Author: Julie Johnson, Care Technician at Center for Change

Early last summer I took a job at Center for Change, a treatment center for women with eating disorders. This is not a direction I thought my life would take; I have not had a passion for this issue, personal experience or someone I love suffering from this illness. I have not been invested in becoming a therapist or going into the field of psychology. Yet this job forces a clairvoyance, a willingness to address humans in a deep engaging way that chips away at my old view of the world.

The Center for Change treats women with severe anorexia and bulimia. It is an inpatient and residential center and employs therapists of all kinds (music, art, recreational), social workers, psychologists, kitchen and cleaning staff, psychiatrists, nurses and care technicians. I am a care technician. Some of my responsibilities include unlocking bedrooms and bathroom doors for patients, flushing toilets and recording bowel movements by size and type. I also help patients keep behavioral rules designed to allow them to give up the strong hold the eating disorder has on their lives. We all eat together in a dining hall. Patients admitted are required to eat 100% and to avoid taking large or small bites, chewing on ice, mangling, shifting, and breaking food. As a care tech, I point out disordered relationships with food to the patients and help them recognize the way they interact with food. A big part of the job is helping the women who come to the Center remain safe. My favorite part is talking to the patients and being a personal support in their care and recovery.

A good friend of mine, who is also the care tech at CFC who told me about the job, talked to me a few days after I started working at the Center. “I like how many different kinds of people work as care techs,” she told me. “I think that everyone has a different style in terms of how they interact with patients. feel like I learn just from watching other people at work.” The next time I worked at the Center, I thought about what she said as I watched how other care techs interacted and helped the patients. One tech worked to keep the schedule running, organizing and helping patients and techs know what came next, herding everyone to the next group or activity on time. Another tech lay on the floor playing a game with two adolescents. One tech sat over in a corner listening as one of the women explained why her day has been so horrible. “Somehow these differences in style work out as there is someone who can relate to any one of the patients”, my friend said during our conversation.

I find my friend is right; working at the Center is an exercise in being a human being and in seeing others as human beings. Patients come in believing they cannot be loved by anyone and engaging in addictive destructive behaviors that make it difficult to separate who they are from what they do. Care and love, though at times complicated, helps patients get beyond addictive behaviors.

Staff who have worked at the Center since it opened nine years ago talk about the people who come through the Center with deep love and respect. They also tell funny stories and have seen intense things. I want to tell a few stories of unusual or extreme situations that had a tremendous impact on me, and my growth as a care tech. One patient was in her mid-40’s, unable to hold down a steady job, had spent some time in a state hospital, ran three miles a day and had whittled herself down to 65 pounds. She was five foot six and held on to her eating disorder for 25 years with uncanny tenacity of the sort you find only with the most severe addictions. When she came to the Center, she had laxatives taped to her feet and other medications stashed throughout her luggage. The first day she sat like a scared owl. Her round eyes huge and blinking – tufts of malnourished hair sticking out around her. The other patients at first felt afraid of this new resident when she arrived at the Center. I think most of us worried any little bump would break her into small splinters. She was a human body peeled down to nothing but a skeleton structure and loose skin. Gaunt, hollow, death. When she bent over to pick something up, her ill fitting clothes slid up around her, exposing her entire pelvis bone.

I work graveyard shifts at the Center. I come into work at six pm and stay until six am. After patients are sleeping I check on them in their rooms with a flashlight throughout the night. I work at the nurses station, doing paper work between bed checks. On the first night of this patient’s stay at the Center, I sat with a clear view of the hall and all the bedrooms, as she came teetering out her room, swaying, stumbling and groggy. “I need to use the bathroom,” she told me. I hurried over to help her afraid she would fall. She leaned into me and the smell of diarrhea overwhelmed me. “I need to take a shower. I got sick.” It was 4:30 in the morning, sleep made my sense acute and my capacity to deal with the amplified senses limited. An involuntary gag reflex threatened to disable me. I wanted to sit down and cry right there on the floor. The pungent realities of human bodies faced me as this brittle human leaned against me.

In situations like this it is embarrassing to admit how small we humans can be. There were my initial thoughts, “I’m going to throw up.” Followed by, “I hope she is not getting any on me.” I wanted to pull away. I wanted to cry. I wanted to go home. I wanted to sleep. A messy, snotty blend of pathetic self-pity and hurt for her jostled inside of me. I looked at her, this shrunken woman whose life had been consumed by her eating disorder and wanted to show her kindness but I felt weak and incapable. I felt like gagging.

I took a mental deep breath and unlocked her bathroom, helping her to turn the shower on. I watched for her at the bathroom door so I could prevent a fall into the shower. I gathered her smeared clothes. I pulled off her bed covers and stripped the steaming sheets and piled them on the floor. I put all of this together and picked it up and walked down the hall starting the washing machine and dumping the whole pile inside. I walked back down to her room with clean sheets and disinfectant and scrubbed the remains before making her bed again. I did all this resisting my impulse to fall apart and telling myself, “To care about someone means you clean up their puke. To care about someone means you wipe up their diarrhea. To care about someone means even when you feel like puking because bodies are both beautiful and messy – even at times, disgusting you clean it up because this is what people are. You can not separate people from that.” This very ill woman taught me that lesson in a way my five senses cannot forget.

