Day 9: another brick in the wall

"Threw you the obvious and you flew with it on your back."

To be honest, I had suspected her all along. I can smell Ana's stench from a mile away. I know just what she's like. I wanted to do nothing more than to leap out from behind the curtains around the bed, point my finger at her and shout "I know all of this is Ana, don't you keep telling me it's something else!" 

Nobody else knew what was going on, not until the episodes started to coincide with meals and with certain foods. But I knew. I knew all along. I knew exactly what I wanted to say to her. 

You may think she's gone but she's always with you. You may have gone to an inpatient unit, you may not have restricted for years, you may think you've left that side of you in the distant past but you have not. I know her tricks, I know where she hides, I know when she likes to come out and play. You may be able to fool your mother, you may be able to fool all the other doctors but you cannot fool me. I may be fat, I may be binge eating, but she's in my head every second of every day and I see her in you too. 

So I talked and talked and talked. I talked to her every day, I talked to her in lots of different ways. And she fought me and fought me until one day she just got it. She got it. She saw what Ana was doing, the weird ways that she was coming out, and now she's all better again. But that made me think. Do we ever shake her off? 

Sorry for being so fatalistic/nihilistic today. Sometimes I feel like we are all the same, all just another brick in the wall, the big, big wall that is ED and that is all we will ever be. 

Sometimes I think all my patients that are annoying and demanding and frustrating are just bricks in a wall that I keep running into. That's how I feel about my job sometimes. I have to get up in the morning, every morning and keep running into the same wall. 

Run, hit, bleed and binge. That's the cycle I'm in. I don't know what to do anymore. I'm so stuck. I'm stuck professionally, I'm stuck personally and I'm so stuck with my ever increasing weight. 

I want to die every time I see Mark because he's just so perfect. And now, to add insult to injury, there is a surgeon who makes me all hot and bothered as well. I don't even know what his name is. But I want to just jump on him. Dammit. I need a break from life. A permanent break from life. 

and what does daddy say?

"I think I thought I saw you try. But that was just a dream."

Firstly, thanks for your responses to my last post. Sammy, blogger hates our love and will not display your comments. It was interesting to find out what areas bother you most. And that we all hate our tummies and thighs. 

Since that post I've spent a week freaking out about going to see the professor for a barbecue and then actually going and feeling extremely young and uneducated. I'm not sure how well I remembered that night, I had just come off long day, post-take rounds and having worked 12 days in a row I was in quite a state. 

In true me-style, I had panicked as soon as he invited me to this bbq with several other consultants and my boss in Bristol, who is over here visiting. It didn't feel right at all. I was the youngest person there by 20 years and I just kind of sat in the corner with not much to say. I was too tired to be witty or charming. But it was still a nice night. 

So the long and short of it is that I had no idea what I was doing there. It was an honour to be invited, but it was odd. I know for sure the others were surprised to see me there. I felt like I was their child, just there to be polite and presentable. It must be some kind of record, no person as junior as me has ever been invited to anything like that. I felt awkward, out of place and juvenile, but in an odd way, I was totally the cat that got the cream. 

Apart from that, the night was odd in another way. I had a weird feeling that out of the 4 women there, at least 3 of us had had some sort of eating disorder at some point in time. The other women were deadly thin, boney and gorgeous in that way. And he watched what I ate. Didn't embarrass me per se, but mentioned that I hadn't taken much food. 

Another thing that I've only just found out, is that my entire class at medical school seem to think that the professor is my sugar daddy. I don't know what a sugar daddy is, but I do think of him as a father so I guess that's close enough. Josh thinks that the professor is my sugar daddy. Which I find sweet. But I don't know why. 

I still have a huge crush on Josh. He's such a nice guy. Unless I'm barking up the complete wrong tree or am completely stupid, if I tried a bit harder, I could probably get him. He sits close to me, always makes physical contact when he sees me. But as usual, I will just wait for it to pass me by. 

I guess besides this, I don't have much to say tonight. I feel some sort of change in me. And as of yet, I don't know what it is. I will update accordingly, when I figure out what is changing. But I can feel that something is going to happen. 

I'm choosing my confessions (happy holidays to you all)

"Trying to keep an eye on you like a lost, hurt and blinded fool. Oh no, I've said too much. I've set it up." 

200 posts, 104 followers and I'm still going. It's hard to believe, but it's the current state of affairs. I can't say enough thank yous to everyone who reads this, to everyone who comments, to everyone who has shown me so much support, concern, loyalty and companionship throughout the times. 

