There was something both funny and frightening about sitting in the unit’s day room, listening to one of the social workers talk about the pain that accompanied attachment. I imagined myself as a patient, bored all day and night, using my attendance at group therapy as a means of escaping the floor sooner. I imagined what the four men in the room thought of me and my friend, two young female nursing students, observing them like exotic creatures to further our studies. For us nurses in training, these individuals were simply case studies. Nameless patients we would discuss later in post-conference, where insensitive remarks about mental health would inevitably be made. Sometimes the instructor would take the lead with a joke: What do you call an unmedicated bipolar? An addict.
Every day of my psychiatric clinical rotation left me tying the experience to the past and future. “Mindfulness,” apparently the act of “being present” according to whoever the hell wrote the handout the social worker was reading off of, was way beyond me. My thoughts wandered to the image of myself occupying the space of a patient, observed and evaluated, considered only in the context of my disease. A schizophrenic. A bipolar. (There was plenty of cultural and religious sensitivity content written into our curriculum, but little education on sensitivity towards those with mental illnesses.) Before long, I would be a bulimic to counselors and nurses in a residential facility. That’s what I thought, anyway, given how my peers and some of the staff at the hospital spoke.
Yeah, that was the funny part. Situated in the day room during a group therapy session, knowing I would be in a similar position as the patients we were asked to observe. That was hilarious to me. Upsetting, yet comical. I’d have a file, like the ones we looked at earlier — a fat red binder with my admission information. Patient reports that she binges and purges 2-12 times daily. Exercises 4-6 days a week for 2 hours. Admits to SI. Denies HI. Physical complaints include muscle cramps, swollen glands, thinning hair. How much of what I said to the woman who conducted my admissions interview would end up in that chart? And then my thoughts took another turn, wondering what sort of forms and tools they used within facilities primarily for eating disorders. Could I ask to look at my own chart? Probably not, I decided.
For a reason unknown to even the clinical instructors themselves, we had two teachers for our psychiatric rotation – one on Tuesday, another on Wednesday. Wednesdays sucked. Not because I disliked the instructor, but because she sat with us during lunch and often turned her attention to the fact that I didn’t bring anything to eat.
The first time we sat together for lunch, I said that I had forgotten to pack food in the morning and didn’t have money on hand. I figured that would be enough.
“Here, here. Have half my salad. I couldn’t possibly eat this all,” she lied, pushing the small plastic container towards me. I denied her offer, but could feel my own embarrassment and anxiety possessing my body — the warm cheeks, the clammy hands, my heart beating hard enough that I felt like it was hitting my sternum. Finally, one of the girls in the group offered a banana, and I took it so that the instructor would leave me be.
“Thanks, Jess. I love bananas,” I said.
“My mom always packs me a big lunch,” she said. “No problem.”
I don’t want to eat this I don’t want to eat this but at least it’s not drenched in dressing and oil. I peeled the fruit slowly, took a few well-paced bites, and threw the rest away so that I could count the snack as 100 calories.
Today, I had a strategy. I brought some money with me and walked around the hospital’s tiny cafeteria for a few minutes. I purchased coffee. If I had something in my hands, maybe the kindly old lady would leave me alone.
“You didn’t bring anything to eat again,” the instructor said. She frowned, deepening the already quite severe creases around her mouth.
“I ate a protein bar before you sat down,” I replied. Not true, but it was a stock excuse for when people commented on my lunch habits. “I was going to get something else in the cafeteria, but they didn’t have many options.”
“That’s not much of a lunch,” she said.
“I eat a big dinner at home,” I responded. Some of the girls at the table turned their attention to the conversation.
“Amber eats like a bird,” Jess said. “She never eats a lot for lunch.” She was always commenting on how small and petite I was, phrasing her compliments in a variety of ways. I wish I looked like you! But Jess – and everyone else at the table – were perfectly beautiful girls. (Women, women. I was a bad feminist.) And I envied them when I saw them eating sandwiches on bread, or the delicious looking cannolis from the cafeteria.
