Plugged in

This morning brought with it wires and monitors. I have been hooked up, taped down, and activated in order to participate in the first comparative phase of one of the many studies. The device they have me tethered to really isn’t all that obtrusive. Mildly annoying and slightly awkward at best what it does is monitor movement and activity. The study, which consists of two parts, is one that is exploring the expenditure of energy in a person who is underweight versus a person at at least 90% of their natural body weight. The little tabs and wires I’ve got on will only be with me for 48 hours this time and then again for another 48 much farther into my stay here, once weight stabilization has been reached.

Although the findings from this haven’t begun to get analyzed, being only a year running so far it is still in its baby phases, there are some interesting theories that come from nature behind it. In a natural basic environment history has shown that a person or animal of a low body weight, despite lack of energy, actually moves quite bit more than they do at a higher weight. It would make sense that their lack of food would give their bodies the drive they need to actively seek nourishment. The question is: Is there such a compulsion in eating disordered patients? How do we move and when?

If bulimic the drive to find food would presumably be there due to the binge aspect of the illness, but what about anorexic patients? There is no conscious desire or need to go forage because of anorexia’s defining restrictive nature.

The hope is that, through this, we may find out if there is any excess movement when underweight due to the subconscious need to satisfy hunger. If so it would lead to theories having to do with the excessive exercising that so many eating disordered patients partake in under the possibly superficial guise that they are trying to burn off extra calories. Could the many long hours spent at the gym and walking the streets be actually due to the body’s misplaced need to seek nourishment? Only time will tell. This study still has years left to it but I’m already intrigued to learn what the findings from it are. In the meantime, though, I can definitely say that I won’t miss the device I am wearing once they take it off Wednesday morning. So far 8 hours down – 40 to go.

Ready, set, settle in!

Early Monday morning and its one week down. The lazily comfortable weekend will be counteracted in a few hours with the return of all the docs, resident students, and various weekday groups. I’m looking forward to it though. It’s a good balance. The last 2 days were just enough down time and now I’m ready to get back into the swing of things. Rumor has it that we will be getting a new patient today as well but we wont know for sure until it actually happens. With the entering of someone new though there is and underlying sadness because it means a bed is opening up and someone else is leaving. This time its Sofie.

I don’t know how else to describe Sofie other than that she is a true free spirit is many many ways. Virtually the opposite of me in social aspects she is a boisterous, enigmatic, outgoingly hilarious actress who lives here in New York. I couldn’t be more happy that this, although short, amount of time here overlapped for us. I have the feeling, and her words to back it up, that we wont be seeing the last of each other once she steps through those doors on her way home today. Especially, if nothing else, she has promised that she’ll be around if I want company on one of my many upcoming passes to go out into the city. She’ll be one of the only people I know that lives around here when my time to explore rolls around so I’m definitely looking forward to accepting that olive branch.

The bottomless pit

It is a truly bizarre array of physical feelings that my slowly waking metabolism is putting me through. After laying dormant for so long it seems to be still blinking its eyes to the light as my body runs the gamut. Right now I am on 1800 calories a day, which is more than double what I have been consuming for at least the last year. Strangely enough though, most of the time, I seem to want more. Of course, right now, I can’t have more because there is a regemine set up here, but it doesn’t stop me from longingly predicting what might next be put on my plate. I’m not always necessarily stomach-growling hungry, per-se, I more just feel an emptiness that spends its time fantasizing about nourishment. In fact, the persistance of this desire even later in the day, when I do already feel physically sated with my abdomen hurting and my intestines cramping up, is one of the oddest sensations I have ever dealt with.

The method behind the madness my body seems to be delving into is one of known success however. Upon arrival we are each started on the 1800 calorie per day diet, no matter what we had been previously consuming, and for the first week we stabilize on that. Then, not so slowly, the additions come. after that week the dawning of the next Monday in line brings with it an additional 400 calories, raising the daily bar to 2200. Then Wednesday, only 2 days later, with another 400 tacked on, and Friday with a third 400. The additions continue on those same days each week until a daily consumption of 3000 is reached and they alternate between the adding of food at meal times and various Ensure shakes wherever they best fit into our individual regemines. All of this is based on the logic research has proven true behind a hyperactive metabolism.

we each need a certain number of calories per day to live and perform basic functions in a successful healthy manner. It varies greatly from person to person as to what that daily need might be but, its safe to say, that any full-grown adult needs at least 1200 and most need more. When a person drops below that required amount for a certain amount of time it will eventually send the body into a starvation survival mode. To conserve what little energy remains in the system our metabolisms go into a kind of hibernation and stay there.