You've shared my highs and my lows, my fears, hopes, dreams, suicidal thoughts. You've been there through the shedding of blood and tears and one way or another, you've held my head above water and here we are, at the start of all things. 

I apologise if I sound a tad too poetic today. There are several reasons for that. The most crucial of which is probably the fact that I got a bottle of 20 year old Portugese port today and I've had a fair few glasses of it already. The second reason is that I'm managing to squeeze into some of my size 6 clothes (I believe this is comparable to a UK6, and a US 2) and even though it is a SQUEEZE, it's definitely better than not being able to squeeze at all. The last reason is that I am still buoyed by my last meeting with the professor. 

There have been quite a few occasions where I have waxed lyrical about him, and part of me can't help it. Now, after several glasses of port and a good dose of Joan Jett and Pink Floyd and Depeche Mode, there practically isn't anything holding me back. 

One aspect is that it is terribly flattering to be so petted by such a powerful man. It feeds some sort of hungry little girl inside me who just wants a daddy to come along and take her hand and make everything okay. And that's what he does, literally. The last time that I saw him, he kissed me more times in half an hour than my own father has in 5 years. When my head isn't clouded by my ED and my self esteem issues, it is so clear that he cares. He's been my most trusted friend, least judging, and most supportive. He tells me I'm perfect, beautiful, and after a few drinks, I start to believe that he actually means it. 

Another point is that I just feel so safe with him. In a strange way, we get each other. We are uncannily similar, sometimes to an extent where I will try and change myself to make myself seem a bit more different. Wouldn't want him, or anyone else for that matter, to think that I was trying to be like him in every possible way. 

At any rate, I'm glad he likes me, likes me enough to get me a Christmas present. I'm glad he's still trying to help me and wants to see me more. 

This time of year always brings out the best and worst in me. I won't lie, the food temptations are hell. HELL. All the foods I love, but all the foods I'm not allowed to eat. At the same time that I'm stuffing my face, I'm also making endless resolutions about losing weight. It's around this time that I start doing the work out videos and popping the laxatives and the odd day of fasting. The end result of all this is that I get through the holidays relatively unscathed. Staying the same, no net gain or loss. 

Being realistic, I aim to do the same this year. Get through, stay the same, don't gain, and any loss is a bonus. 

So here's me, wishing all your girls a wonderful festive season. I hope nobody derails too much and that any damage is easily controlled. I hope everyone has a good time with friends and family, do things that you enjoy before it's nose to the grindstone again. Each little step is a step closer, and if anybody takes a step back, don't despair. We all step backwards sometimes. Just recognise it, and try not to do it again. 

I'm here if anyone is having trouble coping. My family are going away so I'm pretty much alone and always happy to give out advice/company/TLC. 

Happy holidays and look forward to a skinny 2013!!!

Every yours, 

Judith Marie. 

a follow on from "curvy girls" - aka a rant.

Miss Fat Piggy's "Curvy Girls" post...has inspired this rant. And warning girls, this is a RAAAAAAAANT. 

I could rant about overweight people all day, every day but really, I try to hold it in most days, but reading Fat Piggy's post has really triggered me off, not to mention some of the responses to it. Here is my comment on her post, plus a little more elaboration.

Here is my stance on being "curvy" and being overweight and "having a low metabolism". Sure, there are metabolic disorders that PREDISPOSE you to being fat, but at the end of the day, it's all intake vs. output. There are only 3 disorders in the whole world that I think will totally excuse you from being fat: Angelman's, Prader-Willi and leptin deficiency. 

Let's get this straight. Some of the thinnest people I know have PCOS, and NOBODY can blame being fat on having a LOW metabolism because metabolic rate is directly proportional to weight so the more you weigh, the HIGHER your metabolism. Exercise only changes your metabolic rate by a small amount so all that shit about HAVING A LOW METABOLISM IS JUST BULLSHIT. People who are overweight and think they have a "low metabolism" generally are counting their calories wrong. There was a study on these "low metabolism" people and they were compared with those thin people with "high metabolisms" who thought they were thin because they had a "high metabolism". 

GUESS WHAT???? They gave everyone radioactive double labelled water, which measures the number of calories that you eat, and those "low metabolism" people ate roughly twice as many calories than their "high metabolism" counterparts. And GUESS WHAT???? The "low metabolism" people actually had metabolisms that were 30% higher than those people who were supposed to have higher metabolisms. 

