Lost in the Mirror by Richard A. Moskovitz

Author:Richard A. Moskovitz
Language: eng
Format: epub
Publisher: Taylor Trade Publishing
Published: 2001-01-15T00:00:00+00:00

My next meeting with Sara was in a hospital room reminiscent of our first encounter. Instead of the vibrant and engaging woman I first met, however, this time I found her frail and haggard. She was dressed in a plain hospital gown, her hair pulled back to make way for an oxygen mask that covered her nose and mouth. An intravenous line was in place just beneath her collarbone. A clear plastic feeding tube dangled from her nose beneath the mask. She could barely speak.

“How could you let this happen to me?” Sara’s first words tore at my heart with an accusation that echoed my own thoughts. I had miscalculated the margin of safety. If not for the prompt response of the rescue team and the efforts of the emergency room crisis team, Sara would have died.

Over the next several days as she regained her strength, Sara took every opportunity to remind me how I had let her down. She used her helpless and pitiful appearance, encumbered with tubes and monitors, to twist the knife deeper. She played on my guilt to try to enlist me as an ally in her efforts to undermine the medical team’s work to restore her to health. She complained bitterly of the nasogastric tube that was bringing her body the nourishment she had so stubbornly shunned. She begged to have it removed.

I resisted the temptation to indulge her plea for rescue and worked with the medical team to establish realistic goals for the acute phase of her recovery. We agreed that she would have to gain at least ten pounds before she could be taken off bedrest and fifteen pounds before the feeding tube could be safely removed. Her internist and I together discussed these criteria with Sara in order to emphasize our agreement about them. Sara was told that she could eat, even with the feeding tube in place. She could therefore influence how quickly these goals were reached.

Once the rules had been clearly defined, Sara relaxed and began to eat. Since she was no longer in control of what went into her body, she was no longer responsible for it either and needed no longer to punish herself. Besides, her brush with death and the treatment itself were punishment enough. She quickly met the medical goals and was transferred to the psychiatric unit. There we followed up promptly with a treatment contract in which various levels of freedom and choice depended on stages of weight gain and her cooperation with the treatment program.

Sara vocally protested her hospital confinement. She argued with most of the staff when it was time for her to attend group therapy or other activities. She begged for extra privileges and became irate when they turned her down. Only one nurse, an energetic woman in her early thirties, escaped her wrath. She was firm and direct with Sara from the start, and Sara quickly stopped testing her limits. When Betty was on duty, Sara felt secure and softened her hostile stance.

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