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Shalom's comment in "It's not a narcotic" reminded me of this story of an anorexic bulemic inmate I had when I was a nurse in a county jail. She was a challenge to deal with, as she was bound and determined to have her own way no matter what.
She'd been convicted of embezzlement and fraud and had tried to get the judge to sentence her to serve her time in a treatment center for eating disorders in Baltimore (about a 2 hour drive away).
The judge flat out refused, and made it specific in his sentencing order that she could NOT serve ANY time in a hospital.
I remember having a conversation with the doctor about this gal. The warden had made it clear he did not want this chick going to the hospital. Both the warden and the doc were worried she'd go on a hunger strike until she got hospitalized, and she in fact threatened to do this. We couldn't legally force feed her in the jail.
So I asked the doc, "Is she eligible for work release?" Work release is a cherished privilege: you go to your job during the day and are locked in only on your days off and evenings. But it is a privilege that can be taken away.
Doc was confused. "What does that have to do with anything?"
Me: Simple. Tie her work release to weight gain. She doesn't gain weight, she doesn't work. You just tell me how much you want her to weigh. We can also tie it to her yard, library, and commissary privileges.
Well, we tried it, and it didn't work . . . at first. She continued to lose weight, and at first rejected her privileges. Turned out she had to serve some straight time before she could get work release. Doc got very worried, she was on the verge of being back in the hospital for real. She was determined to force us to transfer her to the eating disorder hospital, and thought if she continued to lose weight we'd have no choice, judge or no judge.
Worse, she was stealing food from other inmates, eating it, and purging it. She was millimeters away from the beat down of a life time.
So I called her to Medical and had a sit down with her.
Me: This isn't going to work. The judge has been real clear. You CANNOT go to the eating hospital. It WILL NOT HAPPEN. If you keep pushing this, you'll end up in the local hospital with a tube down your throat force feeding you.
Inmate: I don't care. I'll be out of here.
Me: but your time will stop while you are in the hospital. You still have to serve out your time. And once you serve so much, at least you get work release. Work with me on this. We just want to maintain a healthy weight long enough for you to finish your time. Then, when you get out, you can go to the eating disorder hospital and really work on your issues.
Inmate reluctantly agreed. She was really starting to want her work release.
So I called the doc and said, "Order a calorie count. We'll set a caloric intake she has to meet every day, along with a pattern of weight gain. If she meets it, we'll let the warden know she can have work release, yard, and library."
Doc: How will you do a calorie count on the block? I don't want to put her in Medical for this. [neither did I: didn't have an open ward, but 8 individual cells with 23 hour lock down. No one wanted to be in Medical] How will you keep her from purging after she eats?
Me: I'll post a log in the block. The officers will pull her out of the block and put her in a chair by the floor officer's desk during the meal. To meet our requirements, she has to finish her tray within 30 minutes. Then she has to spend another thirty minutes after that at the officer's desk. Food usually is out of the stomach in 20 minutes. That ought to reduce the impact of purging. The officers will keep track of what she eats in percentages. I can figure out the calories from there.
Doc: The officers will hate you, Panacea. But it is a good idea. I'll talk to the warden.
He was right; the officers did hate me
But it worked. She put on weight and got work release.
Then she started losing weight again. I had to have another sitdown with her.
Me: You are losing weight again. The other inmates tell me you are spending your whole yard time jogging. That must stop.
Inmate: I'm fat. I have to get the weight off.
Me: Don't give me that. You know you are sick, and that your perception of your weight is not trustworthy. You must gain weight. I'm asking the warden to suspend your yard until you put the weight back on. If you keep losing, I'll ask him to pull your work release.
Inmate: You can't do that! I earned work release. The judge said I could have it.
Me: Only so long as you abide by institutional rules. It is a privilege, not a right. Don't test me on this. I will do it.
She complied, grudgingly. She was still stick thin when she finally go paroled, but at least she didn't look like a concentration camp survivor (no disrespect intended to survivors of the Holocaust).
It was one of the most challenging, but satisfying, patient care plans I'd ever done as a nurse.
