At 8:00 A.M. sharp, we take our seats in the breakfast area downstairs. A long wooden table, my first breakfast, my second day here. I have been up since 5:00 A.M.
Trying to keep calm, I pray for coffee. There is coffee. I can do this. Too soon; I see breakfast, half a bagel and cream cheese, wrapped in plastic, land in front of me.
This has to be someone’s idea of a joke. I see no humor in it. I had not wanted to be difficult last night, when yogurt had been served at dinner, but my file clearly states that I am a vegan. Something must be said.
There must be a mistake. I do not eat dairy,
I inform Direct Care as politely as I can. Perhaps I naively expect a waiter to swoop into the room, apologize elegantly for the misunderstanding, and remove my plate.
Valerie puts her spoon down and her hand on the edge of the table.
You will eat whatever the nutritionist has set,
Direct Care replies. Period.
Tuesday’s breakfast is a bagel and cream cheese. No exceptions to the menu.
She turns her attention to the other girls. My name stares at my horrified face, printed neatly in thick black felt right on the plastic wrap. There is no mistake, and this is not a joke. No one is laughing, least of all me.
Quite the opposite. I am angry now. I had tried to cooperate. I had eaten dinner last night like all the other girls and had not caused a scene. I had played along with my treatment team’s game, but they had taken it too far. I push the plate away with as much cold disdain as I can muster.
No cream cheese and bagel for me, thank you. I would like a word with the manager.
I would like a word with the nutritionist please.
Direct Care looks unfazed.
Now, you will complete or refuse your breakfast. As for speaking with the nutritionist, you may do that on the day and time at which your session with her has been assigned.
Officially, I am outraged. Secretly, terrified. My façade remains cool, I hope, but beneath it disaster bubbles dangerously. I try to remain calm, but I have crossed the twenty-four-hour good-behavior threshold. I can feel everyone around the table tensing but do not care at this point.
I would like to speak to the nutritionist now.
Keep calm. Inhale. Exhale.
Are you refusing to complete your breakfast?
Yes, that is exactly what I am doing. I am an adult. Here by choice. Free to leave as I please. To prove it, I stand up as calmly as my shaking knees will allow and walk away from the table.
Much happens simultaneously.
Julia tries to steal a few sweeteners from the table. She is apprehended by the nurse. All the girls jump, one of them spills her coffee. Quiet Valerie bursts into sobs.
And I, the reason behind all this chaos, do not make it very far. In fact, not even out of the breakfast area before Direct Care grabs me by the arm. I contemplate further escalation of the conflict. She appears to do the same. She makes the decision for us both after a few seconds of tug-of-war:
You have two refusals left, after which you’ll get a feeding tube. If you want to see the nutritionist, return to your seat and I’ll see if she’s in her office.
The thought of the yellow feeding tube running through my nostrils and down my throat, pumping dense and beige liquid food into my stomach, chills me in place. Not the feeding tube. Please, not the feeding tube. I have seen those in hospitals before, yellow lines that get taped to the cheek and go straight into the patient’s stomach. I fight the image in my head and a powerful gagging reflex.
Yes, please do,
I say calmly, lowering my telltale trembling chin.
I am escorted back to my seat, where I have full view of the damage I have caused. I disrupted breakfast, got Julia in trouble, and at the very least made everyone uncomfortable. Valerie is given her frozen orange to clutch. Only Emm is still reading the word jumbles.
I feel horrible. I want to apologize to the girls, but I have done enough for one breakfast. Eight thirty A.M. comes and goes. The plates are cleared. The girls stand up and leave the room.
I and my untouched half bagel and cream cheese are instructed to remain. An apprehensive, waiting-room sort of dread. Direct Care informs me she spoke to my nutritionist. She will see me at 9:00 A.M.
At nine I am led to her office and told to wait on the couch. This one is plush and red. Too comfortable. I do not relax.
The portly lady who enters the room next I dislike instantly. Too much makeup, jewelry, perfume. Too much skin. Every bit of her is too much.
She goes straight to the point:
I’m Allison, your nutritionist. What did you want to see me about?
She has not even bothered to smile. We are not going to get along.
So this disagreeable lady and her pout were responsible for my meals so far. Her job is to make me gain weight. Well, our goals are already opposed. I assess this Allison who in the future will dictate every calorie pumped into my stomach. I try not to look terrified.
Keep it polite, elegant, professional, I tell myself in my head.
I would like to discuss the menu with you, please. I cannot eat the food you are serving me.
She finally smiles, just not a smile that bodes very well for me. My stomach is churning, but I try to hold my ground.
I am vegan; I do not eat cream cheese. Nor do I think a bagel is a nutritious breakfast choice. I am open to eating muesli as a healthier breakfast alternative, if you would like to discuss that. Fruits are fine, and as for lunch—
Let me interrupt you right there,
she says. My bravado dissipates.
