Now every blini in her stomach hurt. The acidity of the champagne. Her glass was where she had abandoned it in panic, on the window ledge by her purse. She looked straight at them, across the room. She needed her purse. And to leave.
She would say she was tired after the performance. She was.
Anna! You disappeared.
Their host, and Philippe. And the woman with whom he had walked in, her slender arm nestled in his.
Natasha, this is the girl I was telling you about. Anna, have you met Philippe’s wife?
No she had not, but she had lost her voice, and her center of gravity. She stood, entranced by Natasha, her black dress. It fit her perfectly.
Anna exchanged a kiss on each cheek with the woman with long, sinewy legs. Her attention was held by the smell of her perfume—orchids—and Philippe’s arm around her waist.
Mademoiselle,
said the waiter,
blinis au caviar?
But Anna’s dress felt too tight. Anna’s dress felt too tight. His tray made her want to throw up.
Non, merci.
And to Natasha, finally:
Enchantée.
Her fine chocolate hair, gold wedding band.
Excuse me, I was just leaving. I need to get my purse.
And air.
13
Treatment Plan—May 23, 2016
Weight: 88 lbs.
BMI: 15.1
Diagnosis: Anorexia Nervosa. Restricting type.
Physiological Observations:
Malnutrition—severe. Potential for fluid and electrolyte imbalance. Hyponatremia. Amenorrhea. Osteopenia. Potential for cardiovascular instability. Bradycardia. Poor peripheral circulation—acrocyanosis. Abdominal bloating. Constipation.
Psychological/Psychiatric Observations:
Behavior consistent with manifestation of eating disorder. Symptoms of mild anxiety. Possible depression. Further assessment pending full examination by treatment team.
Summary:
Patient admitted to residential treatment on May 23, 2016. Team will work on improving nutritional intake and nutritional variety, improving patient’s body image and increasing her insight into the severity of her condition. Team will monitor for refeeding syndrome and work to achieve and maintain medical stability.
Given the severity of malnourishment and multiple medical concerns, residential treatment is indicated.
Treatment Objectives:
Resume normal nutrition, restore weight. Gradually increase caloric density and portion quantities.
Monitor vitals.
Monitor labs for refeeding syndrome and replenish electrolytes as indicated.
Prevent worsening of existing medical conditions.
Follow hormone levels.
Caloric Intake Target: To be determined by nutritionist.
14
At 6:00 precisely, Direct Care knocks, signaling the end of the session. She escorts me from the therapist’s office back to community space.
I observe her. She is by no standards thin. Her pants sit too snugly on her waist, a bit of skin protruding over the seams. Nothing too dramatic though, a normal woman’s body. Just not one I would be caught dead in; the gap between standards and normalcy, and between this woman’s body and the others in community space.
All the patients are there. There are seven of us, of whom five, including me, are anorexic. Not difficult to spot; they look pubescent and gaunt. Sunken eyes in sunken faces, scarecrow-thin arms and legs. Pale skin and hair, no lips. One is wearing a bright turquoise sweater. The color stands out.
Their ages are difficult to determine. As is mine, I suppose. They must be older than eighteen, at least; this is the women’s center. But women rings false in my head. These patients are not women. They are missing breasts, curves, probably periods. Most are wearing children’s clothes.
They look androgynous, their skin hanging in loose pockets around fragile frames. Not women; women have bodies, sex, lives, dinner, families. The patients in this room are girls with eyes that are too big.
I look at the other two girls, who seem less pale and emaciated than the rest. The skin around their mouths is dry and chapped, their knuckles are cracked and bruised. Bulimia, I guess. Less evident but just as lethal as anorexia. One of them is bobbing her head to music playing in her headphones.
They do not look like women either, though. I wonder why that is. Then I see the mismatch between their well-developed bodies and the adolescent anguish in their eyes.
Direct Care and the day team sign off; it is past 6:00 P.M. They take their purses, their silk scarves and car keys, and leave without saying goodbye. Those of us who remain do so in silence, with the night staff, trapped in this surreal, contrived environment and the diseases in our brains.
I had been warned that I would be overwhelmed by my first day in treatment; the information to be processed, the forms to be signed, the rules in the patient manual. Watching my tweezers, scissors, keys, and phone sealed away in storage bags. Being assigned a cubby, a bedroom, a seat at the table, a number.
But the warning had been inaccurate; the day had unfolded smoothly. Until it ended and I sat down. Now for the first time today, I am still.
No one speaks to me, no one speaks. I realize that this is not a game. I am not going home tonight. I am having dinner, sleeping here.
Dusk and the panic settle and with those, my despair rises dangerously. I need to break the silence; I turn to the girl—one of the anorexics—next to me.
She is writing a letter on fine ivory paper. Left-handed, beautiful penmanship. I need her to be my friend.
Hello. My name is Anna.
She does not look up, but:
Valerie.
It helps. The heat in my chest begins to cool. Her name is Valerie.
I pause in that instant in which both our identities are still safely hazy. We do not have to be two girls with anorexia. We can just be Anna and Valerie. We can be two ladies chatting in a waiting room, any waiting room.
She continues writing. I watch her, discreetly. Her moving pen soothes me. She does not wear a wedding ring. A locket hangs around her neck. Her eyes are big and acorn brown. A nervous tick in the right one. We must be roughly the same age. She must have been beautiful, once.
I ransack my brain for a question, any question to move the conversation along. Most in this setting seem inappropriate or irrelevant:
What brings you here? What do you do? How do you enjoy your free time?
Is there someone, something outside these walls waiting for you to come out?
I could, of course, fall back on logistics:
Is the staff agreeable?
Do you know if we are allowed to have coffee or chewing gum?
I could ask her for pointers or about pitfalls to avoid, but what I really want is reassurance.
Am I going to be okay?
But she seems engrossed in her writing and my courage is faltering.
I fall back into the seat and the silence. She signs her letter and folds it. Then, the receiver’s name: To Anna.
She hands it to me. I am stunned.
Inside:
I’m so glad you are here. You seem nice. I hope we become good friends. You’ll soon see I’m nuttier than squirrel poop, but don’t let me scare you away.
Don’t let any of us, or this place. It’s not as impossible as it seems. It will be all right, don’t worry. We will all help.
Valerie
She does not look nuttier than squirrel poop. She just looks very sad. And like most anorexics she looks like she is trying to starve the feeling out. Odd that she would mention a squirrel; she reminds me of one. Petite and fragile, her soft light brown hair in a bun, the way I put up mine.
P.S. Here are a few of the house rules.
My brain springs to attention. This set of rules is different from the one I received at orientation.
Emm will surely go over them with you. She is the leader of our group.
I do not know who Emm is, yet, but I assume I will soon.
I read on, curious. The manifesto begins with:
All girls are to be patient with one another.
No girl left at the table alone, because we are all in this together.
Composure is to be maintained in front of any guests to the house.
Horoscopes are to be read and taken seriously every morning over breakfast.