Balancing Act

Brynn is a clean-cut Jewish girl from a large orthodox  family. Maybe I should rephrase – with somewhere around 100 cousins and 12 siblings just in her immediate household, her entire family is more like gargantuan. In her time not spent inhabiting hospitals due to her anorexia she is a 30-year-old teacher of mentally challenged children. Originally from Canada she moved to New York just a few years back and was hospitalized for 5 weeks and then transferred here with us almost two weeks ago. In another week one of her brothers is getting married so many of her relatives are in town for the event. They call, one after another after another, at all hours keeping Brynn so busy at the payphone that she rarely has time to settle down into any sort of leisure activity.

With multiple visitors each day and not being able to take 10 steps from the phone I would be desperate for solitude after about a day and a half. Its all just further proof though of the diversity that walks through these double locked doors. Brynn, on the other hand, loves her family without abandon and does nothing to hide her excitement of their, both announced and unannounced visits. Heck, she doesn’t hide her excitement about anything and it seems that everything, from a french braid in her hair, to a new TV show, to a big brownie, gets her excited. Brynn is something of a 1,000 watt eternal sunshine and proud of it.

Occasionally the exasperation over what so many of us would deem mundane gets overbearing but thats only because most people are just not used to it. She talks incessantly and exudes an extreme polite friendliness consistently. Admittedly, through the mindfulness teachings of our weekly DBT group, she reacts at this point primarily with her emotional mind. Impulse following impulse in a strange indecisive governing of actions. We all do this though when we are underweight. Without enough nourishment the rational side of the mind loses focus and its ability to think things through falters.

The drive of the emotional mind will change as we regain health and the ability to practice finding a balance between the two becomes more available. The balance is known as “wise mind” and it just means taking both sides into account. All of Brynn’s exuberance is the best she can do to rationalize her emotional mindset. For many of us, when we try to do this, the result of the rational mind’s exertion just causes us to be numb to our emotions but is not usually enough to gain any sort of wise mind balance. For Brynn, her rational mind allows her to mask her outward expressions of unhappiness with an attitude so constantly positive that it seems fake sometimes, but only because we aren’t sure how she can stay so upbeat.

Things will change with time though, as always, and for myself, I’m finding I’m more and more in control of my decisions these days…and all I can say is that it feels great.

(That last statement may have come from my emotional mind but I don’t think it needed any rationalization. )

The pitfalls of good health

Lisa is back. Directly after breakfast on Friday morning she, along with most of her belongings, had been hastily packed up and escorted via wheelchair to the actual hospital part of Columbia across the street. She is the one here most at risk of refeeding syndrome and findings that morning had revealed dangerous potassium and electrolyte imbalances. Due to the high possibility of cardiac arrest there was someone at her bedside throughout her entire 48-hour stay. She returned to us unexpectedly this morning in a stabilized condition…for the moment anyway.

Refeeding syndrome, if its going to happen at all, usually occurs at the beginning of treatment when patients are first introduced to a healthy diet. Metabolic disturbances are a common effect from a sudden shift from fat to carbohydrate metabolism and and increase in insulin levels. Very basically, its a major shock to the system of a starved or severely malnourished person. When instituting a new diet the shifting of electrolytes and fluid balance increases cardiac workload and amps the heart rate. Our hearts, already depleted of muscle strength, sometimes just can’t handle it and it puts someone starting the refeeding process at acute risk of heart failure.

All of this is why inpatient treatment is so highly recommended for more sever eating disorder patients. Even if a greatly malnourished person wants to change and has the wherewithal to just fix their diet and start eating more at home inpatient is still the better choice. There has to be gradual steps in the process of renourishment. Every few days adding a little more into the diet to avoid an overload of healthy eating that can ultimately kill. Refeeding syndrome, for us, is just as big a threat as death by starvation is. All of it is a scary, delicate process.

One of the problems in successful eating disorder treatment lies within the basic diagnosis. There is no specific weight range that simplifies a written report for someone seeking treatment. The outward appearance of someone with the disorder does not dictate the amount of physical danger they are in. Some people with anorexia can be slightly overweight, while others with a binge eating disorder can also be underweight. Without constant medical monitoring, the checking of vital signs, pain level documentation, blood testing, and EKGs there is no way to tell who is at risk of refeeding syndrome.

