The Skeleton Cupboard (20 page)

We laughed and smoked on.

“So, where are you sending me next?” I asked then.

“OK. Next you will do six months in an eating-disorders unit.”

“For women who won't eat and have panic attacks over pasta?”

“And men too.”

“Great. We'll have nothing in common.”

Chris smiled as she began to pack up her bags.

Dr. Anne Gee drove around the back of the home to where we were sitting and beeped her horn.

“Gotta go. Oh, and well done—great placement. Dr. Gee respects you, and I think that's a first.”

Chris began to march off toward the waiting car.

“Hey. Thanks—and Chris?”

She turned around.

“You and Dr. Gee?”

Chris rearranged her bags on her shoulder. “You can say ‘fuck you' to me, but never ask me about my private life.”

And off she went.

I finished the cancer stick and watched the sun dip behind the trees.

Eating disorders? As a woman who, like every other I knew, was too aware of what I ate and how tight my clothes were and constantly questioned whether losing a few pounds would make me feel better about myself, I wondered how I was going to empathize with those making a career out of restrictive eating. I made a mental note to nail my personal-professional boundary on this placement.

*   *   *

That weekend I canceled my arrangements with the girls and sank back into my Frankl effect. I wallowed in self-pity and forgot about the privilege of the job I was training to do.

On Sunday afternoon as I was reading some research papers about anorexia and bulimia, my phone rang.

“Hi. It's Anne Gee.”

I was stunned. Soft jazz was playing in the background of where Dr. Gee was calling from.

“Hello, Dr. Gee.”

“I just wanted to let you know that Sarai died in the night.”

“Oh no. I am so, so sorry to hear that. How's Harold?”

“We found Harold this morning lying with Sarai, holding her, although we believe she had been dead for some time.”

My heart raced. “And Harold?”

“He hasn't been speaking. I think he has removed himself from any kind of reality.”

“Is he having flashbacks? Is he confused?”

“Nothing. He is doing and saying nothing.”

I was stunned, could say nothing.

“Are you there?” she asked.

“Sorry. Yes. Just a bit shocked, to be honest.”

“Yes,” said Dr. Gee. “It would have been so much better if they had died together.”

“Will he die soon, do you think? From a broken heart?”

A pause; jazz still playing softly in the background.

“Physically he isn't anywhere near death. He's a very fit man. And as for dying of a broken heart? Well, that would be the right thing, wouldn't it? But I'm afraid that in my experience that kind of thing mostly only happens in books and films.”

I lit a cigarette, breaking my “no smoking in the flat” rule.

“Thank you for calling me, Dr. Gee.”

“No problem. By the way, you did the right thing by Mr. Samuels. And for what it's worth, I think that Sarai died as they both wanted her to.”

I could only croak, “Thank you. Yes.”

The phone call was ending and I was done in.

“OK, thanks for calling to let me know, Dr. Gee.”

“No problem. You did a good job. Oh, and Chris is here and asks me to say hi.”

And then I had a sudden thought. “Dr. Gee?”

“Yes, I'm still here.”

“Could you find the Hirsh Glick song called
‘Zog Nit Keyn Mol'
and could it be played regularly to Harold? I know he'd want that.”

Dr. Gee paused. Oh God, I didn't have the energy to argue.

“Yes, I'll make sure we do that.”

I put down the phone.

I sat and thought. Sarai died in Harold's arms and so they were together in the way they wanted, in the way they should have been. For all the years of their long marriage, she had guided him through times when he was afraid and unable to cope, yet here, at her end, she gave Harold permission to hold her, to be her protector and to guide her on.

I didn't believe in an afterlife, but I hoped that one day they would be together and free from persecution and fear—certainly that is how they have always lived in my mind.

As I made a pot of strong, sweet coffee and put on my Broadway show tunes CD to accompany my next placement reading, I suddenly felt so perversely happy that Sarai died when she chose, with dignity, being held by the wonderful man whom she loved, doing what he needed to do for his wife.

I was beginning to look forward to my next placement. It was a Sunday; Viktor Frankl would have been proud of me.

Never say this is the final road for you,

Though leaden skies may cover over days of blue.

As the hour that we longed for is so near,

Our step beats out the message: we are here!

“Zog Nit Keyn Mol”
(Hebrew:
)
Hirsh Glick, 1943

 

Five

THE SKELETON CUPBOARD

An all-girls private school is the best training ground for perfecting the sport of the eating disorder, and by the time I was fourteen years old, a number of my friends were winning the Olympic gold.

“Did you know,” asked one, “that you can eat what you want when you want but not get fat if afterward you poke your fingers into the back of your throat and puke it all up?”

We were all gripped. Really? Was it that simple?

“Yes!” she said. “And if we all eat some raw red pepper before we eat everything else, my sister told me that apparently we can work out when we've chucked everything up because the red pepper skin will be the last thing to come up! It's difficult to digest!”

So after lunch we all trooped to the toilets, took up our positions in the individual cubicles and heaved and retched our way to weight loss.

To be honest, I was rubbish at it. A proper coward, I hated being sick. As much as I tried, I just couldn't go through with it. My instinct to pull my fingers out of my throat was stronger than my gag reflex. It felt like almost drowning and then pushing up to the surface and taking a big gasp of air.

However, because we went to the sort of all-girls school where success in everything is paramount, my friends offered all manner of helpful suggestions, and so I armed myself with pens, toothbrushes and even a tongue probe that one girl had stolen from her dentist father. None of them worked for me, but my fear of being a failure made me an expert at fake retching, which, combined with a water bottle poured into the toilet bowl at strategic intervals, reassured my friends that I could do it.

