The Girls at 17 Swann Street Page 6
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.
22
Meal Plan—May 24, 2016
Patient Body Mass Index: 15.1
Normal BMI range: 18.5–24.9
Other symptoms: Bradycardia, arrhythmias, osteopenia, unstable vital signs.
Treatment Objective: Weight gain and restoration of patient BMI to within normal range.
Meal Plan:
Patient will consume three meals and three snacks at two-to-three-hour intervals daily.
Initial caloric value set at 2,100 calories per day, to be increased by 250–300 calories every forty-eight hours to seventy-two hours.
Patient will be monitored for symptoms of refeeding syndrome and other medical complications, including but not limited to: heart failure, arrhythmias, respiratory failure, muscle breakdown, sudden death.
Calorie Guidelines (to be revised as needed)
Breakfast: 400 calories (to be increased to 800 calories)
Lunch: 550 calories (to be increased to 800–1,000 calories)
Dinner: 550 calories (to be increased to 800–1,000 calories)
Midmorning snack: 200 calories (to be increased to 400 calories)
Afternoon snack: 200 calories (to be increased to 400 calories)
Evening snack: 200 calories (to be increased to 400 calories)
Meal Plan may be complemented by a liquid nutritional supplement to increase calorie density. Value: 350 calories per 8 fl. oz. Liquid supplement must be administered immediately if meals are skipped, refused, or unfinished.
23
I am back in community space before 10:00 A.M. I try to breathe down the storm in my chest; I have cried enough for today, for the week, and it is only Tuesday.
Only two days, and I am already suffocating in this place, from being told when and what to eat, when to use the bathroom and when to go to sleep. Two days ago I was a grown woman. Now I have two refusals left. I must have signed my independence off on one of those admission forms.
All the women who come here do, with the keys, phones, and tweezers they hand in. They also sign off their lives, careers, families, closets of dresses and high heels. Stripped of the energy to process anything beyond heartbeat, breathing, some body heat, they then devolve into little girls throwing tantrums at breakfast tables.
What a mess and first impression I made this morning in front of the other girls. Most do not even know my name yet. They are now out on their morning walk.
I must apologize as soon as they return. The front door opens and they enter.
Emm comes straight to me and in her professional voice, asks if she can have a word.
I follow her to the alcove underneath the stairs. She climbs into it and sits on the floor, motioning me to join. Her manner is so natural I know she has had meetings like this here before.
I understand how difficult this morning was for you,
she begins before I can,
but you disrupted breakfast. Everyone in here is suffering, and everyone is suffering enough.
She speaks quietly and kindly. It strikes deeper than if she had been upset. The frozen orange, the sweetener, the silence at the table. One of the rules of the house: to be kind.
I open my mouth to apologize but she cuts me off before I can:
It’s okay, and so are the others. We don’t hold grudges here. We each lived our own first forty-eight hours in this house. Just focus on surviving yours.
She pauses.
It will get easier after that. At least then you get the morning walk.
Yes, I remember Direct Care saying that. Forty-eight hours in and pending good behavior. Only twenty-four more to go.
I am sorry,
I say lamely anyway as she climbs out of the alcove.
No need,
she calls over her shoulder.
Twenty-four hours left. I can focus on surviving this place till then.
Then I notice Direct Care setting the table: midmorning snack, already.
I am not ready yet. I have no choice. We all flock toward the breakfast table. I keep my eyes down, still embarrassed by my earlier behavior. Two bowls and a plate are placed in front of me. All three wrapped in plastic and labeled.
The first contains yogurt. Vanilla. The second has animal crackers.
In spite of me, of the horror of the situation, I suddenly want to chuckle. In my head, I hear the first lines of a poem I used to know and love:
Animal crackers and cocoa to drink,
That is one of the finest of suppers I think.
My mother’s voice is reciting the words. I am five and in the kitchen with her. The cocoa is steaming in its wide white bowl, warming me on a rainy school night. My animal crackers are waiting patiently for their turn to be dipped until just soft. They did not scare me then. That memory is a happy one.
I then turn to the plate, confused. I do not understand, till I do: my uneaten half bagel and cream cheese, this morning’s breakfast I had refused.
I choke; I am expected to eat it now, and my midmorning snack too. The girls around me, even Direct Care, are quiet, waiting for me to react.
Yogurt, and crackers, and the bagel and cream cheese. I try to rein in my breaths.…
And hyperventilate.
My body is screaming: Not all at once! Please! The nutritionist’s voice responds: You have two refusals left. And Emm’s, who is sitting across from me: Everyone is suffering enough.
