the small square bottles behind cans of chick-peas and lentil soup. Their sell-by dates read two years from now. Where, I wonder, will Kitty be then? Where will we all be?

 

On our first posthospital
appointment with Dr. Beth, three days after Kitty comes home, she's still shaky and dizzy, but at least she can walk now, leaning on one of our shoulders. The nurse has her pee into a container in the bathroom and put on two hospital gowns, and then weighs her, standing her backward so she doesn't see her weight.

Dr. Beth is gentle with Kitty when she comes in, taking her vitals, talking to her in the kind of low, soothing voice you might use with a frightened animal. After the exam, as Kitty is dressing, I ask the doctor what we should do next.

“I've never had a patient this sick before,” she says, and I feel a now-familiar frisson of guilt run up my spine. Dr. Beth tells us that other families send their children to hospital inpatient units or residential clinics. The nearest clinic is at Rogers Memorial Hospital, an hour away. Lots of teens from our town wind up there, she says. On the plus side, Kitty would probably gain weight there. She'd be in competent hands. We'd have a breather, a break from the relentless drama and terror of anorexia.

On the other hand, says Dr. Beth, Kitty might learn to be a better anorexic at Rogers. I don't understand what she means.

“Right now, Kitty's being fairly straightforward with you,” she explains. “But kids teach each other all the tricks in places like Rogers.”

What tricks, I want to know. Dr. Beth ticks them off on her fingers: Water loading, the practice of guzzling dangerous amounts of water before a weigh-in. (That's why Kitty's urine is analyzed before weigh-in, to make sure it's not too diluted.) Sewing weights in their underwear. Making pessaries out of coins. Stuffing food in their cheeks at the table and then spitting it into a napkin when no one's looking.

I try to keep my face blank, but inside my head a voice is screaming
No!

Not my daughter. Not Kitty, whose face, until recently, I could read like my own. Who can't bear the feeling of having done something wrong. Whose sense of right and wrong has always been overdeveloped—for years Jamie and I have been trying to break her of the habit of apologizing fifty times a day. Who still, until recently, left me little notes saying “I love you, Mommy.” That Kitty would never do the things Dr. Beth describes. If we send her to Rogers, will that Kitty vanish forever?

Dr. Beth goes on. There are residential clinics all over the country; there's a place in Utah that's supposed to be very good, if you can get in.

Utah? Jamie and I look at each other. We don't know anything about eating disorders, but we know that Kitty needs us. And we need to be with her. She panics when we're out of her sight for more than a minute, and, at the moment, so do we. How can we send her to Utah? How can we send her anywhere?

“What if it's her best chance for recovery?” asks Dr. Beth.

That's the million-dollar question: What will give Kitty the best shot at recovery? Is a faraway clinic her
only
chance? Are we irresponsible to want to keep her close?

I'm a journalist; my usual coping mechanism is to gather information. I'd begun reading up on anorexia, and the statistics terrify me: A third of all anorexics stay sick forever. A third to about a half will truly recover. The rest stay on the brink of illness, living diminished lives: they have trouble keeping friends and holding down jobs; they cycle in and out of hospitals. They spend years on the outside looking in, unable to live fully or wholly.

That's not what I want for my daughter.

And there's no consensus on what true recovery means. Everything I read suggests that anorexia, like alcoholism or drug addiction, is a disease with no real cure, a disease you have to “manage,” one day at a time, for the rest of your life. Once an anorexic, always an anorexic.

I refuse to believe that.

But I don't know what
to
believe. I can't read the dozens of books and articles piling up on my desk. They paint such bleak portraits: Anorexics are dying for attention; their parents neglect their true needs, so they take drastic measures to get what they need. Or: Anorexics are dying for control; their parents are so dominating that controlling what they eat (or don't) is the only way they can express their normal adolescent need for autonomy. Or: Anorexics are conflicted about growing up and becoming sexually mature, so they try to keep themselves small and childlike by starving. Choose A, B, or C—the message is the same: anorexics (and their families) are seriously fucked up.