When Lisa was taken 2 days ago we weren’t told anything even though it all happened right under our noses. The realization of actual death being that possible was a heck of a reality check as we all sat around trying to make sense of the wheelchair and panicked nurses busting around us. I don’t know what would have happened if it turned out that we never saw her again and I don’t really want to think about it. All I can say, and I think I speak for the group of us patients in this, is that we are glad to have her back no matter difficult it may be to look at her in her state. At least shes alive.

Gaining

Every body is different. Thats something that I have to remember. We all gain and lose in different places and the skin we wear is suited to fit each of us perfectly. I say the now as a reassurance because lately I have caught myself thinking more and more about how this recovery looks on me. I have to call it that – Its not weight, its health that I’m regaining. I know, too, that when I look in the mirror, what I see may be the common view but I interpret it differently than others would.

When I look in the mirror I try to point out the good things about where recovery is working its wonders. My waist, for instance. In my eyes it is all settling around my waist there is scads of logic and miles of reasoning to rebuke that. Its a fact that in the refeeding process the initial weight does seem to amass in the abdomen. This is because of a few things such as your stomach, not used to food, is digesting slower. It makes sense. Your body, not knowing when it is going to be deprived of food again, tries to hang on to what it does get for a longer period of time than normal.

Its also a fact that, when a person starving themselves of the nutrients that supply energy, the body takes that energy that it needs from internal things in a certain order. Fat goes first. When it has used that up the energy stored in muscle is the new target. Those get used and limbs start looking gaunt and thin, and so it goes down the line. Eventually the energy needed starts getting taken from some organs to keep other, more vital, ones working. Organ mass is lost and shutdown of different ones can occur as your body does its best to keep the two most crucial, your heart and brain, going as long as it can. Thus, when your body is gaining everything back, it regains first what it last took from and things in your torso get replenished before arms and legs do.

All of this comforts me when my mind starts to wander into the questioning black hole realm and I know that what I see around my middle will disperse through the rest of my body in time. I also know that I am going to gain differently than some of the other girls here by comparison for one very BIG and important (and cute as can be) reason. Reese. I have had a child and most of them have not. My amazing, now 8-year-old, son is the driving force behind so much of my work here and there will never come a day when I would choose a flat stomach over him.

We are all different, in all unique shapes and sizes, and if defined by no other label, I am ME.

The Danger Zone

I’m going to start off by saying that it is very hard to talk about or to the new girl, Lisa. Heck, its hard to just look at her. She is tall with chin-length brown hair, brown eyes, dainty fingers, a slow speaking voice, and she is nothing. There is nothing to her. Her thin translucent skin stretches over each and every curve of bone to give pure definition to the movements of skeletal structure. By the laws of science and human anatomy its a miracle that shes breathing, let alone standing up, and thats something she can’t seem to stop doing. Lisa is a self-admitted exercise addict as well as anorexic and she is never just sitting. She is either asleep or walking around.

Lisa has been living in Seattle up until recently when she moved to New York to start law school. After only a week of classes she gave in and made the critical decision to come here and, for her, at 29, its not the first time in treatment. One of the scariest things is that one of her previous treatments was this program which she left, at a healthy weight, just last January. Thankfully she knows, at least on some level, that she needs to be here. Although I don’t know what her mindset was like before, at this point shes vocally appalled at herself for having fallen down that familiar rabbit hole again and so quickly.

I look at Lisa and see the sickest thinnest (at this point the two words are interchangeable, so take your pick) person I have ever seen in my life. At Remuda, someone thinner than me coming into the program, was triggering. Here, at Columbia, all it does is scare the pants off me. I had been so close to that myself, definitely mentally, if not physically. I was too close for comfort to being so entirely lost. I can’t express how glad I am to be given the chance to find my life again. (Big sigh of relief from a set of working lungs now.)

Right now Lisa is settled into the quiet room. Its the same room I was in when I first got here. For me it was just transitional, until another room opened up, but for Lisa its for medical surveillance reasons. She is deemed critically unstable and has the orders, for the moment, to do only 2 things – eat and sleep. Above it all though, no matter how she looks or how slow and disjointed her speech may be, her mindset of recovery seems to be in the right place. She is eating 100% so far and comes off outwardly positive. We’ll have to see what the next few weeks bring but I do, emphatically, hope the best for her.

