Chapter 26

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You woke up a bit later than you would normally do. You were not going to school today because it was sports day and, since you were not allowed to exercise, your mom said it was better for you to stay home; it was better to avoid any temptations: they knew you would want to exercise somehow. Back in time you would've have fought to go, not only to burn off some calories but because you wanted to be the perfect student: the one who got perfect grades, was good at sports, was never absent, participated in every school activity. But now, you were numbed and of course you cared about your grades, you still had one of the top 3 GPAs in your classroom, but the most important thing to you right now was feeling in control and not gaining weight. You had breakfast without complaining, painted for a while with your mom, showered and, obviously, exercised before, and got dressed. Today's appointment was at 11am, so you had morning snack at 10 and prepared to go to the treatment center at 10:30. You had read last night that the best way to fake your weight in was to water load, so you waited for your mom to go upstairs to grab her bag to drink almost 2 liters of water. it was the perfect plan, but when your mom went up, Taylor walked in and made herself a coffee. You were so annoyed, it seemed like she knew what you were about to do.

Your mom came back downstairs and told the both of you to get into the car.

- "What? Why is she going? If you're here, then there's no need for her to go to my weight in appointments" you said panicking.

- "Since I was out last week, she's the one who can answer Dr. Sach questions about your habits and how you did last week" Andrea said.

- "Ugh. Fine" you replied.

You quickly got to the center and got out of the car as soon as your mom pulled up, wanting to get over with the appointment as quick as possible, besides you were holding your pee since last night to help with the water load plan, you needed to get weighted and then pee. Dr Sach greeted you all and told you to do the stay in your underwear-just wear the robe thing. You did but thought about drinking water from the tap to water load, but as soon as Dr. Sach heard the water running, she said.
- "Elizabeth, I hope you're not drinking water before the weight in". Fuck, you thought. She knew all the tricks. You quickly got out and walked over the scales when she added:

- "You know what? Let me ask you: Have you used the bathroom today?" You blushed, of course you were holding your pee in case you couldn't water load as much as you'd like to. She continued: "Try to pee, please".

- "I don't have to pee. It's fine" you said.

- "Try anyway, if you don't, it's fine, but at least try to do it."

You walked to the bathroom back and pretended to do it, but your bladder couldn't take it anymore. You needed to pee. You sat down in the toilet defeated and scared of what the scales were going to show. You heard your mom asking the doctor:

- "What about the peeing? Why do you need her to pee before weighting her?"

- "It's actually very common in patients with anorexia to water load to fake at the weight ins. I just want to make sure to get her weight as much as exact as possible" she said.

You got out and suddenly were not so eager to stand on the scales anymore. You hesitated but did it, anyway, looking up at the ceiling to avoid seeing the number.

- "If you don't want to know the number it's fine. But you've lost weight again, Elizabeth. This is really dangerous" she wrote down the number on a post it and handed it to Taylor. You had lost another 3 pounds. You were heading to the bathroom to get dressed quickly, but Dr Sach stopped you:

- "I'd like to do a general checkup. We'll do the same as we did last week, I'll take your vitals, if your heart rate is under 40bpm we'll send you to hospital. Come over here" Dr. Sach said as she guided you to a gurney in which you jumped on and sat on. She took the regular vitals and said - "your heart rate is at 40 bpm" you sighed in relieve. You forgot about the cuts you did in your left arm and remembered them just when Dr. Sach said: - "When this did happen?" You just shrugged and said softly - "Last week, but it was a one-time thing". Then she asked you to stick your tongue out to check your throat and asked you to turn around to have a look at your back. Taylor and your mom were shocked at the sight of you bending over and all the bones in your spine sticking out, as well as your ribs. Andrea tried to wipe the tears in her cheeks away, but she was unable to hide the fact that she was crying.

Dr. Sach told you to dress, you did, came out at sat down in the chair between Taylor and your mom. Taylor held your right hand in hers and your mom held your left hand in hers. Each of them squeezed your hands tightly as Dr. Sach started speaking.

- "Elizabeth, your condition is very concerning. I know that I said that if your heart rate is under 40bpm, we would hospitalize you, technically we would not advise this, but I'm really recommending either hospitalization or inpatient treatment."

-WHAT? NO!" you said.

- "Even though your heart rate is still in the 40bpm limit, your overall health condition is concerning. I didn't see any signs in your throat that suggests that you're purging often, but I did see your back is covered in lanugo, which is a thin hair that your body grows to help keep the internal organs warm. The body grows lanugo under the lack of body fat, which is normally the one in charge of keeping you warm. Additionally, I noticed you're self-harming, Elizabeth, your life is at risk right now and I spotted multiple bruises on your spine, which makes me guess that you're over exercising, you're doing sit ups, aren't you?"

You froze. You wanted to fight back but nothing came out of your mouth. Your mom started to cry again, and Taylor was doing her best to blink her tears away. In that moment the consulting room's phone rang and Dr. Sach took the call.

