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Skin Deep

Why did you agree to work with me?  


I asked this of Kirsten and my dietician Gretchen recently via email. During treatment I never thought to ask why, despite their initial reluctance,they agreed to take me on.  


"I was skeptical that outpatient was going to give you the support you needed to do the difficult work of recovering," Gretchen responded. "I would still recommend inpatient for someone as undernourished as you were, but we agreed to give you a shot."


"We did agree to give you a chance," Kirsten added, "because of your family situation and you being the sole driver. But that was with the understanding that if you didn't make steady, incremental change, we would have to pull the plug and again recommend residential."


During that first session with Kirsten, I believed her neutral reaction to my body and my story was a sign that I was "not so bad". I took it as an assurance that she had seen women and men much worse off than I. But in reality, she knew what she was looking at, a woman who needed to be in residential treatment, under the care and supervision of trained medical professionals. And that is what she recommended for me. Strongly.  


I didn't realize when I walked into Kirsten's office that day that I was in life-threatening danger in more ways than one. I sat there numb as she patiently laid out the cold hard facts, my heart pounding as I tried to grasp that it was ME she was talking about. With compassionate directness she explained that continuing to live the way I was, undernourishing my body, meant I would continue to break my muscles down for fuel, including my heart muscle. My already low blood pressure would continue to drop as my heart had less fuel to keep it pumping. My electrolyte balance would lead to irregular heartbeats (which I already experienced often), ultimately leading to heart failure.


As Kirsten talked she maintained direct eye contact with me, as if she was willing me to understand her words. I saw, despite not even knowing me, the concern in her eyes and heard the worry in her voice. For the first time, I began to absorb the seriousness of my situation, and it far exceeded the obvious. Until that session, I was only aware of what my body was telling me from the outside. I was focused on how my hair fell out in clumps as I gingerly washed it in the morning. Tentatively looking at my hands, afraid to see the fallen strands tangled between my fingers. Or how my teeth cracked and crowns popped off so frequently, requiring steaming my vegetables to soften them before eating. And the way my wedding ring twisted loosely on my finger, until I had to stop wearing it for fear it would fall off without notice. With Kirsten's words, I began to understand the sacrifices my body was making internally to keep me alive.   


"Okay I get it, "I remember desperately saying to Kirsten when she was done talking. "I'll eat, I promise, I will do it." And at the moment, I meant those words more than any others I had uttered.  Ever.    


Kirsten took a deep breathe, as if she were trying to gather the courage to to respond. And when she did, her words left me feeling hopeless. Trapped in a body I no longer wanted and scared I may never get out.



Over the years, I obsessed about how I looked on the outside, but had no idea the sacrifices my body was making on the inside just to keep me alive.



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