She'd been convicted of embezzlement and fraud and had tried to get the judge to sentence her to serve her time in a treatment center for eating disorders in Baltimore (about a 2 hour drive away).
The judge flat out refused, and made it specific in his sentencing order that she could NOT serve ANY time in a hospital.
I remember having a conversation with the doctor about this gal. The warden had made it clear he did not want this chick going to the hospital. Both the warden and the doc were worried she'd go on a hunger strike until she got hospitalized, and she in fact threatened to do this. We couldn't legally force feed her in the jail.
So I asked the doc, "Is she eligible for work release?" Work release is a cherished privilege: you go to your job during the day and are locked in only on your days off and evenings. But it is a privilege that can be taken away.
Doc was confused. "What does that have to do with anything?"
Me: Simple. Tie her work release to weight gain. She doesn't gain weight, she doesn't work. You just tell me how much you want her to weigh. We can also tie it to her yard, library, and commissary privileges.
Well, we tried it, and it didn't work . . . at first. She continued to lose weight, and at first rejected her privileges. Turned out she had to serve some straight time before she could get work release. Doc got very worried, she was on the verge of being back in the hospital for real. She was determined to force us to transfer her to the eating disorder hospital, and thought if she continued to lose weight we'd have no choice, judge or no judge.
Worse, she was stealing food from other inmates, eating it, and purging it. She was millimeters away from the beat down of a life time.
So I called her to Medical and had a sit down with her.
Me: This isn't going to work. The judge has been real clear. You CANNOT go to the eating hospital. It WILL NOT HAPPEN. If you keep pushing this, you'll end up in the local hospital with a tube down your throat force feeding you.
Inmate: I don't care. I'll be out of here.
Me: but your time will stop while you are in the hospital. You still have to serve out your time. And once you serve so much, at least you get work release. Work with me on this. We just want to maintain a healthy weight long enough for you to finish your time. Then, when you get out, you can go to the eating disorder hospital and really work on your issues.
Inmate reluctantly agreed. She was really starting to want her work release.
So I called the doc and said, "Order a calorie count. We'll set a caloric intake she has to meet every day, along with a pattern of weight gain. If she meets it, we'll let the warden know she can have work release, yard, and library."
Doc: How will you do a calorie count on the block? I don't want to put her in Medical for this. [neither did I: didn't have an open ward, but 8 individual cells with 23 hour lock down. No one wanted to be in Medical] How will you keep her from purging after she eats?
Me: I'll post a log in the block. The officers will pull her out of the block and put her in a chair by the floor officer's desk during the meal. To meet our requirements, she has to finish her tray within 30 minutes. Then she has to spend another thirty minutes after that at the officer's desk. Food usually is out of the stomach in 20 minutes. That ought to reduce the impact of purging. The officers will keep track of what she eats in percentages. I can figure out the calories from there.
Doc: The officers will hate you, Panacea. But it is a good idea. I'll talk to the warden.
He was right; the officers did hate me
But it worked. She put on weight and got work release.Then she started losing weight again. I had to have another sitdown with her.
Me: You are losing weight again. The other inmates tell me you are spending your whole yard time jogging. That must stop.
Inmate: I'm fat. I have to get the weight off.
Me: Don't give me that. You know you are sick, and that your perception of your weight is not trustworthy. You must gain weight. I'm asking the warden to suspend your yard until you put the weight back on. If you keep losing, I'll ask him to pull your work release.
Inmate: You can't do that! I earned work release. The judge said I could have it.
Me: Only so long as you abide by institutional rules. It is a privilege, not a right. Don't test me on this. I will do it.
She complied, grudgingly. She was still stick thin when she finally go paroled, but at least she didn't look like a concentration camp survivor (no disrespect intended to survivors of the Holocaust).
It was one of the most challenging, but satisfying, patient care plans I'd ever done as a nurse.
She's starting to -look- unhealthy, and her therapist wants to put her into an eating disorder unit. But she's not quite bad enough to have her go involuntarily.
hot to even think of moving more than strictly needed and I've had gastrointestinal issues that are clearing up YAY. (Yes I'm eating ~1400 a day, thnx) 
/tmi
]
it's called eating out!
Should be up tonight... if the album's fix'd.)
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