By Jennifer Hutchison
Nancy lowered her head over the toilet bowl, forced herself to throw up again. She couldn’t stay in the bathroom much longer. Bubble Guppies would soon be over. The rest of the cookies, chips, crackers, and granola bars that she had inhaled in an anxiety-fueled rush hit the water, spraying droplets over her face. What was she doing to herself?
There was frantic pounding at the door. Cal’s high-pitched voice. “Mama…I gotta go pee!”
“Okay,” she croaked. “I’ll be done in a sec.” She swatted at the stringy ropes of puke that clung to her lips and hair.
“I really has to go!”
Nancy flushed the toilet and bolted upright, nearly passing out. A glance at the mirror revealed a pale, middle-aged face dotted with red points where blood vessels had burst. God, she had exerted herself too hard again. Plus, the white of her left eye was even redder than yesterday. She looked like a character from one of those zombie shows on TV.
She quickly brushed her teeth, buried her face in the soft folds of the bath towel. As she opened the door, she felt a pang of guilt at the sight of her three-year-old, holding himself and jogging on the spot. What kind of mother was she? She kissed him on the head and moved to the kitchen to drink a glass of cold water.
She couldn’t let Jeff find out about the bulimia that had re-emerged from a distant, adolescent past. He knew about the OCD, of course. Although he would never admit it was the reason he’d left her, he’d had enough. She’d watched herself through his eyes as she descended from a competent, happy magazine writer, lover, and mom into someone else. Someone who would turn an outing into an ordeal, even before leaving the house. Checking the stove, checking the windows, checking the locks. Checking. Checking. Checking. Sometimes, Jeff would have to physically lift her into his arms and force her out the door. Medication had improved things. Enough to convince Jeff that she should have primary custody of Cal. But she had been sliding lately. Her OCD had been getting worse—now she was fixated with her face. Any flaw, mark, spot literally consumed her, not just in the mirror, but in her thoughts. According to her psychiatrist, she needed cognitive behavioural therapy, which he didn’t provide. Over ten months ago, he had put Nancy on a waiting list for therapy covered by government insurance. It was a long wait, but she couldn’t afford the two hundred dollars an hour for a private psychologist. This Monday she would finally have her first appointment. A lot was riding on it.
Cal ran into the kitchen, his Batman underwear scrunched awkwardly in the waistband of his shorts. “Mama, I had a poo, too!”
Nancy smiled. God, he brought her so much joy.
Sunday morning Nancy plunked Cal on the couch with his favourite blanket and a Sponge Bob DVD. He’d be out in seconds; he’d exhausted himself in the park. When she’d said it was time to leave, he’d refused to budge from the swing, his face red, his legs unbending. His screams and her hellish thoughts had competed feverishly for attention. She’d snapped, drawing a pronounced frown from a woman close by.
In the kitchen she heated up some leftover coffee. Normally, she would make a fresh pot, but now things were just too tight. She had to return to work. She’d been off since Cal was born. Margaret, her ex-boss, had told her she was welcome back anytime, but that was before she got sick. How could she even conceive of working when she was such a mess? She took her coffee to the living room and looked at her son, fully asleep, blanket clutched in his tiny fist. Tears burned her eyelids. How could she be the parent she needed to be? The parent she wanted to be?
Despite herself, Nancy wandered into the washroom and examined her face. The brown spots were browner, the acne scars deeper, the wrinkles more profound than the day before. She looked close up, then stepped back, then close up again. Close up, back, close up. Repeat. Her heart sank and tears welled when she heard Cal calling her name and an hour and ten minutes had passed.
“God, Nance, I feel so awful about this crap you are putting yourself through,” Trish said as Nancy opened the door.
Nancy’s stomach lurched. Jeff used to say that. “I’m not putting myself through anything, Trish. I have no control over this stuff. It just…I don’t know…it invades me.”
Trish’s eyes softened. “Yeah, I know.” She stepped closer and gave her a tight squeeze. “You’re going to get through this. You’re stronger than you think.” She tilted her head. “Remember when you got all weird after your parents’ divorce? You checked out of reality then, too, as I recall. And you got better.” She stressed the last word as she moved past her into the kitchen.
