Purge Read online

  Residential Counselor (RC) Shannon meets me at the door.

  I notice immediately that she cannot be older than I am—her hair is too stylish; she says “like” when she talks—but I relegate that thought to the back of my mind. I am trying to keep an open mind about treatment. RC Shannon helps me wheel my suitcases into the office, where they will remain until she and RC Julia search them for contraband. Shannon hands me over to Mark, the person in charge of new-admission paperwork. He has numerous forms for me to sign and fill out.

  I sign myself into the EDC, agree to pay any charges not covered by BlueCross BlueShield, agree to follow the hospital rules, sign a release allowing the psychiatrist to use my writing and artwork for his research, and fill out a survey to determine just how eating-disordered I truly am, and what eating disorder I have. My first diagnosis is anorexia, binge/purge subtype, but it is later changed to EDNOS characterized by restriction and purging, since I’m not underweight and I still menstruate.

  After I’ve signed all the forms, Mark shows me around the first floor of the EDC, where I will be a resident.

  The EDC ’s interior is much like that of a college dorm, except for a few subtle differences. There are no locks on the bathroom or shower doors. The windows don’t open without a special tool that is kept in the RC office, which resembles a nursing station in a medical hospital. The snack cupboards are locked, and the refrigerator door sports a formidable padlock. Then there are motivational posters, made by the residents during free time and art therapy, that are plastered all over any clear wall space: HUGS, NOT DRUGS; ONE DAY AT A TIME; YOU ARE BEAUTIFUL; EATING DISORDERS THRIVE IN THE DARK BUT DIE IN THE LIGHT. The Serenity Prayer is posted prominently on the wall as well.

  I am trying very hard to rein in my sarcasm and negativity.

  I find all this positive-attitude, recovery-speak propaganda to be utter bullshit.

  Mark shows me the snack list taped to the cupboard door in the kitchenette. Each snack is assigned a certain number of exchanges according to its caloric content, and residents are assigned a number of exchanges to meet based on whether they are gaining or maintaining their weight. Cheerios bars (my favorite snack) are two exchanges. Oyster crackers are one exchange. Honey-wheat pretzels are three exchanges. This list of snacks and exchanges is overwhelming. My eyes widen and I look around for exits out of this positive-energy-laden place.

  Then it is time for dinner. I wait in the dayroom with the other ten women who are residents on First Floor. Eliza, a petite woman who lives in the Twin Cities, is my age, and has blond dreadlocks introduces herself and takes me under her wing, asking me questions about myself and telling me about her personal history; for this I am grateful. Eliza is originally from Nebraska and struggles with alcoholism. In the following months, she and I will learn that we have much in common, and we will grow close. Courtney, a tall, thin woman is giggling on the sofa with Sarah, a short but shapely bleached blond whose style reminds me of Christina Aguilera’s during her blond phase. A woman with dark brown hair and black-framed glasses curls into herself on the blue leather chair. I learn that she is Sandra from New York City, and that she is cross-addicted to heroin.

  Someone named Laura, who is to be my roommate, is missing. She is in an individual session with Therapist Elaine. A pale, emaciated woman whose skin has a grayish cast bounces nervously on her toes, muttering to herself. I learn that mealtime makes Danielle, a purging anorexic, nervous. Holly, another resident from the Twin Cities, who is bulimic, does a crossword puzzle, then suddenly bellows, “It’s time to feed the eating-disordered!” Everyone lines up in front of the locked dining room door, and I follow suit. I will learn that this is a ritual: Before every meal, Holly bellows her famous line and the RCs gather up the meal cards (records of our individual meal plans) and lead us into the dining room. I am left wondering how I will fit into this scattered group, with these women who are supposedly my peers, and who, like me, cannot seem to nourish themselves. All I know is that I am neither the thinnest nor the fat-test in the group, which makes me feel better. Before I arrived at the EDC, I was terrified that I would be the largest resident, and that no one would believe I had an eating disorder.

