Hot Metal Bridge

Current Issue : Number Twenty-Five

For Insurance Purposes: These Words Do Not Define Me

BY SARAH SIMKIN


I.  On (Not) Eating

It isn’t that, I insist. I just . . . don’t eat. I don’t remember to. I am fully aware (what you think, how it appears) and that is not my intent—do not speak those ugly words to me. Anorexia Nervosa, Latin, harsh science: uncalled for. This is not a reflection on you: this goes deeper than skin, is less petty.

My reflection: I am ambivalent when I see it—me—in the mirror. It isn’t a “negative body image,” it just isn’t an image at all: so close to a negative in that sense—undeveloped. None of my clothes hang so badly they must be put away, but things given up for lost can be reclaimed—high school clothing, things shrunk by negligence—green trousers ripped instead of hemmed, a shirt from a summer I worked in the city. That isn’t true; an entire shelf of things are put away—all the new jeans my mother bought me at the end of the summer are two sizes too big. I bought new ones and didn’t tell her about my unintentional disappearing trick.

Nights when I can’t sleep—when my worried mind won’t shut down or the sounds of youthful revelry out in the street are too loud too late—I read cookbooks, recipes. Frog Commissary, without which I feel no home is complete or true. Instructions with metric measurements ripped out of British magazines; scones I’ll never bake for tea parties I’ll never have. I compose lists of ingredients I would need for these never attempted projects, scraps of paper that litter my desk and the pockets of my coats.

I don’t track the loss, I haven’t the means: no scale. Rarely do others remark upon it however, and someone always remarks when things get bad enough. Which is how we can know that this is not bad. This has happened before; I have out-waited worse things. This is a strange price paid.

I did yoga for twenty minutes every morning like clockwork for weeks and weeks. But I am not a clock and soon I slipped. (How dull my gears. Messy wiring.) I pretended to myself I’d make up the missed morning sessions in the afternoons or evenings and did not. I cut poses from the routine: triangle, chair, gate, warrior—scrape away my resolve with an ennui like a knife. When I help my roommate knead bread I notice my arms do not have the strength they once did.

Once I was taut and toned out of necessity. I trained six days a week in the way of fist and foot for years leading up to the test for my black belt in Taekwondo, hefted heavy crates at my afterschool job. The gym was a thing I had too, my own fitness something I treasured. Fierce running playlists, hours on machines and mats. A love of working out was bequeathed to me by both parents. At home we shared a family membership to a gym of the well-intentioned middle aged: I liked that no one ever stared or bothered me. Now I can’t convince myself to go.

That I am unable to persuade myself worries me more than the loss of flesh from my ribs, of which I will concede to having a new awareness. My fingers play over them the way I used to twirl my hair when it was long: nervously. I am reminded of whale skeletons in museums—I stood inside a full-sized heart. I am glad to have this cage for my lungs, reassured that some things, at least, are safe and protected.

Appetite is now a matter of remembering conventions, of fraud. One week I carried an apple in my book bag every day until it browned and bruised. But of the things that can be lost, appetite is a small thing to do without; strength and flesh are little compromises. I do not think it was always this way, but then, I may be an unreliable record.

Mornings: every individual second a battle (once I was like a spring arising from my covers and sheets). I can’t think past tea, cognate farther than relief for my aching throat, cracked lips. I uncork the lid of the honey bear bottle. No, I have not uncorked the lid—I have unscrewed it and in my unwaking, hazy stupor poured entirely too much sticky syrup bee nectar. A sip of the concoction is sickening. Disheartened, I resolve to try consumption again tomorrow and idle away the time until my schedule presses me, linger in the kitchen’s weak sunlight. Nothing passes my lips until that late evening when I eat a fortune cookie, which (I imagine) tastes like what a sugary manila envelope might, or should, if such things were what they seemed.

When she bakes my roommate leaves behind two of whatever she’s made—a sort of tithe to the other roommate and I, mea culpa for the oven driving up our electric bills so high and the gooey dishes in the sink. I throw mine away now so she won’t think I don’t appreciate the gesture. Sometimes I stare at the baked good piercingly first, hovering over the kitchen wastebasket, as though the cookie is hiding an answer from me, in case the cupcake has secrets beneath its butter cream icing. I lose many minutes in such fruitless contemplations. I lose many minutes lots of ways.