Nancy laughed, followed her. Same old Trish. “Yes, I ‘checked out,’ as it were…but this time, well, it’s lasting longer and it’s more complicated.”
Trish’s eyes clouded for a second. “I know, sweetie, but you’ll be back to your old self, soon. I promise.” She looked at her watch. “What time is your appointment?”
“Ten o’clock,” Nancy said. “I better go…there’s coffee in the pot and slices of ham in the fridge for sandwiches. Cal gets out at eleven-thirty. He’s excited that you’re picking him up.”
Trish laughed. “I’m excited to hang out with him…did you remember to tell the teacher? I got the full-on inquisition last time.”
“Yeah. Yeah. I told him.” Nancy moved to the door. “Thanks, Trishy. Thanks so much.” She was partway outside when she remembered. “And oh, please make sure Cal has milk at lunch. He’ll ask for apple juice, but don’t give in. Not even when he does that cute pout thing. He needs milk. Okay?”
“O-kay,” Trish said. “Stop being such a worry wart.”
She took a deep breath. If only she could.
Nancy sat in an uncomfortable steel upright chair with faded blue fabric. It was one of three lined up symmetrically against the wall next to the closed office door. To either side stretched an endless hallway of similar doors, mostly closed, with their line of waiting chairs, some filled, some not. This was it—the psych ward. A strange, sickly smell permeated the air. Muted yellows and greens from the sixties adorned the walls, along with pictures of ill-looking people. The one in front of her asked: Do you have one or more of these symptoms?If so, tell your doctor. You could be depressed. What were they thinking when they designed this wing? Didn’t they realize that here, of all places, people needed cheering up?
A girl in her late teens was sitting directly opposite, waiting for her door to open. She didn’t look crazy, Nancy thought. Long brown hair trailing down her shoulders in healthy waves. A pale complexion and a pointed, almost regal-looking nose. She was reading a textbook, a U of T knapsack at her feet. Nancy noticed that she was highlighting just about every line on the page. Something she used to do. Just one of her many compulsions. Hmm.
As though sensing Nancy’s gaze, the girl looked up and smiled, her eyes alighting on Nancy’s white sweater before returning to the book. Nancy looked down at herself. Christ. A chunk of vomit was caked into the fabric. She’d had a binge and purge earlier. No wonder it smelled rank in here. She eased out of the sweater, rolled it into a ball, and shoved it in her purse. Who’s the crazy one now? She thought, mortified.
The door opened, revealing a plump woman with a black skirt, black leggings, and a black wool sweater, overtop of which dangled a huge silver pendant. Her hair was buzzed short, her eyes sapphire blue. “Hi,” she said with a smile. “You must be Nancy.” She stuck out her hand. “I’m Dr. Snowdon. Come on in.”
Nancy worked her way through the stacks of files on the floor to a brown wooden chair, while the doctor took her seat behind the desk.
“So, Nancy,” she said, “just give me a sec while I pull your file from this mess here.” She flipped through a teetering pile. “Okay.” She skimmed the papers. “So, you’re here for…OCD and bulimia, right?” She looked up.
“Yes, that’s right,” Nancy said.
“And your psychiatrist, Dr. Stotts, prescribed Clomipramine in the fall?”
“Is that helping?
“Yes and no,” Nancy said. “I find that my checking and hand-washing symptoms have improved, but my bulimia is pretty much the same. Plus, there is something else, something worse. It’s these thoughts…I’m consumed by them.”
“What kind of thoughts?”
“I know it sounds vain, but they’re focused on my face. Every little mark, you know? I stare at my reflection for hours. It’s pure panic inside. As though it’s a catastrophe that I have these marks. And instead of playing with my little boy, Cal, or doing something productive, I’m wasting all this time.” Nancy was on the point of tears.
“How much time do you spend in front of the mirror, do you think? Per day.”
