Purge Read online

  I am awakened at six o’clock that first morning, when Natalie, the night-shift residential counselor, opens the door and chirps, in a singsong kindergarten-teacher voice, “Time for weight and vitals!”

  Sunlight filters through the blinds and casts patterns on the white sheet. I lie there for a moment, stretch my arms over my head, and stand up. On a bad morning, I will mutter, “Fuckin’ Natalie,” pull the covers over my head, and refuse weight and vitals. But I decide that I will try to make my first morning a good one, although I dread stepping on the scale and not knowing my weight, that measurement that has defined so many of my days for so long. Natalie is one of the most obese people I have ever met (staff thinks this is why most residents despise her—she is what we think we will be if we stop starving and barfing), and every night she brings a smorgasbord of fast food with her to the EDC, to binge on while we sleep. Natalie’s arms are swathed in duct tape bandages. Sandra asks Natalie why she adorns her arms in duct tape, and we find out Natalie has warts, which seems fitting. Natalie is a compulsive overeater. Compulsive overeating is an eating disorder that is treated at the EDC. Yet staff has hired Natalie to watch over all of us almost every night of the week (on her nights off, RC Shannon usually fills in).

  In my closet is a drafty, standard-issue hospital gown. I take off my pajama pants and tank top, ball them up, and toss them on the bed. Before wrapping the gown around myself, I do a body check, taking inventory of my breasts, waist, hips, and thighs, making sure nothing has changed since the night before, that none of my parts have expanded. Some days I stand naked in front of the mirror and I swear I can see the fat cells thickening my waist. We are allowed to wear underwear and a gown when we are getting weighed, but we cannot wear slippers.

  The hall lights are bright and I squint as I shuffle down the hall, clad in slippers and gown, arms crossed over my chest because we may not wear a bra during weight and vitals (the metal under-wire might boost our weight).

  Other residents are stumbling bleary-eyed down the hall. Many of them appear haunted. There is no luster to their skin, and their eyes are sunk in deep, hollow sockets. This early-morning scene, when I am not quite awake, is surreal. It’s as if I am floating through a land of apparitions.

  Natalie, in her duct-taped glory, is waiting for me.

  A pink binder with my name on the spine is sitting on the table in the office. Natalie has it opened to my weight-and-vitals page. I sit down on an uncomfortable office chair and extend my right arm and open my mouth when she asks me to do so. She slides the thermometer under my tongue and wraps the blood pressure cuff around my arm.

  This will become a source of contention for me. Natalie uses the child-size cuff, which I will dub the anorexic cuff. I am not underweight, and therefore do not need the anorexic cuff. An adult cuff would work just fine, but Natalie will insist on using the anorexic cuff, even though it will burst off my strangulated arm on a regular basis. RC Julia will tell me to “use my voice” and confront Natalie about using the wrong blood pressure cuff. I will tell RC Julia that I want to avoid the prospect of any conversation with Natalie. I will tend to peer at her with sleep-slit eyes in the morning, and when she asks how I slept, I will grunt.

  After taking my temperature, blood pressure, and pulse, Natalie weighs me. She turns on the scale and has me take off my slippers, turn around, and step on backward so I don’t see my weight. After the scale beeps I step off, put my slippers back on, and head back to my room to wake up Laura (no small task, since she is on massive amounts of tranquilizers, antidepressants, antipsychotics, and sleeping meds) and get ready for the inevitable: breakfast.

  Breaking the Fast

  Holly bellows her infamous line, and RC Erica and RC Allison lead us into the dining room for breakfast. Everyone but me and the RCs is still in pajamas. I soon learn that no one bothers to change out of pajamas unless we’re leaving the EDC. Why mope around in jeans when you can mope around just as well, if not better, in loose-fitting pajama pants and a sweatshirt? But that first morning, I wear the jeans I wore on the train the day before, as well as a fitted black V-neck shirt. My hair hangs around my face, and I try to hide behind it as much as possible.

