Can I Touch You???? (Eating disorders - how are they caused?)

Member Name: milmol

Product:	Eating disorders - how are they caused?
Date:	13/06/02 (59 review reads)
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Disadvantages: Many

Every once in a while we meet someone who touches us and leaves a mark we will awalys remember. Someone who makes us think about everything we have taken for granted, and how we believe if we have the right body image everything else will be fine. I met someone who made me challenge the way I think. It didn’t happen immediately, even though she was the size of a sparrow and clearly suffering from anorexia, but it happened, and I'm glad it did.

I first met Susan 6 months ago, (I have changed her name to protect her identity, the Royal College of Nurses state it is acceptable to write about events as long as patients cannot be identified). I work in general practice and she came in with her elderly mother. At first she looked like a child, but hidden beneath the large coat and baggy jumpers was a tiny, frail human being. She was 28 years of age and extremely thin, she had suffered from anorexia for 10 years and the effects were clear. Her hair was thin and sparse, coarse like wire and her eyes sunken like a dehydrated baby.

She had been referred to a psychiatrist at the local hospital 10 miles away who had decided she was unable to help her and had therefore referred her onto an eating disorder center at a larger hospital approximately 30 miles away. She attended there as an outpatient once a fortnight, although still battling the illness, her weight had stabilized at 32kg and she was at long last receiving the help she needed. The week in-between visits she was to come to the surgery for weighing and blood tests, the results of which were forwarded to the hospital, should she fail to attend the Gp was supposed to notify them.

I weighed Susan and informed her of the measurement, she made no comment (neither did I). Next came the blood test. Usually an appointment for a blood test is 5 minutes, but sometimes you know a procedure will take you longer and everyone else will have to wait, this was one of those times. First of all Susa
n was very nervous about having blood taken. Pulling up the sleeve of her jumper revealed arms that not only were like a Barbie dolls, but were covered in a fine coating of hair/down. She did not like being touched, I’m not sure if it caused her physical or emotional pain but touching had to be kept to a minimum. We agreed a truce; I would respect her wishes as much as possible, and be as gentle as possible. 'I will try to touch you as little as possible' I said. Somehow I succeeded, and she confessed it was bearable, and then off she went, weak and frail. The appointments continued and she booked regular appointments with me, obviously feeling safe in my blood taking techniques and not wanting to risk someone else. We chatted about routine things, never heavy nor serious and her weight was stable.

My working day changed, Triage was introduced and I rarely worked in the treatment room anymore, I did not know what happened to Susan and she did not cross my mind. Last week the ‘new nurse’ asked for my help, she had a patient who needed ear treatment that she was not qualified to give, so once again I entered my old stomping ground, and was stopped in my tracks by the sight that met me. It was Susan, even tinier and frailer than usual, her mum as usual in the room with her. Despite the thick clothes, her face told me she was thinner than ever, and I felt shocked. I dealt with her ear and then decided I could not ignore the situation, the conversation had to be faced.
‘How are you, I haven’t seen you for a while’.
‘Alright’ she replied.
Alright I wanted to shout, my god look at you, you look terrible. I didn’t of course, far too unprofessional, but I pressed on politely. I explained that I was concerned because she looked iller and frailer than I had ever seen her. The conversation was littered by interuptions from her mum but basically she had stopped attending the hospital. Her father w
as ill and she had no transport, she said she was not eligible for NHS transport and was too weak to use trains or buses as the visits then took all day and she was not up to it. With gentle persuasion she allowed me to weigh her and I was shocked to find she was now 26kg. She was fading away in front of our eyes, wearing her anorexia like a badge for all to see, and yet what did we do, I for one did not know what to do. I promised to discuss her situation with the Gp and look into transport for her and she left.

Two minutes later she returned, ‘I was wondering, do you have a diet sheet?’ she asked. Now normally I give advice to people wanting to lose weight, this was extreme to say the least, but she came back, she walked back down the corridor and asked for help, or that’s what it seemed like to me. I invited her into the room and brought out a leaflet entitled ‘The Balance Of Good Health’, the amounts and types of food needed to stay healthy. Susan started to talk, and after some prompting I learnt that her day consisted of weighing 30grams of lettuce and 30g of cucumber. This was all this tiny person ate all day until 5 o’clock, then she indulged in 2 digestive biscuits, then she vomited. I was amazed, she put so much energy into this disease; if she challenged that energy into something productive, think how successful she would have been. Its difficult to explain how it was, the conversation was surreal, I knew I was out of my depth, better people than me had tried to help her, but what could I do. I hear say that first of all you should do no harm, well what if I said the wrong thing? (Maybe that’s why she’s like this an inner voice said), what if I said something that made her worse? (How much worse can she get? the voice said) and so the struggle in my mind went on. 22 years of nursing does not prepare you for situations like this, I was swimming way out of my depth, I did not have the skills needed
to help her, but I felt compassion, and the fact that she came back meant I felt I had to do something.

I briefly remembered a social event I went to a couple of years ago, a posh restaurant, a million knives and forks, and not sure which one to use. The person sat next to me must have noticed my dilemma and he quietly said (It really doesn’t matter which one you pick up, if you are ever unsure of what to do, just do it with confidence and no one will notice’. He was right, what the hell did it matter, but his words often came back to me when I felt insecure. He said something that made a difference to me, maybe I could do the same for Susan, but you can’t bluff in your professional life, people’s lives are too precious. So I laid my cards out, told her I was no expert with anorexia, but if she wanted support I would do what I could, and so we continued, we set a small goal, it had to be small, achievable. She agreed to add in 50mls of milk over the day, small sips at a time. The voice inside me said ‘You fool, you’ve set a number, another obsession for her to perfect’, but at least it seemed better than doing nothing.

The next day I visited the library, I took out every book I could on anorexia, some written by people who had recovered. Did I gain an insight into Susan’s illness, no actually I didn’t, but I did gain an insight into the people had written them. It seems that everyone’s anorexia was different, personal to them. Some wanted to fade away, almost disappear, some wore it like a badge and craved the attention it gave them. Some knew why it started, others didn’t. Only long conversations with Susan would give an insight into her anorexia and I knew I would only ever stand on the edge of her world, she needed professional help, and she needed it now. The next day I telephoned the Nurse Specialist at the hospital and argued over NHS red tape, was she eligible for a medicar?
Which Authority would pay for it? And on and on. Finally an agreement was made, and transport was arranged. Dam red tape and jobs worth people.

Yes she touched me, I may never meet her again but she touched me, with her tiny little fingers and her desperate eyes. I examined parts of my life, how we as women compare ourselves to each other and how we moan about our weight and our shapes. How we think having the perfect body will give us the perfect life, and how we use our body shapes to determine our worth. We constantly seek approval from each other and our partners based on how we look and sow the seeds in our children. I cannot say meeting Susan will make me a better person, but it certainly did put certain things into perspective. She allowed me to touch her and she certainly touched me.

Thin is not necessarily beautiful or healthy, and every journalist that comments that some star has ‘Put on weight’ needs to think before they print. How many more Susan’s will it take before we know why or how to help? I will not love myself more if I am slimmer, nor will anyone else.

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