Nancy tried to compute quickly. “I guess around two hours or so,” she said. “Sometimes more. But that doesn’t include the thoughts about my face. They’re there all the time.”
“Okay,” said the doctor as she took notes.
Okay? Nancy stiffened. This stuff is destroying me and all she can say is okay? The doctor was looking at her again.
“And what about the binging and vomiting? How often do you do that?” She glanced at the clock on her desk.
“Every day. Sometimes once, sometimes twice, I—”
A cell phone jangled. Dr. Snowdon picked it up. “Sorry, that’s my daughter’s school. I’d better take it. I won’t be a minute.” She left the office, leaving Nancy to study the degrees lining the walls.
After a few minutes, she returned. “I’m sorry. My daughter forgot her gym shoes, and her teacher wanted my permission to send her home to get them.” She shook her head, smiling. “Then I figured while I had him on the phone, I would ask him about her abysmal results on a math test…” She looked at Nancy. “Okay. Where were we?”
“I think I was telling you about my barfing.”
For the next thirty minutes the doctor quizzed her on her symptoms, possible triggers, childhood, marriage, and work. Yes and no answers. Nancy was disheartened. She’d expected the doctor to focus more on the details: traumatic experiences, thoughts, feelings—the ammunition she’d need to form a cure.
Finally, the doctor put down her pen. “Nancy, have you heard of BDD?”
“Body dysmorphic disorder. It’s part of the OCD spectrum. Patients typically obsess about some part of the body. Often it’s the face, but not always. Legs. Arms. Breasts. Hair. And it’s not restricted to women. Men get it too.” She paused.
“Now, it’s important to stress, Nancy, that their impressions of themselves are distorted. Not based on reality.” She looked at her. “Do you understand?”
Does she think I’m a moron? “Yes, but why do I have all of this going on at once? OCD, BDD, and bulimia?”
“Well, it is not atypical for patients with eating disorders to have OCD-related illnesses as well.” She glanced at the clock. “Okay, looks like that’s all the time we have for today. At our next session, we’ll do some CBT therapy. To get going, I’d like you get the book Mind over Mood by Greenberger and Padesky. Read the first two chapters before we meet.” She tore a page off her prescription pad and started scribbling. “I’m going to up the clomipramine dosage for now, since you’ve said it’s helping a bit and it might improve your BDD symptoms. All right?”
Nancy nodded, unsure.
“Keep tabs on the side effects.” She turned to her computer screen. “The way the schedule works, you have an appointment bi-weekly for fourteen weeks. Sound good?” she asked, without looking up.
Nancy watched as the doctor entered her name on the calendar. Another patient with another struggle. Bi-weekly appointments for fourteen weeks, a total of seven sessions. Period. Then she’d move to another patient on the never-ending list without looking back. Do you have lots of experience treating OCD, BDD, and bulimia?”
Dr. Snowdon looked up from the computer. “OCD and bulimia, yes, BDD…” She paused, as though checking through the recesses of memory. “I’ve had one or two patients with it…the truth is, although the research into BDD is growing by the day, it’s still in its infancy. We have many more programs and treatments in place for OCD and bulimia.” Her eyebrows folded downwards in concern. “But that’s not to say that there aren’t treatments out there. Effective treatments. I’m here to help you. We’ll come up with something, okay?”
“Okay.” Why didn’t she feel so assured?
“Underdoggie, Mommy! Underdoggie!” Cal squealed.
Nancy couldn’t stop staring at the young mom pushing the swing next to her. Her skin was perfect. She was at least five years younger than Nancy, but still.
She mentally transferred her brown spots and acne scars to the other woman’s face. Disgusting. A thousand tiny spears impaled her chest. She fought to breathe. So far, the three CBT sessions she’d had with Dr. Snowdon and the spike in meds had not given her much relief. In fact, her symptoms were worsening. She was trying hard, doing everything the doctor told her to do. Reading what she had to read, filling in thought records. She knew she needed more intense therapy than what a harried, pressed-for-time psychiatrist could offer every other week.
“MOM-MY!” Cal was sitting in the motionless swing, his deep brown eyes wide with fright.