Once they are jostled awake again by the onset of a more natural diet they set to work. With elation they continue to work more, with gusto and fervency, falling into the overactive state and burning more calories than a body would naturally normally need…and here that need is fed. It has to be somewhat gradual because, when anything awakes after a period of deep sleep, a time for adjustment is needed. Almost always, however, in a situation like this, underweight people in the act of refeeding wind up actually losing more weight even on an astounding caloric intake before things start to slowly even out.

As much as I think this is an amazingly good well-organized program I am still a little nervous that, due to this metabolic roller coaster, I may wind up having to stay longer than the planned time in order to gain the weight needed to proceed. It is an ungrounded fear though. All I can do is my best, continue to eat everything they put out in front of me, and keep trusting that they know whats best. My life is litterally in their capable hands.

Ways and means

As we stroll slowly out on the lawn during one of our fresh air breaks Laura and I fall into a discussion on power and control in relation to eating disorders. nearby Elle and Benji play a fumbling game of catch with one of the many nerf balls that were brought in for stress coping. It is just after dinner and the sun beats across us at an angle as it slowly sinks in the summer sky.

Laura is my age and holds the wisdom of experience. This being her 6th treatment center she has seen these days, this routine, before. Yet, with so much inpatient time under her belt, her insight and optimism still flow freely. Not in an overabundant or fake way, from what I can tell she wears no mask, but with the genuine hopefulness that this time, maybe, she will go home and things will be different. maybe this time she will go home having gained more than temporary weight – herself. I ask her what she thinks is different about this time and place as opposed to the others and her answer brings up the ongoing insurance company dilemma.

So much of eating disorder recovery goes far beyond putting on a few extra pounds. There are psychological and emotional issues that need to be worked through. There is a sense and reason a person needs to have in order to abuse their own bodies in such a way and, as doctors have found through ongoing research programs, the deeper issues can’t really be successfully addressed until the end of the weight restoration process. There is a certain amount of brain function that is altered with malnutrition so attempting to work through any anxiety, depression, or control issues that landed us here is pretty futile.

However, most insurance companies don’t see that aspect of recovery. Most insurance companies either don’t cover treatment at all for eating disorders or they wind up pulling coverage and deeming a person healthy just as soon as they are within 5 or so pounds of the lowest healthy weight for their body size. Therefore the roots of the problem never see daylight and the odds of relapse are exponentially higher.

Laura explains, as we amble around the lawn, that this has been her story with every other treatment center she has seen. There was never any follow-up. The reason things will be different this time is that weight gain is only the first half of the regemine. This particular program is free to us in exchange for our cooperation. We get the help we need and, in return, we help them with ongoing research to aid the improvement of eating disorder recovery plans. To be the most beneficial to the research we have to be within 10% of our ideal calculated body weights before we dive in. This time will be different for Laura because here she wont be kicked out by her insurance company before getting to the real meat of the situation.

Versus

I got to go outside yesterday for the first time in two. After each meal there is an alloted amount slot of time for “fresh air” and you have to have eaten 100% of the previous 3 meals in order to achieve the privilege. Since I had arrived I had always just assumed that “fresh air” time was more for smokers than anyone else and that all you did was stand around on the pavement out front doing nothing. It didn’t seem terribly appealing to me so I was pretty surprised to find that assumption proved wrong once again.

We elevated down to the bottom floor and exited at the side of the building into the natural light. It was the first non-rainy day in almost a week and the warmth felt great. By comparison our little wing of the hospital could have passed for an icebox. We stepped out onto a short walkway leading to a small lawn, a semi-neglected little garden, numerous benches and chairs, and a rather good view of the Hudson River beyond the highway. I don’t know if I’ll be going out every time the opportunity arises but I was definitely pleasantly surprised.

Towards the end of our little outing we were joined by 5 or 6 guys from the THC study that is occurring in a different wing of the building. Apparently there is a lot more going on here than I am aware of because fascination upon finding out that there was an actual study promoting the smoking of pot definitely ensued. Its like Wonka’s chocolate factory – you never know what going on behind the next closed door!