None of the women at the Center for Change are only an eating disorder – they are depressed, they are bipolar, they are borderline, they are perfectionists, they are funny, they are serious, they are compulsive, they are struggling, they are brave, they are vulnerable, they are liars, they are honest. They are human. Patients come in after using their eating disorder to numb them from painful emotions or to gain a modicum of control in their lives. The Center takes their eating disorder away from them; they can no longer restrict, binge or purge. They can’t mutilate their food, drench it in condiments, take tiny bites, talk about diets or how much they weigh. I have watched women break down and cry as food is set before them. They are exposed and vulnerable. They have to face themselves.

Working at this Center helps me recognize how complex we are as humans and at the same time how transparent. I see how even the most tragic circumstances can be on some level comical. But I also see how abuse and depression infiltrate people’s perceptions of themselves in devastating ways.

At rare times, I feel as though my heart will unravel sinew by sinew when graveyard shifts require entrance into the landscape of repressed memories. Stories of abuse unfurl and I feel like I want to find those people who inflicted so much destruction and show them the girl curled up on the floor in front of me at three in the morning. Did they know what they were doing? What did they experience in their own life that would allow them to hurt another person like this? I want them to see what this woman feels and experience the haunting depth of sadness in her. “Please look,” I want to ask them “and see in what ways you have affected her life.”

One night recently, a patient, a gentle woman who experienced extreme abuse woke up in the night dissociating. She sat on the bed, her adult body shrinking into the little girl terror that made even her voice sound like a small child. With her shaking arms out in front of her and the rest of her body cowering under their feeble protection she asked us, “Are you safe?” Another tech and I helped her “come out’ of the dissociating and this woman explained how a comment made by another patient in group earlier that day made her wonder if anyone would believe the events in her life that scarred her. She described in detail the connection between a comment and her past abuse that made me want to weep for this woman who stood before us sharing her story. I looked at her and saw the fragile courage and strength of her choice to be here and her commitment to recovering from an addiction that numbed her from pain. For this woman, giving up her eating disorder meant facing a past lifetime of intense pain. For many women at the Center, facing that pain is terrifying, nothing in their experience leads them to believe that facing the pain will cause it to end. I remember going to an art gallery to see a show called “A Conversation about Faith.” The artist did a series of paintings with a woman’s figure leaping into all different colors. I think about those leaping images when I am at work and see women like this patient facing her fears with so much courage. Watching them teaches me.

There are days when this job stretches me and challenges me in ways that make me feel like snapping or breaking. I can feel emotionally exhausted, pulled thin with no easy answers for patients. I feel inadequate, tired, unable to put myself out there one more time. These are the days when the job becomes about me. Do the patients like me? Am I helping them? Am I hurting their feelings? My insecurities crop up like lawn mushrooms in clusters. I compare myself to other staff and want to cry. I don’t enforce rules enough, I don’t do this, I don’t do that. Berating myself. These are the moments when if I have enough selfawareness and am cognizant of the mental road I am taking, I stop.

I think instead about an article Rachel Naomi Remen wrote about learning to serve people with wholeness. She talks about the differences between helping, fixing and serving. In the article she writes, “When you help, you see life as weak. When you fix, you see life as broken. When you serve, you see life as whole.” She goes on to say, “Service rests on the premise that the nature of life is sacred, that life is a holy mystery which has an unknown purpose. From the perspective of service, we are all connected. All suffering is like my suffering, all joy is like my joy. When we serve, we don’t serve with our strength; we serve with ourselves, and we draw from all our experiences. Our limitations serve; our wounds serve; even our darkness can serve. My pain is the source of my compassion; my woundedness is the key to my empathy. Serving makes us aware of our wholeness and its power. The wholeness in us serves the wholeness in others and the wholeness in life. Fixing and helping are draining, and over time we may burn out, but service is renewing. When we serve, our work itself will renew us.” (Kitchen Table Wisdom, 1999). Remembering this article I realize through serving it is possible to be part of healing. I try to practice this, pulling myself up when the insecurities rise, “This isn’t about you, this is about the person sitting in front of me, what will help them?” I don’t always get the answer right, but I leave work renewed.

The patients often ask me if I like my job. I tell them I love it, that it is a humbling job and one that makes me think about courage. It is also a job that makes me laugh. Last night I came home carrying an enormous four foot by three foot picture a patient gave me. The stiff paper is painted black with yellow circles that look like stars. A nearly life size unicorn spreading white and pink wings fills two thirds of the poster. The unicorn is locked in mortal combat with a red bull. The red bull fumes from between his huge nose ring. I set it in the living room and sit down and laugh. A patient sat me down last night at 10:30 and told me she really wanted me to have this poster she painted. I think, “What am I going to do with this?” and then I answer myself, “I will let it inspire me.”

Working at Center For Change for over a year while watching the women in the Center struggle with pain and addictions and then choosing commitment to change illuminates for me not only their lives, but my own life as well. I draw courage from their hard choices and I leave with a renewed commitment to be a better person, and to choose to live life deeply.

Written in 2003, Reviewed October 2014