Nancy startled back into reality. “Okay, honey, sorry. Hold on tight!” she said. She pushed the swing mechanically and ran underneath, while her son giggled and cried for more.
After ten more underdoggies fuelled by remorse, Nancy told Cal it was time to go home for lunch.
“No,” Cal said, his lips set in a grim line, his arms akimbo.
Nancy reached into the swing and started pulling, but his whole body was stiff with resistance.
“Cal, come on, honey, let’s go,” she said as she tried to lift him. He wasn’t budging, his face red with the effort.
The mom next to her looked on with a kind smile. “Oh, I hate when they do that,” she exclaimed, glancing at her redheaded daughter, who was pumping her legs happily. “They get this superhero strength from out of nowhere.” She laughed.
“Yeah,” Nancy grunted as she struggled. Sweat dripped down her face. “Cal, you will not get a Freezie with lunch if you don’t stop NOW.” The last word came out with such force that the other woman’s face clouded and she turned away.
Nancy plucked the mirror off the living-room wall. She fingered the delicate scroll along the frame, remembered the day she and Jeff had bought it. They’d been apple picking in the countryside. The weather had been perfect—everything had been perfect. She’d had no symptoms; they had laughed so much. Had a great lunch in a local diner and explored the antique shop next door. They’d both loved the mirror. Jeff called it their first family heirloom, said that all they needed now was to work on the family part.
She took the mirror over to the window and held it directly in front of her face. The acne scars looked terrible in this light. Her family doctor had told her that her scars were minor, invisible. She wished her doctor were here now to see what she was seeing. Her stomach coiled into knots, her pulse surged, and the sweat dripped down her back. She thought of Cal, fast asleep, a bundle of innocence and blue terrycloth. He had no idea—yet—that his mom was responsible for breaking apart his family, that she was ill. That while most moms would be celebrating his nap with a cup of coffee and a book, she was having a raging nightmare by the bright light of the living-room window.
Cal wanted to play hide and seek, but Nancy, trying to quell the anxiety about her face, had eaten everything she could in the last five minutes of his nap. Now she needed to throw up. “Okay, honey,” she said. “Mama has to go to the bathroom first. How about you go hide and I’ll come and find you when I’m finished?”
Cal thought about this. “Mama…ten seconds for peepie.” He displayed all his fingers. “Then you come, ‘kay?”
Nancy laughed, ruffled his dark hair and smoothed his face, still warm from sleep, with her hands. “Yes, baby, ten seconds.”
Cal ran off and Nancy darted to the toilet, tried to vomit, but nothing came. She gulped water from the tap and jumped up and down a little.
“Mama, come find me!”
Damn, she needed to hurry.
She was dry heaving, tried again.
She couldn’t answer with her fingers down her throat.
She opened the door with her free hand. “Cal, I’ll be there in a sec.” Her voice wasn’t recognizable. An old woman’s voice. She succeeded in throwing up, kept pushing herself until every last calorie was out. When she had finished, she stood up and swayed in front of the mirror. A thin stream of blood poured out of each eye. A freak show. She started to cry.
“Ready or not, here I come!” Nancy shouted, although Cal was no longer calling. She crept into his bedroom and whipped open the closet door. “Aha!” she cried, but was greeted only by clothes and stuffed animals. “Okay, so he’s not in here, huh?” she said, trying to sound playful. It occurred to her that she didn’t hear any giggling, which usually gave him away. He was learning.
She dropped to the floor and checked under the bed in a dramatic swoop. “Not there either! Hmm, where can he be?” In the living room, she poked her head over the back of the couch. Next she checked the kitchen cupboard, the front hall closet. A feeling of alarm crept through the nausea. She tried to discount it, but hastened her pace as she searched. “Cal, I give up! You win! Hooray for Cal. The game’s over. Come on out, sweetheart.”
“Cal, sweetie, come out, please. It’s time for snack.” Nancy flew through the house, opened doors, looked under furniture. Could he have made his way to the basement? She ran downstairs. Searched through the piles of suitcases, boxes, and junk. Checked the furnace room.
