Both Tree and the doctor smiled gently at her – relieved they didn't have to involuntarily admit her.
Tree turned towards the Doctor "So what is the process?"
The doctor thought carefully "there is paperwork which needs to be completed with the three of us today – then it's submitted to a lawyer – I assume you have your own you want to use?" Taylor nodded quickly – desperate to avoid anyone new. "Well then by tomorrow it should all be agreed. It lasts for as long as you lack capacity – you can appeal it when well and it will be removed – this isn't forever Taylor"
Tree sighed in relief while Taylor just cried again.
Tree told the doctor about the at home treatment she had looked into – the Doctor was agreed "let's do a physical exam first – just to make sure there is nothing medically wrong but if not that sounds great"
Taylor nodded, unsure of what she would actually have to do. The doctor instructed her to lift her top then lay down. As she lifted it up, Tree was shocked by her protruding ribs and spine. The Doctor felt all along her stomach and chest. She took Taylor's blood pressure, oxygen levels, heart rate and temperature before checking her eyes, ears and mouth. Finally she allowed Taylor to sit up "OK – the treatment team will want to do bloods and ECG's weekly to check everything but right now there is nothing TOO alarming which suggest you need to be in hospital rather than home. The lining of your mouth and throat is very red though – have you been vomiting more?"
Taylor shook her head but Tree glared at her so she sighed "a bit – it's more more anxiety than food"
The doctor nodded "OK, we will need to keep an eye on that. For now – let's get this paperwork submitted for the guardianship, we will get you into home treatment and see how we go"
Taylor and Tree both nodded along, filling in the paperwork quickly before leaving.
As soon as they were back in the car, away from prying eyes Taylor turned towards Tree "thank you for doing that.."
Tree smiled soft "of course. I want to help you in any way I can"
The drive home was near silent as Taylor began to panic about what was going to happen– it was one thing to agree to it to avoid being put into hospital – it was another thing to actually do it.
Tree could sense she was working herself up but wanted to give her time to process it all.
As soon as they got home Tree contacted the treatment team who agreed they would come out tomorrow morning to do an assessment and begin treatment.
They also rung Andrea and updated her on what had happened – she was distraught as she realised how poorly Taylor really was. She knew she was weaker herself and didn't want to worry Taylor and give her more anxiety so she gave the girl a tough reality check – informing her that she wasn't welcome to visit her in the hospital until she was engaging well with treatment and gaining weight. This sent Taylor into another round of crying and begging but Andrea held firm – telling her that it needed to be her motivation.
Tree understood why she had done it – she knew Andrea was very frail herself and if Taylor saw that she would tie herself up into knots with anxiety and not be able to eat – but she was worried Taylor would see it as a punishment which was something she wanted to avoid. She didn't want the woman to feel like she was a child being told off.
When she had managed to calm Taylor down again she gripped her hand tightly "Ok, I am going to stay here tonight – keep an eye on you. Then I will be here in the morning ready for when the treatment team come. We need to get you dinner, is there anything you feel like you could manage right now?"
Taylor's eyes welled up "Tree, it's not even eating disorder related but I am not hungry - it's all been a lot today and I feel really overwhelmed"
Tree nodded "I understand that but 1) you have to eat and 2)not eating when you feel overwhelmed and anxious is peak eating disorder – I cannot let you not have anything. We are starting this tonight"
Taylor bit her lip anxiously "just because you're my 'medical guardian' doesn't mean you can tell me what to do..."
Tree took a deep breath – trying to stay calm "The idea of me being your guardian rather than being admitted is so we can discuss and agree a plan that you will be able to cope with – it doesn't mean you can just do what you want and avoid recovering. Now if you would prefer – we can just plan for an admission instead?"
Tears rolled down Taylor's face as she spoke again "There is nothing I can face"
Tree nodded "OK – is there anything you really can't face?"
Taylor nodded "no pasta..."
"Ok we can manage that – what about that turkey stir fry you like?"
Taylor wanted to argue that technically noodles were like pasta but she nodded, deciding she would just eat the vegetables and meat.
Tree went and quickly prepared the dinner, calling the blonde over when it was done. Taylor looked at it, attempting to force a smile onto her face "This looks great Tree..."
Tree smiled at her "good, eat up"
Taylor looked over, comparing their two plates but Tree noticed this "I have exactly the same portion as you Taylor, eat"
Taylor nodded, stabbing a piece of broccoli and chewing it slowly. After eating around ¼ of the food she began to shift in her seat, the uncomfortable feeling of having any food in her was too much to bare. She used the fork to sift through the noodles, picking out onions to eat.
Tree eyed her up "Tay, you need to eat some noodles and meat too..."
Taylor looked up at her "My stomach is really hurting..."
Tree sighed "keep going"
Taylor glared "I shouldn't have to eat the same amount – I should be aloud to build it up slowly...it's not fair!"
