My 14-year-old daughter was about to graduate from junior high, and I’d decided to get her a gift. But when I asked her what she wanted, I got a very strange response. “The only thing I want,” she said, “is to lose some weight. Is it okay if I drink some liquid diet meals instead of eating lunch every day?”
I was taken aback. Obviously, this was not what I had in mind. Besides, Diana wasn’t really overweight. “I don’t know,” I told her.
“Please, Mom,” she begged. My friends all do it. I just want to lose a little weight.”
Diana, my only child, five feet three and 125 pounds, looked like her heart would break if I said no.
“Well,” I said, “I guess a few times a week won’t hurt. But you have to eat a healthy dinner at home every night. And you have to promise to take off only a couple of pounds.”
“I promise,” she answered.
A few months later, we went shopping for new clothes, and to my surprise, she no longer fit into her usual size 10. “how much did you lose?” I asked.
“Oh, about twelve pounds.”
I was shocked. “Twelve pounds!” I said. “Diana, you promised you’d only lose a little.”
“But, Mom, don’t I look much better?”
She was so excited and happy, I couldn’t bring myself to scold her. “Well, don’t diet anymore: you’ve lost enough,” I told her.
To be honest, it was hard to tell she’d lost that much weight. Lately, she had been wearing layers of loose-fitting tops and baggy pants. “What’s with the new look?” I finally asked.
“Oh, Mom, it’s the style,” she said, looking at me as if I were the densest parent on the planet. “Everybody dresses like this.”
A month later, Diana asked if she could join my friend Patti and me on our regular four-mile walk. We all started out together, but my daughter was soon out of breath and lagging far behind. After awhile, her heart was pounding so hard she couldn’t go on. “Wait here,” I told her. “I’ll get the car and pick you up.”
When we got home, I called my friend Fran who’s a nurse at a hospital eating-disorder unit. “Dorine, you’d better get Diana to the unit,” she said. “With the weight loss and now this, she might have a serious problem.”
I tried to put on a brave front, but I was frightened. Diana was scared too. “I don’t want to go to the hospital,” she said. “Please don’t make me.”
“We’re just going to check this out,” I promised. “Then we’ll go home.”
When we arrived at the hospital, Diana was given a complete hospital. Afterward the head of the unit told me Diana had to be hospitalized immediately. “We’ll need more tests,” he said. “The best thing you can do now is go home, and let us take care of your daughter.”
Diana cried and begged me not to leave her. My own eyes were so full of tears, I couldn’t even see, but I forced myself to walk away.
That day, October 6, 1989, seemed like the worst of my life. I had no way of knowing then that for the next four years, things would only get harder.
The next morning, the doctor had more news — and it was all bad. “She’s extremely anemic,” he said. What’s more, Diana had lost more than 12 pounds. In the past month, she’d taken off an additional 13 pounds and now weighed 100. The doctor told me that Diana would have to be hospitalized in the psychiatric unit for al least two weeks. “We’re going to start her on antidepressants,” he explained. “Regulating the chemicals in her brain will help lessen her obsession with food.”
Stunned, I tried to sort out how all this could have happened. A divorced mother trying to make ends meet, I often worked 13-hour shifts as a critical-care-unit coordinator at a St. Louis hospital. Often, I came home too late to eat dinner with Diana and my mother, who lived with us. A few times, Mom had complained that Diana hadn’t eaten her dinner, but when I questioned Diana, she always said, “I’m eating! Grandma just wants me to eat tons of food.” I remembered what a stickler my mother was about good meals when I was a teenager and assumed she was just being overly concerned.
Now I realized Diana must have been starving herself all along. It’s very difficult to be with someone every day and see them clearly. I expected Diana to look normal — so she did. Still, I blamed myself for not noticing the warning sips.
Diana was in the hospital 16 days before the doctor said she could go home. She hadn’t gained weight, but he felt she’d started getting back into healthier eating habits.
Once home, she continued to take antidepressants and to see a psychiatrist. I knew that recovery would be a slow process, but I sensed that she wasn’t getting better. Finally, in July 1990, my feelings were confirmed. A friend of Diana’s told me she was surviving on diet soda and chewing gum. “She eats,” he said, “and then goes to the bathroom and throws up.” When I confronted her, Diana denied it at first. Then she confessed. She’d eat all she wanted, then stick a pencil down her throat.
Diana was hospitalized again after I told her new doctor what was going on. Nine months had passed since her illness was discovered, and Diana was already on her third psychiatrist. She’d gone from anorexia, or starving herself, to bingeing and purging, a condition known as bulimia.
I visited her every day at the hospital, and learned that she still wasn’t eating properly. One morning, she was all smiles. “Mom,” she said sweetly, “all the kids here collect stuffed toys. Can I have one too?”
I went out and bought her a huge teddy bear. A few weeks later, I found out why she wanted it. She had slit open the bear’s ears and stuffed them with bottles of potassium supplements, which she’d hidden in her luggage. When potassium levels get dangerously low, eating-disorder specialists know that a patient is purging or using laxatives.
Diana figured that as long as her potassium levels were normal — even though she kept losing weight — her doctor would think she’d stopped purging and release her from the hospital. And she did fool the hospital staff for awhile — until a nurse caught her. After that, she was transferred to a closely watched, locked ward for patients who are a danger to themselves.
A month later, the doctor decided Diana was well enough to be released. We tried to get back to a normal routine. She returned to school, but fainted in class several times. Finally, school authorities asked her to stay home until she was better. Her internist suggested she drop out of school altogether. “Diana is better off at home, where you and your mother can watch her,” he said.
