Tamanna Rahman CWA 2015

About Tamanna Rahman

Tamanna Rahman ’16 earned a bachelor’s degree in American studies from Williams College in 2007 with concentrations in international studies and Africana studies. She spent several years working as a community and labor organizer, in Baltimore, New York, West Virginia and Bangladesh, before returning home to LA to work in community mental health. She is a certified psychiatric rehabilitation provider and will graduate as a psychiatric-mental health nurse practitioner.

A hunger artist.

“He lived this way for many years, apparently in the spotlight, honoured by the world, but for all that his mood was usually gloomy, and it kept growing gloomier all the time, because no one understood how to take him seriously. But how was he to find consolation? What was there left for him to wish for? And if a good-natured man who felt sorry for him ever wanted to explain to him that his sadness probably came from his fasting, then it could happen that the hunger artist responded with an outburst of rage and began to shake the bars like an animal.” Franz Kafka, “A Hunger Artist,” 1922 

The ribs jut. The knees bow. Pale, dry skin and a slowing heart. Wasting bones on a DEXA scan. Sheets of lab values  peppered with double red exclamations, critical abnormalities. This is what we see when we see her. A fifteen year old in an old woman’s body, willfully starving to death. Blond hair in a ponytail, bubble gum lip gloss. She asks if she can go to her room. 

I first met her during body checks. An adolescent stranger well versed in the twice daily ritual. I am trailing a veteran nurse, clipboard in hand, and one by one we call out their names, summoning a series of teenage girls from the dayroom. When it is her turn, my patient and the nurse exchange a practiced shorthand.

“Arms.”  She rolls up her sleeves. “Nothing new?” A sullen shake of the head. “Lift.” She rolls up the hem of her shirt. Spread across the sunken skin of her stomach, a lacework of thin red scars in various stages of healing. I try to meet her eyes, but she stares ahead blankly. “Legs.” She pulls down her rainbow-starred leggings. On each thigh, a methodical series of deep, even gashes from hip to knee. The nurse glances at the sheet on my clipboard, where 11 little lines have been drawn on a blank outline of a person. She absentmindedly counts the corresponding cuts on our patient’s legs, verifying that all have been listed.

“Any urges?” The patient shakes her head.

“Any thoughts?”

“Nope.”

“What will you do if you have any thoughts?” The rote response: “Talk to staff.”  We let her go back to her room for the rest of free time.  Later I chart that no self-injurious behavior was noted on this shift, that the patient denies any suicidal ideation or urges to self-harm. I click the box indicating that she is willing to approach staff if such feelings should arise. We sign and co-sign the sheets. Driving home, I am haunted by an image of tangled wounds, flat blue eyes, and a gaunt pale figure fading.

I’m passing meds one day when she comes up to me in the hall.

“I ate my entire lunch,” she tells me. 

“That’s great,” I say.  “I’m proud of you.”

“I’m not. They made me. I feel like a failure.” Before I can respond, she turns and runs to her room, leaping onto the bed. This is an act of defiance: she is not allowed to do any exercise, and that includes running, jumping, even pacing in the hall. She waits to see what I will do, balled up fists planted on her hips. When I look over, she jumps up and down. I quickly hide a smile. A troubled kid, but a kid nonetheless, hoping for attention. When I turn away, she flops down dramatically.

“This place is sooo dumb!” she shouts. “I HATE it here!” She has been here 18 days. 

It is no easy thing to live on a locked psychiatric unit for nearly three weeks. Far more than the prescribed calories or the daily weights, it is our gaze that distresses her the most. For someone whose entire life fixates on the inhabiting of a body, our exaggerated focus is torture. Every five to fifteen minutes, twenty-four hours a day, someone peers into her room, or the dayroom, or the dining room, and notes her exact activity and location in tiny letters on a form. At meals, and for two hours after, someone sits at her side, watching.  There is no hiding here, and yet we see so little. 

When I go and sit with her, I am always struck by her frailty. It is easy to write up a treatment plan, following the strictest eating disorder protocols. It is another thing to high five a young girl with fingers so cold I can feel the chill. When I sit with her, she tells me about her poetry. And I tell her that I like to write too, and we talk about her favorite authors. She says she loves music, and explains to me that things called Tumblr and Snapchat exist. She says she misses her friends. Friends aren’t allowed on her call list. I tell her we’re going to break her out so she can see them, and her face lights up. How, she asks. I reply, “By mastering your coping strategies, of course!”  And she groans, but she is smiling.

Sometimes when we are coloring side by side, I long to tell her: I understand. That the hunger is what braces you, how you keep hold when everything is falling. I want to tell her that I am in awe at her rigor, that I see how hard she has worked at an art we simply can’t abide. I want to tell her that I understand, because there was a time when I too was absent.

But it is not my job to say these things. When she wakes at night screaming, tormented by visions of a party where she is forced to dine on cake and cream, it is my job to dose her with a PRN and send her back to bed. If I could, I would go to her and tuck her in, sit with her until sleep comes, and stay. Remind her that she’s a kid, not a patient, and that maybe one day there will be something beyond the sadness. But for now, I simply make my rounds, every five to fifteen minutes, and keep the watch.