Rice Rice Baby!

The rice smelled amazing as Amy stirred it, letting the contents of the steaming pot slowly absorb the apple cider it was cooking in. It was supposed to be an apple walnut rice recipe that we had found on the internet but, due to majority rule, we wound up omitting the nuts. That didn’t matter when it came time to eat though because the rice had a great unique flavor without them. Beyond the side dish the broiler, oven, and remaining burners were all hard at work on tuna steaks, cheese sauce, broccoli, and a delicious little sweet treat entitled Earthquake Cookies.

All of this came with my first experience in cooking group. Its a group run by Talia every Tuesday at lunch time and we have to be on level 3 and at a certain percentage of our ideal body weights to participate. This time there were 4 of us aside from the staff, Talia and Carly. Besides me our little posse was made up of Laura, Amy, and Diane with Laura being the only veteran. The main objective of the group is what one might expect from the name. We get together and choose our menu, those who are available trek to the grocery store down the street, and we all reconvene before lunch to get our slick cooking skills on.

I was in charge of the cookies which have now turned into one of my favorite recipes due to their simplicity and deliciousness. They called for our choice of boxed cake mix, all of us agreeing on spice cake, 2 eggs, shortening, a tablespoon of water and a dusting of confectioners sugar. Believe you me, I will have this recipe memorized in no time just from sheer repetition. Talia got the fish ready and we each seasoned our fillet with what we wanted before it went into the broiler. Through that Diane and Amy prepared and made the rice and Laura, with her energetic personality, was checking on multiple things during breaks from stirring the cheese sauce.

Finally, after about 45 minutes of mouth-watering aromas barraging our noses, it was time to sit down and eat. Earlier in the day Talia had e-mailed Sally, the dietitian, about the correct portion sizes for this meal so we could each meet our caloric needs and thats where a bit of a problem arose. It just a little shoddy planning on our part but a good lesson of the various things that need to be taken into consideration when balancing a meal. The portions were all acceptable except for the whole cup and a half of rice we each had to consume. Got it. Lesson learned. That was indeed a lot of rice. It would have been a better idea to add in a glass of milk or a sauce to the fish, either of which would have reduced the rice to just one cup, but now we know for next time, I guess.

Full and happy we cleared our plates after the meal and then sat back down at the table for processing. Mostly everyone had done well and felt okay about the experience as a whole. Amy was concerned about the apple rice allotment but, once the reasoning behind it was explained, she understood. The cooking group experience had been a happy success. Not everyone who comes in here has such an easy time with it. We all have different phobias surrounding food including, but certainly not limited to, consumption, cooking, prep work, growing, etc., so that cooking group can become a freakishly intimidating experience. I think, though, that this time we persevered achieving our goal, and, I for one, am proud of it.

It looks like next time the general consensus has fallen on a dinner of quesadillas…yum!

Ahoy, Room-matey!

I guess I got my wish. With 2 more new patients in just 2 days the beds are filling up and rooms are getting switched around. Jeanette broke down saying her goodbyes in Community Meeting today and her beautiful French accent was apparent even through her tears. Having grown up in Paris she is now 24 and has been making her way in New York for almost 3 years now, going to school and actually working in a different part of Columbia’s research building.

Thursday is her last day and she has already packed up most of her room. It takes a few minutes for her to catch her breath and her voice warbles when she does so, but through it all she is still able to express, even while explaining that she can’t find the right words, how immensely thankful she is for this program. Elle, who will be moving out of our room and into Jeanette’s single bedroom once shes gone, puts her hand on Jeanettes shoulder. No one can say that bonds haven’t been made here.

Once Elle leaves I will be figuring out cohabitation with a new roommate for about 6 days or so, until Carrina goes home as well. At that point I will be moving into the twin of Elle’s new room. The two bedrooms are smaller than the doubles but have more than enough space for one person. Once I move Elle will be in the room next door and we will be sharing the bathroom that links the suites together.

I definitely got lucky having my awesome roomie...

