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It was only a glass of water. I put it into her hand and watched her raise it to her lips and very, very slowly, take the tiniest of sips.
This was a real achievement. For the last two days we had watched this young woman deny herself all food and water, slowly becoming more and more malnourished and dehydrated. She was suffering from anorexia nervosa, and had transferred from psychiatry to our medical ward because the risks to her physical health were becoming critical.
Her urine was now as concentrated as her body could make it. Her mouth was dry, she was dizzy and every time she moved her head hurt. Yet still, up until this moment, she had resisted even the smallest mouthful of the water that was always left within her reach.
Under specialist advice, we had been giving her every chance to turn things around for herself without medical intervention. But we couldn’t just watch her any more. My instructions were clear - give her a full glass of water to drink, and if she can’t, start intravenous fluids immediately. She knew that this was coming, and she wouldn’t refuse the drip, but like us she wanted to avoid it if at all possible. So I told her she had an hour, gave her my best encouraging smile and said I would be back soon to see how she was getting on.
Thirty minutes later, about a quarter of the glass was gone. So far, so good - a little slow off the mark but making progress. I said I would check on her again in fifteen minutes.
This time, we were halfway there. Still behind schedule, but still drinking. We’ll keep going.
Another ten minutes and a mere couple of millilitres later, I was starting to get frustrated. I was busy, after all. I had other patients too. It didn’t look like she was going to manage it. But she was still trying, and she had already had more than she had drunk in days. So I kept at it, coaxing and cajoling, checking every few minutes, willing her to finish it for both our sakes.
The longer it went on, the more I doubted myself - I should have stuck to my word, put a stop to things at the hour mark, started the fluids and had done with it. I was wasting my time, I wasn’t following the plan. But every time, we were getting closer and closer. I didn’t want to give up.
I realised that on some level I was being manipulated. Though the situation was deadly serious, it felt like I had been drawn into some kind of a game. I had become entangled in the patient’s tortuous battle with herself. It wasn’t entirely clear who was on whose side. I wasn’t sure any more how it would end.
Then, visiting time came round and the patient’s father arrived. His encouragement gave her the final push she needed, and she finished it all, the whole glass, after an hour and three quarters. That evening she even had a few mouthfuls of dinner, and several days later she was stable enough to transfer back to psychiatry.
I’m not sure who won the game, but I like to think maybe it was both of us.
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