To Dine Out

Today was my second lunch group outing. Sally, who normally runs it, has been on vacation for about a week now so it has been presided over by her protegé, Calista, and the rec director, Talia. Now Talia has been working here for years and knows her dietary ED info pretty well even though her main focus is recreation. Calista, however, is another story. She is new, still in school, and here for the purpose of completing her dietetic internship. Granted, shes still learning the ropes a bit, but she has been here long enough to at least have figured out how to eat meals around a bunch of eating disordered patients.

Talia is excellent to eat with. When we are out she gets roughly the same amount of food as us and she eats all of it without a hitch. Calista has been consistent as well but not in such a good way. In fact, many of my peers here would much rather not dine with her at all. She is a naturally thin woman of indian origin who, personally, I think is quite beautiful. The problem is that she doesn’t eat enough. There are many dietitians with food issues but they have jobs working with people who are trying to lose weight, not gain. If there is one thing a dietician should do when eating meals with us its to be a good example. One of Sally’s mantras is that we should model our plates after hers.

To make a long story just a bit shorter, Talia asked me a question as we walked back to the inst, ahead and out of ear shot of the rest of the group. She wanted to know if the amount that Calista had left uneaten on her tray had bothered me. After an honest “yes” on my behalf Talia then asked me if I would bring it up at a short meal process group when we got back. Hesitantly I agreed so long as all the others who had similar complaints would back me up. She asked why no one had addressed the group about it before and found that, although most of us were irked by it, none of us wanted to rock the boat. We are generally a pretty passive bunch.

So I did it. I said it made me uncomfortable that she didn’t practice what she preached on a routine basis. Others agreed with head nods while Calista immediately got defensive. On that note Talia wrapped the group up and too Calista in back. Since it was Talia’s idea and urge to air out the dirty laundry I can only assume that they had a chat about the issue. Hopefully things will change. Just as we are doing our part learning here the is learning as well. In one way or another we are consistantly helping eachother – it just depends on how accepting of it we are.

The Creative Outlet

There is no art therapy on the unit. When I fist got here there was sort of hap-hazard art group that was halfway organized for the weekend slot but mostly we just sat around reading the newspaper. The woman who was supposed to be there for the purpose of the group never had anything specific planned. She was presumably around my age and, although very pleasant to be around, seemed as though she was only with us for the means of filling a quota. One day though, about three weeks into my stay here, she came in and announced that she would be replaced with someone better suited to the eating disorders unit. Its been almost two months since that announcement now and the scant, bedraggled, art supply remnants sit collecting dust.

The general consensus around here seems to be that the lack of an art therapy group, a real art therapy group, is not the ideal. There are few select groups that art therapy seems to be very beneficial to and one of those is the treatment of eating disorders, especially where body image is concerned. All of this, not so much taking it but counseling with art therapy is something that I am extremely interested in. It is something that has caused a whirling excitement of hope for a while now. Every time I think of being able to help others in that way I can’t help but feel almost a giddy centering sensation.

I’m scared too, of course. I can prospectively see myself getting passionately woven into the thick of art therapy dynamics but there are aspects of this dream that I am not so solid on. First off is how the get there. I can’t readily be of any accountable access to others if I’m still engulfed in an eating disorder myself. I have taken that step though. I am on my way to recovery and, although I wouldn’t feel comfortable really practicing with potential clients until I was at least a year in, I now need to bring some focus onto whats next. What scares me about the whole thing is the possibility of disappointment. I’m terrified of wanting something so badly and having it fall through like so many other miscellaneous dreams. If I expect the worst and prepare myself for possible failure then it surely will be laid to rot but if I hold hope too tightly then I’ll be broken if I can’t achieve.

I’ll need help. I know I’ll need help with this just as I’ll need help with recovery once I get home, but it’s hard to say so. I’m so used to not relying on people. sometimes I say that if I’ve learned anything in life it is how to be self-sufficient but thats not always a good thing. In general I don’t like to believe that people will do what they say and, because of that, I try to do everything myself. Past experiences have just taught me that its easier that way so I don;t have to be mad at people if they do let me down. I’ll work something out though. Asking for help may very well be the hardest part of this endeavor.

The lack of descent art therapy here versus the heightened interest in it from the group has put a new and unexpected spin on things though. It seems that I have been voted the unofficial leader of a new impromptu art therapy group. I have checked out project ideas and inventoried the supplies at our disposal so I think I’m at least somewhat close to prepared. Its another new adventure and it kicks off tomorrow morning. I have my fingers crossed.

Know Thyself

Sometimes around the unit things fall into a sort of sync that is what I can only imagine having a whole houseful of sisters feels like. Games are played, secrets are shared, clothes are handed down, hair is styled, and comfort with understanding is doled out on an as needed basis. It was gorgeous out all weekend. We really couldn’t have asked for better through the 3 day hiatus from groups and meetings and, with the great weather, came high spirits and a not always apparent sense of comraderie.Elle, getting ready to leave in a few days and dealing with her own troubles surrounding that, got the shoulders she needed to lean on and some friends to panel as sounding boards. A nail-painting party ensued during a lull on the bright Sunday afternoon. A multi-player game of scrabble roared into competitive action on one side of the room after the day’s visitors had gone. It was busy. Busy in a calmly balanced sort of way.