Every girl is to be kind. I cannot make a scene. But I cannot do this! Please …
The animal crackers in the bowl. I hear the poem again. Somehow, my mother’s quiet voice drowns out all the others in my head. It trails along rhythmically, soothingly slowing the pace of my inhales and exhales:
Animal crackers and cocoa to drink,
That is one of the finest of suppers I think.
This is ridiculous. I am twenty-six years old and reciting a children’s poem. But it helps, if only with the breathing. I continue, in my head:
When I’m grown up and can have what I please
I think I shall always insist upon these.
I cannot refuse this meal. I wish Maman were here. I wish I were anywhere, anywhere but here. How did the poem go?
Focus on the next line. And on unwrapping the bagel. Now the cream cheese. Spread. Take a bite. And another bite. Chew. Do not think, keep your brain on the poem.
What do you choose when you’re offered a treat?
When Mother says, “What would you like best to eat?”
Swallow. Drink water. Start again. One more bite. And another, and another after that.
Is it waffles and syrup, or cinnamon toast?
Keep chewing
to the end of the stanza. I swallow the last bite of bagel and recite:
It’s cocoa and animals that I love the most!
No one is talking and I do not know if anyone is looking at me. I cannot look up to find out, however. I cannot stop. Now the snack.
The yogurt is smoother and easier to swallow. I keep reciting nonetheless.
Chew. Swallow. One more spoonful. Think of the next line, the girls, the morning walk. Just a bit more. Breathe. Good, now only the animal crackers are left.
I line them up as I used to and contemplate their childish shapes. Maman, I am twenty-six years old and scared of little animals.
But I eat one, then the other, and recite the last stanza. I finish the poem and the snack at the same time.
And it is 10:30. The table is cleared in front of me. The room, and my brain, are quiet.
24
I am not dead. I am drained but not dead. So drained I can barely walk. Perhaps it is a good thing. I cannot think of what I just made myself do.
None of the girls speak to me. That is good too; I do not trust myself to talk just now. Now I need to be alone and to cry. I need to process this meal. This meal that stood against everything my brain has firmly believed for so many years. I need time for the yogurt, bagel, cream cheese, crackers, and anxiety to settle down.
I’d like to use the bathroom please,
but am not given that luxury:
You can go after group therapy, Anna. Now follow the other girls, please.
I have no choice. I follow the others to the back of the house, a sunroom, for my first group session at 17 Swann Street. There are chairs set in a circle in the middle.
Each girl automatically takes a seat. Here too, each has her spot. I hesitate: Where is mine? Three voices call out at once:
This seat is free if you like.
They have spoken to me!
Emm was right: No grudges here. I sink into the nearest chair gratefully. I notice her looking at me, a few chairs away. Thank you, I mouth. She nods.
Valerie, across from me, is obviously still shaken from both the breakfast incident and her last snack, but her fingers are unclenched and she even, maybe, I imagine, smiles at me.
Julia is sitting to my right, headphones around her neck now. She shakes my hand buoyantly:
Ah, the French rebel. Glad to meet you, neighbor! I’m Julia, from Bedroom 4.
Hello Julia, I’m sorry I got you into trouble at breakfast—
but she brushes it off:
Nah, don’t be sorry! No worries, I was just trying my luck anyway. They won’t slap my wrists too hard for stealing a few packets of sweetener.
Speaking of wrists, my osteopenic bones are cracking in her jovial grip. I look down and see fresh calluses on her knuckles: Russell’s sign, caused by self-induced vomiting. The skin is chafed where it scraped against her teeth while she was making herself gag. I do not want to imagine what the inside of her mouth must look like.
There are dark circles under her eyes, but she seems quite upbeat.
It’s the coffee, it’s still morning,
she answers my unvoiced question with a wink.
The days are all right. I like the meals here, and I chew gum during sessions. It’s the nights that are hard. But hey, we share a wall. Let me know if my music is too loud.
Bulimia nervosa. Julia does not look emaciated or frail. She is warm and misleadingly jolly, but, as she said, it is still morning.
She pops a piece of chewing gum in her mouth. It must be allowed here.
Want some? I’m always well stocked.
No thank you,
but good to know. I used to chew gum all the time as well, to keep hunger and anxiety at bay.
I look away from Julia as a therapist walks in. I have not seen this lady before: loud bleached hair, loud bleached smile. She sits in the last empty seat, closing the circle of quiet patients, and, queuing all the loud bleached sympathy she has, asks:
How is everyone today?
