When I first knew L was ill, she asked me if she would have to go to hospital. I told her that if she didn’t get better at home, of course she would. But the truth is, I had no idea what hospital meant. I imagined hopeless shuffling young women with drips in their arms, with paper thin skin, being tube fed. I had no idea what they would do – if food was the cure, how would hospital food be different? I also thought that if she went in she would learn new tricks from ‘hardened’ inpatients, in the way that prison makes better criminals.
I now know better and thought I would write about the treatment L is receiving, in case there are others out there who think the same. All units are different though, but this is what happens where L is.
She sleeps in a room with four beds, which looks like a residential study centre or boarding school. Each bed has a notice board for pictures and cards. She can take in her own duvet and bedside lamp. She is woken at half past seven and weighed every morning. This is part of Stage 1 refeeding, which applies until she is BMI 16. (She was 14.9 on entry)). She is not told her weight outside her weekly review. She eats breakfast which is milk, cereal and milk plus toast. She has 30 minutes to eat it, at the main table with a nurse and other residents. If she struggles, she moves to a smaller table for one to one support. If she will not eat, she must stay on bed rest until the next meal or snack. Lunch and Tea are essentially the same, both two course meals with the same rules as breakfast, except 10 minutes are allowed for pudding. At Stage 1, L is not allowed meal choices. She can choose three dislikes on admission, but these must not be whole food groups. If she was vegetarian, this would be respected.
After each meal there is a 10 minute ED group to debrief. L seems to really like these. In the hour afterwards, patients are supervised and are not allowed to use the bathroom.
There are also three snacks and L can choose from a list, as well as bringing in foods from home, which are kept for her.
L must have an hour bed rest morning and afternoon. She can take part in some activities and has one to one sessions, but does not undertake the full therapeutic programme as she is too underweight. It is the school holidays, but if it were term time, she would not be allowed to take part in classes until she reaches stage 2.
There are 4 therapy days and 3 rest days. Inpatients are allowed home for short visits of 2-3 hours at the weekend, after they have spent their first full weekend in the unit. There is a full therapy and teaching programme across the four days, along with activities such as dance and relaxation. But L is too ill for those yet.
Once she gets to stage 2 she will be weighed only 3 times a week. She will have some choice at meals and will start a full therapy programme as well as some limited schoolwork. At this stage she can try weekend home visits, but first the staff from the unit will arrange to eat with all of us at home, until L feels confident to eat at home with us.
Stage 3 is when she enters the normal BMI range, but will still need support and therapy. It is hoped she will transfer to the day programme at the same unit and start to plan a course back to school.
All of this will take weeks, possibly months. I just keep thinking and hoping that by Christmas we will be in a different place altogether. A happier and healthier one.