The best thing, for me, to come out of the weekend was the great clothes swap of Labor Day morning. Each of us here struggles with body image in one way or another. Its more or less a multifaceted battle that creates conflicts on a daily basis. within the confines of such tumultuous inner struggle thats different for every person it is hard to find the solace needed to break away. Mirrors become gateways to depression, the clothes that once were so a part of us become the enemy, and the practice of body comparisons morphs into a second nature. Its hard to fare and hold our own when we each have such distorted views of ourselves that are apparent to our eyes alone. Its a hard beast to keep on a leash, this negative body image issue.

The great clothes swap started just after breakfast with a knock on the bathroom passageway door from Elle. I had been feeling somewhat crummy (thats putting it lightly) about the small amount of clothing items I had shown up with. This was purely to do with how they now fit on me even though I had attempted to bring things that could “grow with me”. Shirts were awkward and tight in places they hadn’t been before, pants required a little squirming to pull up, and all of it had been making me self-conscious enough to wheedle my wearable wardrobe down to just two outfits. I wasn’t thrilled.

When I opened the door for Elle I was surprised at the large stack of clothes in her arms. It was all items she knew she wasn’t going to wear anymore and we stood together, sifting through them on my bed, as I got first pick. I sorted out what I liked and tried on what I could. Keeping what worked for me in one pile I sorted through my own clothes to add to the donation heap before it got shifted off to Amy who was next in line. This went on through most of the girls on the unit, the clothes pile decreasing and then growing again to varying degrees. In the end, each of us getting a few new items, we all had new wardrobes that held articles we could actually feel good in.

By the time it was all over I wound up with 4 new pairs of pants, 5 new shirts, and a good new attitude as to my appearance. Elle didn’t take anything new, because she already had so much, but she got to see her clothes find loving new homes. In turn I gave away the pair of jeans I had arrived in and they wound up looking great on Brynn who, being orthodox, had never owed any denim. In this fashion the cycle went on and, at the end of the day, it seemed that the overall self-esteem of the unit had risen a few notches. Its back to routine tomorrow but at least we’ll all be comfortably happy in our new attire.

Clickety clack

The scale clicks as one of the nurses moves the little weights around. It takes a minute to get it right. The final verdict has to be perfect, safe, and secure. There can not be room for error. It’s an important process and, after a few minutes, Tiffany emerges from the exam room and holds the door for me to take her place.

I rise from my sitting position on the hallway floor and get a couple of “good luck” comments from Amy, Elle, Benji, and Laura who are next in the queue. Today is the day that I am aiming to meet my 75% of ideal body weight goal. If I can do this I can move up to level three and assume all the privileges that come along with it. There is the ability to go on staff-accompanied outings to pretty much wherever they are willing to take us. There is the emergence of new activities on the schedule that I wasn’t eligible for below 75%. These include some of the more physical things like going to the gym for a game of badminton on Sunday, participating in the yoga group thats held twice a week, and going food shopping off the unit in preparation for coffee klatch. At 75% there is also the cooking group that is immediately followed by a lunch in which we dine on what we have cooked. There is now the Wednesday lunch group in where the unit’s dietician, Sally, takes a few of us out to lunch at one of the many nearby restaurants or delis. Then, at 75%, there is the group that has been my aim for a while now – Menu Planning.

Finally I will get to decide from, limited mind you, list of meal options for each week. I have been here long enough to go through the rotation and try everything they have to offer, for better or worse, and now I can have more say over the composition of the meals I am consuming. I consider this with a slight smile bringing light to my still sleepy 6 am face as I enter the exam room.

The heavy door closes behind me and i start to get undressed. Its just me and today’s nurse in there and she is busy updating and organizing the charts on her clipboard while I lay each article of clothing on the counter as it comes off. The room is not as chilly on my bare skin today and I am thankful for that. I am down to the one thing we get weighed in, my underwear, and she follows me into the tiny bathroom where the scale stands tall and intimidating. The authority this hunk of metal takes on is almost eerie; its extreme influence unnerving.

I am used to the nurses doing double and triple takes when they first see me undressed. At first glance it almost looks like I am still clothed due to all of my tattoos but this nurse has been through weights with me before. It’s not new to her. I step up onto the scale’s platform with determination, feeling the rough non-slip surface beneath my bare feet.  The nurse slides the bottom weight around, first to the 100 which proves too much, and then back down to the 50 pound mark. The upper, smaller weight takes a little longer to adjust, a bit more back and forth. I watch the needle on the side do it’s slow shimmy.