- "Sorry, I need to go for about 10 minutes, I'll be quick, but it's an emergency. You can discuss about what I just said while I'm gone" Dr. Sach said as she headed out. You turned to your mom and said:

- "Please. Please don't. I don't want to go to hospital. I'll be good. I promise. I won't self-harm again, it was a one-time thing".

- "Honey, I think that we're running out of options. This is not working. Plus, you're self-harming" your mom said with tears in her eyes.

Dr. Maine knocked the door and asked your mom to come to her office to have a quick word, you were left with Taylor in Dr. Sach consulting room.

You were both about to speak but you were faster:

- "You were right Tay; I've been throwing away the supplement. I'm sorry. I've also been hiding food and exercising when nobody is watching me" you said crying.

- "I know baby. I know. But thank you for acknowledging it. It's a great step" she said rubbing her thumb over your knuckles.

- "I'm sorry for what I said yesterday. You only care about me, I know that you want to support me, but I'm so scared. I don't know why I act like I do. I want to control, I want to restrict, I want to feel thin, but when I get away with restricting the pleasure just lasts for a bit, then I'm anxious again. I don't feel thin, even though I rationally know that my body is not working properly at this weight. I want to feel sick enough to deserve to eat, to deserve treatment; but when I get dizzy or when Dr. Sach says that my condition is critical, I don't want to go to the hospital. I don't want that. But I feel like being hospitalized would make me feel like I'm sick enough too."

- "I know it might feel like that, but before we brought you here, what did you think you needed to feel like you deserved getting help?" Taylor asked.

- "Mmmm... I thought that I needed a doctor to tell me that what I was doing was not normal. That I needed to recover" you said.

- "And it happened, didn't it?" Taylor asked.

- "Yeah, it did" you replied.

- "But still you didn't t feel like you deserved to recover. You got into treatment, doctors told you that you needed to gain weight, but still you didn't feel like you were worthy of recovery. Doctors are telling you that your body is shutting down, that you're in danger, but still, you don't feel sick enough... do you get where I'm going with this?" Taylor asked.

- "I 'll never feel sick enough to deserve help? Not even if I go to hospital. Then my brain will convince me of needing to go a little further to deserve recovery?" you said.

- "Exactly. There's not such a thing as sick enough. You'll end up dying if you keep going on like this, Lizzie. But mom's right, this outpatient program might not be helping you the way it should" she said squeezing your hands.

- "No, please. Please I promise I'll stop tossing away the supplement. I'll stop hiding food. I'll stop the exercise. I'm never self-harming again. But please convince mom to let me stay here. I don't want to go away from you" you said begging.

In that moment your mom came back and said:

- "Dr Maine suggested an inpatient treatment at a specialized eating disorder clinic. It might be another option to consider" your mom said.

- "Please. I don't want to leave to some inpatient clinic. I'll try. I promise" you said crying.

- "I think we need to make a decision here darling, it's either the eating disorder clinic or the hospital. But we cannot keep going on like we are" Andrea said wiping her tears away.

- "Give me a chance. Just one chance. I won't keep going like I am right now. Please" you said crying your eyes out.

That's when Dr. Sach came back and sat down in her desk.

- "So... I'm aware that Dr. Maine also suggested an inpatient treatment at an eating disorder specialized clinic. What do you think about it?" Dr. Sach said.

Andrea looked between you and Taylor. Taylor blinking her tears away and you looking directly at your mom panicking. After about 30 seconds Andrea spoke up:

- "I want to give Elizabeth just one last chance to start improving on outpatient treatment. Is that an option?"

- "Yeah. We could make it work, but under two strict conditions: we will take your vitals twice a day, once here and once at home in the morning, you can buy the equipment Mrs. Swift, I need you to email me the results every morning to keep a record of how Elizabeth vitals are doing. If Elizabeth's heart rate drops below 40, we'll rush her to hospital. Even if you don't agree, we'll go to court if we need to, her life is in danger" Dr Sach said with a serious face and Andrea nodded.

- "What's the other condition?" Andrea asked.

- "Elizabeth weight must at least maintain at next week weight in" she looked right into your eyes "you cannot drop weight, not even half a lb. Got it?"

You nodded and thanked them, Taylor hugged you. Your mom and Taylor were dismissed, and you went off to the dining room to have lunch. You didn't want to go to hospital, you were going to try your best. It was now or never.

As Andrea and Taylor headed out, Andrea said:

- "I don't know if I made the right choice. What if it just helps her to get worse?"

- "Lizzie admitted everything to me: the hiding food part, the secretly working out part, even the throwing the supplement away part. I think this might be her rock bottom. She acknowledged and understood that there will be no sick enough for her eating disorder to be pleased with. I think we can make work this out, I think it was right to give her one last chance. At least I hope so" Taylor said with a broken voice.

They jumped in the car and drove home, wishing you would keep the promise you made.

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