On the way back up, she noticed with a thud to her chest that the screen door to the backyard was ajar. She ran outside. The gates were all closed and locked. She scanned the hedge, stabbed herself with the prickly branches.
Back inside. Upstairs. Downstairs. Back upstairs. Back downstairs. “Cal!” She was crying now. She grabbed the phone off the wall. Punched in 911. “Please come. 271 Birch Street. It’s my son. He’s missing. We were playing hide and seek and—”
“How old is your son, ma’am?”
“Okay. What’s his name?
“What was he wearing?”
“A blue terrycloth sleeper with stars on it.”
“Okay, and how tall is he?”
“I don’t know! How tall is a three-year-old?”
“Try to calm down. You can manage better if you stay calm.”
“Stay calm! What? Please just send the police!”
“We have. They’ll be there any second—”
Nancy disconnected and phoned Jeff. Voicemail. “Jeff…he’s missing. Cal…I can’t find him,” she sobbed.
The police arrived within minutes. A stout young man with piercing green eyes that shone through the acne and a middle-aged woman with broad shoulders and a kind face, her hair pulled back under her cap. They both had startled expressions. “Hi. We’re responding to a 911. Were you in a fight?” the policewoman asked. The two of them were taking in her arms and legs.
Nancy looked down and saw deep scratches and blood.
“No! My son, Cal, is missing. We were playing hide and seek…I was searching in the hedge out back,” Nancy said, stunned at finding herself on the defensive.
The officers looked at each other and then the woman pulled out a penlight from her pocket and pointed it into Nancy’s eyes.
“What are you doing?” Nancy asked.
“The whites of your eyes are red,” she said. “Have you been doing drugs?”
“No, goddamn it! I haven’t fucking been doing drugs. I have an eating disorder, okay? I was puking my guts out. Can we do this later? I need to find my baby!”
The woman’s expression softened. She looked at her partner and then back.
“Okay, yes, let’s find your son. Tom, you start in here.”
With that, the male cop moved into the living room.
“Do you have something of Cal’s that our dog Charlie can use to trace the scent?” the female officer asked. Nancy must have looked alarmed, for she hurried to add, “We’ll find him, don’t worry. He’s probably still hiding. We see it all the time.” She smiled.
Nancy nodded and grabbed a baseball hat from the hook. “Would this work?” she asked, handing it to her.
“Perfect,” she said. “Why don’t you come with me while I get Charlie? Fill me in on a few things.”
As they walked to the police van, Jeff’s car pulled up in front of the house. “Have you found him?” he asked as he jumped out of the driver’s seat.
“No!” she cried and ran into his arms. She pulled away and looked up at him. His jaw was throbbing at the corner, a nervous tic, and his eyes betrayed his terror.
“What happened?” he asked, a hint of accusation underlying the words.
“We were playing hide and seek. I was…I was throwing up in the bathroom…”
The policewoman walked toward them with the dog. “Hi. Are you the father?”
“Yes,” Jeff said.
“We’re going to search inside with Charlie, here,” she said.
“Cal could be outside,” he said. “In someone’s backyard…on a street. Let’s organize the neighbours—”
The officer interjected, “We will do all of that, but let’s rule out the house first. Okay?”
Jeff nodded but he didn’t look happy about it. He ran into the house, calling Cal’s name.
Once inside the door, Nancy felt lightheaded. She sat on an antique war chest in the entranceway, put her head in her hands. How was this happening?
Charlie, meanwhile, was barking furiously, running in circles. He jumped on Nancy and she batted him away.
“Stand up!” The officer practically threw her off the box, lifted the latch and opened it.
Cal was curled up inside, his thumb in his mouth.
“Thank god!” Nancy cried. She lunged for him, but the officer grabbed him first.
She placed Cal gently on the floor and started mouth to mouth.
“He’s not breathing?” Nancy wailed. She was on her knees. “No!”
Jeff appeared, the male officer at his side. Jeff grabbed one of Cal’s feet, rubbed it in his hands. “Fuck. Fuck. Fuck!”
