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Story By Little Sunshine, Canada
A Hospital Story Part 2- Julia gets caught!
The staff of the Young Adult Psychiatric Unit was an eclectic bunch. There were the nurses who patrolled the ward in shifts, 24 hours a day, 7 days a week. There were several psychologists and social workers on staff, who ran counselling and group therapy. A psychiatric resident, Jason, was a young redheaded medical student who had been working on the ward for several weeks. There was a dietitian, who monitored the patients’ food intake. Finally the occupational therapist taught life skills such as shopping, cooking and money management. Most were highly experienced, and committed professionals. The head of the staff was Dr. Henry Morgan, the psychiatrist and medical director of the unit. The staff liked and trusted him. They had seen him work minor miracles with some of the most difficult patients.
Each Monday and Wednesday morning, the staff gathered in Dr. Morgan’s private office for Ward rounds. At these meetings they discussed each of the patients in turn. They talked about how the patients were relating to one another, what medications they were on, and other day-to-day details.
Today, they had been discussing (some might say arguing) about how to deal with 22-year-old Julia Quinn. Julia was a quiet, cooperative patient, being treated for severe anorexia. Lately the staff had become worried about her, despite her sweet demeanor.
“She’s been here over two months now and she’s only gained four pounds,” complained Mary, the dietitian. “She’s purging, or ditching her food or something.”
Henry Morgan looked at Mary intently. “I’ve seen no evidence of bulimia in her lab values. I don’t think she vomits,” he said evenly.
“Well, she’s getting rid of it somehow. We’ve got her on 2300 calories a day, we should be seeing more of a gain by now.”
Henry nodded. “We’ll have to watch her more closely.”
Julia’s primary therapist, a social worker named Jeff, spoke up. “What about the bedwetting? In the last week she’s woken up with wet pants at least four times. I’m wondering what’s causing it. The poor kid is really upset by it.”
The staff debated several causes. Could it be the stress? It wasn’t unusual for youngsters to regress when they were hospitalised, due to the tension of being in treatment. Another possibility was that Julia’s system was not used to all the fluids she took in during her meals. One psychologist suggested that Julia was wetting deliberately to gain attention, but most of the staff disagreed. No one who had witnessed Julia’s anguished face as she confessed an accident could believe that they were deliberate.
“I think she’s water-loading,” said Jason, with a smirk on his face. Henry Morgan didn’t care for Jason, the new resident on the unit. The young man was smart and skillful, but always seemed to expect the worst from patients. Water loading occurred when one of the eating disorder patients deliberately drank excessive amounts of fluid to temporarily boost her weight, faking weight gain to fool the staff.
“What makes you suspect water-loading, Jason?” asked Henry.
“She fills up on water before bed, because she knows she gets weighed in the morning. She wants to trick us so that we don’t figure out she’s purging her meals. But she drinks so much water that she can’t hold it all and ends up peeing in her pants.” said Jason, crossing his arms and smiling.
Privately, Henry doubted this theory. He had seen first hand how humiliated Julia felt by her nighttime accidents. However, he couldn’t deny that it was a logical possibility.
“All right then, we’ll weigh her after breakfast from now on. It won’t be as accurate as first thing in the morning, but it will dissuade her from water loading, if that’s the problem.”
The meeting ended, and the staff left Dr. Morgan’s office and went back to their various spaces on the unit. Henry was left alone with his thoughts. He personally believed that it was the stress of hospitalisation that was causing Julia’s bedwetting. She was such a sensitive girl who took everything to heart. In any case, it certainly wasn’t the end of the world. If it continued, he would suggest that the nurses put her in absorbent underpants. At least that could make her more comfortable, and allow her to wake up in a dry bed. He was more concerned about her lack of weight gain. For her own safety it was imperative that restore much needed body mass. It was entirely possible that she was vomiting her meals secretly somehow, or perhaps hiding her food. The anorexic girls were often so desperate to avoid the dreaded weight gain that they would resort to almost anything. He resolved to observe her more closely.
