Chapter 13 Amelia Blue
In the morning, Dr. Mackenzie knocks on the bedroom door. She doesn’t wait for a response before letting herself in.
“Thought it best to let you sleep late. You’re still on West Coast time, after all.”
I blink a few times, giving my eyes a chance to focus.
Dr. Mackenzie’s outfit is almost identical to yesterday’s (black pants, crisp blouse), this time with a soft-looking heather-gray wrap thrown over her shoulders.
I’m not sure exactly when I fell asleep last night.
My phone is on the bed beside me, the battery almost dead, Instagram reels still playing one after the other, old videos of my mother’s antics.
I swipe the screen blank as Dr. Mackenzie crosses the room.
She places a familiar metal slab firmly on the floor in front of the bed.
I nod but ask to go to the bathroom first. Brush my teeth, scraping my tongue with the bristles until it bleeds.
I spit the blood into the sink. In the mirror above, my reflection looks hazy and warped, my nose too long, my eyebrows too wide.
My lips are dry and my hair is wild with sleep.
It takes me a moment to realize that the mirror isn’t made of glass but brushed steel.
Dr. Mackenzie tells me to take off my long-sleeved shirt and pajama pants so that I’m wearing only a tank top and underwear.
She makes me roll the top up, tucked under my arms, so she can see my torso.
She notes every beauty mark, freckle, and scar, describing it out loud as she makes a notation on her phone.
I try not to shiver in the cool air, pretending that having my body inspected by a near stranger doesn’t bother me.
Here’s another thing I know: These places need a record of the state their patients arrive in, at least when they arrive for reasons like mine.
(I don’t, obviously, know if Georgia was subjected to this sort of thing.) I’m surprised the doctor doesn’t ask me to open my mouth, make note of my bloody gums. (Would she consider it self-harm or poor dental hygiene?)
Finally, Dr. Mackenzie tells me to step onto the scale. I wait for it to beep and light up with a number between my feet. But nothing happens. For a second, I think maybe I’m too light to register.
I wait for Dr. Mackenzie to tell me the machine’s not working, but she merely glances at her phone.
“The scale texts me the results,” she explains.
“What if I want to know what it says?” I ask.
“We don’t think that would be conducive to your journey with us,” Dr. Mackenzie explains, slipping her phone into her pocket. Her face betrays nothing.
Places like this say they consider eating disorders and addictions diseases, but they treat them as behavioral problems, like addicts and anorexics are unruly children in need of stricter parents.
They want you to feel powerless, because only when you’re powerless do you stop resisting—whether it’s eating what they tell you to eat, saying what they want you to say, doing what they want you to do.
Maybe that’s why Georgia couldn’t stay sober.
I can’t imagine her admitting powerlessness.
“Why don’t you get dressed and join me in the living room?
” Dr. Mackenzie suggests with false lightness as she lifts the scale off the floor.
She doesn’t use the language treatment centers usually do: weigh-in, goal weight, ideal weight.
(Incidentally, the same language people with eating disorders often use.)
I shower; the towels are plush but small. (Too large and they can be tied into a noose.) There’s no full-length mirror, only the warped metal over the sink that renders my reflection slightly fuzzy. (Glass can be broken, used for self-harm.)
I rub my skin with the organic lotions on the counter.
There’s a blow-dryer, but it’s battery operated.
(Wires can be dangerous.) I dry my hair, soft and smooth down my back, even though I know it will end up frizzing later.
It always does, but I established my morning routine when I was in middle school, and I haven’t deviated since.
I must take too long getting ready, because Dr. Mackenzie calls out, “Everything all right in there?”
She opens the door without waiting for an answer.
(Again: powerless.) Why don’t you get dressed and join me in the living room?
wasn’t a suggestion but a command. Even though she’s already seen me nearly naked, I rush to cover myself with one of the too-small towels.
There’s no bathrobe. (The belt could be used as a noose.)
“I’ll be out in a minute,” I answer, hands crossed over my body.
