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“And how much do you weigh now, sweetie?”
She was the intake coordinator for an eating disorder treatment program, and still I feared what she would think of the number. I lay slumped against the wall opposite a row of vending machines in a tiny room on the third floor of my dorm, dizzy and so, so ill, and still seared with shame.
I spluttered my weight into the phone and gritted my teeth. There’s not much that compares to that kind of visceral disgust, at least not for me; I was ashamed to be literally bleeding inside and not even have thinness to show for it.
For the past two weeks I had spiraled, and the irony of speaking to the treatment center intake coordinator facing a row of vending machines hit me hard. I had been here today, many times, and the grocery store, and the gas stations, and the dining hall downstairs. By this point I had been bulimic for over two years and had an eating disorder of one kind or another for nearly eight, and sent my money right back out through the dormitory plumbing system upward of eight times a day. A scholarship student (until that semester, an excellent one), I was wasting myself by the hour. Yet it was a struggle to care.
“And are you currently suffering any medical issues due to purging so much, sweetie?”
I might, in another situation, have hated the “sweetie” and the motherliness in her voice. I regretted the dehydration that made it difficult to cry. It might have been a relief, another form of purging, but I couldn’t manage it. I described the night the ulcers in my stomach and esophagus ruptured and, writhing with pain, I was rushed to the emergency room. In the back of the ambulance I remembered thinking "At least I got it all out," which I would recount later in group therapy to a chorus of understanding nods.
The memory of my residential and partial hospitalization treatment comes back to me in a bit of a fog. People who describe depression as like being underwater are exactly right, particularly when that depression coincides with severe dehydration, moderate malnutrition, and the inability to sleep more than every other night. Having slept two hours in the last 48, on my first night in the treatment center I crashed into a murky sleep.
I filled out a novel’s worth of financial and medical paperwork on the morning of my arrival, and assured of coverage, I didn’t give my insurance much thought beyond what was necessary. The staff was resolute in that we as patients should focus only on recovery, and brought up finances only when negotiating with insurance for more time. On the day I was approved for five more fully-covered days in the program, the group gathered in the therapeutic room cheered and clapped for me.
Contrary to what I’d expected, everyone in the program was genuinely supportive; the love I felt for and from the other women made for a strange, perpetual ache in my chest. None of us have kept in touch, and I understand why. I know I could never wring a real-life relationship out of so much deeply personal pain, experienced in an environment that now feels like a foggy dream.
My stomach may have roiled with discomfort when someone in group therapy cried -- something I couldn’t do under any circumstances -- and I might have blushed every time a staff member checked the toilet after I had used it, but I felt safe in that house. The closest I came to crying was in fact when I stepped down to partial hospitalization, moving my suitcase into a small apartment shared with another girl in the program. I spent less than a week there.
Before afternoon snacktime on an icy January day, I was called into the office, informed that I was being dropped from the program by my insurance unless I could pay out of pocket -- I couldn’t -- and made the cold walk back to my apartment. I was out. Still numb, I flew home the next afternoon and began the spring semester of my sophomore year of college. I celebrated my three-week anniversary out of treatment by putting my head back in the toilet.
A month later I was back beside the vending machines, just as dehydrated, just as ill and just as hopeless, now with a nearly $9,000 bill in my hand. The roiling in my stomach was not nausea; the news didn’t make me sick. It made me numb. My urge was not to throw up again but to disappear, and to scream, and to undo everything about the past eight years. I did none of these.
Eating disorder treatment in my home state, or even the tri-state area, is non-existent beyond a few hospital-based programs for adolescents. I had been admitted to the program geographically closest to home under the impression that I was covered by insurance -- and until receiving my bill, was never told any differently.
There is nowhere to put the disappointment and rage I feel at my failure to get better at such an enormous expense -- and at the lack of communication from the financial department of my treatment center until after my discharge. I have since attempted one appeal and am currently awaiting a decision on my second, meanwhile making payments to collections. And I can barely, barely afford any of it.
I truly wish I had never undergone treatment. Perhaps the program has worked for other women and sent them in a better direction than mine of illness, pain and shame, but my time there was too short to make much of a dent in the years of abuse to my mind and body. Still a student, I’m pushing myself to the limits to be able to make even the minimum payment on my bill, plus rent, food, and the like. The great irony of my treatment is that its expense has weaseled into my unconscious with nightmares of never being free from my debt. Ironically, it has also made it nearly impossible to purchase fuel for binges as of late.
This is not to say I haven’t made progress in recovery since being discharged. I’ve scaled down my obsessive exercise to a healthier level and have stopped losing my hair. Even when I do slip up -- and I do; I’ve never expected immediate recovery -- my disordered cycles are less extreme than they were in the winter of 2013. I’m proud and grateful to have made these steps. It still hasn’t been worth nearly $10,000, and the decision to undergo treatment is among my biggest regrets.
On the plane home, armed with a sheaf of prescriptions, patient assessment sheets and meal plan guides, I had imagined a life free of my disorder and major depression, a newly-cut pathway to the real self I’ve always been sure lay somewhere behind my armor of disease, pain and failure. The strength and drive I have today to fight my way out of this hell does not come from my experience in treatment, but from my urgent desire and need to dig myself out of the hole it has helped put me in.