Hope and Other Luxuries (47 page)

“To Clove House,” she said. “It's an eating disorder treatment center for residential patients. You get care twenty-four hours a day.”

Elena named the location of Clove House, and we looked at each other a little blankly. It was several states away. I had driven through that city once on the highway a long time ago, and my imagination pulled up a memory of wide, smooth freeway lanes. It played me scenes of an impressive downtown, of swooping green hills, crummy little apartment houses, and then forest.

“Let's look it up,” I said, and I fetched my laptop. I sat next to Elena on her bed, and we paged through Clove House's website together. The images we found there looked friendly. They didn't scare Elena off.

“The map says it's by a park,” I pointed out, and for some reason, that seemed encouraging. “I'm going to go call them,” I said before she could protest. But she didn't seem able to protest anymore.

Maybe it was good that she was so weak.

The admissions lady at Clove House was encouraging, too. “Yes, we're on your insurance plan,” she said. “We don't have a vacancy at the moment, but we expect to have one in a couple of days. If you like, we can do an intake interview with your daughter at one o'clock this afternoon.”

This sounded very promising. I could barely believe our good luck—except, there's no such thing as luck.

Please help us, dear Lord. Please please please
 . . .

One o'clock came, and Elena sat up in bed to take the call, and I could hear her from the other room, answering the interview questions in her clear, high “company” voice. The answers were confidential, so I wasn't listening to what she said, but her voice sounded stronger than it had in weeks.

The admissions lady told me that the interview went well, and they would expect to see Elena on Thursday morning. I searched for my purse and read out our insurance information to her and asked if there was anything I should do.

“Should I call our insurance company?” I asked.

“No, we'll get that arranged,” she said. “But there are tests we need from her medical doctor there in Texas.”

I found a pen and started a list on a Post-it note:
Patient files. Standard blood work. EKG
.

A plan. We had a plan!

“Here's our fax number for those test results,” she said, and I jotted it down below the list. “Till Thursday morning, then. Oh, and if you'll just call and tell us which flight she'll be on, then we'll know when to expect her.”

I drew a line on my Post-it and added:
plane ticket
.

“Do you send a shuttle to pick her up?”

“No. She'll need to take a taxi. But it's only a fifteen-minute trip.”

So I jotted down
taxi
as well. Then I called Joe at work and told him what was happening.

“Thank God!” he said quietly.

As I was on the phone to Joe, I heard the bathroom door shut. A few seconds later, the shower came on. Such a simple thing, but it reduced me to tears. It was all I could do to keep control of my voice.

Elena was up and in the shower—without me nagging her!

I hung up the phone, and now I was racing to get ready, racing to beat her out of the shower. By the time she opened the bathroom door, I had my keys in my hand, and I drove her to school so she could sign herself out of classes.

On the way, we didn't speak. Elena stared out the window. It was her first day out of the house in weeks.

Can it be possible?
I thought.
Is this really going to happen?

Together, we stood in lines and filled out papers. While we waited at the registrar's office, Elena reached into her purse, pulled out a little notebook, and began to make a long list.

I peeked over her shoulder. The list was titled
What to Pack
.

The title swam. I was blinking away tears again.
This is real!
I thought.
This is going to happen!

A couple of days began to seem like barely enough time for everything that needed to get done. Elena said she needed toiletries. Oh, and
she needed new pajamas. We scoured the bookshelves for interesting books to take. I needed to find her a flight. She needed her blood work done.

She was still up at midnight, kneeling next to her half-full suitcase.

“I need to go to Walgreens to pick up photos,” she said. “And a new hair straightener. Mine doesn't work right anymore.”

“Tomorrow,” I said, yawning. “I'm going to bed.”

But an hour later, Elena came into the bedroom and woke me up.

“I think Valerie's having the baby!”

I tiptoed out into the living room and took the phone.

“How are you doing?” I asked.

“Oh,
you
know,” Valerie said. Her voice sounded as jaunty as ever. But sure enough, her contractions were starting.

“I wish I could be there,” I said, feeling sudden sharp guilt that my daughter was having to go through her big day without me.

“It's all good,” Valerie said. “Kinda glad you're not. It's not like you'd see me at my best.”

“Are you going to the hospital now?”

“Nah. There's plenty of time. I'm going back to bed. The hospital's only five minutes away.”

In the morning, Valerie called again to say that they were on their way to the hospital. She sounded amazingly relaxed. Then Elena and I talked to Clint. He sounded like he was being mugged.

“I hope Clint doesn't drive,” Elena confided to me. “He's so nervous, he might pass out behind the wheel.”

Off and on, Elena and I got updates. Then came the first photo of Gemma, Valerie and Clint's new baby girl.

I sat down on the bed, and I looked at her, and I cried.

What is it about a new baby that makes life seem like such a miracle? Is it the thought of the danger along that first lonely journey? Is it the fact that so many things have gone right when they could have gone so terribly wrong?

A brand-new person has entered the world. Something completely unique has been added. Our lives—the entire planet!—will never be the same.

Valerie's baby. Clint's baby. Their voices brimmed with excitement and wonder. The most ordinary sentences vibrated with hidden awe. As the photos came in, I could see it on their faces:
This is an event greater than each of us and greater than all of us. History and Fate have paid us a visit
.

The air of the hospital room was thick with angels.

I remembered that very first day, when Joe drove home from the hospital at twenty miles an hour, cursing out the window at any motorist reckless enough to drive within fifty feet of the car because our precious newborn baby was in the backseat. I remembered carrying her up the apartment stairs—oh so carefully! We put her down on our bed and the two of us sat and looked at her . . . just looked. “Our baby is beautiful,” Joe had said softly, and I could hear the awe in his voice.