And also people, I give this speech to each overweight patient who tries to sell me the "low metabolism" bullshit. I went through 6 years of medical school bitches, you think you can fool me with that mainstream bullshit??? And yeah, sure, you might have the "obesity gene", the greatest excuse for being lazy any generation has ever had. But GUESS WHAT, only 10% of overweight people have that gene. So 90% of them are just overeating. 

Fat people use it as such an excuse for being fat. "Oh I have a low metabolism because everyone in my family has a low metabolism." Bullshit. The reason your whole family is fat is because you all eat the same shit. 

I do think that overeating is a behavioural issue, and that is is taught by observing other people's behaviour or is developed as a coping mechanism and you can't really blame people too much for that. However, it is their choice whether or not to continue their pattern, or to make a change. 

And NOOOOOOO, weight loss DOES NOT depend on WORKING OUT. So all those people too fat to move, or actually physically disabled in some way (perhaps they lost a limb due to the diabetes they gave themselves from being too fat) have no excuse. 80% of weight loss is diet related. And working out generally makes people more hungry, so they eat more. It's all about the food people. IT'S ALL ABOUT THE FOOD!!!! 

No, it's not easy to diet and lose weight. Of course it's not. If it was, nobody would be fat. And yes, food tastes good and food comforts us when we're upset. That's why it's so easy to be overweight. I'm not saying "fuck fat people, it's their own fault so tough titties". I'm not saying that at all. What I am saying is that until they start to really recognise their own eating and behavioural patterns as contributing to them being overweight, they will not be able to lose weight. 

If being overweight was really just simply metabolic, I'm sure medical research would be pouring billions of dollars into finding a step in that metabolic pathway to block and then BAM! SKINNY PEOPLE! But that's not happening, because it's not metabolic. 

And Angelman's, Prader-Willi and leptin deficiency? BOOM! CHROMOSOMAL DISORDERS! No cure, sorry. But when you don't have the ability to feel full, yes, of course you keep eating. 

Don't get the impression that I have a thing against fat people. Not at all. Yes, they might sometimes make my heart sink because they make my job harder. And yes, sometimes all their excuses make me want to beat my head against a wall. But the only reason I feel like this is because I've been on the other end of it. 

You only have to witness one failed resuscitation, of a young woman in her 50s, who had a heart attack because of her eating. Doing CPR on this lady, three times my size, while her family stand around me, crying and wailing, her children begging her "mum! wake up!", I only had to see that once to know that I would happily whip and beat every overweight person I come across to avoid that happening to another family. 

You only have to go to the amputations ward once, see the young men and women in their 40s and 50s, missing legs due to their diabetes, waiting on super large wheelchairs, going blind from their diabetes, crying about how they are dying because they can't stop eating, yet eating chocolates at the same time to comfort themselves. You only have to see that once to know that you will never care about making a fat person angry, or making them cry if that means that there is a slight chance of the message getting across. At night I weep for the people who are blind from their diabetes, who will never be able to look at their children again. 

Yes, I'm harsh. I'm the same with smokers. Seeing one lung cancer patient will do that to you. And I used to run lung cancer clinics. And by the time they get to me, I know they are going to die. These wonderful people, these wonderful caring people, RUINED by eating too much and smoking too much. So yes, I'm harsh. Because I'm trying to save them from themselves. If I don't tell them, then who will?

If women have a natural hourglass, curvy figure, great. If they are fat, then fuck, their fat. And if they don't face it then I will happily see them in hospital after their heart attack or stroke at 45 years of age, or when they are 50 and their knees are worn out because of the massive strain on them. And you know what, then they will have to face a lifetime of medication, and then they will have to face themselves. 

What goes around comes around sisters. And if people choose not to do something about their weight today, then they can face the consequences of that decision later.

as I formulate denials of your effect on me

To start off with, thank you to Rachel, Fat Piggy, strive4perfection and Christina for your lovely comments on my last blog post. 

It's raining outside. I'm upset but I forget exactly why. All I know is that I feel as though the world is ending. Melodramatic? Yes. 

I rush through many sets of double doors, down vomit-beige coloured corridors and I know that I'm in an unnamed hospital somewhere. I'm running and running down my vomit coloured hospital corridors and somehow it is raining inside now. The stinging icy shards of rain melt into the hot tears streaming down my face. I'm cold and tired and devastated.