Its going to be a bit hard losing her as a roommate since we have grown so accustomed to each other and work in a balance of quirks and moods but at least I’ll be getting my own place in the end. It will be nice to have that extra privacy and she’ll still, at least, be near by for the occasional late night chat.

When I first got here, if I had been asked, I would have probably voted Elle as the person I would be least likely to really become friends with. She was very quiet and seemed to regard me with, what I thought at the time was, contempt. I read her silence as though I was an annoyance to her. Something like a gnat on a balmy summer night. As it turned out that was just me though, my mind jumping to assumption, thinking that whatever anyone’s problem is it must have something to do with me. Elle has a quality of neatness that is consistent with OCD. The compulsion to organize and color-coordinate her perfectly folded laundry is the same one that insists she eats things in a certain order and doesn’t allow her to pick up food with her hands. Recently she has been doing much better at mealtimes but, when I first met her, it was these issues of her own plaguing her that caused my misguided interpretation.

At the age of 29 Elle is the proud head manager of a large clothing store. Its a chain store and her branch is located in Seattle where she lives with her Shih tzu puppy, Sisko. Born in Guatemala and adopted into the US as a baby she has lived in Washington most of her life. She stands at least 4 inches taller than me and has an amazing fashion sense that i have found completely suits her the more I get to know her. She is a lesbian and constantly gels her short black hair into various styles of mohawk-esque spikiness but her clothes are more femenine than the items I have hanging in my own closet. She pays pique attention to picking outfits and matching jewelry, somehow wearing whatever the choice comes to for the day with comfort and grace.

A roommate classic.

She is unique. Its something about the way she carries herself in front of others. There is a strength and determination of almost stoic relentlessness behind her dark eyes and yet, when she opens up, shes got a beautiful laugh and an astounding singing voice. I like our late night talks and I’m glad she feels she can confide in me. It just goes to show that sometimes the people you least expect can make the biggest difference.

Snicker-snack

Everyone loves snack time!

“So you really do like cottage cheese now, huh?” We are all sitting around the snack table with our white paper bags flattened and spread out before us. Each one is individualized with our hand-written goodie choices on a small slip that comes stapled to its corresponding bag. We choose our snacks for the week at the tail end of menu planning on Thursdays and work from a printed list of options and possible combinations. There aren’t specific calories listed but the general idea is to pick what we want with the goal of aiming for about 400 calories in total. The list is pretty extensive and the combos seemingly endless, plus we can ask about adding in different things that we may have liked about one of that particular day’s meals. For instance, if cheesecake was the dessert with dinner and a second helping is wanted for snack, then voila! It is done! A dessert lover at heart this is an indulgence Benji frequently partakes in. Right now he is sitting to my right, watching, as I unload goodies from my bag.

Tonight the magic number is 3, there are 3 snack components, and I pull out an individual serving of Honey Nut Cheerios, a half cup of cottage cheese in a plastic container, and a small wax bag with 10 vanilla wafers in it. Benji has got a half cup of granola and a personal-sized carton of whole milk like the ones I remember being served in school cafeterias back in the day. At the moment he is busily picking through the granola and sanctioning off his favorite part – the raisins. He does the same thing with Raisin Bran cereal whenever he has it.

“Yea, I guess so.” I reply to his question. “I don’t know…its weird. Its good with salt and maybe some granola mixed in…”

“I just remember you saying, when you first got here, how much you hated it and how much you hoped you wouldn’t have to eat it.”

“I know, and I didn’t like it then. At all. As far back as I can remember I have always hated cottage cheese. The stuff that they serve here though isn’t how I remember it.”

Benji pushed through the granola with his index finger searching for any extra stealthfully hidden raisins. “Probably because here it is full-fat. I bet thats why it tastes different.”

“Part of its the texture, too. Before I didn’t like how it was just runny and watery with little things the consistency of blood clots in it. I didn’t like how it felt in my mouth.” I had finished my vanilla wafers which were on the low end of the quality scale this evening since they were chewy, like gum. Due to such variations in crispness among the wafers I guessed a while back that the kitchen probably portioned out our little bags from a much larger industrial type of box. The ones that came out when the box was first opened still held the crispness the ‘Nilla creator had in mind, while the others, the ones at the end, may have been of better use to a glue company judging by the amount they stuck to the roof of your mouth.

