the unit

by MIRIAM COHEN

   We sat around a table, each of us with a tray that had our name on it, but first names only, for privacy. Privacy from whom, we didn’t ask. Certainly not from the therapists, psychiatrists, nutritionists, nurses, social workers-in-training who made up, in their words, our “team.” Our trays were filled with individually wrapped everything: slices of bread, slices of deli meat, slices of cheese, graham crackers that came two to a pack, granola bars, little boxes of cereal, miniature cartons of milk, Dannon yogurts in coffee or blueberry or vanilla. Nutritional supplements called Boost in strawberry, vanilla, chocolate and, occasionally, butter pecan. We had thirty minutes. We hid the food we could—cream cheese spread under the table, an energy bar strategically stuck to the bottom of a chair. If we got caught, we lost privileges like smoking or standing up. They called it Unit Restriction and Bed Rest. We called it fucking bullshit. At the end of the meal, a nurse checked each of our trays. She made us scrape yogurt containers until there was nothing left, not even a skid-mark of blueberry, and turn over our milk containers to prove they too were empty. We had to gather up any crumbs.
   They had access to our files. They held daily meetings about each of us, and in those meetings they discussed our daily vital signs, what we ate and when, the time it took us to finish our food, how many ounces of fluid we drank, the medications we were taking, the dosages, side effects, our compliance, or lack thereof, in matters of food, drink and meds. They knew our weights, down to the ounce. We wondered if they were ever jealous, if they ever compared their heights and weights to ours. Especially the social workers, the Jessicas and Kimberlys, with their bouncing ponytails and crisp button-downs tucked into skirts that stopped just shy of the knee. We saw how they crossed their legs when they led us in group therapy—carefully, so as to provide the illusion of orderly, containable thighs. We saw how they looked at themselves when they passed mirrors, windows, doors made of glass.
   Most of them didn’t stick around very long. Our unit was where they went while waiting for something better. So we saw them off to getting fellowships, better jobs, having babies, changing career directions entirely. Who wanted to work with us? The therapists, we imagined, would have preferred the straight-up depressives; the nurses and dieticians had surely hoped for diabetics. Instead, they got us. Occasionally a guy would join our unit, but mostly we were girls—even if we were women in our fifties, we were girls—who were not to be trusted with, among other seemingly-innocent offenders, pockets, batteries, nail polish remover. Because we would hide our food, falsely elevate our weights, try to kill ourselves. We were exhausting, incorrigible, entitled, wastes of everyone’s time.
   While we were there, they tried their darndest to keep us alive, but only because it was their job.

   Sometimes we fell into bragging: Could we wrap our fingers around our biceps? Our ankles? Had we grown any lanugo? How big and how numerous were the clumps of hair we found in the shower? Did we have edema? Were we orthostatic? How low was our body temperature? Heart rate? Did we have osteoporosis, or just osteopenia? Did we need an IV, a feeding tube? Had we ever? How many times had we been hospitalized? For how long? How many calories did we eat at home, how much did we exercise, how often did we weigh ourselves? And, shyly, because this was a question we really weren’t supposed to ask: What was our lowest weight?

   They liked to speak to us in catchphrases, platitudes itching to be embroidered onto pillows. Variety is the spice of life, they’d tell us. Food is fuel. We learned that fat was good for satiation and taste, that our bones needed milk and periods, that food is more appealing when it isn’t all the same color. So, turkey on white bread with a banana and vanilla wafers and milk was out. It should be turkey on whole wheat bread with a red apple and chocolate chip cookies and orange juice. That was better, wasn’t it? Did we see?
   We saw. We weren’t idiots. But we wanted to ask them what world, exactly, they thought we lived in. Because the one in which we would show up at school or work with a brown paper bag filled with this earnest lunch seemed appropriated from a fifties sitcom. Especially when we took into account the lunches we saw our nutritionists themselves eat—a rubbery bagel from the hospital cafeteria, salad with ranch dressing clearly asked for on the side, a paper carton of soup with mushroom-barley sloshed over the edge.

   Cigarettes. Phone calls. Coffee. Walks around the block. These were our privileges. If we were close to discharge, we got day passes. My father called it “being on leave,” as though we were in the army. We would go out into the world for a few hours, slipping off our hospital bracelets, attempting to pass for sane. We would go out into the world with a specific task: eat a sandwich in a restaurant. Maybe we really would go into the restaurant, order the sandwich off the menu in a too-soft voice, spread a napkin over our laps and eat it. Or half the sandwich. Or the whole thing, plus chips—but then we’d throw it up. Or we wouldn’t go into the restaurant at all, and instead we’d buy a cup of black coffee and feel our hearts skitter up against our ribcages. It was always a relief to come back. To come home, we said, by mistake.

