Me vs. The Cookie

Today I went to the internist for a follow-up ultrasound, scheduled after the results of last week’s blood work indicated high liver something or other. During my initial visit, the internist (or, rather, her staff) performed an EKG and drew blood for tests. All patients here undergo this regimen at least once, primarily to make sure that they're not only still alive, but that they'll probably be for awhile longer. No big deal. However, my liver whispered funny things to the blood they drew, so today's abdominal scan was scheduled. Afterwards, the doctor reviewed the glamour shots and told me that they looked good. (Score.) Even so, she ordered more blood work for additional tests, and I hesitantly offered my right arm to the Transylvanian technician. Despite my aversion to the needle and to watching my blood leave my body, no big deal.

The big deal came later at lunch. I missed breakfast at the eating disorder center because the abdominal ultrasound came with a don't-eat/drink-after-midnight prerequisite. We eat breakfast together at 8:30 a.m., but my appointment was set for 9:30 a.m. I agreed to eat something immediately afterwards, and I did, meeting all the requirements in the breakfast block of my meal plan. Then I chugged the first of two daily supplements (Ensure Plus or something similar). This was around 10:45, with our 12:00 p.m. lunch already peeking out from behind the shrubs. By the time it was in full view and approaching, I hadn't managed to generate enough hunger to meet it with a smile. (Note: Anorexics aren't usually all that open to meals anyway.)

But, I had to eat lunch - you know, meal plan and all. Today's fare was a boxed lunch from Honey Baked Ham. The nutritionist chose my order, since I was probably wiping away ultrasound goo when she asked the others for theirs. She understands me well enough to know that I prefer turkey to ham, and I’m fortunate enough to have a nutritionist who doesn’t feel the urge to screw with me. So, a turkey sandwich it was, with baked lays and a chocolate chip cookie, both of which were part of the box deal.

First thought: Do they not offer a wheat bun option?

When I asked aloud, the nutritionist said no.

Second thought: If I eat the entire lunch, I'll exceed the lunch requirements in my meal plan by a couple of exchanges (1 grain and 1 fat, to be all too specific). Sooo...maybe I'll forgo the cookie (the major culprit and an item I cut out of my life a long time ago) and meet the requirement-compliant portion of it with something else containing much less sugar (something I all but eliminated from my life long ago).

Third thought: Eat the damn cookie! Your weight-gain meal plan is a minimum, and the treatment team encourages you to exceed it. They've suggested milkshakes, for crying out loud! Stop treating the plan as a maximum. You'll gain weight faster and get out of here faster. What's your freaking deal!?

I decided to eat the cookie - last, as dessert. After all, it would give me some of my daily energy requirements and, if I stuck to the meal plan without compensating for the additional exchanges later in the day, might help me gain weight faster - highly recommended by the treatment team. Besides, it's just a cookie.

Fourth thought (after eating the sandwich and chips): The cookie. You know, you've already met your grain requirements for the lunch block and are only missing 1 fat. Why not just eat a few almonds to get that in? It feels like you just ate breakfast moments ago, anyway.

I decided to eat the almonds and "save" the tightly wrapped cookie for another meal or snack (another's meal or snack, if lucky). But, the nutritionist noticed me rummaging the cabinets in search of the almonds, and probably noticed how I guardedly doled out the too-precise quantity with my back facing her.

"Whatcha looking for, Justin?"

"Oh, I found them. I was just getting some almonds."

She didn't reply, but we've had cookie discussions before and my cookie was still in the wrapper.

After downing the “better” fat exchange and taking my seat at the table again, she asked, "Where's your caloric drink?" 

Those of us on weight-gain meal plans are required to have a caloric drink - such as milk or juice - with meals and snacks. These caloric beverages can count toward meal plan requirements - e.g., a cup of milk (soy included) counts as a dairy exchange and half a cup of fruit juice counts as a fruit. Until this moment, I had been drinking water with meals that already met dairy and fruit requirements with solid food - like cheese or actual fruit. I figured such an exception was allowed, but, really, I always wondered if I should ask to be sure. Apparently it's not.

"I had cheese on my sandwich and ate an apple, so I got those in."

"The caloric drink can count towards your exchanges, but, regardless, you're supposed to have one at each meal."

Fifth thought: So, you've essentially just dictated how I'll get my dairies and fruits for the supervised meals and snacks I have to eat here – breakfast, lunch, and afternoon snack.

I didn't argue and poured a cup of soy milk.

Sixth thought: I can always compensate for the additional exchange at the unsupervised dinner or late-night snack.

Later, when I jokingly mentioned the episode to one of the therapists, she said she knew (i.e., already) that I had avoided the cookie.

Seventh thought: She wasn't there, so the nutritionist must have spread the word like the peanut butter I've been eating so much of here. Conspiracy?

Welcome to the anorexic mind. Enjoy the tour. The John Malkoviches live over there.