Tree sighed "Taylor – you don't get to make the decisions around food anymore. I have given you what the original meal plan said – it's not unreasonable"
Taylor shrugged "I don't agree with it – I should be able to say when my body is full"
Tree rolled her eyes "when you start to eat properly then yes, but right now? No. You just don't like not having control – but giving up control is necessary to let go of the eating disorder"
Taylor began to cry again – weeping her way through the rest of the meal. Tree let her stop when she had eaten about 3/4 of the food -sensing the blonde really couldn't eat anymore.
As they sat on the sofa together Taylor began to shift around uncomfortably again – wrapping her arms around her stomach to try and comfort herself. Tree noticed "is your stomach hurting?"
Taylor looked at her, nodding sadly, her voice becoming more frantic "Tree – I know treatment starts tomorrow and I really did try my hardest to eat tonight. But you have to let me get rid of it. I'll start tomorrow – I promise I will. But my stomach is going to explode"
Tree looked at her sadly, holding her hand "you know I can't let you do that honey. Do you want me to get you a hot water bottle? It might help?"
Taylor shook her head "No, I just need to get rid of it! You don't understand. It's hurting"
Tree pulled her into a side hug "I do understand, but I can't let you make yourself sick. First of all – you need the food inside of you, your body will start to adjust as time goes on, it's just not used to it. Secondly – remember what the dentist said – if you carry on being sick, you will wreck your teeth – you'll need more treatment, you don't want that do you?"
Taylor practically growled at her "I don't care – it's only one more time!"
Tree smiled kindly "It's never just one more time. If you did it tonight – you'd want to do it tomorrow. You have to accept you have purged for the last time"
Taylor cried harder again now "But I didn't know! I wasn't ready. I didn't agree to this!"
Tree rocked her slightly "slow down, take some deep breaths. I know it doesn't feel nice right now. But I promise it'll pass"
They sat like that for the next hour before Taylor begged for some peppermint tea to help with the bloating. Once she had drunk that she headed up to bed and fell into an restless sleep – worried about what the morning would bring.
At 8am, Tree and Taylor were sitting up the table, battling about what she could eat for breakfast. Taylor was adamant she just wanted fruit but Tree would not let her. They had compromised to yoghurt with granola and fruit but Taylor was just pushing it round the bowl. The doorbell went and Taylor's eyes widened immediately "who is that?"
Tree shrugged, "I'd guess the eating disorder team?"
Taylor shivered "But – it's early!" Tree would have laughed if it wasn't so sad but she quickly got up and answered the door – leading the team back into the kitchen "Taylor – this is Dr Dunn and his team"
Taylor looked up, embarrassed as the doctor, dietician and a nurse filed into the room – she greeted them awkwardly, slowly pushing the bowl of food away from her. The nurse sat down next to her, introduced herself as Sarah and gently pulled it back towards the blonde "why don't you keep eating that while we chat?"
Taylor looked to Tree to help – to get her to tell the woman that Taylor couldn't possibly eat in front of all these people but Tree smiled kindly at her, encouraging her to go ahead.
Taylor reluctantly picked up the spoon again, dipping it into the yoghurt and bringing the tiny spoonful up to her mouth. She put the spoon back in the bowl as Dr Dunn recapped everything with her and Tree but as soon as it was down again – the nurse picked it up handing it to her "keep going"
Taylor frowned at her, unsure why she was meddling like this straight away but she took another miniscule bite of yoghurt as Tree informed him of the appointment yesterday.
Finally when he thought he had all the information he turned towards Taylor "Ok – I don't know how much you know about our treatment style. We are an at home service. So basically all the same rules apply as if you were in hospital. You will be supervised at all times – you will have somebody with you during meals, in between and overnight. The advantage to being at home is you are more comfortable in your own surroundings – plus you can have visitors whenever you want but we would advise not at meal times to start with. Now Wendy here will come up with a meal plan tailored for you. You don't get to pick what you are eating – we base our treatment on what your body needs. We don't focus on setting a target weight gain each week. We believe if you feed your body the right amount of nutrients with a balanced meal plan then you will gain a healthy amount of weight and your body will balance again. You will eat everything you are given. We do not negotiate around food."
"If you don't set a weight gain target – how do we know if I am gaining too much too quickly?"
The dietician stepped in this time "the weight gain itself is actually irrelevant now as long as we are nourishing your body. Initially it will hold onto more as it tries to replenish but it will even out"
Taylor was panicking now "but – if it is too much we can adjust it?"
The doctor smiled at her "I can see this conversation isn't helpful for you right now as I don't believe anything we see will reassure you. Let's move on from this and we can re-address this another time"
Tree was impressed with his direct response but Taylor took an instant dislike to him, glaring at him. The nurse handed Taylor the spoon again but she just stirred the yoghurt, unwilling to eat any more in front of them all. The dietician addressed both Tree and Taylor "is this a typical reaction to meals? Avoidance and delay?"