   In psychotherapy group, we rated our feelings on a chart of 1-10. We were never a 10. We were 2s and 3s and crying and shaking our legs to burn calories, sitting up straight as rods to burn calories, counting the calories we’d eaten so far, knowing we couldn’t burn them all, couldn’t get even close, but as soon as we were discharged—then we would. We talked about our fear of the unknown, which was really just our fear of how many calories were in the piece of pie with its mandatory whipped cream we were going to eat during one of our three snacks as a “challenge” food.
   There was something they were trying to get out of us. They wanted us to talk about something real. But it was hard to think about the lives we’d left behind. It was too much to ask of us. We could give them only this: we were there. That’s where we lived, in the moment of our being there, locked up, shoelace-less, peeing into plastic hats with little lines that measured our urine in cc’s, shitting into commodes. We could talk about that—our shitting—but the therapists didn’t want to hear it. We were constipated, they got it. Enough already. But it was never enough for us. We could talk about shitting all day, if they’d let us.
   The attending physician prescribed Metamucil and Colace.

   A good anorexic is a dead anorexic, our therapists liked to tell us, meaningful eyebrows raised. We widened our eyes and tried to look chastened, but really, we always took it the wrong way. They meant to scare us, but we saw it as a criticism, proof of our failure to be true anorexics. We weren’t thin enough. Our heartbeats were too steady, our nail beds too pink, our bones not imminently apt to crumble.
   Still, anorexic was the best thing to be. Bulimic was the worst. We felt sorry for the bulimics, with their ruined teeth, swollen cheeks and average bodies. “It’s much harder to be an anorectic than it is to be a bulimic,” my always-on-a-diet mother said one evening during visiting hours. “Yeah,” my brother said. “We’re so proud of you.” My brother and I laughed, but our mother, her voice thinning to a whistle, said, “That’s not really what I meant!” Her use of the word “anorectic” showed she’d been studying up. Regular people might call us “anorexics” but she knew “anorexic” to be an adjective. “Anorectic” was the true and rightful noun. We were embarrassed for her.

   Heather had a dual diagnosis. She was bulimic and also an alcoholic. One day, her boyfriend came to visit her and she went down on him in the day room. Liz's children, ages 4 and 7, walked in on them. The fact of the children was what made the story so wonderful. Without them, the story was a different one. Take out the children, and it was hard to tell why we all felt so surely, so smugly, that what Heather had done was wrong. Heather got transferred to the substance abuse unit, and sometimes she'd wave to us from her new window when we were out on smoke breaks. We waited in a line for the Kimberly or Jessica to light us up.

   We were woken at 6am by nurses aids, who were the nicest, most likely because they only spent this early morning time with us, when we were too groggy to rage or cry. We would put on paper gowns that gaped open in the back. We held the paper tightly to ourselves, a last-ditch effort at dignity. In the weight room, we had to let go of the back of the gown so the nurse could check us for objects we might have taped to ourselves in an effort to trick their scales. Here’s what the nurses didn’t understand: we were never tricking them. It was never personal, though they always acted as though it were. Our thinness was like a piece of art, or a newborn child: that precious, that hard-won and spectacular.
   Of course we tried to protect it.
   During our intake interviews, there were forms for us to fill out. One of the forms asked that we finish the sentence “I am…” Most of us couldn’t think of an answer, and we left that one blank. Our minds moved slowly, as if underwater, thoughts rippling to the surface and then sinking back into the murk. And our mothers—because it was most often our mothers who brought us there—seeing us fail to answer that question, would lean over and hiss, “I can’t believe how sick you are.” But a few of us came up with good answers: I am blond; I am female; I am fucking pissed off.
   Our thinness was the true rest of that sentence. To take that away from us was outrageous. No. It was cruel. And so we cried and raged and they called us manipulative, non-compliant. They weighed us backward, and if we cut ourselves, they also checked our bodies for fresh wounds, running their hands over our old scars like scanners at the airport. Efficient, disinterested.