All this time, I’d been reading everything I could find on bulimia, and talking to anyone with expertise on eating disorders. Armed with the latest research, I’d challenge her doctors. My questions were always the same: Couldn’t they do mole? Why wasn’t she getting better? How long could this go on?
And it was going on. Diana was now 16. Gradually, she’d lost most of her friends, and she hardly left the house anymore. She was also thinner than ever, weighing between 50 and 60 pounds. I didn’t know what to do. When I tried to stop her from going to the bathroom after meals, she’d vomit in plastic bags and hide them all over the house.
“Why do you do this?” I pleaded with her for an answer. “Please make me understand.”
The only explanation I got was that it gave her a huge sense of relief. “I just can’t stop myself,” she said. “I have to eat until I throw up.”
Finally, I was so desperate, I put locks on the refrigerator and the cupboards. Mom and I would have to unlock them before she could get something to eat.
I went with Diana to one of her weekly therapy sessions, and I told the doctor about the bingeing and purging. Diana denied it.
“It doesn’t help for you to tell me what she’s doing,” the doctor said. “Diana has to admit she has a problem.”
But Diana wouldn’t — or couldn’t — admit it. So I took her to see yet another doctor. By then, I’d lost count of how many psychiatrists and therapists she’d seen. When I didn’t see any progress, I’d switch her to another expert I’d read or heard about. And in each case, Diana would cheerfully go along. But once there, she’d insist there was no problem; she was just fine.
One doctor handed me a Bible and said, “It’s in God’s hands.” Another told me, “Diana’s too far gone to survive. You should get yourself some help so you don’t keep beating yourself up about this.”
I couldn’t accept that, though Diana’s condition was grave. She was sometimes throwing up as many as 70 times a day. I had to call for an ambulance at least twice a month because she was shaking uncontrollably as a result of being so underweight. Three years had passed since her first hospitalization. Since then, there’d been many more, and I’d had to refinance my house three times to pay die medical bills. But I was determined to do anything and everything to keep my daughter alive.
The doctors put her on a feeding tube, but she kept pulling it out. Finally, one was surgically implanted and, for awhile, it helped. Diana got up to 58 pounds and with that little bit of success, they took the tube out and let her go home — where she promptly resumed the purging.
By February 1993, Diana’s weight had dropped to 49 pounds. She was listless, without strength, and had to be hospitalized again. A resident gave her a blood transfusion for her anemia. Then he turned to me and said, “How could you let your child get to this weight? What kind of a mother are you?”
“I’m the best mother I can be,” I snapped. I was so angry at that point — angry at this young man who had no idea what I was going through; angry at the doctors who hadn’t been able to get through to my child; angry at anyone who had healthy children, most of all, angry at myself because my daughter was dying, and I couldn’t do anything to save her.
When Diana was well enough to be moved to the psychiatric floor of the St. Louis Children’s Hospital, I put her under the care of a new physician. By then, I’d run out of insurance coverage and had to sign over my home to the hospital as collateral. Dr. Marta da Silva, a child and adolescent psychiatrist in the hospital’s eating-disorder program, sat me down and very carefully explained what she would do to help Diana. “Patients with eating disorders have a serious problem with control,” she said. “I’m not going to fight Diana over what she eats and what she keeps down. It’s no good warning her that she’s going to die. Dying doesn’t mean anything to Diana. We need to motivate her in a different way.”
Then the doctor told me she wanted me to stay away from Diana until she could get through 24 hours without throwing up. “You and Diana are so close, I know it’s extremely hard to be separated,” she said. “But you have to let go of her now so that she can make her own decisions.”
Diana was shocked when I told her I couldn’t see her for awhile. “Let me go home with you,” she begged, gripping my hand as hard as she could. If I can just get out that door, I remember thinking, nothing in my life will ever be this difficult again.
Although we couldn’t see each other, Diana would call and swear that the nurses were mean to her. “Take me home,” she pleaded. “I’ve learned my lesson.” When I complained to Dr. da Silva, she told me, “you’re falling back into your old patterns. Diana knows whenever she says people are mean to her, you’ll pull her out of treatment.”
I backed off and let the doctor do her job. This was something brand-new to Diana. In the past, I’d fought her battles. Now I couldn’t be there, and Diana had to fight for herself.
Six weeks went by, it was the end of March when the doctor called and said I could visit. Diana hung a calendar on the wall to mark off the days she didn’t throw up. Almost before we knew it, there were five days marked off, then nine, then 12! At the same time, Diana was finally able to keep the anti-depressants in her system, and they helped control her compulsion to binge and purge.
There was more good news. She was gradually gaining weight. It was clear that Diana had decided she wanted another chance at life.
At the end of May, Diana came home. She weighed 102 pounds. As part of her treatment, she and I began family therapy with Barbara Silverstein, an instructor in psychiatry at Washington University Medical School. With the therapist’s encouragement, Diana earned her high school equivalency diploma, got a sales job, and is currently involved with a nice young man. She’s even thinking of going to college. The main thing@ Diana weighs 112 pounds and has maintained that weight for three and a half years.
Sometimes, there are little setbacks. When she’s upset, Diana will eat less than usual. But she won’t purge, and the mood passes. And she’s still on a low-dosage antidepressant to control her compulsion.
As for me, I benefited from therapy too. I was under tremendous stress while Diana was ill. Then, when she got better, I felt guilty: I wondered if there was anything I could have done differently to help her recover sooner. But I truly believe that Diana would have died if I hadn’t kept trying to find the best treatment for her.
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