  RC Julia, a tall blond in khakis with a pronounced Wisconsin accent, unlocks the dining room door, and the other residents shuffle in and jostle each other for a view of the list of exchanges for tonight’s meal. I hang back at the end of the line, nervously chomping on my ragged cuticles until they bleed and pushing stray pieces of my hair behind my ears. RC Julia and Eliza help me with my new-admission meal plan (the standard meal plan I’ll have until I meet with the dietitian). I take one slice of ricotta-spinach pie, one carton of skim milk, and one mixed-fruit cup. RC Julia checks off my meal card; I have successfully met all my exchange requirements. As long as I eat all my food, I will be marked as “compliant.” If I’m “incompliant,” an RC will question my decision to not eat my food (not eating is symptomatic of a larger issue, according to the EDC staff). Incompliancy prevents a resident from moving up through the level system and gaining the privileges associated with each level.

  I sit with RC Julia, Eliza, and another woman, who angrily slathers her bread with the required four tablespoons of peanut butter. RC Julia and Eliza try to talk to me, but I am petrified. This is too much food. Unless I can purge, I don’t want to eat this much, and purging doesn’t seem to be an option right now. Later, I will learn how to subvert the system, how to sneak down the hall and purge after meals, how to toss my snack off the deck and into the woods. But right now I am convinced that I have just signed away my right to an eating disorder.

  I am shaking from the diet pills and Diet Coke I consumed on the train ride here. Otherwise, I have not eaten anything all day (my last hunger strike, what I believe will be my last act of eating-disordered defiance). I should be hungry right now, but I’m not. I will have to relearn hunger cues: when I’m hungry versus when I want to eat to fill some void within me, or when I’m symbolically purging myself of emotion via food.

  I eat everything but the fruit cup. I know I could eat the fruit cup. The reduced-sugar fruit cups I allow myself to eat are seventy calories each and taste of artificial sweetener, but these fruit cups are not reduced sugar. I can taste the difference. I’m estimating the EDC fruit cup at ninety calories, but I still won’t eat it, mostly out of protest, and because I’m convinced the ricotta-spinach pie is loaded with fat and calories. Secretly, I yearn for the slippery peach cubes, to scoop up the thick, golden nectar with my spoon and swish the sugary liquid around in my mouth, but doing so would be a sign of weakness, of giving in to my hunger.

  RC Julia tells me I did a good job with my meal. My incompliancy is forgiven because the first meal is never easy for anyone. I think back to last week at this time. I was finishing up an essay for my Poetry of Social Change workshop and grading student papers. I was roaming around Minneapolis as I pleased. Now I’m sitting in an institution where someone practically my own age (RC Julia is twenty-three) is in charge of me and has just complimented me on eating most of my dinner.

  After everyone has finished (or not finished) dinner, we file back into the dayroom and sit in a circle on worn and comfortable furniture. Each woman introduces herself, offers a little information about her history, and talks about how her day went. Then she sets goals for the next day and says whether or not she accomplished her goal for today. My introduction goes like this: “Hi, I’m Nicole, I’m twenty-two, I’m a graduate student in creative writing at the University of Minnesota, I’m originally from Pennsylvania, and this is my first time in treatment.”

  Everyone looks at me for a moment. They are waiting for the rest of the introduction.

  “And I have a mom, a dad, a brother, a dog, and a cat.”

  I think the second part of the introduction is absolutely ridiculous. It sounds like a kindergarten exercise. Later, I will refuse to say that I have a mom, a dad, a brother, a dog, and a cat. But I don’t want to get in trouble
within hours of arriving at the EDC, so I go along with it.

  “What is your goal for tomorrow?” asks RC Julia.

  “To get adjusted and settle in.”

  One of the EDC nurses pokes her head into the dayroom and asks if she can get a medical history on me. I follow her to the conference room and answer her seemingly endless questions.

  “Health problems, other than the eating disorder?”

  “Asthma and heart problems.”

  “What kind of heart problems?”

  “PVCs, PACs, and bradycardia.”

  The nurse records all this information on her computer without blinking. She is used to hearing about eating disorder-induced heart problems. She takes my temperature.

  “Ninety-seven point zero—that’s low.”

  “I always run a bit low.”

  “Eating disorder patients often have lower temperatures, pulse rates, and blood pressure.”