The secretaries at my office worry about my not having a lunch break. Strictly speaking, it’s illegal for me not to take one; they are staunch unionists all and concerned with my rights as a worker. I cannot confess my squirrel-like diet, do not know how to tell them that the handful of nuts and berries I nibble on is my meal for the day. I’d just as soon not leave my desk. Work is focusing, centering.

II. On Action

I want to fight this. I want chemotherapy and radiation and invasive surgery. I want to be a brave survivor with a color and a charity race like all acceptable disease survivors have. Any action that isn’t fighting feels like surrendering—every action. I want a course of radical action. But the mind cannot be fought radically. Instead, I see Joy.

The sheer cliché of Joy irks me. Her clunky new age jewelry, the scarves and paper lamps decorating her office, her desire to be more than my therapist but also my friend (as though such a thing were desirable or even possible in a clinical setting, I inwardly scoffed when she declaimed that intention). When she asks me how I feel about how I feel, I nearly laugh in her face. Still, an appointment is an appointment, and making the appointment is a thing I have done for myself, a fragment of my fate I have gripped with both hands.

Joy is in every way the reverse of Dr. Keller, my doctor from the first time this happened: I may have taken as much comfort in his tweed blazers with the elbow patches, thick glasses and loafers as I ever did in anything he said or gave or prescribed. He just looked so much like how a psychiatrist should, you know?

Diagnosis: a Venn diagram of disorders shaded and layered: throw darts at them and ascribe what you will. These problems are sisters and link arms, come in waves and duos and trios. Sidle up on you sideways. It could be just as much one as the other but, for insurance purposes: a Major Depressive Episode. Keystone Blue Cross will not pay for medication without that classification. Those words on my records mean that I will never receive top-level security clearance for government intelligence agencies, which I might never have wanted had it not been a door closed to me. Content with that categorization, no one addresses the other underlying issues, like an asbestos infestation in a house that burnt down long ago.

Keller doesn’t like not to see me. He proposes phone sessions when I am away at school. His attentions begin to strike me as excessive, perhaps unprofessional, not concerned or consistent with someone who has supposedly taken the Hippocratic oath. Primum Non Nocere. Should I invite him for coffee and idle chatter? Is the thirty-dollar co-pay he receives for seeing me is so valuable? He expresses jealousy when I tell him I prefer to meet with Joy, who is available in person, for free, blocks away at the student counseling center. He does not return Joy’s calls when she attempts to consult with him, leaves voice mail on my cell phone about being hurt I didn’t schedule an appointment over winter break.

I cannot forget the South African woman who tried to put me away. I remember her office, too calculated to soothe—with the exact reverse result. I remember her tactless questions, I remember wanting to scream and my parents sitting stiff in high-backed chairs, fingers clenched white on the armrests. I remember knowing I would not live the rest of my life as someone who had been put away. One way or another I wouldn’t. I am not a flight risk. After her, of course Keller seemed like a savior.

I will say that Joy is not entirely without merit. She leads me through guided body meditations with a voice like freshly fallen snow and the color blue and silent bells. I imagine walking the pathways of my body; gain an excruciating awareness of every inch of sinew and flesh—few as there are these days. She asks me what my chest feels like and I tell her I’m not sure, I don’t know how a chest is supposed to feel.

At home Keller was my guiding star. If not his personage certainly his office: situated at the crux of two major intersections, Wellspring Plaza is an ideal landmark for navigation. During lighter sessions we would joke that I should have a Wellspring bracelet: What Would Keller Say. In some trying circumstances I would try to ponder what his input would be, or rather to predict what he would say later when I told him about what had befallen me this time. Now I think a better wrist adornment might be WWJA: What Would Joy Ask. She never tells me anything but her questions can be insightful; as often as she asks unanswerable queries about my interior (literal, metaphorical) she asks things that strike me to my core and make me tease the knot of myself apart.

I deign—or rather desperately decide—to consign validity to Joy’s questions. I begin to consider them. Together we uncover that not only do I indeed possess emotions about my emotions, I’m a baklava of emotional layers. When she peels away my phyllo dough and honey and almonds—fury about being despondent, rage against being vulnerable—I find at my core nothing truly amiss but a few clusters of norepinephrine and dopamine and several unfortunate circumstances. I am shockingly well adjusted, we determine. Just clinically depressed.

While I’m visiting home on a school break I see Keller and he tells me, finally and definitively, that he doesn’t think there’s anything wrong with being in therapy forever. Think of it as self-improvement, he tells me. There is always something you can learn or work on. There are patients he sees bimonthly for years, for decades.