I’m not interested in your views on nutrition. I went to college for those. I’m here to make you gain weight, and fast. You will eat what you’re served.
I stare at her in disbelief. No one has ever addressed me like that. But I do not have time to react because she carries on:
You will follow a weight-gain meal plan. The goal is two to four pounds a week. Your portions and caloric intake will be increased gradually. You will meet with me on a biweekly basis so I can determine those, and in between you will be closely monitored for symptoms of refeeding syndrome.
Refeeding syndrome. Potentially fatal shifts in fluids and electrolyte levels, like sudden drops of phosphate in the blood, when a malnourished patient is refed. Starving bodies that have starved for too long can quite literally be shocked by food. Muscle weakness, coma, possibly death.
She knows she now has my attention.
The nutritionist continues:
You will be given the chance to choose all your meals once a week. We usually offer our patients two options, but since you’re vegetarian—
Vegan,
I try again.
We do not accommodate vegans. Now, as I was saying … Since you’re vegetarian, you will only have one nonmeat option to choose from.
What if I do not like that nonmeat option?
Then you will have a substitute meal like the one you had for dinner yesterday.
What if I do not like the substitute?
I am irritating her, but this is too horrifyingly important for me to let up. She sighs and closes her eyes, and when she opens them again, speaks in a sickly sweet voice I immediately recognize as dangerous:
You don’t know what you like or don’t like, not that it matters at this point.
I beg her pardon?
That smile again. In the same sickly voice, but with an eyebrow lifted, she asks:
How do you take your coffee?
Black. No sugar.
How do you take your tea?
Hot. Green or ginger.
Sugar?
Of course not.
How do you take your eggs?
I do not like eggs.
How do you butter your toast?
I do not butter my toast.
I do not eat butter or toast. No fats or simple carbohydrates.
Milk or dark chocolate?
Neither, thank you.
What do you like to eat?
What do you eat? would have been a simpler question to answer. I eat fruits, apples mostly. Sometimes with a squeeze of lemon. When I want something salty I eat lettuce or cabbage. For a treat: microwave popcorn.
What do you like to eat?
I have not answered her. Apples and popcorn, I suppose. Once upon a time my answer to that question would have been very different. Once upon a time I also would have told her that I ate my eggs scrambled, chocolate dark, toast warm and just barely crisp and golden. No butter but sprinkled with salt.
But now I do not like to eat anything. I eat out of necessity, to silence my hunger and function a while longer.
Apples and popcorn
do the trick. I do not need or want anything else, her horrible bagels and cream cheese.
I would like to order off the menu please. Something healthy and natural, something like—
Popcorn?
she interrupts. Her patience and even her fake, thread-thin smile have run out.
You would need to eat thirty-five bags a day, or forty-six point sixty-six medium apples to meet your caloric needs.
She has succeeded, again, in shocking me into silence. I do not understand what she means. Rather, I do not want to understand what she means by “caloric needs.”
Let me explain the refeeding process to you, who seem to know so much about nutrition:
A normal body, at rest, needs a thousand calories to survive. Just the basics: heartbeat, breath, blood flow, body temperature.
I already wince at a thousand.
A normal woman of your height and age needs a thousand to fifteen hundred more to carry out the basic active functions of her day: like getting out of bed, going to work. Driving her car, talking on the phone, picking up groceries, walking the dog, hanging her coat up, even watching TV … but you need even more than that.
More? More? Than two thousand calories? More than two thousand five hundred?
Because you’ve been starving and overexercising, you’ve been feeding on your own organs. You have no fat reserves, no period, no calcium in your bones. No estradiol in your bloodstream. In fact, you are less woman now than a two-year-old girl.
She is treating me like that two-year-old girl, the recurring theme of this place. But I have no time to be angry; the nutritionist drops her next bomb:
In order to repair the damage you’ve done, your body needs more energy. More energy means more calories: five hundred more, at least.
I do the math, poorly, in my head. I feel a panic attack coming on.
Two thousand five hundred calories?
I shriek.
At least. Probably more. I have had patients consume up to three thousand five hundred for results.
Three thousand five hundred calories! A day! More food than I consume in four! She is mad, utterly mad.
You need low-volume, high-fat, calorie-dense foods. Believe me, thirty-five bags of popcorn will not fit in that stomach of yours.
I do not even bother to hold back the tears. The time is past for pretense at poise. I cry like that two-year-old girl, terrified and trapped in a body I have no use for.
I do not scream. I hiccup and sob. I tell her to go to hell and that I am done. I am taking my anorexia with me and we are both going home.
If you leave you will die,
she says, indifferent, bringing this conversation to an end. She walks past the plush red chair and opens the door. Our first session is over.
And keep in mind that you have two refusals left before you get the tube.