  Next, she takes my blood pressure. As the cuff inflates on my arm, I know this won’t be good. My blood pressure is usually low, even when I’m healthy. Lately, though, it has been abnormally low.

  “Ninety over sixty—that’s low. Now I need you to stand up so I can take your pressure again and see if it drops.”

  I stand up. My blood pressure drops to 80/53. This explains my frequent dizziness when I wake up in the morning, and why everything turns black and sparkly if I don’t stand up slowly. This condition is called orthostasis. The nurse assigns me mandatory blood pressure checks every morning. If I drop below 80/40, I’ll be put on a special watch.

  I tell the nurse about my drug allergies (Ceclor, Septra, Compazine, Claritin-D); my hospitalizations (tonsillectomy at age four; concussion, dehydration, and irregular heartbeat at twenty-two); my current medications (multivitamin, Zyrtec); my menstrual cycles (almost nonexistent since I lost weight); how much weight I’ve lost in the past year (approximately thirty pounds); how often I purge (sometimes once a day, sometimes multiple times a day, at least five times a week); the brand and number of diet pills I take (Metabolife or Dexatrim, upward of two a day); my caloric consumption (no more than five hundred calories per day, or I have to purge and take extra diet pills); how long I’ve had an eating disorder (since I was thirteen). The nurse tells me that I’m scheduled to be driven into town the next day for a physical from Dr. Lorensky, who examines every EDC patient within twenty-four hours of arrival. Then she draws a few vials of blood to check my CBCs and electrolytes. After she draws my blood, she asks me to pee in a cup so she can check my urine for infection, ketones, and evidence of drug use.

  After I meet with the nurse, RC Julia and RC Shannon pull me aside and tell me it’s time to search my suitcases. We go into my room, and they each take a suitcase. I feel violated as RC Julia paws through my underwear and searches my bras for contraband. RC Shannon flips quickly through my journal, and I resist the urge to tear it from her hands.

  RC Julia and RC Shannon are respectful. They refold all my clothes and are gentle with my papers. They make small talk with me the whole time. RC Julia goes through my purse, pulls out my bottle of diet pills, and takes them to the office to be disposed of. Then it is all over, and I’m left in my room with my suitcases. I set to putting away my things, even though I don’t think I will be here long, because I have convinced myself that my eating disorder will be under control by my birthday, at the end of June.

  Laura, my assigned roommate, throws open the door and flings herself onto her unmade bed. I have surmised that she is crazy. Not crazy in an I consume five thousand calories in one sitting and then stick my finger down my throat and vomit way, but in an I’m obsessed with serial killers and I’ve spent serious time in lockdown way. Laura is wearing fatigue pants and a pale pink camisole that showcases her prominent collarbone. She asks if I want the “grand tour” and stares me down with intense brown eyes. I say yes. She shows me which drawers and what closet are to be mine, and where I can store my things in the bathroom.

  Laura tells me she is from South Carolina and is a purging anorexic, meaning that anything she eats, she usually throws up. Prior to coming to the EDC, she did a stint in detox (Laura is also an alcoholic and a drug addict; cross-addiction is common among ED patients), and then went to a treatment program in Utah, where she was kicked out for alcohol possession.

  RC Shannon comes into our room and tells me I have to take my nighttime meds and get a picture taken for my chart, for identification purposes. I follow her to the office, where I tell her and RC Julia that I don’t take any medication, other than a multivitamin and allergy medication in the morning.

  RC Shannon asks me to smile so she can take my picture. The flash goes off and the camera spits out an image. My expression is somewhere between a frown and a grimace. My diet pills have just been confiscated, I’m not allowed to have Diet Coke, I’m not allowed to purge, and I have just eaten something called ricotta-spinach pie. I see no reason to smile.

  RC Julia tells me it’s snack time.

  I’m still full from dinner but take a red apple from the refrigerator. I don’t like red apples, I like only green apples, but everything else seems too risky to eat without the possibility of purging. I eat one-quarter of my apple and show the remainder of the apple to RC Julia before I pitch it into the trash. She doesn’t give me a hard time about not finishing my snack, and I decide that I like her.

