Direct Care pulls a patient manual from the shelves over Katherine’s desk, bulky and identical to the one I was given on my first day. She opens it and flips through the sections to:
“The Stages of Residency at 17 Swann Street.”
I remember those. She begins:
“Stabilization Stage: Patients admitted at this stage may or may not recognize their eating disorder is a problem, and may or may not experience a desire for recovery.”
Not. Definitely not.
“During this stage the focus is on medical stabilization, nourishment, and hydration. Due to the intensive level of supervision necessary, patients at this stage are not eligible for therapeutic passes, outings, physical activity groups, or daily walks.”
In other words, hell. Girls rarely come here at Stabilization Stage, and if they do, rarely stay. They are often just too close to death to be outside a hospital ward.
Excuse me, Anna is at Stage One,
Katherine interrupts. Direct Care replies testily:
Yes, I was getting there.
She gets there:
“Stage One: Patients at this stage still require a high level of medical monitoring, but not one as extensive as that of patients at Stabilization Stage. During this time the focus is on medical stabilization, normalizing eating behaviors, developing adaptive coping resources, and establishing a collaborative working alliance with the treatment team.”
“Collaborative.” The operative word.
“Patients at Stage One may go on one therapeutic pass per week. Meals are not allowed on passes—”
Unless she is at Stage Two.
I look at Katherine, surprised but grateful; she is actually intervening for me. She reaches for the manual:
May I?
Direct Care hands it over to her. Katherine reads:
“Stage Two: Patients have decided that they are ready and willing to work for recovery. They collaborate with their treatment team to develop a course of action for their treatment.”
She pauses for a pointed look at me:
“Patients at this stage must be committed to exploring underlying issues that have contributed to the development of their disease. They must also present with increased honesty and accountability for their behaviors…”
I wince—
“… urges, and thoughts. They are allowed two meal passes per week.”
She does not read on and into Stage Three. Too far away, too surreal. But she does look at me and ask:
Do you think you’re ready for Stage Two?
Have I decided that I am ready and willing to work for recovery? Can I be honest and accountable? Do I want to collaborate?
Well—
The nutritionist protests:
She has a feeding tube in!
She and I exchange dirty looks. The psychiatrist asks her:
How’s her weight?
She shows him my chart.
Hmm …
Katherine addresses me:
Anna, you have not answered my question.
No I am not ready, but I can only go forward from here … or to a hospital ward.
I want to try, I have to. I have to bring Matthias back.
No further questions. I am told:
Anna, you may go now, thank you. Direct Care will take you back to community space while the team makes a decision.
Neither Danielle nor her husband is in community space when I return. I conclude he probably left and she is probably in orientation. The rest of the girls are out on the morning walk. I have some time to waste. I decide to write Danielle a welcome letter, like the one Valerie had written me.
Short, signed, and folded. I slip it in my pocket to give to her when she returns. It’s what we do here. The girls return, the mailman, and preparations for midmorning snack.
I do not see Danielle in the morning, or as we cross the lawn for lunch. After it I ask Direct Care about her. She says:
She had to leave. Don’t worry: she’s stable now.