On All Accounts

There is something to be said for going out to eat by yourself. It is one of the hardest things I’ve had to do yet. Its the test of accountability taken to the height of the eating disorder. Sure, on our passes we write down meal plans, where exactly we will go and what dish we will be consuming, but that doesn’t mean that the staff will know if we actually did it or not. To go out on a pass meal with someone is to work with that person and keep each other in check with the agenda. Without that it is almost unbelievably easy to find yourself with your butt in the dirt and the wagon rolling away without you.

On the unit my eating disorder knows full well that it can find no balance. I checked it at the door when I entered this treatment center only two short months ago. Unfortunately, each time I go out though, its still right there waiting and wanting to know where we are off to today. So I go, trying to ignore it, trying to leave it behind, hoping that it will realize that its really just not wanted and I have had success with that many times now. Most of those times though have been when out with other people.

So far I have done two meals out completely by myself. The first of them wasn’t a total disaster per se, I just came out of it relatively disheartened. The main point was that I should have followed the plan I had written. Instead I got out there and got overwhelmed, second-guessing the original choices I had made, and just had a lot of trouble coming to a decision. It was a frustrating venture but a learning experience at the same time. My mini-shmorgashboard included an egg salad sandwich with tomato on wheat, a bag of sea-salt multi-grain chips, a banana, and a triple berry yogurt muffin with a water and a soda.

I wound up eating about half of each item and calling it lunch. Its hard because we are supposed to get about 900 calories per meal but its gets really difficult to estimate the amounts for items without labels. I know its not supposed to be a strict science but in the beginning nerves get wracked because we haven’t yet learned the flexibility, intuitive eating, and general friendliness of food that should be the end result of all this.

Today was dinner. It was a  dark, rain-soaked, two-block walk to Reme’s up the street. This was the first time I had been there and the little restaurant with the red awning was the exact opposite of its foretold crowdedness. It could have been the dreary weather or the early meal time but, whatever the reason, I had my pick of tables and chose a booth in the corner. The pass meal was written for a Hawaiian ham steak with sides but the price on the menu was a good $3 over what the unit menu said so the plan changed. I wound up getting a hot open brisket sandwich with fries and a dish of green beans. Not so keen on the sandwich bread I ate all the meat and beans. I gave the fries a fair shot too but they were very much lacking in the flavor department, even with catsup, so I gave up.

Out int the rain again I rounded the corner to University Deli for a dessert. It had to be enough to make up for the uneaten fries. I stood in the little carry-out eatery deliberating over the sweets until I was uncomfortable with my own actions. In frustration I made a grab for whatever and wandered back to the atrium with my goodies. I have to say that, although delayed, my final decision was a pleasing one. I munched down a good-sized chocolate chip cookie and half a peanut butter Twix which turned out to be just as amazing as I had dreamed each time I ogled it at the store.

All in all the practice of a second time wasn’t perfect but it was just the tiniest bit easier. I’m learning to be accountable to myself. It does help to have someone there with me but, in life, thats not going to be the case all the time. I realize that the harder something is the more I need to do it. Its taking on the challenge thats key and thats the whole reason I’m here.

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.

Yes, Stomach, I hear you

Score one point for getting through things that I didn’t want to do. My tally must be pretty high right now but this time I think I will count double points for the added factor of having to do it 2 days in a row. These back to back trials of perseverance that I refer to are the long-awaited research meal days. I was too anxiety-ridden to write about it while in the midst of the experiment but, now that I can breathe with the assuredness of it being over, hindsight has again set my thoughts in motion. part of me, the forgiving part, wants to shrug and chalk it up to just having been an experience. The other part, however, would love to riddle the telling of the last 2 days with some very colorful language. I think I’ll try to find a happy medium.

The anticipation on Tuesday, the morning of reasearch meal #1, was quickly dropping like a fog over my world. When I sat down to breakfast I knew what to expect on my measly tray – two 4 oz. apple juices, a yogurt and an apple. Everyone else got the pancakes we had been asking for fervently through the last two months. Balls. I missed out on that one. I was told that they were really good though. After that I was okay until about 9:30 or so…until the hunger started to claw its way into my consciousness. Then it was all over. I couldn’t think about anything else except the pending lunch. The others did their best to help distract me but the anxiety grew to an all-consuming high. Its strange to think that I used to eat so little when my body craves so desperately now. At this point there is no denying what it wants. No confusion.

Finally, just before noon, one of the research assistants came up to get me. I followed her, in her white lab coat, downstairs and back to the same tiny room I had done both the exercise study and the sweetener test in. Everything was the same except this time there was a little round table with a plastic tablecloth ala “Lady and the Tramp” in the middle of the room. She sat on the bed while I sat at the table and in front of me was placed a sheet with a 1-10 scale and varying degrees of anxiety provoking situations listed throughout as a guide. We sat in silence for a full 3 minutes while I was instructed to think about the upcoming meal. At every one minute interval she asked me to rate my anxiety level on the scale.

