Nursing Voices

Friday, September 29, 2006

Dying to be Beautiful

Margie from admitting was on the phone. Her usual bright and bubbly phone voice was subdued. My new patient was down stairs ready to be picked up and she added with a whisper to bring a wheelchair. This girl was in bad shape. Her name was Lisa.

I grabbed a wheelchair out of the hall and scurried down to admitting. Lisa was waiting for me with her parents in a side office. She weighed just over 80 pounds and looked like a refuge from a concentration camp. She was weak. The muscles in her neck could hardly hold her head up. Her face was ashen . Her legs were swollen and red. Her blond hair was dry, brittle, and falling out. She could hardly speak. After signing voluntary admission papers for the psychiatric unit, I took her up stairs to her room.

Lisa typifies so many young women in this country who starve themselves to be beautiful. What is anorexia? Simply put it is the refusal to maintain a body weight at or above a minimally normal weight for age and height. There is an intense fear of gaining weight or becoming fat even though the person is under weight. How common is anorexia? There are many idea about that, but no one really knows for sure. It’s prevalence in the United States is around 0.1%to 0.6% in the general population and several times higher in adolescent girls. In this country women are getting heavier each generation while the concept of beauty is getting slimmer. More than half of American women say they are on a diet. In recent surveys of 5th to 8th grade girls, 31% said they were on a diet, 9% said they had sometimes fasted, and 5% had deliberately induced vomiting.

Lisa was more than a statistic. I was new to the psychiatric nursing field and she was my first anorexic patient. Why did this happen to her? Lisa was the only child of highly educated parents that were both highly respected professionals in the community. They treasured her. She had majored in the arts and was on her way to a highly successful career. She had everything to live for - and she was dying.

I worked with Lisa for 2 years. Her disease even baffled her. She wanted to be “normal” again. She didn’t know how she had become sick. She would look at her frail body in the mirror and see rolls of fat hanging off of her withering frame. I remember her saying “I just want to be beautiful”. Her parents felt guilty. She felt ashamed. We worked with the entire family. She would reach 98 pounds, and be discharged. After a month or two she would come back to us, weaker and more depressed then ever. This was her cycle until she died of a cardiac arrest in her sleep.

Lisa gave me insight on caring for patients with anorexia. She and I took our victories where we could. Instead of allowing her to focus on her guilt, for not gaining enough weight to meet her goal, we would celebrate the six ounces she did gain by taking a short walk around the block. We would take this private time to focus on the future,discussing what she wanted for herself. This was how I got her to focus on living another day. When she met her goal we really celebrated. I kept two plastic champagne party cup in the nurses station and we would toast her triumph with Perrier water, her favorite.

The use of visualization worked well at times. I would assist Lisa by aiding her with progressive relation techniques and then have her visualize her body as healthy again. She would tell me later that during those sessions she could feel her physical and emotional energies recharging themselves. Because Lisa found this technique to be useful, I continue to use it with all my anorexic patients.

During Lisa’s illness her parents were fighting two battles - the anorexia and their insurance company. The treatment of anorexia is a long and expensive one. Their insurance company threatened to cut off paying for Lisa’s care. I went to the hospital’s utilization review coordinator to see what the insurance companies target in the nursing notes that would determine the status of a claim. These are points I address in all my care plans. This points assure good patient care, and help patients and their family members when dealing with their insurance company. All entries must show in a measurable way the success or failure of the patient’s treatment. Calorie counts and daily weights are done accurately and documented. Any quotes the patient gives during therapy can be important especially if the patient is depressed and suicidal. Monitoring the patients medical condition including vitals every shift, intake and output, observe for signs of infection, and for any signs of stress fractures or organ failure. All patient and family teaching done must be documented in detail.

I was Lisa’s nurse, but she was my teacher. I keep her alive in my heart by using what I learned from her to help others.


Blogger Sid Schwab said...

It's a tragic and mystifying condition. This post provides mucdh insight.

11:25 PM  
Blogger Julie, RN said...

Thank you for sharing that story. You go the extra mile, and I think that is wonderful.

1:34 AM  
Anonymous may said...

that is so sad.

by the way, welcome to the nursing voices :)

7:31 PM  
Blogger mother jones said...

Hi Sid, it is a tragic condition. Thank you for your kind words about my post.

Julie RN. Thank you for stopping by. I love your blog, and I put you on my blogroll.

May: Thanks for welcoming me aboard Nursing Voices.

10:13 PM  
Blogger MadMike said...

This was a real eye opener. What a devastating condition. While I had certainly read about it I don't think I really knew about it. Thanks MJ!

5:55 PM  
Blogger Birdy said...

I just hate that disease. It's such a shame that, during the Terry Schaivo ordeal, very little media attention was given to eating disorders--the condition that stopped her heart and caused the PVS.

5:19 PM  
Blogger Prisca said...

Oh my...this is so sad. You were just wonderful with Lisa and I commend you for that!

What a horrible disease.

5:56 PM  
Blogger MandyHamm said...

I keep re-reading this post; it is a sad and mystifying disease; but as long as there are nurses out there like you to provide hope, hopefully this pt will see there ARE people out there who care and want her better; by the way, when's your next post? You have gotten me hooked!

Hope to hear from you soon,

11:51 AM  
Blogger Dr Dork said...

A very sad topic. As I recall, eating/body image disorders, especially anorexia nervosa, have by far the highest mortality rate of any psychiatric condition. I might be wrong, but I seem to think it was a 20-25% likelihood of death as a consequence of the illness. Pretty disturbing, especially in light of the typical patient profile.

In Oz, our supposedly comprehensive public healthcare system has no facilities to treat eating disorders. If you have private insurance, there are excellent programs and inpatient clinics available. If not...tough luck.

Thanks for such a poignant and heartfelt posting.

6:49 AM  
Anonymous Rob said...

Well done.

I care for several anorexic and several bulimic patients. While it seems so simple for them to just eat more, there is this incredible urge to lose weight. It is very similar to addictions to drugs, alcohol, gambling, etc. People know they are harming themselves, but some underlying emotion is driving them to this behavior.

I have become convinced that it is an issue of control. They feel out of control in other areas in their lives and want to control it in this one area. It gives them a sense of order in an otherwise disordered life.

Unfortunately, the anxiety is not changed by knowing the right things. If there is recovery, it is a long and slow road. One of my ladies with this is in a very abusive relationship, so until she gets out of it, she will always go back to her harmful behavior.

Hats off to you. It takes someone to show patience and longsuffering beside them to give them a chance. Most people don't have that kind of help.


3:02 PM  
Anonymous emmy said...

My mother was anorexic and I agree that it is totally an issue of control, but the sad thing is that they are really out of control. My mother used to say "I'd eat if I could, but I just can't." It has taken my sisters and I the rest of our adult lives to re-learn how to eat healthy. I'm glad that Lisa at least had your compassion.

8:50 AM  
Anonymous Kim said...

Wow - my interest in psychiatric nursing began with eating disorders. I would have worked with them exclusively but the specialized unit closed down before I was able to work there.

The disease (and body dysmorphic disorder) has always fascinated me; still does.

I"m sorry to hear Lisa died - I was hoping for a different ending to this story : (

6:25 PM  
Anonymous George said...

Intense! I am impressed not just by the way you write but also the way you think and work. Lisa is truly a teacher who had a loving and caring confidante!

Thank you!

6:25 AM  
Blogger Grabi said...

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9:53 AM  

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