Spare Me!

Today we bowl! Our group of  10 that included both recreation directors, Talia and Carly, all piled into the van with the non-existent shocks and headed out to Queens. The alley was small and more crowded than I would have expected for 11 am on a Tuesday but we got 2 lanes and settled right in. Amongst the sorting out of shoes and registering of names we all found ourselves in a horseshoe around the facilities only snack machine. A seemingly strange place for a bunch of eating-disordered patients to convene, but yet there we were ogling the goodies. We were actually owning up to our true likes and dislikes while letting the caged sweets run away with our imaginations to new horizons. A passer-by would have thought that none of us had ever seen a contraption such as this before.

Back at the lanes we divided into two teams of five and begin the mass shop-swap. Each in turn, with constant support and cheerleading with each roll of the ball, we played for about 20 minutes before breaking for lunch. We took plastic seats around a few of the small tables that littered the main floor area and let loose a torrent of white paper bag meals. We unpack like kids in a school cafeteria to inspect the loot.

General consensus amongst the group was that the 900 calorie lunch guideline had definitely failed to be met. Each of us had about 2 ounces of turkey on wheat bread with no cheese or condiments. Other than that there was 4 ounces of juice, a small apple, and a bag of sunchips. Mostly we just shrugged, ate, and went back to bowling after disposing of the remains. It was common knowledge that if any of us wanted more we could drop some money at the alley’s little cafe. Some opted for snacks, some for drinks, but it wasn’t until Elise came back with a cup of coffee that we all knew what we wanted.

The single cup was worth the $1.75 price on such a damp and chilly day right up until Talia and Carly realized that artificial sweeteners were in use. By the time they got over to the counter most of us had dressed our drinks and returned to the lanes. only myself and Molly remained at the prep station. That was when we remembered what we were in reality – essentially a bunch of psych patients on a field trip from the hospital. Its a little disheartening to be having a great time out with friends just to later be reminded that we are actually being baby-sat.

With all the ‘tsk’ of an elder to an out-of-line child Carly informed me that sweeteners were not permitted. I tried to explain that we were not only off the unit and spending our own money but that others had already done it without getting scolded. She told me that, while she hadn’t gotten to them in time, Molly and I were not allowed to follow in their footsteps. When I am treated like a child, instead of the adult that I am, first instinct is to act like one and rebel. I promptly told her that if that were the case then I just didn’t want coffee and dropped the entire cup in the garbage.

I understand how this looks and, in the past, a situation like this would have let in a cloud of grumpiness that would likely last the remainder of the day. This time it didn’t though. I didn’t realize the difference until we were headed back to headquarters in the old rickety van. Thats the point of all this though – The amazement at my subconscious dropping of a grudge. After the incident we went back to enjoying the game and generally having a good time. It may take baby steps but its just more proof of how things are changing.

 

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.

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.