Benji watched me open the Cheerios and drop a few into the first layer of cheese, the top section that I had just finished mixing salt into. “I still hate cottage cheese.” He said somewhat warily, as though someone might try and force him to eat it sometime soon. “I can’t stand the stuff.”

“Oh well,” I said with my mouth full, “I don’t know what kind it was that I was eating before that I didn’t like so much but I like this now.” I spooned some more cereal onto the concoction. “And thats something new to add to the list too. Its not just good with salt or granola, but Honey Nut Cheerios as well.”

“Did you ever consider just eating it like a normal person?” He asked.

I grinned at him. “Whats normal?”

The Trust

Dusk is slowly rolling in and the couple of floodlights meant to illuminate the fresh air park have flickered on. We walk and chat, Benji, Laura, and I, the only ones with the ability and desire to go outside at this point, as our 8 pm snack digest. This time there is focus on the conversation. Its turned to an attempted tackling of the trust issue, specifically in regards to dietitians.

“Look, its not possible for Sally to know the exact calorie count of every food item in New York City. I think thats the point shes trying to make though, that its just not as important as we want to believe it is.” I feel like I am skirting the edges of this conversation because I really don’t want my mind to delve too much into the realm of calorie analization. Its just one of those places that I don’t feel safe letting my thoughts go to yet.

“I don’t know.” Laura states as she ambles along to my left. “Its just something I would like to be able to count on. If we are expected to make our own meals in regards to a specific calorie count then I feel like I should know so that I can do it right.”

“Are you sure thats not your eating disorder talking?” Benji, on my right, having remained thoughtfully silent, now pipes up. “We all know all too well that the eating disorder is about control and rigidity.”

“I don’t know.” Laura says again, her previous conviction wavering. “Maybe I should get a dietician for when I leave here.”

“If you do that,” says Benji, “you will have to choose to believe what they are telling you. If you are just going to question everything he or she says then there wouldn’t be a point in paying the money for sessions with one.”

“Right now I just want to be able to trust Sally and I’m not sure if I do.” Laura sighs with frustration, not at us or at the conversation, but at the delicate situation. “Once there is that ounce of doubt I can’t help my mind from just questioning everything.”

I watch the ground move beneath our feet as I try and choose my words carefully. “I think one of the main things that is the job of a dietician, when treating a person in eating disorder recovery, is to portray that it really doesn’t have to be exact. We have such a need for strict planning when it comes to our meals, and there is the idea that keeping with that but in a different way will help us to get healthy, but when it comes down to it we really don’t need all that rigidity. It doesn’t matter if its aimed at the goal of health or not. That rigidness is still part of the eating disorders control. What we need to learn and apply is intuitive eating. Our bodies know whats best for them and, if we learn to listen to what they are telling us instead of the ED, then we know we can trust them. I think its somewhat of a dietician’s job to ultimately help us to identify and really use our filters between the disorder and what our bodies are really telling us.”

Laura seems a little more at ease but its visible that her mind is still hard at work. “I mean, yeah, I know that our bodies are smart about what they need and all. I don’t know. I just want to know that I’m doing the right thing, and if Sally says something is 220 calories when its really 300 how can I trust that I am getting the calorie count I am supposed to?”

“I think thats what shes saying though,” Benji added into the mix, “Its that over all that 60, 80, 100 or even 200 calories shouldn’t matter in the long run. At the end of the day variations just don’t make a difference if you keep your generalized calorie count in mind.”

“I get the feeling that dietitians just don’t outwardly stress how much discrepancies of that nature don’t matter because, as eating disorder patients, most of us can’t deal with that lack of control over what they eat. I think thats why they add on specifics like 200 extra calories now, an extra 300 next week, an extra protein bar for a daily snack, etc.” I said, as i watched Gina rise from her bench and signal that it was time to head inside.

“I know you guys are right,” said Laura, rounding the last corner before the door. “Its all just so much easier said than done.” With that Benji and I nodded in agreement as he held the door and we filed inside.

Volumes of Issues

Walking alone, half a lap ahead of my peers, I watch the quiet surroundings of the fresh air park rotate in their slow carousel around me. I’m in a more contemplative mood although part of what I’m to work out in my head is whether or not I should be talking to my friends instead of thinking about things that have the potential to bring my mood down. Its just that between last night and so far today there has been enough drama around here to suffocate any amount of good intentions. I’m trying to not let it get to me. I’m trying to stay positive but its hard.