  In the food line, I pick out one English muffin, two packets of butter, a fruit cup, and a carton of skim milk. Back at the table, RC Allison introduces herself and checks that I have met my exchange requirements. Perhaps she senses that I am struggling as I stare at the food on my plate, trying desperately not to cry, throw the plate at the wall, or run screaming into the woods of southeast Wisconsin. RC Allison sets her plate down on the table and begins buttering her toast as she asks me where I’m from and where I go to school. I answer in monosyllables and play with my peach chunks.

  I observe RC Allison furtively. She is a pale redhead with blue eyes, and I think she is pretty. This is what healthy women look like, I tell myself. RC Allison’s eyes are not sunk into her skull, her hair shines a bright copper under the lights, and her skin is smooth and clear in a way that mine is not. RC Allison does not play with her food—she simply eats it—and this amazes me.

  Eliza and Laura are the two other women at my table. Laura bolts out of her chair as soon as she finishes eating, and heads to the deck that is adjacent to the dining room to have her post-breakfast cigarette. Eliza lingers over a cup of herbal tea and talks to me and RC Allison while I slowly eat my English muffin. RC Allison tells us about Anthony, her fiancé, who is in the military. She tells us about her dogs and gives me a crash course in what southeast Wisconsin is like. Both RC Allison and Eliza ask me about growing up in Pennsylvania, but I can’t concentrate on talking to them about Pennsylvania while I’m trying to eat.

  Eventually, I gulp down the last drop of my milk and RC Allison marks me as compliant. I discard my tray and join the smokers on the deck because we are not allowed to be alone for two hours after meals and one hour after snack, since we might sneak down the hall and purge or attempt to exercise off the food we just ate. So I stand on the deck with the other residents and wait for whatever happens next.

  Dr. Lorensky

  After breakfast, Mark informs me that he will drive me into town to get a physical. I assume I am the only resident going, but when I walk out to the van, I see another resident sulking in the back seat. I’m wearing black pajama pants, tennis shoes, and my Penn State sweatshirt because I am exhausted. This is my first day without caffeine, diet pills, and purging, and I am struggling to stay awake and alert. My limbs are heavy and I have a pounding headache. I almost pass out every time I stand up, but I fight the black sparkly stars because I don’t want to be sent to the hospital. Breakfast sits in my stomach, although the English muffin, skim milk, and fruit cup I ate keep lunging up my throat. My stomach is trying to evict them.

  Before she released me to Mark, RC Allison handed me a packet of graham crackers for my morning snack. I am to eat the graham crackers and then show the empty wrapper to Mark, who will report back to RC Allison. I trudge, graham crackers in hand, to the van. I say hello to the pale, gaunt teenager from the adolescent floor in the back seat as I climb in. She glares at me and clutches a snack-size box of raisins. When Mark isn’t looking, she stuffs the raisins under the seat in front of her and shows Mark the empty box. He nods and throws the raisin box into a plastic trash bag.

  We stop at the obsessive-compulsive disorder (OCD) cottage to pick up an OCD resident. The resident is a young woman in her twenties who appears to be on the verge of a massive anxiety attack. Her eyes dart left and right, left and right. I smile at her and she tries to smile back at me, but her lips just quiver.

  At Dr. Lorensky’s office, Mark announces that we are here for our admission physicals. An old man reading National Geographic peers at us from behind his bifocals, and I want to sink into the gray industrial carpet beneath my feet. I have officially been adjudicated as crazy. Before I can blush bright red, a nurse calls my name.

  She smiles a perfunctory nurse smile and asks me to step on the scale
backward. I oblige. I hear the click of the metal balancers sliding along the numbered bar. After she weighs me, she leads me to an exam room, where she records my drug allergies and takes my blood pressure and temperature, both of which are low, per usual.

  Dr. Lorensky marches into the room. She’s a formidable Polish woman with a stiff helmet of bleached hair. She listens to my heart and notes my dismal pulse. She shakes her head and asks about the diet pills, purging, and caffeine. She checks the glands under my chin for swelling. They’re swollen from purging.

  I lie down on my back and she presses on my stomach. As I unbutton the top of my jeans she notices my tan line.

  “Been to the beach lately?” she asks.

  “Just the tanning booth,” I say.

  “That causes cancer,” she says.

  “I know.”

