Slow and steady.

I’ve been at residential for 8 days.

The whole ride to the treatment center from home (a whopping 15 minutes) I wondered if I should call it quits and turn back around. Going to “residential” sounded so scary. But with my daughter’s face in my mind, I knew I had to get help and continue with treatment. And I gave up my big Italy trip! If I didn’t go, that was for nothing.

I arrived at my designated admit time, 11:30 am. After filling out some paperwork, taking a tour, and peeing without supervision one last time, I said goodbye to my husband and was on my own.

I met with the medical nursing practitioner, dietitian, and psychiatrist before going to my first group session. Nearly immediately, I was pulled from it to meet with my therapist. There are lot of EDTs (eating disorder technicians) who work here as well. Basically, all I did was meet a lot of people and eat some on that day.

During the week, we are programmed from 7:15am when breakfast starts until 8:45am when evening snack ends. The days are filled with various skills and therapy groups, 3 meals and 3 snacks, yoga, art, and a fair amount of free time in the evenings.

The center is currently full with 16 of us and a wait list but I have learned that it’s a revolving door, as just in my eight days here, two people have left and two admitted. Of the 16, I am the oldest by about 10 years as far as I have been able to tell. I’m one of only two who are married, and the only one with kids. There are two men (one of whom is transgender female to male). The majority are females between 19-25 years old. I’m one of very few without colored hair and/or tattoos. A handful clearly have other mental illness besides an eating disorder, and a handful have scars on their arms from self-harm/injury. Two are overweight, most look to be around a normal weight, and a handful are clearly underweight. I think I look like the normal weight category, though I’m underweight, so I’m not sure of others but those are my observations. I stick out, or I feel like I do.

Everyone enters as a Level 2 here. At this level, you must be in line of sight of staff (usually EDTs) at all times. After evening snack ends, you’re allowed to be in your room (door open) until morning. Also at this level, you must have your toilet checked by a EDT before flushing (super fun for someone with a shy bladder like myself), and are not eligible for passes to leave. I adjusted to all of that reasonably well, and decided to just see the humor in the whole toilet situation so as to not lose my sanity.

As of today at lunch, I’m on my third meal plan. In my case, as someone who is underweight and is therefore in “weight restoration” phase and at risk for refeeding syndrome, the dietitian started me on a small meal plan. She increased it on my 4th day and increased it again today. The meals have felt manageable so far, regarding portions anyway. I think they will get increasingly harder. The chef cooks well, so that’s nice. My favorite part is that I can’t overeat here. They don’t let you have more than your meal plan. One of my big fears is overeating and being out of control, so that fear is taken away here.

Have I explained meal plans? I had them in PHP, but can’t recall. In treatment, meal plans are comprised of “exchanges” of the following groups: protein, grain, milk, fat, fruit, vegetable. I have various exchanges for each meal, a total # of exchanges for each snack, and a dessert each day. While the meals have felt pretty manageable so far, I have felt pretty full most of the time. Sometimes, I feel very slight hunger pangs shortly before we are due to eat again.

One big difference between PHP and residential is finishing meals and using boost. At PHP, everyone basically finished their meals. I believe twice in my three weeks there, someone used boost (a liquid supplement) to finish instead of eating all the food. If you refuse to finish or boost at PHP, you are sent home for the rest of the day. At residential, at almost every meal, one or more people at my table do boost and/or don’t even finish the boost. I have eaten 100% of every meal and snack without using boost (except once, see story below), which has left me feeling somewhere between a bad anorexic, a goody two shoes, and only somewhat happy with myself for eating the food.

Another big difference between PHP and residential is conversation during meals. At PHP, the entire focus was on your thoughts, challenges, judgments about the food. At residential, food talk is pretty much not allowed during meals/snacks. This has been a very hard difference for me. I had been struggling so far with feeling like I couldn’t talk about my ED outside skills groups and my 1-1 meetings with providers. At a place where I had 15 other people who also have an eating disorder, we were just doing small talk and ignoring the elephant in the room. It was driving me crazy!

My biggest bump so far happened on Saturday night at dinner. It was a climactic moment building on 5 days of frustration of feeling isolated and like I couldn’t talk about my ED despite being at a 24/7 treatment facility. I was sitting with three other clients and a EDT for dinner, which happened to be pizza. The client next to me pushed her pizza plate away and was reading her index cards, trying to calm herself to eat. The rest of us were trying to talk about anything other than the pizza. The EDT and one of the clients talked about dogs, and then I asked the EDT if we could know where the pizza was from. She asked the EDT who had ordered it, who responded that they couldn’t tell us. To this, the already upset client said, “That’s bullshit, then I don’t trust this food,” and walked out of the kitchen.

After she walked out, one of the other clients said they shouldn’t have been talking about dogs because that’s a trigger for the upset client. The other client apologized and said she should have known better. I was completely confused, and asked why we couldn’t talk about dogs, and was told to “just drop it”.

Two minutes later, I told the EDT I needed a few minutes and walked out crying. I spent the rest of dinner crying in the hallway (line of sight, you know). I had enough of being more alone in my ED than ever, yet surrounded by other ED people and staff. When someone asked me if I was okay after dinner, I flipped out in the hall with about 5 clients and a EDT as witness.

I decided to put in a 72 hour notice to discharge, which would be Tuesday evening. It certainly hadn’t helped that as a new admit, I was not eligible to go on the Saturday outing and, therefore, spent between lunch and dinner reading and watching shows on my computer. Surrounded by people. Isolated. Sunday was a marked improvement, as I was able to go on the outing to the market and with the nice weather, went outside for the smoke breaks and formed a non-smokers group with a few girls who actually talked about ED. Refreshing.

On Monday, I talked with my therapist. I believe PHP is a more appropriate level for me, for a number of reasons that I laid out for her. She agreed to talk to the PHP team, but thought the recommendation for residential would stand. Meanwhile, I met with the nurse practitioner. She spoke my black & white language:

  1. I have not gained any weight in my week at residential. My mind was blown. How was that possible?? I have eaten 3 meals and 3 snacks per day, other than The Great Pizza Walkout of 2018, and not exercised other than mild yoga and mindful walks. Apparently, in a case like mine, the body goes into hypermetabolism and uses all the energy from the food you’re finally giving it to replete what’s been missing. As my meal plan increases and my body adjusts, I should start gaining weight.
  2. My heart rate is just below the normal range.
  3. My standing to sitting blood pressure shows a 30 point difference. It should show basically no difference.

These are signs I can understand that I am actually sick physically, as well as mentally. With my new connections in the non-smokers group and this medical information, I revoked my 72 hour notice and decided to stay.

As I told my therapist my decision, she changed me to a Level 3. At this level, I can flush my own toilet without EDT checks (hallelujah), be out of line of sight in the building, and am eligible to go on passes this weekend. This was a good mood booster.

I am so lucky to live close to the center. My husband and daughter have visited five times. My daughter, at 23 months old, says “mama clinic”. I find this unpleasant but better than “mommy scale”. We have fun visits but it’s hard to say goodbye when she says “Mama come” and I have to tell her I’m staying there and will see her soon.



Synopsis of week 1 in residential: Slow and steady wins the recovery race.

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