Back in the building again I finally got the okay to move into my new room. My roommate, Elle, had already established herself in the space closes to the window so I began unpacking my thing on the remaining bed next to the door. Twin sets of basic furniture decorated either side of the room and we each had a barren closet that I wasn’t entirely sure what to do with. Elle, who has been here once before for treatment, informed me that they used to come equipped with hangers but that privilege was taken away when one of the previous residents had apparently tried to hang herself from her hanger. So, with no real dresser as replacement, I finagled my suitcases into a make-shift tower for my clothes with a shrug. Heck, you win some, you lose some, right?

Oh, and due to the force of gravity vs. the strength of a plastic hanger I wasn’t surprised to hear that the suicidal girl hadn’t succeeded. This may be a semi-surreal setting compared to every day life but the laws of physics do still apply.

Well…duh…

I don’t know why I didn’t think of it before – the headaches, the extreme exhaustion, hello caffeine withdrawal! It didn’t occur to me in the least that the immediate cessation of coffee and soda would carry repercussions. It was like a lightbulb hitting me in the head when I realized that I had gone from 3 cups of coffee and 6-7 cans of soda a day to nothing. If my head wasn’t already sore from getting beaned with the lightbulb I would be smacking myself for not thinking of this sooner. Upon the onset of clarity I sighed, took a nap for an hour, and spent the rest of the day feeling a hell of a lot better about the whole situation.

Stitch by stitch

That nagging feeling of having forgotten something rang true when my blood sugar level dropped right before dinner on the first night. I guess I have gotten so used to my schedule at home and eating at the right times in order to keep it in check that I forgot to let anyone know that hypoglycemia is an issue for me. The nurses were less than thrilled.

Most of the other girls here are from various places in New York and a majority of them, like me, have been to treatment before. A few have actually been here before. Our ages range from 18-35 with a pretty good balance on either end of the spectrum. Things will change thought since discharge somewhere within a months time is imminent for more than half of them.

The hospital itself, within the little wing we call home, is equipped with 2 rec/day rooms, 2 TVs with a moderate array of channels, 2 computers with both internet access and printing ability, an art room with slightly used but abundant supplies, several “interview” rooms, a dining room harboring a tiny kitchen, the required amount of bedrooms, and a large cabinet stuffed full of games and puzzles. There is a descent amount of freedom and personal responsibility placed on each of us and I, at least, am finding that the lack of constant supervision works to my advantage. Somehow it makes me more proud of my decisions and actions than the parallel of Remuda Ranch and its naughty-child-strictness. I’m slowly growing comfortable, fitting in stitch by stitch, and finding that it’s a great feeling.

Through the doors

Its been done. I’m here. Now it will just take some time for things to fall into place. Through the expected amount of stand-off-ishness the other girls (and one guy) have slowly extended tentative feelers of friendliness. There is a hesitance that lingers like mist around each attempt at outreach as we try to mask our individual fragility in not-so-subtle ways. personal experience has shown me that the act of normal conversation can require more effort than one might think possible, but we try. The toe-hold we have on common ground will get firmer with time. We are really not so different, them and I.

Promptly at noon, having already been tapped and drained of the necessary bodily fluids for analysis, I sat down to lunch with the group. The food arrives on hospital trays with the heated plates hidden beneath their thick plastic domed shells that have always reminded me of the top of R2D2’s head in Star Wars. We are each provided with a labeled list of the exact tray contents including portion sizes and the precise amount of pre-packaged condiments that have been deemed appropriate for the specific meal being served. Each is individualized in accordance with its intended’s needs. Mine is just the right size for someone who hasn’t been presented with a hot meal in longer than she can remember. Or at least hasn’t been accepting of a hot meal in that time. I surprise even myself at the speed with which I gobble it up. Not messily or chaotically, but it does make me reflect on post-war POW footage.

To me the menu was different for obvious reasons but apparently its items varried from the norm for the others as well. The main component was a grilled cheese sandwich on pumpernickel bread that was stuffed to the gills with red and green peppers, carrot slices, and onions. It wasn’t something I would have normally ordered on the “outside” but it wasn’t bad…even with the onions. The sandwich was accompanied by lentil soup, which I don’t remember ever having had before, and a small bowl of red grapes.

