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Published On January 24, 2018

CLINICAL CARE

This Side of the Scale

An anorexic patient struggles with a seemingly unsympathetic doctor.

I launch into the list of food I’ve eaten in the past day: “Oatmeal with blueberries and skim milk, a spinach salad with salmon, a protein bar and an apple with some nonfat Greek yogurt.” Hunched on the exam table in my paper gown, my eyes fixed on the floor. I haven’t met my meal plan requirements, and I know my doctor is going to scold me for it.

My friends and family had been urging me to seek treatment for anorexia nervosa, and I was under no illusion that the process would be easy. For years I had been wrestling with disturbing thoughts and behaviors about food. I believed certain foods were “bad” or “toxic” if they weren’t raw or organic; and I would obsessively count the calories I consumed and burned, as often as two or three times an hour. I also became extremely agitated if I couldn’t plan a meal exactly.

The result had been steadily eroding health: My period stopped, I faced cardiac problems, and I walked through life in a fog of dizziness caused by malnutrition.

My therapist took a gentle approach in our sessions together. She would reach for my hand to comfort me and have tissues ready for when I started to cry. (I cried a lot.) My nutritionist is also tender with me. But with my internist, who we’ll call Dr. Cooper, it is different. Every Wednesday afternoon when I enter that sunlit waiting room, I feel like a misbehaving child walking into the principal’s office.

My appointments always start the same way: I step on the scale backwards so that I can’t see my weight—that information can send me into a tailspin of anxiety and depression. Then comes the “intake,” which involves my running down the list of what I have consumed in the past 24 hours. I feel ashamed when I haven’t eaten enough to meet my prescribed goals, which is most of the time, and Dr. Cooper has no interest in letting me off the hook because of a few tears.

“Doesn’t your meal plan call for full-fat dairy instead of nonfat?” Dr. Cooper begins today, peering over her glasses with a stony expression.

“Yes,” I say, my cheeks burning.

For six weeks this is exactly how all of my appointments with Dr. Cooper go—the silence, then the steady admonishment. “Promise me you’ll gain another pound,” she says. “You can do better.” Over the weeks, her unwavering pressure has set me in a rebellious mood. She couldn’t possibly know, I think. This is harder for me than she could ever understand.

Today she looks at my chart and frowns a little. “Your weight is down again,” she announces with characteristic brusqueness. “I’m worried about you.”

As she pulls her clipboard onto her lap, I catch a glimmer of something on her wrist that I haven’t noticed before. It is a bracelet with a silver charm etched with two curved lines. Very few people would know what they mean. I know that they represent a heart and also suggest the curves of a woman in full health. I also know that this is the symbol of an eating disorder and that most women who wear them have come through treatment. Someone had given me one on a necklace.

I wonder. Is she a survivor, too? I review our conversations in a new light. Maybe she was challenging me in a way that her own doctors had. If she had been on my side of the scale before, she must know exactly what kind of grit it takes to push this insidious disease out of my thoughts. Maybe she thought that what I need, what she had needed, was a little tough talk.

I don’t know the answer. But I work up a smile for her today, one of my first. “Thank you for pushing,” I say, “I’m trying. I am. I do want to get better.”

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