Before the meal came I was repeatedly scoring quite high. I was anxious because I just wanted to eat. There were no guidelines as to how much had to be eaten. It was just whatever I wanted to do while the video camera in the corner taped my actions and her voice buzzed in over the monitor to periodically rate my levels. The tray that was finally placed in front of me had only a few items on it but they were large. I was suddenly staring at a large bowl of regular potato chips, an 8 oz. bottle of water, a family-size tube of real mayo, and a footlong turkey and swiss Subway sandwich on wheat. Other than the meat and cheese there was only lettuce and tomato on the sandwich.

That was it. Once I got the go-ahead I dug in. That first day it was excellent but I think I would have eaten just about anything they had put in front of me. I only ate 2 or 3 chips but I got through almost all of the sub, eating all of it’s insides and leaving about 1/3 of the bread; all the while my anxiety slowly decreasing. It felt great to just get some substance. After that they had some paperwork for me to fill out, some questions to answer, and then I could go about the rest of my afternoon as usual. That didn’t stop me, though, from dreading to have to do it all again the next day.

When I awoke the next morning I was calmer. The exact same test two days in a row so I knew what to expect. I was armed with knowledge. Then they threw a wrench in my gears. I was hungry going into breakfast and actually looking forward to the small amount of bulk I would get from the meal. Something, anything, to fill me up just a little. When I got in the dining room and saw my tray my jaw dropped. Apparently all I was to consume today was one lowly toasted English muffin and a 4 oz. container of apple juice. I grudgingly ate, trying to make it last as long as possible, and then spent the remaining time at the table not only hungry and anxious but pissed off as well. No one else who had done the same study before had gotten the English muffin version of research breakfast.

I got through it though. Lunch and a twin meal to the previous day was placed in front of me. I ate, with less anxiety this second go-round. I’m going to have to ask at research group next week what exactly they are looking for in this study but, for now, I’m okay. For now I can go back to enjoying my normal size expected meals.

At least until I have the third research meal day just before I head home.

Hunger Games

Today is the day! I just made it this morning with the scale balancing right at the 3/4 pound gain that has occupied my line of vision for the past 2 weeks. Not only am I not RTU for the weekend but I am finally at my 85%. The next step is to put in a privilege request form to move up to level 4b so I can roam the building at my leisure. I could, potentially, be annoyed that I have to wait through the Labor Day holiday weekend before they approve the request at the next staff team meeting on Tuesday…but I’m just not feelin’ it. I’m too happy that I got to where I wanted for so long to be at to let it frustrate me.

It was before lunch, only a few short hours since I had been weighed and realized my goal in the scale clicks, when Dr. G pulled me aside. With 85% comes the two major therapy studies that Columbia is doing right now: exposure and CRT. There are 4 weeks of each, 12 sessions apiece and each person eligible does both. Its a random draw as to which one you start with but I’ve got my fingers crossed for exposure.

First things first though. I won’t know which will be kicking me off until I’ve done whats known as research lunch for two days in a row. From what I’ve seen and the details I have been told by other patients who have already been through it I am curiously anxious to start. The breakfast and morning activities (or lack there of) prior to research lunch has me a little nervous towards my mixed emotions.

Its all very moderated so that each person doing the meal has the exact same thing for the breakfast leading up and the standard that they serve is much less than what our bodies are used to having. Every person I have seen with the diminished breakfast on their chosen research day ambles around the whole morning try their darndest to not gripe too much about the every persistent stomach pains growling audibly.

Aside from the miniscule meal, in order to keep everyone’s physical exertion and intake in check, there is no morning coffee allowed. So there goes the once daily caffeine boost we are each allowed and then we also omit the 10am morning Ensure as well. It may seem that being on so many calories each day would cause us to kneel and thank the ceiling at the cutback but thats just not so. All there will be is annoyance and hunger, hunger, hunger. We need all of those calories right now! Our bodies want them. They crave them! To top it off, on research lunch day, we are RTU till the afternoon meal is over. That means no fresh air, no trips to the store, no nuthin’.

Thankfully all of this only goes until 1:30 in the afternoon and, with my newly approved 4b status I already know where 2 pm will find me. I’ll be sitting in the upstairs cafe with my Boston Globe Sunday crossword book lounging in full relaxation mode. Oh, and one more thing, my nice caramel-colored steaming cup of coffee will be my teatime guest of honor.

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!

Weathering Passes

It looks like rain outside today, even though they aren’t calling for it until tomorrow, but the weather is nice with the gray layer of cloud cover. There is supposed to be a high of 80 but, with the light breeze rolling off the Hudson River, it feels more like a perfectly comfortable low 70’s sort of day. Its quiet around here again with all those eligible out on passes as much as they can be in the weekend down-time.