For the most part we chewed away in silent concentration, consciously aware of the rate/time/quantity ratio. Conversation was sparse and I was lightly peppered with the usual get-to-know-you Q and A.

After the meal we stayed where we were for whats known as “process group”. Its something that happens a few times a week and is basically what the title calls it. We process our feelings, thoughts, and questions about the previous meal. It is a lot like the other groups, in which what people contribute reflects the level of interest anyone would find in it.

General admission activities filled out the time block between lunch and dinner with required paperwork and doctoral meet-n-greets.

The big day

Biding time. Biding time. Awake at 3 am again from the pain of rolling over in the not-so-soft bed as my jutting bones make me feel much like a low-sitting table when I am laying down. Thats the only way to explain the sensation of not quite being flush with the mattress no matter what position I’m in. I am held up, hovering it seems, by my hips and elbows.

As I flipped on the light and threw the thin sheets the bruising on the outsides of both my knees and thighs glare in many purple dime-sized spots back at me. It would seems that I may have been a bit more bested in my battle with my two heavy bags than I originally thought as I ambled my way from train to Inst to hotel yesterday. At least my arms aren’t as sore as I had imagined they would be.

The community bathroom was thankfully empty so I showered, not quite sure when I would next get the chance. Curiouser and curiuoser I am wondering what the upcoming day will bring as the lukewarm water runs comfortingly down my spine. Is it a sign of situational direness that the foremost question in my mind has to do with what they will be serving for lunch? Out of all possibilities the coming day may hold this is what keeps creeping into my thoughts. It will be the first meal I will be partaking in at the Inst and I have been told that, at least for the first few weeks, options in my menu will not exist. I tried to ask what I am supposed to do if I am faced with something I just plain don’t like but the answer comes in the form of imminent repercussions if 100% my every meal on the plan is not consumed. All I can say is that hopefully they don’t serve things like cottage cheese, melon, or egg salad very often. I may be a picky eater but there isn’t too much that truly makes me gag so my best bet sounds like it will be to close my eyes and choke it down. I understand that it is all about exposure to variety and that so many of us int this state of starvation don’t know anymore what foods we actually like and dislike. So many foods fall out of our daily consumption routines for superfluous backwards reasons that, without even being aware of it, our taste buds take a backseat when it comes to ingestion.

I am determined though. That will be my first vow: I promise to at LEAST try everything that is placed in front of me. I won’t have to eat things i don’t like forever and a few weeks, until I can start choosing thing on my menu, won’t kill me. In fact the opposite – What I do in the next few weeks will be the first steps in saving my life.

Its 6:30 and there is a Starbucks down the street that seems to be calling my name. Time to break the bay and brave the crosswalks as the morning traffic thickens.

Eve of construction

It’s the first night of the rest of my life and the city slowly grows dark. I am in my closet of a hotel room at the YMCA with my minimally channeled TV, lack of enough light sockets to even plug-in my alarm clock, listening to horns out in the street and waiting for the new episode of Intervention to come on. Don’t think I’m complaining though – not at all! I see this as nothing less than an adventure. It’s honestly exhilarating in this minimalist environment whose hollow halls echo with more foreign languages than I can identify. This must be what my brother, Andy, felt like in his various youth hostels as he backpacked across Europe a few years ago as I looked on with a loving envy. This is my little taste. Alone in NY, nervous, anxious, excited, and eager to see what tomorrow will bring.

I have to be at Columbia University’s Psych Inst bright and early at 9 am tomorrow morning. It’s an oddly shaped building right on the Hudson river near the George Washington bridge. 1051 Riverside Drive will be my home for approximately the next 3 months. For the first night or two I will be bedding down in what is commonly known as the “quiet room” next to the nurses station in our skinny girls wing of the 2nd floor until a real bedroom complete with a real roommate opens up. It wont be long though, I’m promised.

First thing on the agenda when I deboarded the train was to catch a cab and haul myself, with my heavy bags in tow, out to the Inst for a brief tour and meeting with the women in charge of my intake process. I feel like I know them even before we meet face to face due to the lengthy screening that has been my main priority for the last few weeks.

The Inst is what it is. It’s a hospital essentially, not glamorous, not like Remuda, but it looks assuredly as though it will serve the purpose I am here for. It looks like its going to take things seriously and I know that is what I need. Time will tell and I am planning on taking as much from this experience as I can manage. It wont be easy but it will be right and, for that, I am excited.