Church of the Holy Hungry: Dead Bulimics Anonymous
The picture of a dead bulimic girl slumped over a toilet that reified severe mental illness for me.
So, Sally can wait
She knows it's too late
As we're walking on by
Her soul slides away
But don't look back in anger
I heard you say
"Don't Look Back in Anger," Oasis
She was a coltish blonde in a burgundy chenille dress stamped with a darker pattern that I couldn't make out, mainly because she was doubled over the trashcan outside my building - throwing up, presumably.
"Are you okay?"
Stupid question, I reprimanded myself.
I moved closer, circling around so that she should've been able to see me.
Snuffling and a deeper sound: Something like when thick batter is being folded over and air keeps getting pocketed into it.
It was 1:30 a.m., and I was on my way back from my dealer's with a family-sized supply of heroin and benzos. We were right outside my shithole apartment, which was wedged where Yuppie Greenpoint degenerates into Junkie Williamsburg, long established as the H capital of NYC.
No one who was up to any good would be out at this hour on a Wednesday night.
Thursday morning, I corrected myself. And I have to work tomorrow.
Today, I realized. In seven hours.
"You want me to walk you home?" I offered, crouching down to try to make eye contact through the slot between the trash can and the metal frame that contained it.
I was eager to use, starting to feel anxious. This was not a good look for either of us.
"I can't stop it, when it gets like this," she machine-gunned.
Her voice was throaty, her hair was perfect, and her face was covered in white blotches that I took, at first, to be a disfigurement; then, I realized it was cream cheese.
In the next moments, my reptilian brain drew my attention to the wrongness of this urban tableau. Nothing was going into the trashcan: Her hands were inside of it, and no - it couldn't be, but it was - she was rooting through the garbage.
I watched her fish out several of the small plastic pouches that the bagel shop on the first floor packaged their products in. She tore them apart with wild abandon, and each time that she found the remnants of a bagel or a sandwich, she shoved them into her mouth.
There were crumbs and condiments covering her dress, her face, her hair. She looked like an X-rated actress after a lox-bagel gangbang.
I am known, to my inner circle, as someone who can demolish a dessert, and yet I was sure that I had never seen anyone eat this quickly. As we talked, her hands kept roving.
"I just can't stop it," she repeated between bites.
"Do you want me to walk you home?"
"Do you have Addy?"
"Huh?"
"Do you have Adderall, Ritalin, anything? It's the only thing that stops it."
"I have Dexedrine."
She paused, straightened her back, gave me a dubious up-and-down. I had seen that look from born-and-bred New Yorkers before, shrewd social appraisal ingrained in them like a sixth sense.
"Do you have food in your apartment?"
"A lot."
"Cool; I'll come with."
***
"Have you ever seen the picture of the dead bulimic girl next to the toilet?" She asked me twenty minutes later.
What? Why would I have seen that?
"I don't really know much about eating disorders," I confessed.
"You mean none of the girls in your high school had EDs? What are you, Amish or something?"
To her, growing up where I did in Upstate NY was probably tantamount to being Amish.
I shook my head, feeling nonplussed, a little uncool. I decided to do my drugs in front of her.
Not rude as long as I offer her some, and besides - I already gave her a Dexedrine.
"Oh God, get the Xanny away from me - it'll make it worse!" She shrieked as she watched me sift through the contents of my pill / powder parcel, which my dealer had cheekily tucked inside a pharmacy bag from Rite Aid.
I'd spent the previous weekend at home in Syracuse, and when I returned, my Aunt Mickey had sent me back with three huge Tupperware containers of her sauce and meatballs - as delicious as any on offer from the nonne of NYC.
My strange visitor had hastily heated one of them in the microwave, dumped half a canister of what she referred to as the "Walmart kind" of grated Parmesan cheese on top, and was now working her way through a dozen of the fist-sized meatballs. She was shaking like a crackhead, which didn't bode well.
"Did you go out tonight?" I asked her as a proxy for What drugs are you on?
"Nope, just some champagne... The shaking is because of my blood sugar," she explained, her tone indicating that she found her body's glucose regulation failures an intolerable nuisance.
"Interesting," I replied.
"Oh my God, I think the Dex is kicking in. Finally!" She said.
She tried on a lopsided, almost goofy grin.
Amphetamines kicking in at 2 a.m. didn't bode well, either.
"My name's Vivienne, by the way."
Of course it is, I thought.
***
"It's this one - you're going to love this, since you're a medical person!" V exclaimed.
The paper was titled "Death due to neurogenic shock in an anorexia nervosa patient," and it was accompanied by a picture of a nude, dead 19-year-old girl, who was slumped over in front of a toilet.
Her left arm was hooked inside of the toilet, while her remaining limbs were folded into a strange "K" shape. They were covered with bluish-purple splotches on their lower surfaces due to the settling of fluids during the 12+ hours after her death.
I couldn't see her face, but her hair was cute, a dark-blonde, pixie-type cut that she might have done herself.
Her body, aside from being dead, was unremarkable. I imagined her as the slightly homely girl who sat next to me in British Lit and always shared her Norton Antho when I forgot to bring mine.
I read, in horror, of what had killed this girl.
She'd consumed 5.6 liters of food and drink during a binge (average adult human stomach capacity tops out at 4 liters, according to studies done on cadaveric stomachs). Her stomach had expanded so much that it shoved her diaphragm and lungs upward, which would have made it difficult to breathe; it extended all the way from where her ribs met down to her pubic area.
The gastric overfilling had caused a massive tear down the front of her stomach, which is a very odd place for the organ to rip. Its contents exploded into her abdominal cavity, spreading all the way down into her genital region, which gave the impression of fresh bruising and therefore necessitated an autopsy.
