When she first arrived on the unit, we had no idea that she had an eating disorder. She started off by literally hiding in her room. She was so anxious and nervous and no matter what we did, we could not get her to come out to attend groups, eat meals, or participate in activities. It was day three of me being her nurse when I realized that she was not eating. I went into the room and saw she had a plate of food from the previous day hidden in the corner of the desk under a stack of papers.
I knew that she had not eaten much the first day, which was not uncommon, especially for patients with high anxiety. When I realized that it was the morning of day three and the food from day two was still sitting in her room, I was definitely concerned. I asked her if she was hungry and she started to cry. I knew instantly that she had been hiding the truth as to why she was here.
It was strange, honestly, because her parents knew too, and yet we were not informed that she had anorexia. She was skinny, but I had seen skinnier. She was anxious and scared and I thought at first that was why she was not eating. Turned out that this had been her life for the past few months and things were getting worse.
Eating disorders are a very difficult illness to treat. It’s also one of the most heartbreaking declines to watch. These patients truly feel no control over any aspect of their life and start trying to gain control by controlling their weight and body.
It’s also heartbreaking hearing a patient with such body dysmorphia talk about the way they see themselves.
I’m fat. I’m skinny. I’m ugly. My arms are huge. My belly button is gross. My toes are embarrassing. I hate the way I look.
Sure. Many of us have said these things about ourselves before. It’s perfectly normal and common to not like certain things about ourselves. But when it turns into something more, such as an eating disorder, it's beyond difficult to overcome.
I know a few posts ago, I talked about the way the diet worked for the patients with eating disorders on the unit. Just as a refresher, these patients do not get to pick what kind of foods they eat or when they eat them or how long they have to consume them. Their calorie intake is determined based on their current weight and height and what their goal weight needs to be. Once that is determined, foods of all sorts, usually healthy foods, are picked and made into meals that the patient has no say over. They then have thirty minutes to eat their meals and if it is not finished, they have to finish the remaining calories by consuming them with Ensures. If you’ve never had an Ensure, they’re like thick, gross, protein shakes. Not appetizing at all.
With the story from a few posts ago, she would almost always eat her food within the 30 minute time-frame and would only have to drink the Ensures on occasion. But when someone refuses to eat their food, refuses to drink their ensures, then what? They have to have a nasogastric tube placed and all of the calories are then consumed via the tube.
The NG tubes are long tubes that go into your nose and down into your stomach. Sounds painful, right? Thankfully, I have no what one feels like. However, I do know what it’s like to have to insert one into a child with an eating disorder who refuses to cooperate. Not only is it heartbreaking, but it’s also overwhelming for both the nurse and the patient.
Once she started coming out of her room on day three to start her special diet, she was extremely emotional. She cried during most meals on that first day, but she did eat them. Even the foods she didn’t like.
When day two rolled around, it was a different story. She refused to touch any of the food within the 30 minute time frame at breakfast. Then the patient has 30 minutes to drink the calorie supplement through the Ensures. She refused to do that as well. So, an hour later, with no progress, it was time for the NG tube to be placed so she could have the Ensures that way.
I’m going to stop here and talk about how as a nurse with a patient like this who needs one-on-one attention for the majority of your shift is absolutely exhausting. Usually I had three other patients at least as well as this girl. Needless to say, my other patients did not get much of my attention, if any at all, which was beyond frustrating to not just me, but also to them. I constantly felt behind and annoyed because every single child on that unit needed the care they deserved, and I felt like I could not give it to them when they needed it most because I was with this girl my entire shift.
After thinking about it for awhile, I had to remind myself that I could only do the best I could. And at that time, this girl needed me. She needed someone to be there to support her and help her overcome these demons that she had no idea how to fight.
I learned to delegate as much as I could with my other patients to the other nurses and techs and thankfully, everyone I worked with was so helpful because I could not have done it without them.
So, at this point, I had never done an NG tube insertion on a real person. I had taken them out before, but that’s it. So I had another nurse who had done one before come in and help me. Thankfully, this first attempt, I was successful and the patient was cooperative. She sat up and talked to me while I fed the Ensure via gravity through the tube. About 40 minutes later, we were finished…and then it was time for snack!
See what I mean when I said it was nearly impossible to take care of any other patients except her?!
She refused to eat her snack. 30 minutes later, refused her ensure. 20 minutes later, we were finished feeding via NG…and now it’s lunch time!
It was a brutal, long, exhausting day for us both and I couldn’t stop thinking about how brave this girl must be. To be fighting an eating disorder and then be forced to face it head-on all day, every day while in the hospital. I could not imagine what she was feeling.
I spent a ton of time with this girl over her two month stay with us. I learned that she loved horses, she was crafty, she liked school but not the teachers. I learned that she had an amazing voice, and when I say amazing I mean probably one of the best voices I had ever heard.
It got to the point that she would not eat any food and every meal was given via the NG tube. There were times when she would cry during this and we discovered that playing music for her to sing made it a little less overwhelming.
After awhile, we knew that she needed more care than we could give her. Eating disorders did not get better overnight and she was going to need this long-term intensive care for months. She was going to be flown out of state to an eating disorder residential facility for teenage girls. She was hopeful about this, but I could see the nerves piling up the day before she was leaving.
I think that kids adapt quickly. They take in their environments and are attuned to everything going on around them at all times. They adjust to the fears and anxieties and unpredictability, even if not always in a positive way.
I think that although she had only been on the unit for two months (which was a long time on an inpatient unit), she had grown used to the routine, the people, the predictability. She was scared to leave and I didn’t blame her. I couldn’t imagine being a 16-year-old girl who was struggling so severely and about to fly across the country for months of treatment.
After lunch, which she refused to eat or drink on day, it was time for another NG tube. Once we placed one, they could stay in for a short time, but they did have to be cleaned and replaced. Hers was due to be replaced that meal. Once we walked into the room where we did the NG feedings, she ripped out the tubing on her own and started screaming.
I had seen her cry. I had talked her through panic attacks. I hugged her while she talked about how much she hated herself. But I had never seen her like this.
I had to call for assistance from other staff and when others came into the room to help me, she started to scream and kick to the point of having to be restrained to the bed. She had never had to be restrained before. She then refused to let me place the NG tube and had to be held while I placed it. I had never felt so conflicted.
Was this the right thing to do? Hold down this poor child to insert this tube into her nose and down into her stomach to force feed her?
She would have died otherwise.
But I hated it.
I turned on my phone and started playing Taylor Swift and she instantly started singing through the screams and tears. I held her hand as she cried and sang. She slowly started to catch her breath and her amazing voice took over. She sang while the rest of the ensure dripped down through the clear and orange tube. She kept her eyes closed, but she squeezed my hand as she sung and I felt like I could take a breath for the first time that shift.
She needed to go to that facility. She needed this help.
I have so many people ask me how I do this job; how I could work in mental health for so long without going crazy or without crying every day.
But this is why.
This girl will get to keep singing; her ability to push through the intrusive thoughts in her mind that took her down this long and difficult road of anorexia was astounding. The fight she had left to move forward. The will to live in spite of the thoughts of wanting to die.
People amaze me. Every single day. I see so many people just like this girl who have to fight harder than anything to just make it through another minute, another hour.
That’s my why; why I do this job and why I love it. Because I love seeing people’s strength and ability to be, in spite of their mind telling them to stop fighting.
I wonder if this girl is doing okay and if she made it through the program successfully. I hope wherever she is now, that she is singing her heart out.