In that way that can only happen in dreams, I am suddenly redirected from my Newtonian method of running to walking down carpeted floors and richly painted walls. It takes me a while to notice that I am no longer where I used to be. His arm is draped across my shoulders as we walk and then he picks me up and I am being carried through time, and I know I am going to somewhere safe. 

I find myself standing in his living room. He's sitting on his leather couch and he pats his lap. I squirm a bit and shake my head. "Why not?" I shake my head again. "Are you scared you'll be too heavy for me?" 

I sit in between his legs because no force on this earth and in the land of dreams will compel me to sit on his lap. He cradles me and softly croons to me in that deep, melodic voice of his. I slowly drift off...

...I look around my room to find what has woken me. 

My phone is buzzing. New Text Message. I curse it for waking me from such a nice cream. I look at the time and find that it's some ungodly hour of the morning. Who on earth is texting me at this time? 

The professor. The shock of seeing his name immediately after that dream causes me to fumble and drop my new iPhone. His text says that he's in Abu Dhabi. At least that explains the time difference. 

The past week has been an unmitigated disaster. I can't even bring myself to stand on the scales because I know I've gained weight and I really, REALLY don't want to know how much I've gained. And I know it is A LOT. 

I started the week off with binging. I stained my bedsheets with blood from all the cutting and I snuck around at night cleaning them. I felt so full that I was dying for some laxies. And by the time Wednesday swung round, I resolved to fast and go to the gym. Good plan. I was looking forward to getting back on track. That morning, I rush to theatre, scrub in for the first case of the day and faint within the first half hour. Fainting in theatre. I will never live down the shame. 

And this brought on an amazing amount of binging. Endless binging. More and more food. Clothes are tighter, things cease to fit me. I can see the fat piling on. And that's not a turn of phrase. I can actually see that I am fatter. I hate it. I hate it so much. But I brought it upon myself. I am so ashamed of myself. I didn't want to open this blog because I don't deserve to post here and have you lovely ladies read what I write when I am such a failure. 

I miss the professor so much. Somehow, knowing that he is in Abu Dhabi makes me miss him more. I wish he was here. I want to do what I did in my dream and sit in his embrace and tell him about how I hate everything that I have become. I can't even lose weight properly. I want to hear him to tell me that it's okay and that I am a good person and not a complete waste of space and energy. 

But that scenario is really one that only exists in dreams. 

Then I think of J, the professor's wife. She's slightly taller than me. Maybe by an inch. And she weighs 56kg. He told me this. And so it makes me think. J is like a mother to me. So if my mother is going to be 56kg, then I should be well and safely tucked in the 40s. The ideal would be for me to be 10kg smaller than her. I'm not sure why, but I feel like being smaller than her will make them both like me more. 

Flawed logic, yes. 

Next week will be better. Next week. 

stick thin

Heigh-ho, heigh-ho, it's off to work I go. And work is work is work is work is work! Apart from feeling like I don't know jackshit about medicine, it's all going quite well. Medically. I won't bother you with the details of my clinical incompetence. 

The weight loss was also progressing. I got down to 121lbs last week. Still not quite as low as I was, but I'm at least losing the Singapore weight. It's very easy for me to not eat breakfast and lunch, however, all I want to do at dinner is binge. Maybe I will have to start spreading calories around. 

Bad news for today is that my team mates have started force feeding me. Today it was only a small apple, which isn't bad at all because I was planning to eat an apple anyway. But still, the registrar sat down and put it in front of me and said that she bought it for me and so I had to eat it. 

Then my house officer piped up and said that when she was a student, her team used to buy her lots of food and she gained weight. 

By the by: the hierarchy goes me (the student), house officer, registrar, consultant (the boss). And where I work, the doctors get free food so "buying" me food means spending some of their food allowance on me. 

The thing about all this is my house officer and registrar are both stick thin. And when I say stick thin, I mean STICK thin. They are SOOOOO thin. I feel that them forcing me to have food is a little bit hypocritical, although they both eat quite a fair amount of food. I think that when I start working, I might have lunch as my only meal so that people don't worry about me not eating at work. 

My calorie count for today is still below 600cal, and I'm about to go to the gym to take a class in muay thai boxing so that should burn off some calories. But I'm still unhappy about eating that apple and all the food that I had for dinner. The only good thing about this is that I can tell the professor that my team are force feeding me to make him worry even less. 

I hope to lose 2lbs this week. I don't have a scale here so I will weigh in on Friday and see how things went. Fingers crossed I'm losing weight again! 

