But she seals that crack swiftly and her next question is professional again:
Would you say you want recovery now?
Another loaded question. I balk. Rather, part of me does, clinging to the safety of the anorexia I know. The other part answers:
I would say I want to try.
At what cost?
She pushes,
Dairy? Protein, fats, and sugar? Eating those every day?
She leans forward and asks:
Anna, do you think you are ready for Stage Three?
Silence. In my head too. I have no idea what Stage Three entails. I tread cautiously:
What exactly does that mean?
Katherine reaches for the patient manual, flips it open, and reads:
“Stage Three: Patients at this stage still require daily medical monitoring and treatment for their eating disorder, but have demonstrated their commitment to their recovery and collaborating with their treatment team. They have experimented with instances of limited autonomy and exposure to eating-disorder triggers, and have performed satisfactorily.”
I suppose both meal outings were experiments, and my performance was satisfactory.
“The focus is now on a protracted and gradual increase of patient autonomy and exposure to normal life circumstances—”
How so?
I interrupt.
“By downgrading treatment and supervision to ten hours daily.”
Meaning?
She looks up at me and translates:
Meaning you would still have to come in for full treatment programming every day, eight to six, but would no longer be required to have dinner or sleep here.
The air and thoughts race through my brain as it registers that last sentence. I am surprised at my first reaction: No, I am not ready for Stage Three.
I have only been on two meal outings. I had one ice cream cone, once! Forcing myself to eat dinner, every day, unsupervised, on my own?
No.
Her professional face does not stand up to this. Katherine is genuinely shocked:
What do you mean no, Anna?
No I am not ready.
But I thought you said—
What I said is irrelevant! Now I am panicking.
I do not know how I managed it! It was just an outing with Papa! I cannot do this every day— But don’t you want to?
The softness of her tone nips the anxiety in the bud. She lets the question float. I contemplate it, and the image of me having a meal on my own. She looks back at the manual:
“Patients at Stage Three must begin taking action independently…”
She pauses to look meaningfully at me.
“… despite the discomfort this elicits.”
She closes the manual.
What are you afraid of, Anna?
I am afraid of myself. Of spiraling out of control and falling into anorexia again. Of throwing away all the hard work I did this month because old habits die hard. Of leaving the treatment center at 6:00 P.M. and never coming back. I am afraid of dinner on my own.
I do not trust myself not to relapse.
She does not brush away my concern. I am grateful for that.
Instead, she says:
That may be the most honest sentence you have said to me since you came here.
I think of that. She may be right. To her and to myself. I decide to keep going, wobbly, down that line of thought.
This weekend was a one-time act I performed for my father. I cannot do this every day.
What other choice do you have?
Silence. None.
Do you want to stay here forever?
No!
Why not, Anna?
Because … Emm. Because I do not want to be Emm.
Or Julia. Or Valerie, but I do not tell the therapist that. Instead I say:
I am scared.
She nods. She is human again:
I know you are, Anna.
She changes tactics:
Let’s say you weren’t, why would you want to leave?
Because,
Because I want to buy my own cereal. Maybe even Lucky Charms. I want to go to the bathroom without asking for permission from anyone. I want to take a shower in the middle of the day. A long hot bath, actually. I want to go for a walk. Alone. I want to turn right instead of left.
Because I want to keep walking aimlessly till I discover a sidewalk café. I want to sit at a table outside and order sparkling wine at 4:00 P.M. I want to listen to someone play the guitar as I read and sip, soak sun and air, looking at the people passing by.
Because,
Because I also want to want something more than a walk and my choice of cereal. I want a goal. I want to make a list of goals. I want to have purpose again.
I was ambitious once. I was a dancer, a dreamer. I was loved, I was in love, I loved life. I once had books to read and places to see, babies I wanted to make. I want to want those again.
Because I think I want to live,
that life Katherine mentioned I may get. Hazy outlines of family Christmases; children; basil, mint, and thyme in clay pots.
I want more weekends like the one I just had,
more time with the people I love.
And what are those weekends worth?
Everything, I realize. Everything.
Worth eating?
Yes, worth eating.
Worth the weight and calories?
Yes.
And the pain and the anxiety at every meal?
Coffee and croissants, a conversation with Sophie. My father’s famous omelettes. Crêpes on Sunday mornings with Matthias, stealing bites from his fork.
Yes,
because a birthday cake means a birthday celebration and ice cream means a good date. I can swallow the pain and anxiety if I can see that.
She looks at the clock; our time is almost up.
Let me summarize Stage Three: Patients continue treatment every day from eight to six. That will be at another facility. You will be assigned a new treatment team. You will take part in programming with another group of girls, and be responsible for your own dinner and evening snack.
Suddenly, I notice something. My head begins to spin.
I get to sleep at home.…
You get to sleep at home,
she says with a smile.
I get to sleep next to Matthias again.
88
Treatment Plan Update—June 24, 2016
Weight: 99 lbs.
BMI: 17
Summary: Treatment team has approved patient transition to Stage Three of treatment, effective Monday, June 27, 2016. Patient will be transferred to the day treatment facility at 45 Forest Park Road.
Physiological Observations: Patient weight has been increasing steadily and consistently with increases in meal plan. She remains significantly underweight but has been open to increasing food variety and reassessing body image distortions. No signs of refeeding syndrome. No other physical complications.
Psychological/Psychiatric Observations: Patient has been completing meals and working on replacing negative eating-disorder behaviors with positive coping skills. She continues to struggle with poor body image but is working on challenging cognitive distortions.
Treatment Objectives: Contingent upon medical stability and continued commitment to recovery, treatment team recommends a gradual and protracted increase in autonomy and exposure to normal life circumstances.
Patient will be required to present herself for treatment daily from 8:00 A.M. to 6:00 P.M. Patient will be allowed to complete dinner and evening snack alone and sleep at home.
Target caloric value: 3,500 calories daily, to be maintained upon discharge until adequate weight is reached.
89
My fifth and last Friday evening at 17 Swann Street. My last Friday-night date here with Matthias. It must be different.
I have an idea. I share it with Direct Care, who, to my surprise, says yes. She finds what I need easily enough: a box of colored chalk. Then, after lunch, she escorts me to the sunroom, where I spend twenty minutes on my knees, sketching and scribbling on the floor. I use up all the chalk.
At 7:26, I am long finished with dinner and peeking out the window. I am wearing my white dress for the occasion, pink lipstick, a little blush, my mother’s pearl earrings, some perfume.
Matthias’s blue car pulls into the driveway at 7:28. He does not know. I cannot wait to tell him, cannot wait for him to reach the front porch.
I open the door before he rings, too excited to wait.
Why, hello,