I am not a work in progress or continually ongoing construction: I am a sweater with a hole that needs to be patched, I am a doll with a limb snapped off. What is wrong has a fixed and finite solution, thread and glue. I want very much to believe this. I want very much not to be broken always.

III. Chemistry

Then of course there is chemistry, and how our lives might be better lived through it—or how my life most definitively is. What was once a nightstand—radio, forgotten glasses of water, unread books—is now a pharmacy. I used to keep pill bottles neatly, discreetly, in a decorative box. Now it’s too important that I not forget them; I need to see them every day. A constant reminder not just to take them but of what is happening to me and what countermeasures I have taken and that how I feel is not really how I feel.

You build a blood level like a cathedral or a pyramid: slowly, pill by brick-like pill, without certainty, unable to see the overarching scheme of the architecture’s construction. A concentration of chemicals seeps and insinuates between platelets and plasma, bringing two things at once: alleviation of symptoms, onset of side effects (tremors, insomnia . . . momentous loss of appetite). But you begin to feel like a person again. Or, perhaps, for the first time.

Keller: never a creative diagnostician. Many times since he has acknowledged that if he was not wrong he was not entirely correct in his prescription and spent vast amounts of our sessions together pondering different branches of pharmaceutical trees. He would describe the molecular differences to me as though I could possibly have any informed insight as to which might yield more desirable effects on my woeful serotonin levels, my Shakespearean amounts of bile, my worrisome ideation. These cognations were pointless, as he never changed my regimen; every day is 200 milligrams of aquamarine stabilizers without an end in sight.

When I first had attacks I didn’t know what they were; mine were not showy like my sister’s. I was older but she did most things first, including collapsing in front of her high school locker in a convulsion of tears. No one tells you a panic attack doesn’t have to be shaking and hyperventilating, fevers and fainting. It can be just your mind quietly refusing to work. Renal failure of the will. Collapse of the mental organ’s walls.

No, that’s not it. It isn’t a strike but an uprising, less a sit-in than a riot. It’s thinking of everything at once so loudly and in such excruciating depth that you aren’t thinking of anything, and then sudden dead silence when the awareness of your rapidly closing throat wallops you and you realize that maybe there need not be any more noisy thoughts—if you stop breathing and subsequently thinking altogether, that you could ride this wave past the shoreline and into the clouds, past the clouds to the cold atom-less stratosphere.

IV. Reflection/Victorious Defeat

Forgetting is a common occurrence I should like to prevent. I’ve found it difficult to discern progress when my recollection of even the immediate past is foggy and distorted; another side effect, these short-term memory lapses (facial aphasia, occasional mild hysteria). Did I cry last Wednesday or did I get through that entire week? I’d like to chart the improvement or stagnancy or devolution, just to know where today is in the flow of the episode, what phase I might expect tomorrow.

My attempts at journal-keeping in the past have had lackluster results; instead I buy a pack of tinfoil stickers at the drug store and try to keep a log. A star for every day on the calendar I can’t muster the enthusiasm to mark: What’s worth planning for? Most days are silver (wistful) or green (resigned). I hesitate to ever assign a gold star. Some moments are tolerable and some even okay but I aspire for great, for brilliant, for fireworks and falling in love. I have no interest in an existence of subsistence.

Any day containing a crying jag is automatically demoted to a blue star no matter what else happens. There are days I sob through boxes of tissues, improbable amounts, and lack the coordination or inclination to take care that they arc into the wastebasket. My floor becomes littered with those saline-drenched cherry blossoms, books I am unable to concentrate on, clothes I neither wear nor put away: a tableau of misery I never expected to find staged in this room—not here. I never though there would be a day I was so angry that red stars would need to be introduced, but that came to pass as well. The starred calendar fails to reveal a pattern.

This is not like a pet turtle dying. This is not like being sad. This is not something I will snap out of alone with time, without pharmaceuticals or therapeutic experts.

Before this episode began in earnest I was lost at sea, trapped drifting on a dinghy, my life a series of bleak horizons and ominous dorsal fins. The downswing of the bell curve was like slipping overboard and drowning. Now I’ve hauled myself up and lie gasping on my tiny insufficient vessel, out of immediate danger but still adrift and soaked in brine.

“Defenestration of attachment to the future” is a phrase that occurs, a reluctance to rely on time’s forward march in terms that I’ve glossed with showy lexicon. It isn’t a matter of living in the present—it’s reflecting and reconciling with the very recent past. It’s trying to live a second ago and constantly reassuring, “That wasn’t so bad. That wasn’t so bad.”