Questions

I was on a locked psychiatric ward this evening visiting a family member.

While I was visiting, a new patient arrived with her husband. She was gaunt and grey and in her fifties, and she was clearly, painfully, achingly a longtime sufferer of anorexia nervosa. I immediately wondered what she was doing at this particular hospital, on this particular ward, since there are quite a lot (relatively speaking) of good inpatient eating disorder hospitals and wings in the New York area, or at least within two hours or so. I figured, "I'm not a psychiatrist; I don't know what's going on. She may have another underlying psychiatric issue that they have to treat here first." As I kept watching her in the corner of my eye or with the back of my attention, I just felt more and more pity for her.

I thought about the food that was being served for dinner and realized if she were presented it outside the bounds of a meal process group, she would, to put it nicely, lose her shit (and that she'd probably still lose it within the MP group, but that it wouldn't be as humiliating). For this dinner, the admitting psychiatrist had apparently ordered an Ensure for her, and some juice. All she wanted was her chocolate. (She said it like that: "my chocolate.") The mental health worker assigned to keep track of dinner brushed her off with a vague promise of seeing if the person who could bring up some chocolate had gone home yet. Understandable in a general psychiatric facility, but not the way an eating disorder unit would handle the request. (Not that they'd immediately procure chocolate, but a therapist or doctor would be at the meal itself to work through the strange request, instead of a nurse who gives off every impression of being in over her head.)

I thought about the fact that there isn't a nutritionist or registered dietitian on staff on this ward. Perhaps there's one for the hospital at large, but the meals are clearly not prepared with eating disordered patients or weight gain in mind, and not even really geared toward optimal nutrition for refeeding. (Two words: frozen. vegetables.)

I thought about how alone this woman is going to feel. None of the (few) other patients are in this ward for eating disorders.

I don't know why the doctor "sold her a bill of goods," as she put it, to get her into this particular institution and ward. I don't know why he didn't send her to Cornell, upstate, which has an excellent (if infamously strict) eating disorder unit. I don't know why he didn't send her to Renfew in Pennsylvania which practically invented eating disorder inpatient treatment. I don't know why he told her there would be a nutritionist on staff at every meal (according to her, anyway).

But I kept my mouth shut. I wanted to tell her about Cornell and Renfrew, but it wasn't my business, and she was so agitated that she'd probably have lashed out at me for eavesdropping. (Understandably. I was definitely being nosy.) I wanted to find the doctor and find out what the hell he was thinking. I wanted to ask if he knew from personal experience or prolonged ground-level observation what it might be like to be the only e.d. patient in an institution. I wanted to ask about his understanding of older e.d. patients and how they often feel an even more compounded kind of shame than do many of the younger women who make up the diseases' majority of victims). I wanted to ask if he understood where the lines are drawn between bulimic guilt and anorexic guilt and the guilty pride of the severely underweight. I wanted to ask what exactly his specialty was and if there was, in fact, anyone on staff on this ward who truly specialized in eating disorders, since most of the patients I'd met shared the same diagnosis, and it wasn't anorexia. I wanted to ask if my cynicism was spot-on in guessing that he wanted to get her admitted so he'd have another patient pouring money into this nearly-empty wing of the hospital (5 patients for 26 beds).

Clearly, I didn't ask any of these questions. I kept my mouth shut and I kept my hands to myself, even though I really, desperately wanted to wrap her bony frame in a bear hug.