Maybe I'm in denial, but our family doesn't seem particularly pathological. We've got our issues, like all families. I've had panic
disorder since I was a child, which I manage through therapy and medication; Jamie grew up in an alcoholic family where emotional self-expression was not encouraged. We bicker sometimes. We're grumpy sometimes. We're far from perfect. Still, I don't recognize us or Kitty in the literature. Each time I read another chapter, another article, I feel worse, not better. Reading has become another exercise in self-flagellation, and I don't need any more of that, thank you very much.

And so I stop reading, and Jamie and I move through the hours in a stupor of barely suppressed terror and confusion. We're back in the same boat we were in before Kitty was hospitalized, only now she's eating a little more. The hospital scared her. It scared all of us. But I can see that it won't be enough.

Dr. Beth calls the day after our appointment with an idea: she's talked to the head of a new adolescent psychiatric hospital in town, and although the hospital doesn't treat eating disorders per se, the director has agreed to what's called a partial hospitalization. Kitty can spend eight hours a day at the hospital, going to classes and group and individual therapy, but come home at night. It might be a good compromise.

The next afternoon, I help her into the car and we drive across town to see the hospital for ourselves. A storm breaks as we pull in, complete with thunder and lightning and pea-size hail, which pelts us on our dash from the parking lot to the building—a fitting demonstration of Sturm und Drang.

The receptionist buzzes open the front door; every door in the hospital, it turns out, is kept locked. We wait in a growing puddle for the therapist who will take us around. Dr. N. is young and friendly, greeting the teenagers we see as we walk slowly through the building. Most are oddly dressed—bathrobes over blue jeans,
hair unbrushed, eyes dazed or combative or both. Kitty squeezes my hand and I squeeze back.

Dr. N. leads us to a small conference room for the intake interview. Kitty, she tells us, will come to the hospital at nine each morning and stay until five. She'll have individual and group therapy; the group will comprise other teens struggling with illnesses like depression and bipolar disorder. Kitty can also attend the hospital's “school.” “Like right now,” she says, turning to my daughter, “the eighth graders are learning about volcanoes and building birdhouses. You can sit in on a class if you'd like.”

Kitty physically recoils, and for the first time in weeks I feel like laughing. One of her long-standing complaints about school has always been the slow pace and endless busywork, especially in middle school. Spending the rest of the summer building birdhouses and learning about volcanoes is about the last thing she'd want to do.

Besides, the other kids here are
really
messed up. Kitty's not like that.

But isn't she? Isn't she, in some profound way, like the other teenagers, with their disoriented eyes and odd behaviors? Yes and no. Eating disorders affect a person's thinking and cognitive abilities, but only around certain subjects. Kitty can rattle off a quadratic equation, speak eloquently about World War II, play a violin solo. Her intelligence is unaffected by anorexia—until the subject of food or eating or body image comes up; then she'll eat two bites of turkey and spend an hour sobbing because she's eaten so much and she's going to get fat. When this happens, as it does every time she eats, I want to say, “Don't you get it? You need to eat or you'll die.”

I'm only just starting to understand that she really
doesn't
get it. That her perceptions are genuinely out of whack. Much later, an
other therapist describes anorexia to me as a kind of “encapsulated psychosis”: someone with anorexia suffers under a set of delusions just as powerful as the delusions of a schizophrenic—but only when it comes to food, eating, and body image.

Dr. Walter Kaye, director of the Eating Disorders Program at the University of California–San Diego and one of the leading researchers on the biology of eating disorders, once found a way to make this dissonance clear to his students. He invited two anorexic women to class and asked one of them to describe how much she weighed and how she looked. The woman said that she weighed seventy pounds and that she looked fat. Then he asked her to describe the other woman. “She said, ‘She looks terrible; she's so thin; she looks like she's going to die,'” Kaye tells me. “And I said, ‘But look, you're seventy pounds and she's seventy pounds and you're the same height. How do you put this together saying you're too fat and she's too thin?' And she just looked at me and said, ‘I don't know, but I feel too fat.'”
^*