That day during the lunch hour, Dr. Morgan strolled through the ward, keeping a particular watch on Julia. The regular psychiatric patients were allowed to eat their lunch anywhere they chose, and were free to not finish items, or to save things for later. Their caloric intake was not normally a concern. Everything was different for the eating disordered girls. They ate in a special corner of the ward, with a nurse watching every bite. Their portions were strictly regulated and measured, and their meals specially balanced by the dietitian. Any food not eaten was replaced with Ensure, a high calorie, and nutritional milkshake. The girls loathed Ensure for it's high fat content, and tried to avoid it at all costs. They often had to drink it, however, because eating regular portions of solid food was too challenging.
Henry watched Julia amongst the other girls, out of the corner of his eye. She stood out as being the tiniest in the group. With her mass of rumpled, dark hair and bony frame, she looked extremely frail. However, she was also the cheeriest, joking with the nurses and speaking kindly and encouragingly to the other girls. She was somewhat of a favourite amongst the patients, and many a time Henry had seen her talking earnestly to other girls. “Shelly, you know you need this nutrition to get well,” she was saying pleasantly to another, blonde girl. “Just try a tiny bite, it’s not so bad, you’ll see.” Although she was funny and charming, today, Henry noticed how distracting her behaviour was. He tried to observe whether she was eating, but it was difficult. Julia was constantly moving: fiddling with her napkin, taking small bites, wiping her mouth, toying with her cutlery. She was doing so many different things at once. He also noticed that she had positioned herself at the corner of the table, where it was most difficult to watch her. Julia didn’t finish her lunch, so the nurse portioned out a cup of vanilla Ensure for her. Henry didn’t watch her drink it, as he was distracted when speaking to another patient. When he looked up, Julia was up and smiling, walking rapidly away from the table back to her room.
“Julia,” he called out. She stopped and looked at him, questioningly. “Come here please.” He noticed that she hesitated. However, after a moment’s pause, she obediently turned and walked towards him. He noted how much clothing she was wearing. Thick white sweatpants, and a heavy, black hooded sweater with a zipper over another long sleeved shirt. These clothes hid her bony frame. It also occurred to Dr. Morgan that they were capable of hiding an awful lot of food.
“Good afternoon Lassie,” he said pleasantly. “How are you today?”
She smiled brightly. “I’m fine thank you,” she said. “Are you having a good day Dr. Morgan?”
“As a matter of fact I am, my dear. Now, I just need to take a moment and give you a bit of a check.”
Julia unconsciously took a step backward.
“What do you mean?” she asked, her smile fading slightly.
“Sometimes we need to check our girls after meals, to make sure they aren’t playing any little tricks. It will just take a moment."
Julia turned on her heel and said cheerfully, “Okay, just a minute, I want to go and get something…”
Dr. Morgan reached out and gently held her arm, pulling her towards the table where she had eaten. “I’m afraid not my little friend.” Holding her hand, he sat down at the table. He stood the thin girl in front of him, turning her around to face him, and then began gently patting her, checking for suspicious lumps. Sure enough, he heard a crackling in her sleeve. He reached inside it, and pulled out a full Nutrigrain bar, still in the wrapper.
“Oh Julia,” he said, in a tone of such grave disappointment that her green eyes immediately filled with tears.
He continued his gentle inspection. In the pockets of her sweater he found soggy bundles of napkin, stuffed with the chicken and potatoes she was supposed to have eaten for lunch. He also found a sealed container of juice hidden in the hood of the sweater, and a package of cheese and crackers in her sleeve. When he touched the seat of her thick pants, his face became concerned. They were cold and soggy to the touch. She had wet her pants. Had she wet herself in panic as he checked for hidden food? He looked up and realised that everyone on the unit had turned to look at the two of them. Julia now had tears streaming down her thin cheeks. At this point, he realised he would need to examine her in private. He stood and led Julia by the hand into the unit’s examining room. Once there, he lifted her gently up onto the table. “Up we go, my dear,” he said quietly. “We had a little accident, did we?” She said nothing.
He took a closer look at her pants. They were soaked from the waistband to the knees. There was a familiar odour in the air. Suddenly Henry realised that it was not urine he was smelling, but Ensure. The little monkey had poured her Ensure in her lap to avoid drinking it. The white pants had soaked up the cream-coloured Ensure quite well. He wouldn’t have suspected, if he hadn’t felt how soaked she was.