  Holly stumbles into the office, claiming she has just purged blood in the bathroom. Her face is pale, and she lies down in the hallway because she is afraid she will pass out. RC Julia calls an ambulance while RC Shannon takes Holly’s blood pressure. It registers at 40/10. Laura and Sandra hold Holly’s hands and tell her help is on the way. The ambulance crew files up the stairs and straps Holly onto the stretcher. At the local hospital (the EDC is part of a psychiatric hospital), nurses and doctors suction blood out of Holly’s stomach as she fades in and out of consciousness. She has a Mallory-Weiss tear, which is a tear in her esophageal lining from the strain of her constant purging. Holly returns the next morning, after countless IV bags of saline and potassium. The tear should heal if she stops purging and takes her gastric medication.

  During this drama, the other residents watch music videos on VH-1 (it’s the summer of Britney Spears, OutKast, and Christina Aguilera), smoke on the deck, or talk on their cell phones. Holly is prone to health crises, so her purging blood does not shock anyone. RC Julia assures me that an ambulance crew at the EDC is a rarity. I decide to comment on some of my students’ papers at the back table. I put my headphones on and listen to Tom Petty’s Wildflowers album while I comment. I am inside my head, and I am trying as best I can to forget that I am at the EDC. As long as I’m working on things pertaining to school, I can hold on to the person I am outside these institutional walls.

  I sit at the back table, absorbed in commenting, until 10:00 PM, when I decide to go to bed. In the morning, I will be weighed facing backward so I can’t see my weight. My blood pressure will be dangerously low. I will find out that my potassium is low and will start a regimen of potassium tablets that will last long after my discharge, and I will learn that I have a vitamin deficiency. Tonight I sleep the sleep of the exhausted, curled up on my regulation hospital bed, on thin, white institutional sheets with a flat pillow, wondering how I ended up in this place.

  Psychiatric Evaluation

  Patien is a 22-year-old, single, whit female in Masters Program in Creative Writing at the University of Minnesota, originally from Pennsylvania.

  “I’m eating-disordered.” Patient describes onset of purging at age 14 with original issue being difficulty of adjusting to onset of puberty associated with weight changes. Things worsened when she went to boarding school at age 16. Patient says binges “atypical.” Typical binge is a candy bar. Typical pattern would be purging 3x a week. No purging from April to September of the past year, but things have progressively worsened over the academic year, with stress. Low weight 117 at 17 years old. High weight 160, now weighs 1
33 with decrease this year. Also restricts, less than 1,000 calories a day, skips meals, no meat. Takes diet pills, denies laxatives and diuretics. Denies compulsive exercise.

  Treatment has included individual psychotherapy and eating disorder group that patient did not attend regularly due to school conflict.

  In Jan/Feb, patient had episode of syncope, related concussion, electrolyte abnormality and heart rhythm irregularity.

  Patient denies any problems with depression and related symptoms although sleep is irregular. Some anxiety, she feels may be related to diet pills.

  No prior psychiatric hospitalization. Some self-injury when 12 or 13, related to poor school performance. Trial of Paxil, 20 mgs for 1 year to help binge/purge cycle when 17-19. Did not feel right—sedated.

  Social drinker.

  Episode of syncope and concussion, heart rhythm irregularities in the form of PVCs, PACs and bradycardia. Exercise-induced asthma. Ovarian cysts. Seasonal allergies.

  Allergies: Ceclor, Septra, Compazine, Claritin-d.

  From intact family. Oldest child. 16-year-old brother at boarding school. Parents not college-educated, was pressure for patient to do well in school and patient feels this relates to perfectionist qualities. Father is an operations manager. Mother is an accountant. Enjoyed boarding school. Switched from Ohio University to Penn State Erie where she got BA. History of dating, most recent relationship female. Has been barely functional at the U of M.

  Appropriate hygiene, good eye contact, speech normal, “some anxiety here,” affect full.

  Anorexia, binge/purge subtype. History of eating disorder since age 14, characterized by bingeing and purging or restricting. Patient relates perfectionist traits and poor body image as a related issue. No prominent disruption in mood at this point.

  No psychiatric medications at this point.

  Day Two- Weight and Vitals