She receives no response, though in our defense, I do not know what she expects to hear. The question seems far too high-pitched to be anything but rhetorical. It clashes as loudly as her hair against the melancholy in the room. Everyone around me seems too tired for theater. Except for Julia, who pops a bubble.
Emm finally breaks the silence, on everyone’s grateful behalf:
Everyone’s fine.
Fueled by the answer, any answer, the smile beams louder. The white teeth are unnaturally straight. The therapist turns to look at me specifically:
How are you today?
Well, I am on the spot, unprepared, and extremely uncomfortable. I just had a terrifying meal. My stomach hurts and I want to cry, but I doubt that is what she wants to hear.
Fortunately, I do not have to reply. She speaks again instead:
Welcome to group therapy. These sessions are a safe space where you can share and receive feedback.
I nod politely and whisper thank you, hopefully loud enough that she hears. I then look down at my pink trainers, signaling she can move on.
She does not.
Since this is your first time with us, would you like to introduce yourself and tell us a little bit about your past?
Oh I most certainly would not, but as I am coming to learn, at 17 Swann Street most questions are really instructions in sweetened, buttered disguise.
I could introduce myself—
Hello, my name is Anna.
—but my past is not hers to know. As far as she is concerned, I am just another patient at an eating-disorder treatment center. My disease is just a variation of that of every other girl in this room. All of whom, I suspect, have heard more than their share of sad anorexia stories.
That’s all.
The therapist’s eyes widen, glance briefly at the clock, then look back at me with a clear message: I am going to stop wasting her time and share. I look back at my feet, wondering how and where to begin. Help …
It comes from the girls. Valerie, to my surprise, goes first:
Where did you grow up? Any siblings? Pets?
Another patient chimes in:
Married? Kids? What do you do in real life?
Emm asks me why I came to the States. Julia wants to know if I like jazz. Another patient—potatoes in small bites, I remember, from dinner last night—asks with a sly smile:
Will the gorgeous man who came to see you yesterday be back?
The irritated therapist tries to redirect the conversation onto a therapeutic track:
Or, if you would rather, you could tell us about how your eating disorder developed.
I would rather not. So I turn to the questions the other girls asked.
I grew up in Paris. I have a sister and a brother,
I tell Valerie first.
I am the eldest. My sister and I are very different but very close. She is the sophisticated banker; vodka martinis and the like. My brother …
was hit by a car when he was seven. His name is Camil. But I do not want to mention him, or Maman.
I switch tracks, hoping no one notices:
I do have a pet: a limping dog called Leopold. He lives in Paris with my father.
If they did notice, no one mentions it. I am grateful to the girls yet again.
Yes I am married. To the gorgeous man from yesterday,
I add for potatoes-in-small-bites’ sake.
His name is Matthias. He is kind and my best friend and we have been married for three years.
Space, and then,
No kids.
Now, what do I do in real life? I cannot remember, is the honest answer. I have not had a real life in years. This one I have been spending mostly just stopping myself from eating. It takes up a lot of my time. And energy, and concentration. My brain is slow and rarely looks beyond anticipating the next hunger pangs. Or back past the guilt of the last bite. By nighttime, it is exhausted. I sleep.
In real life I starve and I sleep, but I know that is not a proper
answer for this crowd. So I rummage through my memories to pre-anorexia:
I was a dancer for a while. I was not very good. I also hurt my knee, then we moved here, and
now I remember:
Now I work as a cashier at a supermarket. Or I used to before checking in here. I hated it. It was supposed to be temporary, but at least it paid a salary.
I trail off with the thought.
In an ideal world, I would go to university. I went straight to ballet after school. I think I would study art history, or Italian, or maybe teach dance to children.…
I realize no one had asked me about that. Embarrassed, I move on.
To Emm:
Matthias was offered a position at a research laboratory here. He is a physicist and very smart. Or I am biased. I don’t know.
The offer was generous, and we were struggling in Paris, especially when I stopped dancing.
It was a brilliant opportunity for Matthias,
and we needed the money.
And now I need a lighter interlude. Julia’s question provides it:
I do not know enough about jazz, but what I do know I love. I love music that moves me. The saxophone. I like Billie Holiday.
I wrap up:
And yes, Matthias is coming tonight!
and add to myself, self-consciously: I hope I can put some makeup and perfume on before he arrives.
That leaves the therapist’s question unanswered. I hope she does not notice.
She does:
So what made you seek treatment for your eating disorder?