Henry looked at Julia. She was a pitiful sight. The long sleeved, blue shirt that she had been wearing under her sweater was stained with food, which had leaked onto the material. Her face was tear-streaked, and her she sat in a spreading circle of Ensure, which was dampening the examining table. His mind raced. How long had she been hiding her food? Possibly since the beginning. He was angry with himself for not watching her more closely. She had a private bathroom in her room which she had been allowed to use unsupervised. Most likely she had been disposing of her food by putting it down the toilet or the drain. She could be vomiting, too, for all he knew.
He knew he should be angry with her, but he had such a soft spot for her that he really couldn’t manage it. The poor girl was handling the situation the best she knew how. She was as good a girl as she could be, but her phobia of weight gain maked her to reject as much nutrition as she could. If anything, he felt more affection for the child. However, Henry knew he must be stern with her. He mustered up his most severe expression.
“Well, what have you got to say for yourself Missy? Hmm? I never saw such a mess. My goodness. You've soaked your pants with your Ensure, I see, instead of drinking it. And what about the food in the pockets? Did you put that there?"
“Do you know that’s against the rules?”
She nodded again, looking miserable.
“I don’t make rules on my unit for little girls to break. You know you’re supposed to eat all of your meals. You need this food to get well, child.”
Julia looked up at him with tear filled eyes. “I know I shouldn’t have done it, please don’t be angry. I just couldn’t eat it, it was too much!”
Dr. Morgan kept his face stern. If he was lenient with her, all it would show her is that he wasn't strong enough to win against her anorexia. He knew that he must not lose this battle. It was for her own good.
“Lassie, you aren’t capable of deciding what is a proper amount of food. If you knew how to eat, you wouldn’t be in the hospital in the first place, would you?”
She shook her head wordlessly.
“Well, then, let’s get you cleaned up.” He gently slid off the sodden pants, and pulled the other filthy shirt over her head. She looked painfully thin and ill as she sat on the table in only her underpants and undershirt. With concern for her modesty, he left the room briefly, to allow her to sponge the Ensure off her legs and change into fresh clothes. When he returned to the room, she had changed into a clean hospital gown, and sat on the examining table, her thin legs dangling. Her eyes widened as she saw what he held in his hands as he came back into the room.
Dr. Morgan seated himself in a chair and beckoned her towards him.
“There are going to be some changes around here, I’m afraid, Lassie. We can’t continue to let you make yourself sick, can we? So for now, love, you haven’t got bathroom privileges.”
Julia spoke in an alarmed voice. “No, please, Dr. Morgan. I don’t want to wear those…” Her eyes were fixed on the white garment he held in his hand. It was a pair of underpants, but they were thick and artificial looking. Anyone could see they were absorbent. Anyone could see they were…
“Diapers. I’m afraid so, my dear. There’s too much temptation for you in a bathroom. You’ve proven that you can’t be left alone. I don’t want you vomiting your meals, or taking pills, or disposing of the food you’ve been squirreling away in your pockets.”
As he spoke, he pulled him towards him and guided her as she stepped into the pants He pulled them up until the fit snugly around her waist. He patted her now padded bottom, which rustled babyishly under the hospital gown. “Now, now, lass, it’s nothing to fret about. You just have to let us look after you.”
“But I’m not a baby…” she said despairingly.
“I know you're not,” he said comfortingly. But you acted like one today, didn't you? You know better than to put food in your pockets and pour Ensure on your clothes. You didn't give me any choice, love. When you show me you can't keep yourself safe, then I will step in and do whatever it takes. This way you won’t be tempted to break any rules when you’re alone in the bathroom. And, Lassie, if you have any more accidents in your sleep you’ll be much more comfortable."
Julia said nothing. She reached for the door handle. Then she stopped. She looked up at Dr. Morgan and reached out to him for comfort. He bent and hugged her thin frame, stroking her hair and murmuring soothing words. “There, there child. There’s nothing to worry about. I know you don't like any of this. But it's for your own good, dear."
To be continued…
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