Taylor was shocked and her jaw dropped, she stuttered as she tried to explain herself but Tree interrupted – "yes – everything is a negotiation. There is always begging and bargaining. Taylor definitely likes to try and control her intake heavily"
The dietician nodded "well the great news for you Taylor then is, that by having a meal plan there is no negotiating – it takes away some of that effort for you so you can just focus on eating whatever is put in front of you"
Taylor was about to protest but the doctor stepped in again "think of your treatment like a pendulum – for most people it rests in the middle. You are an extreme right now – it is all the way to one side, that means to reset it to the middle, we need to swing it all the way to the other side. That is going to mean that at first – it is going to feel quite drastic for you, but that is what is necessary to get you to 'reset'. You will have a set meal plan, set meal times. No arguing about food or quantities. Although that seems unfair – it is a necessary step in removing that control from you, so you can release the eating disorder."
Tree nodded along and smiled softly at Taylor, trying to reassure her but the blonde looked back with terror in her eyes – trying to portray she wanted this all to end right now.
The doctor pushed on, despite Taylor's obvious discomfort "you will have twice weekly therapy face to face, the other days it will be via zoom. That will be with Michelle – she had a session so couldn't join us today but Sarah will introduce you later. Now in order to have somebody with you 24/7 – the nurses will work in shifts. Some will do 8 hours – some 12. But they are a great team, all very experienced in working with adults with anorexia and bulimia"
Taylor frowned "I don't...it's not...It's just a blip"
The doctor smiled "again – that's something you can unpick in therapy."
As they went through the rest of the rules, the nurse kept handing Taylor the spoon but the blonde became more and more reluctant to eat – feeling very self conscious in front of everyone. Finally the nurse gave up and made a signal to the dietician who nodded. As the doctor finished speaking the dietician spoke up for the last time "I can see that food is a real struggle for you right now so I think, straight from the beginning, we will introduce supplements – anything you don't eat will be made up with a supplement. If you eat half the meal, you get half the supplement. Anything less and you get a full one"
Taylor wanted to protest but was stopped by Tree nodding "that sounds like a great plan – it'll be easier for your stomach when you are really struggling with quantities of food initially"
Taylor put on a fake smile "yeah, that will be great", she knew she just needed to get rid of them so she could try and convince Tree that it really wasn't necessary.
Taylor zoned out again, jiggling her leg up and down trying to expel some of her anxiety, she zoned back in when she realised that everyone was looking at her.
Tree prompted her "Any questions Taylor?"
Taylor hesitated then shook her head, so the doctor spoke up again "Ok. Well it sounds like it's all agreed then. Tree, if you are happy we will have you sign the paperwork to admit Taylor to the programme and Sarah will be back at lunchtime with some supplements and a meal plan to start properly."
Taylor frowned "What if I don't want to do this?"
The doctor was kind but firm "then an emergency hospital admission would need to be arranged. Tree is now your medical guardian so she has the final decision. It really is time to hand over control now Taylor."
Tree quickly signed the paperwork, avoiding eye contact with Taylor – knowing the blonde would try and guilt her out of doing it.
The doctor explained that he and Wendy (the dietician) would visit weekly to check her progress but that Sarah the nurse would return at lunchtime and from that point, she would have somebody with her until she was well enough to be discharged from the service. There was a weekly shopping list that would be generated for the week ahead and the supervising nurse would prepare the agreed meals.
As soon as they left, Tree turned back towards Taylor, sensing a meltdown was incoming "hey, you're ok – it just feels like a lot right now. I actually thought they seemed really nice – really practical and reasonable"
Taylor's eyes practically popped out of her head "reasonable? He basically said it doesn't matter how much weight I gain – as long as I am eating what they tell me to. Tree that's crazy! What if I gain 10lbs in a week?!"
Tree tried to calm her down "what he is actually saying is that your body will even out once you're eating regularly. The amount of food in your meal plan will not let you gain 10lbs in a week Taylor. He is right – it is all about handing over that control"
At this exact moment, Taylor broke – Tree could see the terror invade her body as the blonde began to cry "Tree, do not make me do this, please do not make me"
Tree sat down next to her, pulling her into a hug as she continued to beg "don't let them do this to me. I hate eating in front of strangers. They're going to be judging me. I want to just do it with you! Please Tree – tell them you've changed your mind, that we are going to manage this. Please, please, please. I will do anything you want"
Tree's heart broke as Taylor continued to sob and beg but she squeezed her tightly "we are where we are because we couldn't manage this. I know it seems hard right now but I promise this is better than being in hospital – away from us all – away from home. And as for eating in front of them? They're not judging you – they're just trying to help you"
Taylor realised she wasn't going to win this so she looked up, panic still in her voice "can you stay? Today while she's here – can you stay? I don't want to be on my own"
Tree hesitated "you heard what they said – they don't encourage it around meals...but we can ask. OK?"
This seemed to calm the blonde down and she began to breathe more evenly again, regaining control of her body.
The next few hours went quickly, Tree was still working on explaining the cancellation of the tour so she was busy. At nearly 1pm the door went, Tree turned to Taylor with a kind small "ready for this?"
Taylor grimaced "as ready as I'll ever be"