People that have been here longer than me are starting to have problems stemming from the prospect of going home. Some are having extreme family issues that peak into screaming matches both over the phone and in person when people come to visit. Some of the newer people are just having problems with the meals in general and there have been a lot of tears shed at the table recently. Some are also having food issues due to being scared of going above the goal weight that they have already met while here. Reaching “maintainance weight” and still trying to restrict your eating, still accepting that you can more or less eat whatever you want is harder than can be represented in words. I can admit, too, that seeing my peers, my friends, have their own questions and doubts does scare me. I have to admit it because, if denied, it has the potential to sneak up and just floor me.

I care about these people because I see at least some aspect of myself in each and every one of them. Its difficult to just stand by and know that I can’t really help them with their issues. I want to. Badly. Its in my nature. If I choose to do that though I know it would jeopardize my own recovery. I just can’t go back there in any part of my head right now without the potential of losing what I have worked so hard for. Some encouraging words and just letting them know that I understand is about as far as I can safely go. I have been both stunned by my positivity and in love with it in such a way that I’m terrified of losing it.

This is why I hang back. They walk and I hang back just absorbing my surroundings, absorbing my thoughts. There will be a right way to do this. This is just one in a line of speed bumps that will unfailingly be along my road to recovery. I hate to get so cliché with the terminology but is just what best describes it in this case. It is a road we are each traveling, a journey we are each individually on. And, in the end, it is each of us who decides just how big the obstacles along the way will be.

When the head aches…

For two days now I have been plagued by a sinus headache that just wont seem to let go no matter how much Sudafed or Tylenol I take. My head throbs every time I turn my neck or move too fast. Periodically there is some relief as it unclenches its grip on my brain, but it never seems to fully go away, as I find more and more tired and less able to concentrate. I never used to have sinus problems but they started off mildly about 4 or 5 years ago and progressively get worse with the onset of each year’s spring and the subsequent fall. If they continue to escalate in the way I will have to find some other battle tactic or weaponry to fight them with. I don’t mean to sound like I’m griping, they just make it so hard to focus beyond the pressure.

Ok, thats enough of that. As far as other things go we finally have a new person on the unit. If I really want to get technical about it we have got 2 new people…except one isn’t really ours. I’ll start with Molly. Molly is the actual eating disorder patient. Her thick shoulder-length red hair frames her narrow face that ends with an angular chin. Arriving here already at her 75% she isn’t given the gradual caloric additions but instead is right away started at the 3,000 calorie level. I don’t know very much about her yet because, with her arrival yesterday, she has not been so much untalkative but shes quiet in a friendly sort of way. Its as though shes poised to answer a question about herself happily but doesn’t readily provide info without that prodding. I know that shes 20, grew up just outside Boston, and now lives in Ney York, but thats really it at the moment though. I have the hunch though that she’ll be a pretty ok addition to our little bunch of bananas.

The other new entity is Jose. He is Benji’s new roommate. Jose walks around more or less like the ghost of Bigfoot. He lumbers awkwardly through the halls, during the rare times he is not sleeping, buried in sweatpants and a large hoodie. His long black hair hides his face most of the time and everyone’s first guess to his heritage is American Indian but we later learn, in his somewhat broken english, that he is from Mexico. The staff won’t tell us what he is here for although its made clear that his issue has got nothing to do with eating disorders. I suspect its detox of a sort but I don’t know from what substance or for sure thats even what it is. He seems friendly enough and my money is on the bet that if we asked him to clarify he would. However this would require him to be awake long enough to ask. Basically, the reason for all of this is that Jose belongs on a different unit within the hospital and is just here until one of their beds opens up. He doesn’t have the same protocol as us and therefore doesn’t attend our groups or eat meals with us but his strong patchouli scent lingers through our halls long after he has retreated back to his room.

My sinuses now have a fog of medication to wallow in as the Tylenol takes the pain down from the top shelf into a manageable arena. Its still there, just dulled, and, just like anything else, I’ll have to wait and see what the rest of the evening brings.