She and Maurice are waiting in the kitchen when I finally emerge.
“What would you like for breakfast?” Dr. Mackenzie keeps her voice cheerful, as though the question isn’t fraught.
“Coffee would be great.”
My new doctor doesn’t suggest that coffee isn’t a proper breakfast, simply nods at Maurice. He prepares a cup without asking how I take it. Black, two sugars. Sugar is worse for you than fat, but I went through a phase in high school where I ate exclusively fat-free foods, and sugar stuck.
“It’s decaf,” Maurice says apologetically as he hands it to me.
Caffeine is considered a mind-altering substance, so they don’t allow it. Plus, I might chug it to burn extra calories.
Dr. Mackenzie gestures to the couch in the living room.
“You’re not going to force breakfast on me?” I ask as I sit.
“Would you like me to?” Dr. Mackenzie asks. She faces me at an angle, sliding off her shoes and tucking her legs beneath her. I’m wearing sweatpants and a ragged oversize sweater. I feel underdressed and pull my sleeves over my wrists.
“Obviously not.” I take a sip of the coffee. No shitty rehab sludge here. This is French press.
Dr. Mackenzie isn’t holding a pad or a notebook, nowhere to scribble an observation in my file.
She simply looks at me, as if I fascinate her.
If this place requires a record of my weight, my scrapes and scars, then surely it requires a record of my doctor’s thoughts, too.
Maybe Maurice and Izabella are also expected to report their impressions of me and at the end of each day all three of them will disappear to scribble notes on what I said, noting every mannerism—that I sat cross-legged like a child, that I bit my nails or picked at my cuticles.
I imagine all their notes neatly organized in a file with my name on it.
I meet my doctor’s gaze. Her face would be symmetrical but for a smattering of mismatched freckles across her nose.
“So what’s your approach here?” I ask finally. “Not CBT, clearly.”
“Why not?”
“Because then you would’ve forced breakfast on me,” I answer. In cognitive behavioral therapy, they focus on (you guessed it) the behaviors around your disorder, putting you on a schedule of what to eat and when, as though meals were a homework assignment.
I don’t want Dr. Mackenzie to see how relieved I am that she’s not forcing me to eat, so I keep talking, trying to sound clinical and detached, like this is all so boring to me.
“And not family therapy, either, because I’m here alone.”
They tried that when I was younger. Grandma Naomi never missed an appointment. Mom’s attendance was sporadic, and eventually the therapist agreed that we made more progress without her. (We didn’t make much progress either way.)
“Internal family systems?” I ask. “That’s all the rage these days. Or maybe you’re out there with psilocybin? It’s going to be more popular than Prozac before long.”
“Have any of those approaches worked for you?”
“Obviously not,” I say again, though I smile a little so she doesn’t think I’m blaming the doctors, but myself. So she’ll know I’m a good patient who wants to get better, not a difficult one who fights every step of the way. “I just like to know what I’m getting into.”
“Why?”
“It helps me manage my expectations.”
“And why do you want to manage your expectations?”
Apparently Dr. Mackenzie is taking a traditional talk-therapy approach. Answering all my questions with questions until I accidentally reveal my deepest, darkest secrets.
When I was underage, my therapists shared their observations with Naomi (and Georgia, if she remembered to ask), but after I turned eighteen, it was as though a wand had been waved and my family no longer had any right to hear about our sessions together.
Think of all the families who send loved ones to places like this, desperate for help, but not allowed to ask for details, blindly putting their trust into strangers who keep secrets for a living.
The privileges of doctor-patient confidentiality spread far and wide.
Even when a patient wants their data shared, it isn’t easy: They have to fill out forms, sign legally binding documents.
I take a deep breath, picturing a room lined with tall cabinets filled with files for each patient Rush’s Recovery has ever had: doctors’ observations and diagnoses, the hints they’re trained to pick up on as they gather information the rest of us don’t know enough to recognize.
Files, including mine someday, stubbornly protected by doctor-patient privilege, even after each patient’s death.