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.
73
Treatment Plan Update—June 10, 2016
Weight: 89 lbs.
BMI: 15.3
Summary:
Treatment team has approved patient transition to Stage Two of residential treatment, with reservations by team nutritionist.
In light of low patient weight, behavior and mood, and the continued need for feeding by means of nasogastric tube, treatment team acknowledges the precocity of this transition. However, it highlights that this transition is exceptional and probationary, approved with the main purpose of allowing patient to go on a therapeutic meal outing with her spouse.
Treatment team feels reasonably confident that the benefits of the therapeutic meal outing outweigh potential risks of noncompliance and relapse at Stage Two. Maintenance of Stage Two status is contingent upon patient’s full compliance with her assigned meal plan, all treatment activities, and the team’s instructions.
Date, location, and meal plan of the therapeutic meal outing will be determined by the nutritionist. Nasogastric feeding tube will remain in place as a precautionary measure. Failure to complete any meal or snack prior to the outing will result in the immediate revocation of the permission.
Residential treatment remains necessary.
Treatment Objectives: Complete a meal with spouse without resorting to eating-disorder behaviors or necessitating nasogastric feeding tube.
Alleviate symptoms of depression and motivate patient to resume work toward recovery.
Resume normal nutrition, restore weight. If needed, ensure nutrition through nasogastric tube feeding.
Monitor vitals. Monitor labs. Follow hormone levels.
Target caloric value: Maintain and secure at 2,700 calories until reevaluation.
74
I will have the pizza margherita,
Anna told the waiter.
I knew it!
Matthias triumphed.
Of course you will, you unpredictable one.
To his teasing, she deftly responded,
Do not be too cocky, mon ami.
And to the waiter:
The gentleman, I believe, will have the tartuffo. Extra mushroom and truffle oil.
Matthias laughed and topped the order with two glasses of the house red.
It was Friday night, one of their earlier dates, but he had already known her forever. He was also beginning to suspect that he was in love with her.
We’re in a rut!
he lamented.
Boring!
she exclaimed, her mouth twitching mischievously.
Before we know it, we will be finishing one another’s sentences.
Drinking our coffee the same way!
he added.
Ah non! Never!
she gasped.
You drown yours in cream and sugar!
And yours is disgustingly black!
They both laughed. He reached for her hand across the table and looked at her. She was beautiful.
I like knowing these little things about you,
she admitted shyly.
I like knowing what side of the bed you sleep on and the way you smell in the morning. How you like your eggs and fold your socks.
He was in love with her.
I like knowing that about you too.
The wine and pizzas arrived.
So tell me, Matthias, why do you cut off the crust?
It’s a useless filler; I’d rather save the space for more mushrooms,
he said.
The crust is my favorite part,
she answered.
Really? Ha! You can have all of mine.
He put the first piece onto her plate. She bit off the end and smiled:
Merci! But what will I give you in return?
Hmm, let me think, olives?
The waiter had placed a small bowl of green ones on the table.
C’est parfait! I hate olives. You can always have mine.
And you can always have my crust.
Now we really are boring!
she laughed.
I love you,
he replied, leaned over the table and kissed her, pizza on their lips and all.
75
It was a tradition: Friday nights were our date nights, even after we were married. Tired or not, we dressed nicely and went out to places with wine lists and dim lights. Those outings, of course, had grown more sporadic as my food repertoire had narrowed. Till they had become nonexistent. And then I had come here.
Now it is 6:22, Friday night, and we are getting ready for dinner, after which Matthias will not be visiting, for the third night in a row. Still no word from my treatment team, and an hour till I get my phone back.
The usual air of quiet pre-meal dread sits with us in community space, our stomachs and minds in knots. I think of Matthias and wonder what he is doing right now. Is he home? Does he have plans for dinner? With a friend? A girl? A date?
Matthias on a date with someone else. The thought hurts too much. I suppress it. Bring Matthias back, Emm had said this morning. Was it only this morning?