I explained to V that the girl's stomach had been dying even before her final binge. The autopsy report indicated transmural necrosis, meaning that the organ's wall was decaying because its blood supply was cut off during these repeated, epic binges.
It wasn't the gastric rupture that caused her death, though. Instead, the massive increase in her stomach's size had put pressure on key nerves, which then set off a chain reaction involving decreased blood pressure, slowed heart rate, and cardiac failure. This was the "neurogenic shock" referred to in the title, and it more commonly affected athletes with spinal cord injuries, for example.
It was a particularly gruesome death, and something about the girl's discarded clothing being piled beside her made it even more unsettling (she had swelled up so much, I realized with belated wonder, that she couldn't even keep her top on).
V guided me to another report pertaining to a similar death, except this time the gastric dilation had not resulted in rupture. Rather, it had put so much pressure on the inferior vena cava and the superior mesenteric vein that not enough blood could return from the organs to the heart. This second woman died of hypovolemic shock, just as if she had bled out due to an injury.
There was something Old Testament, demonic about these deaths.
It wasn't lost on me that, if I died of an infection or an overdose, there would be a similarly sad and sordid element to my passing.
"Let's look at something else, now," V command-suggested.
"Hey, have you ever seen this tornado vid?" I wondered.
***
"You live in Brooklyn?" I asked incredulously, pronouncing Brooklyn like it was the name of an alien planet.
It was the thing that I'd been dying to ask since I'd first met V earlier that night. She struck me as an Upper East Side or Upper West Side girl if I had ever met one.
V had just returned from another trip to the bathroom. I was preparing my second shot, a process that she observed with quiet fascination.
"No. I got kicked out of my apartment, and I was sort of wandering around tonight."
"What happened?"
"I ate like two hundred bucks' worth of my roommates' groceries, again. They put a lock on the fridge, but I got around it."
"Did you eat the lock?"
She gave me a knee-jerk smile.
"I mean, they were really cool about it the first couple of times that it happened, 'mental health matters' and all of that. But everyone gets tired out eventually."
"Boy, do I know that," I said sincerely.
"I bet you do," she replied as she studied my paraphernalia altar.
"The same thing happened with my sorority," V continued. "I ate two whole pantries' worth of food during the week of spring break, and they kicked me out."
The confessions never stopped with this girl. I knew from the fact that she didn't name her college or her sorority that they were prestigious and hot, respectively - probably DG at Brown or some combo like that.
I didn't want to ask, but I did.
"Where'd you go to school?"
"Yale."
Of course you did.
"What about you?"
"Cornell."
For the second time, a reserved respect registered in V's expression (the first had been when I told her that I was applying to medical school). This kind of status stuff was hard to resist, and it was why I was developing a distaste for the City.
"You can sleep here, if you want," I offered.
"Thought you'd never ask."
She wanted to take the couch, but I let her sleep in my bed.
I grabbed my spare pillow and blanket and headed for the couch, which was all of seven feet away.
"Will you sleep with me?" She asked.
My head was starting to droop with opioid exhaustion.
"Of course."
Needless to say, we were up all night, talking.
***
When it comes to tragic deaths, everyone insists that our final moments are just that - moments.
That - whether we go out in a blaze of glory or hunched over a toilet, expelling the vomit that's now packed from taint to trachea - they don't mean that much in the context of our entire lives.
I'm not so sure about this. As I shared in my last post*, it is a nightmare of mine to go out during a low point of my disease - say, an episode of drug-induced psychosis, severe withdrawal, an infection that goes septic, an OD.
*Six weeks and two days without methadone or fentanyl or anything else other than buprenorphine! Feeling fighting fit (almost), fam.
Maybe the Buddhists are right, that we either find a way to transcend the struggles of this lifetime or we must return to repeat them (or worse).
I hope that the dead bulimic girl didn't realize that she was dying. She must've sensed that she'd pushed things too far, dangerously far, but she'd no doubt had that feeling before.
Princess Diana described the sensation of being filled with food during a binge as "like having a pair of arms around you." I've heard bulimics speak of the relief that arrives as the food is brought back up and the pressure is released.
I hope that the poor girl from the picture died with a sense of arms encircling her, with a dawning relief.
If she had any self-reflexive awareness - if it's true that we escape our bodies and look on as we leave - I hope that she felt freedom in knowing that she would never have to suffer like that again; peace in recognizing that life makes fools and losers and victims of us all; love for the broken but beautiful vessel that she was leaving behind.
***
I don't believe in Trigger Warnings as a general principle. Life is brutal, and we need to do the work to be able to confront it head-on. However, in this case I'll make an exception for the photo of the aforementioned young woman who died during a binge, which follows. Don't scroll if you don't want to see a dead body.
Lately, I've struggled a bit with how graphic to get with the photos that I use in my video and written content. Humans are visual creatures, and that saying about a picture being worth a thousand words exists for a reason.
For example, during Part 1 of my YouTube video series on Amy Winehouse, I wasn't sure whether to include photos that showed her when her addiction, self-harm, and ED were at their worst.
In general, I ask three questions.
First, is the person still alive? Second, did they have a clear position regarding how they felt about such photos / videos?
Finally, and arguably least importantly, I ask myself whether I would be comfortable with someone using similar language / materials when discussing my life. If I don't like the idea of it being done to me, I obviously won't do it to someone else.
In this case, I believe that there is educational and (constructive) shock value to the photo of the girl who died from her bulimia. While searching for the photo, I came across Reddit threads in which ED sufferers describe the positive impact that such materials have had on them and urge each other to get help today.
EDs, like addiction, erode our awareness of the mortal peril that we place ourselves in each and every time that we allow our mental illnesses to dictate our behavior.
In that spirit, I hope that the following photo helps someone - not tomorrow, but today.
Love you guys. Stay safe.
B.
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