Finally, with one reassuring glance at the exact numbers, I get my answer. In the last 48 hours I have gained the one pound needed to hit my 75% goal. Its just the first of many accomplishments in this arena and I can’t wait to see what is behind the new doors it will open for me. I dress again and head back to my bedroom giving the others in the hallway a thumbs-up as I go.

The weight of progression

I am sitting in the dimly lit dining room where the tables have been pushed against the wall and yoga mats laid around the floor. Stress and coping group is rolling right along as the Friday afternoon sun leaks in through the slatted blinds. We do different things each week in this group but it’s mostly meditation and guided imagery oriented. If we aren’t into that sort of thing we have the option to read, journal, or do something else deemed suitably soothing quietly while the meditation tape plays in the background.

Elle is asleep with her Star Trek novel open in her lap on the couch next to me and I look up from my writing as her breathing becomes audible. On the other side of her, in a chair, Benji struggles to keep the comic book he’s reading from falling to the floor as his own eyes threaten to give in to the atmosphere of this makeshift sanctuary. The others lay on the mats more or less following the direction of the recorded voice that urges calming exercises between interludes of piano music and nature sounds. If proposed, I’d definitely place a wager that more than one of them is asleep as well.

Its one of the more stressful days due to some clashes between patients and staff earlier and the weekend weights taken this morning. The rule is that, once each of us enters the official weight gain phase of treatment, we have to gain a minimum of 3/4 of a pound each time the numbers are taken. Every Monday, Wednesday, and Friday are the stressful days as, at 6:30 am on the dot, we line up outside the exam room for the scale’s verdict. These days it’s a difficult balance that shakes everyone’s ease. It’s hard for most to watch the scale go up no matter what the amount is but, at the same time, we want that 3/4 difference because if we don’t make it we will be RTU until the next weights check.

RTU stands for “Restricted To Unit” and basically means that we are confined here no matter what our status level is. For me that would mean no fresh air breaks, which I value pretty darn highly due to it being the only outdoors life I have right now. For Elle, who is on level 3, to be RTU would mean the loss not only of fresh air breaks but also of any other outside privilege. At level 3 we have the eligibility to go on staff-accompanied outings to places outside the building. sometimes its to the store down the street for supplies. Sometimes its a trip out to eat with one of the staff members for practice. Then, occasionally, its doing something that involves delving deeper into the city like going clothes shopping or getting a haircut.

To have that freedom and then lose it, for any amount of time, can be a depression-inducing blow. RTU is meant to limit the amount of physical activity a person does so they can gain the intended amount of weight by the next official day. However, these days can be mood lowering on the other hand too because a lot of girls here are still terrified of the scale moving at all. They may be eating more but they are still giving their eating disorder sanctuary in their back pockets and letting it have its way from there.

Regardless of the confusion and sense of upheaval most of us feel regarding the weights vs. RTU issue, I believe they have a really good system here. They know what they are doing, as far as the program structure goes, and what a lot of it comes down to is acceptance. There is no other choice beyond that of accepting your body, accepting the weight gain, and accepting that you will have to live with your new self for at least 4 weeks once you are in the weight maintainance phase and doing a bulk of the research participation. I don’t know the exact numbers but, from what I’ve heard, Columbia has a higher long-term success rate than many other in-patient programs, and that’s some news I can definitely accept.

Stuffin’ stuff

The amount of energy that digestion of this quantity of food takes is astounding. After each meal I feel like I have just run a five-miler that I forgot to stretch for before hand. It’s definitely a different kind of tired than the one caffeine withdrawal had induced though. This kind is easier to deal with and almost more comforting in a strange way. I’m sleepy and full but it’s because I’m doing something that I know is good for me. Something I know I need to be doing. I also know that it won’t be like this forever, and that is the thought that most often covers me like a snuggly afghan to keep the anxiety shivers away.

I am up to 2600 today and this, plus my one daily Ensure, is the level I will hover at through the weekend. Its Friday and the rain they have been calling for these past few days has finally broken free of the overcast cloud bellies above the city. The gray day outside is persistent but I find it comforting; it just seems to fit in so nicely with the fullness, tiredness, and generally contemplative mood around here. The sweet vanilla scent of sugar cookies is still lingering in the atmosphere from when we made a fruit pizza in baking group this morning. The things we bake on Friday mornings in the tiny kitchen are later the challenge snack presented at Coffee Klatch.

Mostly Coffee Klatch is to experience conversation, fun, and social behavior where there is optional food present. Generally a game of some sort is played as we sip our cups and chatter. Its a good end of the week afternoon activity and good practice. Isolation and resistance to social settings is a common eating disorder side effect and some of us have given into that so much that we aren’t really sure anymore how to act in public. Its something that you don’t realize you have forgotten until the time you need those basic skills comes up. You have to reassess how to act, what to say, appropriate behaviors, how to eat around others. It’s definitely a strange thing to realize you have let go but it does happen.

The fruit pizza is cooling now and it looks, and smells, delicious. I don’t know if I am gong to have any or not in group because I am already so so full. I don’t have to make that decision for another hour or so though and I know I will at least consider it, which is all they ask of us.