Passes are something you can request when you have reached the 90% mark of your personal ideal body weight. They come with moving up to level 4 and each one has to be specifically written out and approved. The request form includes the times of departure and return, exactly where in the city you’ll be going, how you’ll get there, and a basic play-by-play of what you’ll be doing. Generally on a pass you will eat one or two meals while out and this is where the bulging, over-stuffed, menu folder for the until comes in handy. It is required that you write down each item that you plan to order for your meal along with a backup plan in case the restaurant of choice is out of something. Unforseen snags in this method of recovery practice are always possible but the staff works with those going out to prepare as best they can for anything from the realm of the unknown.

Much of going out on passes involves the honor system. Thats why frequently patients, who don’t fully trust themselves to make the right decisions when the moment arrives, go on passes in pairs. The company is nice and you also have that unspoken safety net of someone being able to hold you accountable for your actions. Elle and Benji left only a few minutes ago to embark on just such a pass. neither of them are from Ney York and have no family in the area so the choice is to either brave the city alone or try and hack it as a duo. Today’s afternoon agenda for them includes a few hours spent at the Natural History Museum, with a strict exhibit schedule due to it’s vastness, and then dinner on the town.

Elle has been doing passes for about 2 weeks and Benji just a few days. In the beginning the outings are done a few times one-on-one with a staff member for a sort of practice and this can be just about anyone of the patient’s choosing. Both Elle and Benji went to breakfast with their personal therapists in the past week and came beck from the challenges with a noticeable amount of gained confidence. I have thought about it a little, as to who on staff I might like to go eat with, and the Griz is looking like a good candidate as well as either Talia or Gina.

It will be a while still though before I have to make a decision on that since I still have at least 15 pounds to go before I reach my 90%. I hope that when the time comes for me to try making my way around the city with some of my fellow patients there are still some left on the unit to join me. At the rate the exit door is revolving compared to the spider webs collecting on the admittance entrance I may well be left to make due on my own. Whatever happens though I know it will be an adventure!

At the table

For some reason we have been processing after meals a lot more recently. Its a basic exercise that really just involves the group of us sitting around the large dining room tables for a chat. After loading our more or less empty trays back into the trolley to be taken downstairs we kill the radio that livens up our mealtimes and settle back into our seats.

With this being an eating disorder treatment center it goes without saying that there will inevitably be some issues surrounding meals. In processing generally someone starts the group off, lately this job has fallen to Elle, and from there we go around the circle and discuss anything from the dining experience that might have been difficult for us. Usually any staff with us at that point remains pretty quiet and we do our best to offer each other support for our various issues.

Just because I have been tacking each meal with an ease and acceptance thats surprising even to me doesn’t mean that everyone else has such a relaxed time with it. Different meals have different components that create different amounts of anxiety in different people. For some of us its been so long since we have eaten in a natural social setting that we aren’t even sure what a “normal” way to eat certain things might be. Questions, like weather or not you would use a fork to eat a brownie and how many pieces one would usually cut a hamburger into before picking each one up and biting in, do come up. These quarries may seem silly to someone looking on but, to my peers, they are legitimate and the search for the answers is real. We just want to get back to a societal normality because our versions of table manner are so bizarrely skewed.

Elle, for instance, has problems touching her things. The idea of something being a finger food is not a concept that is easy for her to accept. Once she touches a food she gets the feeling that its crumbs, oil, or other remnants are all over her face and hands. In the beginning she wouldn’t pick up any of her meal with her hands. Now, after some time and a lot of encouragement, she still cuts things up a bit more than other people but she will pick up the pieces to eat. She has also been doing a great job fighting the urge to wash her hands of the imaginary debris the food has left after each bite.

Another one of the girls, Carrina, has issues with peanut butter. It’s a fear food of hers and she doesn’t want to be around it because it used to be the main thing she would binge on when she was back home. The other day she explained to some of us that, before she came to Columbia, she cleaned her room and dug up about a month’s accumulation of jar from its depth. She admitted that there were 26 cleaned out peanut butter jars that had been stashed in various spots. Here though she still has to face her fear. She doesn’t have to tackle the peanut butter issue everyday but she’s not allowed to avoid it either.

Other issues surrounding our meal table include things like cutting food into miniscule bites, putting salt on literally everything, the compulsion to eat things only in a certain order, or chew each bite a certain number of times. We are all trying though. Its hard but we are doing our best to overcome these things which can be so baffling to the average public.

Processing after meals helps all this and, although I don’t always have a whole lot to add myself and sometimes people say the same issues over and over, its good to help. As far as providing support goes we are a good little family. I’d be more than happy to have any of these girls on my side when and if I ever need that extra help.