  “Your health is a mess.”

  “I know.”

  Dr. Lorensky spends the better part of a half hour preaching at me and scolding me about my apparent disregard for my health. She requests a repeat EKG and the results of my cardiology workup in Minnesota. By the time I leave her office, I am waiting for my potassium-deficient heart to seize up on me, for my diet-pill-induced overactive thyroid to cause my eyes to bulge out of my head, and for a suspicious mole on my arm to metastasize into a particularly virulent strain of malignant melanoma. I wonder if this visit to Dr. Lorensky is part of my recovery plan (scare the patient into recovery), and if the EDC is like the army in that it is going to break me down and then build me back up.

  Yet, a year after I am discharged from the EDC, I receive my medical records and discover that Dr. Lorensky found me to be a “well-nourished, well-developed young woman,” despite her diagnosis of low potassium, low and orthostatic blood pressure, low thyroid-stimulating hormone, dizziness/fainting, anorexia, and bulimia.

  Observation

  After my visit to Dr. Lorensky, I spend the rest of my first full day at the EDC napping on the sofa and meeting various members of my treatment team. For the first seventy-two hours, every EDC resident is restricted to the floor, as most women arrive somewhat medically unstable. The first full day is a blur of memories: I remember eating a snack and meals when told to eat, standing up and almost passing out several times, falling into a deep, dreamless state that was more coma than sleep, and meeting with Therapist Elaine and Dietitian Caroline.

  Therapist Elaine tells me I filled out my patient survey with the most attention to detail she has ever seen. I take this as a compliment. I tell her about my eating-disordered behaviors, about my childhood, my life in Minnesota, and other necessary facts. Perhaps what I don’t tell her is most significant, but at this point I simply don’t trust Therapist Elaine or anyone else at the EDC. I am guarded. In time, I will decide how much of my history to divulge. But for now, I am suspicious of this perky young woman with bright green eyes and a Wisconsin accent that rivals RC Julia’s.

  Dietitian Caroline tells me that most residents hate her, and that their hatred is completely understandable and normal, as she decides our meal plan. As I listen to Dietitian Caroline, I wonder how anyone can hate this woman with the gentle voice and empathetic eyes.

  “Would you like to know how much you weighed this morning, Nicole?”

  “Yes, please.”

  I am hoping Caroline does not hear the desperation in my voice.

  “You weighed 131.5. We’re setting your target weight range at 127-140. Does that sound reasonable?”

  “Yes,” I say.

  Secretly, my brain is screaming, Fuck, no. The thought of weighing 140 again gets me panicking. I start to sweat and am fighting back tears. I begin to wonder if it’s too late to back out, to sign myself out and leave this place, with its meal plans and weight ranges. I have fought to lose every single fucking pound, and I do not want to gain it back. Every pound lost was a battle, an exertion of willpower and strength. I wear my now-loose jeans like a badge of courage and proudly display my newfound clavicle. I run my hands over the fine bones of my ribs and cup my hipbones delicately, tracing the sharp outline with my index finger. I stare lovingly at my now-defined jaw in the mirror. I have liberated my jawline from the double chins that used to occupy it.

  I am at war with my body.

  When my scale blinked 127 at me, I jumped and whooped with elation. Only seventeen more pounds until I was officially underweight, and underweight was my ultimate goal, because then I could start over—my body would be reduced to its bare essentials, and everything would be okay.

  “Nicole, what are you thinking about?” asks Dietitian Caroline.

  “Nothing, I’m just tired,” I lie.

  “Well, you can go nap if you like,” says Dietitian Caroline.

  I try to nap, but underneath my blanket I frantically run my hands up and down the xylophone bones of my rib cage in an effort to reassure myself that I am not fat.

  That night, all the residents except Holly and me go on an outing to Milwaukee. I can’t go because I’m on observation, and Holly can’t go because she purged blood last night. Since the RCs on First Floor are accompanying the residents on the outing, Holly and I have to stay on Lower Level while they are gone. We trudge down the stairs and take over one of the Lower Level sofas and watch American Idol. Holly texts in her vote for Kelly Clarkson, and I am bored and dreading snack time. The Lower Level is composed of older women and adolescent boys, a strange combination. I write in my journal and attempt to watch television. Eventually, I venture out to the back porch and call some of my friends from my cell phone, but no one is home. Holly comes out to join me, lights a cigarette, and offers me one, which I accept.