We were the champions!

The problem was that while my friends were all getting thinner, I was staying the same weight. They became suspicious; we were not allowed to fail at anything, not even being naughty eating-disordered girls.

One day in a really boring music class led by the small, round amateur opera singer Miss Giddens, I decided to be properly naughty and so rather pathetically took my shoes off and placed them facing outward from underneath the long curtains in the music study room.

Oh, ho, ho, look—there's a girl behind the curtains. No! It's only a pair of shoes. Too funny!

Miss Giddens was deeply unimpressed; she told us that we were in the top 5 percent of the population and if we were going to prank, we should either make it a bloody good one or not bother.

I was so terrible at self-induced vomiting and pranking. Even before my rather poor A-level results, which definitely did not place me in the top 5 percent, I was already a failure at that school.

To put my suspicious friends off the scent of my poor performance in the purging department, I got into actual sport. I worked out that exercising can get rid of calories as much as puking can, and that strategy worked better for me.

I played for the school field hockey and lacrosse teams and was goal defense on the first netball team. I got fit and ate what I wanted, but sadly never really lost that sense that my school imbued in me: I could and should do better. I was never satisfied with my body and often battled thoughts about what I “should” and “shouldn't” have eaten.

Tomorrow I must try harder.

And so working on an inpatient eating-disorders ward became the hardest and most frustrating of my training placements. I had to put my own “shit” aside and be a success.

*   *   *

Within forty-eight hours of being on the ward, I had decided that I could never work full-time with women who wouldn't eat. There was a sort of carbohydrate-induced panic in the air.

My first day was spent sitting at a table of anorexic young women who were lunching in the most painful and excruciating way. They had to be monitored constantly to make sure that they didn't either fill up with fluids before the meal or manage to secrete their food about their person. Have you ever seen an anorexic girl trying to hide a pea in her knickers? Trust me, you don't want to. Sitting at that table, I just wanted to grab their plates and eat the food for them to put them out of their (and my) misery.

Based in a large London teaching hospital, the ward was huge and bright but seemed to me to be peopled by figures painted by Lowry—little matchstick people, like tiny, lonely islands within a vast expanse of space. To be admitted onto a specialist ward like this, you had to have a body mass index of less than 15, which indicates a body weight that is dangerously low for the height of that body. To calculate BMI, a weight in kilograms is divided by height in meters, and then that figure is divided by the height again. A BMI between 18.5 and 24.9 is deemed healthy. Anything over that moves upward from overweight to morbidly obese. A BMI under 17.5 would be considered an early indication of anorexia nervosa, and everyone who had been admitted desired and worked really hard to achieve a BMI of 14, 13, 12—even though once you've hit those numbers, your blood pressure is dangerously low, your core temperature drops below 95 degrees Fahrenheit and the body grows downy hair, lanugo, to keep it warm. Basically, you're staring death in the face.

Death via self-induced starvation is hideous, as the brain and organs shut down and open sores leak protein, while, perversely, the body becomes edematous, filling with fluid and leading to weight gain. To see a young person head toward that hideous and painful end of life is truly tragic.

One of the worst staff teams I felt that I had ever worked with ran the ward—the kind of team where meetings were always tense because of interdisciplinary rivalries. The doctors were rarely present, the lead psychiatrist was a red-cheeked, purple-nosed alcoholic and most of the nurses, I thought, seemed a bunch of female-hating, power-crazed, mostly overweight women. This was the placement where I saw that we, the clinicians, could easily be them, the patients.

“I am,” I had told the nurses, rather arrogantly, “a clinical psychologist in training and would love to take some cases for cognitive behavioral therapy.”

“Great, go for it!” they had all chorused as they tucked into the multilayer box of Belgian chocolate biscuits left in gratitude by the family of the last patient to be discharged.

Noting that the staff team seemed just as eating-disordered as the patients, I had shoved a couple of praline chocolate surprises into my mouth and left the staff room.

*   *   *

Mollie did not attend the communal lunches. When I met her, she was too weak to feed herself and too stubborn to be fed. In the end there had been no choice but to give her the nasogastric special delivery, meaning a tube was put up her nose and down her esophagus and into her stomach, feeding her a cocktail of isotonic fluids.

“Watch out for that one,” Linda, the ward sister, had said as I reviewed her notes. “She's tougher than she looks.”

I'd looked at Linda quizzically.

“It takes a lot of self-control to food-restrict like she does. Mollie may look ‘butter wouldn't melt,' but she's got a core of steel.”

I was beginning to think that these nurses really didn't like their patients. I understood that iron-clad control was key to a “successful” eating disorder, but I wondered whether years of working with such young people had left the staff battle-weary and cynical.

Mollie sat up in bed looking paper-thin and fragile. She was beautiful and vulnerable.

“Hi.”

Mollie smiled and I saw her skin stretch over every bony contour of her face. “Hello.”

Her voice was tiny, and a tear trickled down one of her cheeks. Long arms and thin fingers stayed still by her sides.

I grabbed a tissue and dabbed at Mollie's cheek. I didn't know how hard to dab—she was so fragile I was afraid I'd tear her skin.

We talked.

She was your textbook eating-disordered young woman: fiercely bright and from a well-off, aspirational family. Mollie, who was seventeen, was doing her A levels and on track to get top grades and a place at medical school. She was cheerful and funny and hugely talented at sketching and drawing. Here was a girl who had everything to live for but wanted to starve herself.