Freedom of Sketch

Plus One

Daniel finally comes to visit, which takes a while because he doesn't answer his phone for a couple of weeks. He waits for me in the cafeteria, his eyes as downcast as the sky. His hollow face is a testament to a recent bout of weight loss. When I hug him, I feel his bones reaching through his baggy clothes - the same outfit he wore the last time he came here.

"Are you sick?" I ask immediately, brushing his damp bangs away from his forehead. "You look a little... yellow."

"Oh, I'm fine," he insists. He blames the lack of sunshine for his pallor, but we both know that the days have been longer.

We sit at a table that offers a generous view of the yard. Some landscapers spent the last three days planting new saplings, trimming the hedge into clean-cut green blocks, and sculpting future flowerbeds - or graves, perhaps - out of the soft, dark earth. Our construction paper daisies from art therapy cling to the safety glass, yearning for a chance to touch the clean spring air. My daisy loiters closest to the door handle so it can be the first to escape.

Daniel hides his mouth behind his hand, like he's suppressing the urge to reveal a horrifying secret, or to vomit.

"You sure you're okay?"

He nods, takes a deep breath, and peels off his visitor's sticker. He re-applies it to the center of his chest. "Sorry I haven't been up here to see you for a while, Shi," he says. "School's been crazy. It's like all of the teachers are holding this contest to see who can make the most students crack before the end of the term."

"Ouch," I say with a cringe. "Is that why I haven't seen or heard from Lizzie? Because three weeks ago she promised to visit, but she just sort of vanished from the face of the planet or something."

Daniel doesn't answer right away. Instead, he examines the cutout daisies, our DIY seasonal décor. Finally, he responds, the palm of his hand muffling his voice. "She's here," he says. He won't look me in the eye. One of the corners of his visitor's sticker comes free from his shirt, curling away from the fabric.

I look around the room and spot about three sets of tearful families, plus a couple of patients whispering with their BFFs. No Lizzie. "She's here?" I echo, confused. "Where?"

"She's not visiting, Shiloh." Daniel's heavy words fall from his reluctant lips and thud to the floor. "She's a patient... like you."

My last three meals rearrange themselves in my gut. It feels like someone kicked the air right out of my chest. I want to lie face down on the floor and allow the cold linoleum to burn the skin from my bones.

Daniel explains the entire story. Lizzie was transferred from Children's Hospital this morning. Ten days ago, her dad came home from work and found her unconscious on the bathroom floor. She had had a seizure from an electrolyte imbalance: a result of purging. She hadn't eaten in five days or slept in three. Her heart was beating at half its normal rate, her potassium level wasn't high enough to sustain life, and she had another seizure on the way to the hospital.

"She weighs only eighty-six pounds," Daniel says. As soon as her doctor declared her as "medically stable", he sent her straight here. She won't be going home anytime soon.

My brain won't accept this.

--

Clinical Notes:

Patient Name: Elizabeth Mary Elridge

DOB: 08/18/1999

Admit Date: 03/15/2017

Diagnosis: Anorexia Binge-Purge Type; Generalized Anxiety

Attending: Jeremy Fox, MD

Pt is a 17-year-old white female seen in evaluation. She presented as anxious, dysphoric, and tearful. She was fidgeting, possibly attempting to burn calories at rest. This patient has anorexia binge-purge type with severe medical complications to include bradycardia, hypokalemia, and seizure activity due to an electrolyte imbalance. Upon admission pt weighed 86.3 pounds at a height of 5'7", making her BMI a dangerously low 13.5. I will immediately place her in our inpatient eating disorders program where she will receive frequent and intensive therapy, food supplements, and NG tube for refeeding. Pt has indicated that she does not intend to cooperate and states, "you can't tell me what to do with my own body". Proper consents for involuntary treatment have been signed by both parents, who so far appear to be very supportive, concerned, and involved in their daughter's care.

--

She enters The Lounge right before bedtime. Looking at her is like staring at a ghost. I worry that if she turns to the side, she'll disappear. I want to hold her and feel something solid, but she is like cold, unfamiliar smoke in my hand. When we make eye contact, I get lost and break down into short, choppy sobs. I cry like a child, wrinkling my nose and gasping through an ugly and desperate mouth. My nerves collectively shiver, turning my body into crackling, metallic static that leaves me trapped in a skin so numb that it stings.

Talia hugs me from behind. Her cheek rests against my shoulder. "Shhh," she murmurs. "She's finally in a place where she can get some help."

"You didn't have to go this far!" I say to Lizzie. "You were already skinny thirty pounds ago! You've been beautiful ever since I met you." Warm tears trickle between the fingers of my hand. I sniff and watch two tears race each other down my arm.

Lizzie is silent aside from the occasional sniffle. Her red, weepy eyes are nearly swollen shut. A tube snakes its way out of her nostril, crosses her face, and loops around her ear. She picks at the tape holding it in place until a tech gently reminds her to leave it alone.

"Leave me alone," she says. She wears a bulky knit sweater beneath two hospital gowns. Her star leggings droop around her ankles.

I reach out to touch her, to make sure she's real, but she pulls away. "Don't!" She is bone and skin, muscle and shadow. Her tongue licks her stained teeth. The hollow echo of my breathing fills the room. The other girls stare and whisper. One of them flicks her eyes back and forth, measuring Lizzie in her head. She curls her fingers around her own arm and tries to slide them over her bicep. I want to smack her almost as much as I want to shake Lizzie back into the girl she was years ago, before adolescence scarred her forever.

***

"I can't do this! I can't do this anymore!" I wail into the phone while Daniel listens from the other side of the universe.

"What can't you do?" he whispers.

"Care!" I rap my fingernails against the phone's hard, plastic body. "I can't let myself love her or care about her! I'm too selfish to be friends with someone who could still die!"

"She's in the hospital, Shi," Daniel says, trying to soothe me through his weighted words. "They're not going to let her die."

I press my forehead into the wall. "What is happening to us?"

"What do you mean by 'us'?"

I watch Meredith tape up some more artwork on the Self-Esteem! board. One of the pictures is a waxy crayon drawing of the sun resting on top of a mountain. "You can do it!" is written on the bottom in loopy red letters. Meredith fumbles with the paper and drops it. It slides over to my feet with a hushed sigh. I snatch it and for a moment debate whether or not I should shred it.

"Shiloh?" says Daniel.

I hand the drawing back to Meredith without removing my forehead from the wall. "What?" I say.

"You wanted to know what's happening to 'us'. Who is 'us'?"

"You, me, and Lizzie."

The line crackles a little as Daniel switches his phone to the other ear. I imagine him running an impatient hand through his hair, and I shiver a little. He finally speaks. "We're holding it together," he insists.

"Are we? You're the only one not in a freaking mental ward."

"You sound disappointed." He laughs tiredly. "Look, times are tough. I might end up in a funny farm if these teachers don't stop hammering us with homework and surprise tests. But you and Lizzie won't be in there for the rest of your lives. When you guys get out, we can start fresh."

"I know I won't be the same when I get out," I say. I start sobbing again.

"I'll still love you either way," Daniel says.

"You mean it?" I sniff.

"Of course."

My heart skips a couple of beats. Nope, I'm not imagining it.