  “Where are you from again?” she asks.

  “Pennsylvania.”

  “Oh yeah, that’s right, but you go to the University of Minnesota, right?”

  “Yeah, but I don’t think I’m going back. I hate it there.”

  “Are you some kind of genius or something? You’re in graduate school and you’re only twenty-two?” she asks with a grin.

  “No, I’m not a genius,” I reply, thinking about how I am the lousiest writer in the program, probably because I spend more time barfing than writing.

  “I had to drop out of school a bunch of times; I’m still a sophomore in college,” says Holly.

  “Yeah, I thought I was going to have to drop out this past semester,” I say.

  “Most everyone here has dropped at least one semester of college. It’s kind of hard to stay focused on school when you’re so sick with the eating disorder,” says Holly.

  I exhale smoke out of my mouth and try not to cough, while Holly blows smoke out her nose and laughs at my amateur smoking attempts.

  RC Marie calls Holly and me in for evening snack. Holly picks pretzels and I pick cheddar Chex Mix. RC Marie introduces herself; I am suspicious of her pleasant temperament. She sits beside me on the sofa and tells me about her baby girl and asks me how I’m adjusting to EDC life. Later, RC Marie tells me she thought I was shy, as did most of the EDC staff, because I said so little in my first days there. Really, I was just too overwhelmed and too sick to string together many coherent thoughts. RC Marie excuses herself, saying she has to go pump, and I am confused about what she is pumping until Holly tells me RC Marie is breastfeeding.

  When the First Floor residents return from the outing, Holly and I go back upstairs, now friends after our cigarette break. It’s time for nighttime meds, and then it’s off to sleep again.

  The Middle

  Disclaimer: The middle is messy.

  The summer has a sense of timelessness, as day after regimented day fades into another. We, as EDC residents, are no longer part of the world. Instead, we are part of an insular microcosm where the rules are defined and enforced. New arrivals bring the breath of the outside world, the “real world,” as we dub it. Then they, too, fade into our routine. We are all very tired. Our damaged bodies are attempting to mend, and our minds are exhausted from therapy. Any venture into the real world
leaves us fatigued. There are food courts to avoid, traffic to deal with, and evidence that most people are living their lives. We sleep during any free moment. I fall into such a deep sleep during my late-afternoon naps that I liken them to comas.

  I awaken disoriented and confused about where I am. Then I remember.

  Phone calls from the outside world are an intrusion, as are visitors. We form unique bonds among ourselves—we are a sort of Sisterhood of the Starving, and we are our own society, complete with hierarchies and rank. Each of us has a function within the group. We pretend to hate the staff, our guardians. In loco parentis. Secretly, we love them. They protect us from our self-destruction.

  It is easy to place blame. My father calls me one night; I know he’s been reading books about how to help his eating-disordered daughter when he asks me if I’ve figured out the root cause of my eating disorder. If only it were that simple. Our gut impulse: Blame the media, blame the parents.

  It’s not so simple.

  Meal Plans

  BREAKFAST:

  2 grains (1 English muffin)

  2 fats (2 packets of butter)

  1 fruit (banana)

  1 milk (carton of skim)

  LUNCH/DINNER:

  2 grains (2 slices of bread)

  2 fats (2 packets of butter)

  2 proteins (2 slices of turkey)

  1 fruit (banana)

  SNACKS:

  3 (optional)

  This is the customized meal plan ietitian Caroline creates for me after our initial meeting. a maintenance meal plan, meaning I don’t have to gain any weight, so I am spared the extra calories of an Ensure supplement or nightly feedings administered through a nasogastric feeding tube.1 But I gain weight on my maintenance meal plan, and this makes me hate my body even more. Dietitian Caroline tells me that some of the weight gain is due to my body’s rehydrating itself, that some of it is simply because my vital organs are replenishing themselves, but I don’t believe her.