   If this hospitalization were our first, we might get visitors every night, and those visitors might include our parents, our siblings, our grandparents, our friends (if this were our first, we probably still had friends). They’d bring gifts like flowers, but in plastic vases so we couldn’t kill ourselves. They weren’t allowed to bring us food. But greeting cards, yes. We’d line our rooms with all the cards we received, each cheering us on, in various fonts, to Get Well Soon!!
   If this hospitalization was not the first, but rather the third or fifth or eighth, we definitely wouldn’t get flowers, but we might still get cards. Only those cards would have a different tone. Those Get Well Soon!!s would start to sound more like commands. If we didn’t have visitors—if we were lost causes—we would watch Jeopardy!. “Alex Trebek is my visitor tonight,” we’d say. We’d watch and we’d knit and call out answers in the form of questions. “Hey, you’re pretty good at that,” someone’s father was bound to say.

   When we said we felt fat, they said, “Fat is not a feeling.” They gave us worksheets. What did we really mean, they asked us, when we said “fat”? They gave us options: lonely, scared, angry, and also a few sophisticated suggestions, like maudlin and melancholy. We were to check a feeling off, circle the space around a feeling, fill in a blank. “There,” the Jessica or Kimberly would say. “Very good. So just remember, when you say you're feeling fat, it's actually, okay, in this case...maudlin!”
   Maudlin!
   Yippee!
   They couldn't help the way they spoke. They'd been trained, and we were crazy. Because how could we—really, how?—look in the mirror and see anything but our grotesquerie? Our Halloween-skeleton bodies? Our sallow skin, our bulging eyes and sharp, sunken faces, making us look angrier than we really were. Or maybe, we would think, years later, looking at old pictures, remembering this time, exactly as angry as we really were.
   But fat was a feeling in the most elemental sense. We felt it with our reptilian brains, in the dumb, animal tongue of the body, sharp as hunger or thirst. They pointed to our bones and if that didn't work, our BMIs, and even if we saw the bones, understood their charts, we also still felt the fat, the phantom limb of fat, pale and softly quivering, a mound of risen dough just before it's punched.

   Dr. Katz was our favorite psychiatrist. He told us all we were fat. I'm fat, we'd tell him, and he'd say, “Yeah, you're quite the cow.” “Then don't make us keep gaining weight,” we'd say, victorious, but also ducking our heads to hide our smiles. “I gotta,” he'd say. “Gotta get that BMI closer to normal.” We scowled, crossed our arms. “Then why'd you say we were fat?” It almost felt like we were flirting with him. Like we were, or could be, eyelash-batting coquettes who knew how to have fun. Phat with a ph, he'd say. He had two daughters, and he told us he had beds on reserve for them both. He'd written a book for parents called You Are Not to Blame.

   When we’d gained enough weight or our insurance ran out, we were discharged. We made each other goodbye cards with glitter during art therapy. We said we were glad to be leaving, thank goodness we were done with all that. We said we were counting down the minutes, and never that we were afraid. We promised to keep in touch, but most of us didn’t. Outside of the hospital, we stopped making sense in each other’s lives.
   We did call each other when there was a death. There was no one in our lives outside who understood what we had lost. “What a waste,” the people we lived with—our parents, roommates, spouses—might say. “She was only thirty.” And they would go on with their day, but we kept remembering: how she used to crochet everyone slippers with animal faces, how wonderful she was at braiding our hair, the way we used to line up for her. “Which one of you lugnuts is next?” she used to say. We remembered her sitting hunched over in the day room after meals, knees pulled up to her chin, hairy stringy around her shoulders. She was not to be touched. We remembered her name.
   Sometimes we’d have a dream about our dead, and we’d wake up sweating. The dead person would say, “I didn’t die! I don’t know why you thought I did.”
   And we’d say, “Oh, good. But please be careful. Please take care of yourself.”
   We tried, some of us, to meet up for coffee. We missed each other. “Do you remember ‘Variety is the spice of life?’” we said, when we got together. And, “‘Fat is not a feeling!’”
   We stirred and drank our coffee and said wasn’t it great that we could use as much Splenda as we wanted now, how the particular joy of unlimited Splenda was one no regular person could ever understand.
   And then we didn’t have anything else to say.

Miriam Cohen’s fiction has appeared in The Black Warrior Review, StoryQuarterly, West Branch Wired, Cream City Review, The Florida Review, DIAGRAM, Carve Magazine, Cimarron Review, The Collagist, Bennington Review and Joyland. Her fiction placed first in a Black Warrior Review fiction contest and has also placed in contests from StoryQuarterly, The Florida Review and Joyland. The recipient of a Carol Houck Smith Fiction fellowship at the Wisconsin Institute for Creative Writing, she received her MFA from Sarah Lawrence College.