How did people eat like that and not feel guilty?
My friend, who was my partner during the rotation, agreed with Jess’ statement. “She eats really healthy.”
Not true either. Not when alone, or when I knew I’d have access to some privacy and a bathroom. I was a complete and utter failure when it came to valuing my own health.
It reminded me of hearing from people in my program — instructors and peers alike — that I seemed calm and in control when it came to the didactic and hands-on challenges of nursing school. Wow, thanks! I’d say, with forced enthusiasm. An honest response would’ve been too frightening: I’m slowly self-destructing and if you knew who I really was you’d be disgusted. Calm? In control? No, not when people weren’t looking. Outside of college, I was the real and terribly disappointing version of myself that occupied nearly all free time by eating massive quantities of food so that I could then self-induce vomiting. There was also exercise, but I had angrily quit going to the gym when the woman responsible for my admissions interview claimed I overexercised. I don’t. I don’t even need to go. So I didn’t, but the guilt was overwhelming.
I was a fraud. I wasn’t healthy, and I wasn’t in control of anything.
Do I really need to go to residential? The question was on repeat in my mind. I’m functional, I thought, pulling into the ACME parking lot. No one knows. I’m going to finish this semester with great grades. Do I really need that level of help? I parked my shitty, decades old Toyota Corolla in a spot that was far away from the store itself (despite a downpour and the flats on my feet) so that I could increase my step count for the day.
As soon as I entered the store, my gray pants and blue button-up completely soaked, I became self-conscious about my current activity. Any time I shopped for food to binge on, my anxiety became transformative, granting people who did not give a shit about my presence the psychic ability of mind-reading. Oh, yeah. They totally knew what I was doing, and they were absolutely judging me. And I think I don’t need help, I thought, self-awareness colliding with the paranoia brought on by a part of me that was seriously disturbed.
Where was I in relation to the continuum of mental health? What did it mean to be functional on the outside, but to internally live in compulsions that, while providing temporary relief, made my life feel like a living, inescapable hell?
I carried these thoughts with me as I picked up a basket. I browsed the ice cream aisle first to see what was on sale, determined I would grab a gallon of Turkey Hill before I checked out, then moved onto the reduced-price baked goods. Most binges were ultimately disappointing, but a cheesecake for half its original price or chocolate frosted brownies at a steep discount always gave me some hope that the next session would be a fantastic opportunity to relieve some stress and feel genuine pleasure. Today, there were muffins, 50% off. Not easy to purge, I thought, as I often did when I considered an item outside my typical foods, but I don’t really care.
Eventually, my frugal values wore down to nothing. I told myself that I would be done soon, given I was going to residential in a week’s time, and that it didn’t matter if I spent a lot of money on foods that would end up in the toilet. When I was finally finished, I brought to self-checkout my gallon of ice cream, four large muffins, two packages of Oreos, two boxes of Entenmann’s donuts, a frozen pizza, a box of poptarts, and a rotisserie chicken.
When I got home, I ate everything. I took at least five breaks to purge, but at a certain point lost count. During these hours, my thoughts became fuzzy, lost in the overwhelming compulsion to eat and vomit. (Well, that and disturbed fluid and electrolyte balance. You know, nothing chugging Powerade Zero couldn’t fix.) But it occurred to me that what I consumed didn’t matter. Not at all. What I really desired most was the relief I felt following the purge.
Nothing else in life provided the same feeling. Probably because I was also deeply depressed, and found myself incapable of doing activities I used to enjoy – read, watch Netflix, play some video games, cook (haha). But I couldn’t justify the idea that I needed help with my eating disorder, or with constantly feeling on the verge of ending my life, when I woke up every day and went through the motions.
I was doing well in my nursing program. A lot of people respected me for being intelligent and motivated. I’m fine.