RAAAAGE!!!! (over fat people and Mila Kunis cops some flack)

There has been something that has got up my hooter. I know that Black Swan was a while ago now and the comments that Mila Kunis made about weight loss were equally long ago, but someone brought it up recently and it got right up my nose so brace yourself for another rant.

I am frankly sick and tired of fat people making excuses about why they are fat. Oh, it's genetics, oh, it's big bones, oh, it's slow metabolism. BULLSHIT. I don't know if any of you watch a TV series called "Embarrassing Fat Bodies" but it has basically proved that each of these little theories that fat people use to make themselves feel better are absolutely positively false.

The slow metabolism one is my favourite pet peeve. Slow metabolism my ass. Want to know who has slow metabolism? Anorexic people, severely underweight and malnourished people. So, my friends, if thin people are more likely to have slow metabolism, by deduction, who do you think will have fast metabolism? Fat people! The fact of the matter is, metabolism is determined by body mass, the bigger you are, the faster your metabolism. Metabolic rate is made of 3 parts. The energy your body needs to keep all its cells functioning, the energy used to produce body heat and the energy used to digest food. Fat people have more cells, produce more body heat and eat more and so they have faster metabolic rates. As I said, slow metabolism my ass.

The big bones one doesn't bother so much as it is so obviously bullshit. Look at a fat person, does it look like they have huge bones? No. They just look like they have lots of layers of fat. In fact, it would be good if a fat person had "big bones" and by that I mean "dense bones". The increased load that the extra weight puts stress on the bones and they should become more dense in order to deal with it. Unfortunately, most fat people eat junk food and so actually don't have much nutrition and so they don't get dense bones. This makes them more at risk of breaking their bones. The thing is, the fat causes the dense bones, not the other way round.

Nooooow, for the genetics *cracks knuckles*. Oh yes, it is perfectly true that there are those among us who have a genetic predisposition for obesity. But that is just genetic potential. It's what we do with the potential that actually defines what happens. Now, in embarrassing fat bodies, they tested the genetics of a family of fat people who were convinced that they were genetically fat and they also tested the genetics of their doctor who was a normal sized lady. They scored each person based on how genetically likely they were to be obese. Every person in the family scored very low and the doctor had an extremely high score. This means that out of all these people, the thin doctor was genetically the most likely to be obese. So, a genetic potential is a genetic potential. If you eat right and exercise, nothing in this world can make you gain weight. If you eat less calories than you use, you lose weight. And even if you have no genetic predisposition to get fat, you will get fat if you eat too much and sit on the couch.

These are just all excuses for laziness and not wanting to face up to the truth. I hold a certain amount of respect for fat people who front up and say "I'm fat because I eat too much". I also hold a certain respect for fat people who I see at the gym or out running because these are the people who have decided to do something practical and lose the weight instead of sitting on their asses and complaining and making excuses.

Now Mila Kunis was slagged off widely online and in the media for saying that anyone can lose weight. WTF. I don't understand why she was slagged off. What she said was perfectly true. It's just fat people getting defensive and other people labouring under political correctness. I think by now you have realised that my blog is horrendously politically incorrect and I am pretty straight up in saying what I think is true.

I hate all the excuses we as a race make for those who are fat. I hate how obesity has become almost accepted. Especially where I live, a size 14-16 has become "normal". WTF it is not normal, size 14 is freaking huge. Somehow the general public has come to accept the lies and excuses made by fat people. We tolerate them, we think, oh, poor fat person, maybe they are genetically like that or maybe they have a slow metabolism. Bullshit, they are just lazy.

Mila Kunis was absolutely correct. I read a comment online about what she said. It said that oh, there are some fat people who just can't lose weight and skinny people who believe what she said have no hearts or souls. Fired me right up! Fat people can lose weight if they put in the work. If they worked out 8 hours a day and ate 1200cal in 5 small meals like Mila Kunis did for Black Swan, each and every one of them would drop weight.

Plus, look at The Biggest Loser. Morbidly obese people who are kicked into action by tough trainers and forced to stick to a healthy diet. They lose hundreds of pounds. These are people who have been fat their whole lives and come from fat families. (By the way, the reason families are fat is because families eat together and tend to have similar exercise routines and so tend to have the same weight ranges.) It just goes to show that if you work hard, you will lose the weight. Anyone who is forced to eat less and work out more will lose weight. End of story.