Now, I was a grandmother, and Joe was a grandfather. The wheel had turned, and we took our rightful places.

The birth of this new family member wrapped a spell of peace and happiness around the whole house. Elena finished her packing. Very early the next morning, Joe and I drove her to the airport and hugged her good-bye. We watched her walk away through security. Then we went to a nearby pancake house and ordered breakfast—just the two of us again.

The last few months had been chaos. The next few months would be crazy. But right now, I stirred my coffee in its chunky mug and felt contentedly old and ordinary. The relief I saw on Joe's face mirrored my own relief.

One daughter was a real adult, with a husband and a family. The other daughter was getting the help we couldn't give her. Joe and I were well on our way to fading into rest and retirement, and we were more than ready to play that part.

“Do we get the senior discount?” Joe asked the waitress. “We're grandparents now. Look!” And he showed her Gemma's picture on his cell phone.

Joe dropped me off at the house and went on to work, where he would no doubt field complaints from colonels and generals as far away as Korea and the Indian Ocean. I crawled back into bed and slept like I hadn't slept in months.

Elena woke me up to tell me that her plane had landed and that she needed help finding Clove House. Then she called again to tell me that she'd gotten there and they were processing her in. She had to put away her cell phone now, she said. She wasn't allowed to keep it with her.

She sounded nervous, but I felt perfectly calm.

I had heard of people feeling lighthearted. Right then, every single part of me felt light. I could feel the enormous weight of Elena's life-or-death struggle lifting off my shoulders. I got up to feed Dylan dinner, and he puffed his blue-green fins out like sails and swam into the palm of my hand. I fixed food bowls for Genny and the cats and watched them roll over, one after another. Then Genny went scampering around the yard on her ridiculously thin legs, and the cats bolted after her and raced up and down the tree, while I stood in the bright, clear sunshine and laughed.

Later, when I cleaned the kitchen, I turned my favorite music up loud. Elena wasn't there to creep out of her room, sick and exhausted, and beg me to let her sleep. Elena was where she needed to be. This was her decision, and it was the right one. The professionals would help her rediscover her passion for life.

It was going to be okay.

My poor damaged daughter was going to be okay.

Late in the afternoon, the phone rang. It was a staff member from Clove House. “We need you to book another airline ticket,” she said. “Your insurance company won't pay for treatment. They say it's not medically necessary. Your daughter is going to have to go home.”

T
he refusal of insurance companies to pay for care that is “not medically necessary” is supposed to prevent frivolous or fraudulent treatment. Until Elena's diagnosis, I had never even heard the term. But psychological care is much less precise than medical care, and it can also be a great deal more expensive—particularly the long months of around-the-clock care for anorexia nervosa.

I'm not the only family member of an anorexic who has had to hear this unhappy news. More anorexia patients than could possibly be numbered have gotten kicked out of treatment because their insurance won't pay up. In most cases, the insurance company has stepped in and cut off treatment as “not medically necessary.” And many of those patients have gone on to die from their illness—some within a matter of weeks.

Anorexia nervosa isn't just a deadly mental illness. It is the deadliest mental illness of all. This isn't just me being dramatic, either. It's a medical statistic anyone can look up. Anorexia nervosa is orders of magnitude more deadly than other mental illnesses. It kills three times as many victims as bipolar disorder and twice as many victims as schizophrenia.

One out of every five anorexics will die early because of this disorder.

One out of every five!

And the “not medically necessary” snafu doesn't help.

When I got this devastating phone call, it was too late in the day to do anything about it. Offices around the country were already closing. So I found out what I could from the Clove House staff, and I asked them to give me one more day. And then, all evening long, I made my plans.

My insurance company had ruled that Elena's care at the treatment center wasn't medically necessary. They were refusing to pay the bill. And
if they didn't pay for it, nobody else could, either. The charge for residential care at Clove House was eleven hundred dollars a day.

But if Elena came home . . .

I knew what would happen if Elena came home. This disappointment would only speed things up. She would disappear into her room, and she wouldn't come out again.

Not alive, at least.

That made my plan simple. It was childishly simple. There was only one thing I could do. Somehow, I had to make the insurance company pay.

The lightness I had felt that afternoon was gone, nothing now but the dimmest of memories. Once more, my overwrought brain churned and schemed. The Clove House staff had told me that a psychiatrist at our insurance company had reviewed Elena's case and made the “not medically necessary” decision. Fine, then I would ask for another psychiatrist to review this psychiatrist's decision. And because I could argue that an insurance company employee couldn't be impartial, I wanted this second psychiatrist to come from outside the insurance company.

That's what I would do: I would demand an outside review of my daughter's case.

I knew how important these plans were. I knew that it wasn't enough to call and complain. In any bargaining situation, before going in, it's vital to know what you want. Only then can you work toward that goal.

Now I knew what I wanted, and I also knew I would have to back up my demand with facts. So I started digging through my files. I dragged out all the paperwork from the Summer from Hell. I pulled out old lab results and new lab results. I compared blood values and EKG findings, and I put together my arguments:

• The last time this patient had to go into the hospital, she was at a higher weight. She had a damaged heart at that higher weight—maybe she does again.
  
• You paid those claims, so at that higher weight, you judged that the identical eating disorder treatment you're denying now was medically necessary.
  
• That means this is a borderline case.
  
• That means it deserves an outside review.
  

The plan kept me busy for several hours. But once it was complete, there was nothing to do until the following morning, when the insurance company phone lines would be open. I should rest up. I would need to be sharp. I should get some sleep.

But of course, I didn't sleep.

If Elena came home . . . If Elena had to come home . . . I knew what would happen.