An ambulance arrived outside. Paramedics rushed through the door. A young man bent down and felt Cal’s wrist while the officer continued breathing in and out. “He’s got a pulse. What happened?” he asked as he transferred Cal to a gurney.
“He was trapped in the old metal chest there. No oxygen,” said the policewoman.
“We’ll take it from here,” the paramedic answered.
Nancy leaned back in her seat, watching Jeff pace the waiting room. “It’s my fault,” she mumbled through tears.
“It’s my fault!”
Jeff put a hand on her shoulder. “No, it’s not, Nance. You can’t help it that you have the flu.”
“It’s not…” she gasped. “It’s not the flu.”
“What are you talking about?” Jeff sat down next to her.
“I was in the bathroom because I was making myself throw up.” She forced herself to look at his face. She watched as he weighed her words.
“You were…doing this by choice?”
“It’s not just OCD anymore, Jeff. I have bulimia and something called BDD, which means I’m in the bathroom a lot—”
“Jesus, Nancy, get over yourself! This is our son. You should have been looking after him…not sticking your finger down your throat! What the hell.” Jeff’s features aligned themselves in fury.
In that instant the doctor pushed through the door and walked toward them. He looked at them briefly and then at the floor. “I’m sorry,” he said. “We tried everything, but he didn’t make it. He’s brain dead, the lack of oxy—”
“No!” Nancy tried to stand up but crumpled to the floor.
“He was breathing,” Jeff whispered. “How can he be dead?”
“Yes…yes, they got him breathing, and he’s still on a ventilator, but it was just too late. The damage to his brain is catastrophic.” He paused, bent down, guided Nancy into her chair. “Look, I know it’s hard and it seems repugnant to even think about this right now, but we have potential patients for Cal’s heart. Would you be willing to sign the release form?”
“No, I’m not signing anything. He’s breathing. He’s alive. He’s my baby!” She ran past the doctor out of the room and down the corridor.
“Nancy! Stop!” Jeff called.
But Nancy couldn’t stop; she followed the sound of her son’s beating heart.
Cal lay on the bed, a tiny burst of blue on a white canvas. She approached on quavering legs, took his hand in hers. His nose and mouth were covered by an acrylic mask attached to a ventilator. His dark hair fanned out on the pillow. She heard his voice. Mama…ten seconds for peepie. Then you come, ‘kay? But she hadn’t come. She watched the tears drop onto his pale skin, his dark lashes. She didn’t turn as the door opened behind her.
Jeff appeared on the other side of the bed. He stood transfixed for a moment and then lifted himself onto the mattress next to their son. He stroked his forehead, convulsed in sobs.
“I am so sorry for your loss.” The doctor’s voice drifted over, disembodied. Another doctor and a nurse had silently taken their positions in the room, like stage actors preparing for the final scene of a tragedy. “But we need a decision. About the heart.”
Jeff’s words were thick from crying. “Sign it, Nancy.” He reached for the clipboard that the nurse was holding out to him. “At least he can live on this way.” The scratching of the pen filled the room. Then he looked at Cal once more, kissed him on the forehead and left.
Nancy took the clipboard, looked at the doctor who had come to them with the news. “Is there any chance? Any chance at all?” she pleaded.
“No.” This time he kept eye contact. “He is, for all intents and purposes, dead. We are keeping him breathing for the sake of the organs. That’s all.”
She looked down at the sheet. Slowly, she took the pen, but her fingers were trembling so much that she couldn’t get a proper grip. A nurse glided over, put her arms around her and held her hand in place. Nancy watched as the letters unsteadily appeared on the page, like a kindergartner’s.
She left the room, left her son. Jeff was halfway down the corridor, his gait furious, quick, but wobbly. He reached out to the wall for support.
“Jeff!” Nancy cried.
She couldn’t catch up to him until he was at the car.
He opened the driver’s door, glowered at her. “Go to hell.”
Nancy watched as he screeched away. She knelt down on the ground and pummeled it with her fists, willing it to open up and swallow her whole.