"Bulimia nervosa is rarely about appearance. It's about control."
Distractedly, Connie breast-fed her nine-week old son in bed, while she analytically scrutinised an online lecture about the condition. She had completed the mandatory psych rotation as a trainee doctor at KCH but her expertise in emotional disorders was far from advanced.
"In adolescents and children, especially, bulimia provides a sense of control over their life. It is a mechanism to help them cope with events that may be traumatic for them to experience. This can vary from all kinds of abuse to parent separation; instability they're not prepared for -" The nasal American accent scratched on Connie's last nerve and she slammed the MacBook screen down, frustrated. It was little more than a TedTalk and she needed a real solution. She moved the machine aside and pondered the best course of action available. She could pull rank and have Grace admitted into Holby's paediatric ward, but that would oppose Sam's - "Let her come to us." - laissez-faire approach to parenthood.
By the hour Sam had returned home from the days shift, the house was immersed in darkness and his family were all fast asleep. After he had checked in on Grace, his body pulled him into Connie's bedroom, where Henry contentedly lay in the co-sleeper crib attached to Connie's side of the bed. In the empty space of the bed was a mountain of paperwork Connie had printed off, most likely with the intention she would commission him to learn more about Bulimia Nervosa. The exhaustion of a relentless, thirteen-hour shift didn't prevent him, as he rested on the unclaimed side of the bed and absorbed the written information. Red pen, in the style of Connie's hand, denoted methods of treatment for adolescents with the condition and what Sam could only presume to be her humble opinion on their respective efficiency. No doubt, Connie planned to discuss each and every one at the appointment with the specialist, which was less than twelve hours ahead. He consumed his mind with the statistics, until his brain shut-down and he woke several hours later to an empty bed.
When he padded down the stairs, bare-footed, and into the kitchen, Connie addressed him coolly, "You were home late." Her manner proposed that she was unbothered to wake up with him in her bed but Sam suspected otherwise. "How was your shift?"
"Madness," he rubbed the sleep from his eyes, "Dr. Munroe collapsed."
"What?"
Sam rolled his eyes, with a sorrow shake of his head, "Don't ask."
Connie forcefully detached herself from any concern for Alicia or whatever else her staff endured in her absence. Grace had to be her main focus, at least for a while. "Sam, about Grace…" she hesitantly broached the topic, as he prepared a cup of coffee. "You and I really need to present as a united front, where she's concerned." His expression was one of cynicism about what the aforementioned united front entailed, since his and Connie's views about Grace rarely coincided. She sensed his lack of enthusiasm. "She needs stability, Sam."
Before Sam could pry her plea apart, Grace returned from a walk with Simba on his lead. Within an hour or so, Audrey arrived to care for Henry and Simba, while the family of three attended a follow-up specialist appointment. For ninety minutes or more, Grace held steadfast and silent to questions like 'Do you worry you have lost control over how much you eat?' and 'Have you recently lost more than one stone in a three-month period?' All the while, she jotted down Grace's responses - or, lack thereof - and finally prompted, "Tell me in your own words, Grace. Why do you think you're here today?" The specialist pushed her notepad aside and zeroed in on the adolescent.
Grace swallowed hard, the lump in her throat almost cancerous. "I make myself ill," she mumbled the words, quickly and quietly.
Grace received a teacher-like smile, the one that indicated she had selected the correct answer to the question at hand. The specialist politely excused Sam and Connie, and proceeded to conduct a physical examination. Another set of questions from the on-shift psychiatric nurse followed; they varied between Grace's relationship with food, with her parents and even with herself. Grace affably humoured every question. Almost two hours had passed, until the specialist confirmed their suspicion - "It's in my professional opinion that Grace is at serious risk of Bulimia Nervosa." - and educated Grace on the irreversible physical effect the condition would have on her body should she continue. Connie swallowed the reoccurrence of nausea, as the specialist warned Grace of the bowel issues and ulcers, amidst other manifestations. She witnessed and treated the symptoms on a daily basis, yet it was intolerable when she envisioned Grace as the patient. Still, she was thankful Grace seemed to experience the same discomfort, and prayed it would be the first step to recovery. The specialist proposed a family-based treatment to combat Grace's decline; "Research has evidenced that FBT has sustained abstinence rates for adolescents, far better than CBT or any other treatment." Connie warmed to the recommendation, when the specialist reported that an early positive response rate all but ensured a permanent, successful outcome. With a recovery plan in motion, Sam and Connie departed the centre with concrete hope.
Later that eve, with Grace and Henry asleep, Connie searched the house for Sam and discovered him seated on the doorstep. She left the front door open, in case Henry should wake, and hunkered down beside him. "I'm not convinced this will work," Sam confessed aloud, as he clutched the information booklet the specialist had provided. The staple requirement of family-based treatment was that the parents act as one. He didn't believe he and Connie were capable of that, even for Grace and her health.
"It has to; it's our only option," Connie reprimanded his skepticism. "FBT recovery rates are double that of CBT -" He started to chortle, his face of amusement hidden in another direction but Connie paused and scowled, "What's so funny?"
"You," he answered, bluntly. It was her stubbornness that Sam had initially fallen in love with, and equally despised. Connie Beauchamp never settled for second best, nor accepted failure well. Ambition wasn't an alien concept to him but Connie possessed it like no other human on earth Sam had ever encountered. He became a little more serious, "How determined you are to fix what's broken."
Connie reacted with exception to his comment, "Grace isn't broken."
He exhaled, heavily, "I didn't mean it like that." Connie admired the constellations in the dark sky above. Sam observed one tear trickle down her cheek and clumsily curled an arm around her back, in the style of en embrace. "She'll be okay." Vulnerable, Connie leaned into his touch, her head on his shoulder and her hand on his lap. The moment overpowered her self-awareness and self-control, so much so that Connie found her lips travel upward to his and a sense of relief wash over her body, when Sam deepened the kiss on his own stead. "I've missed you," he mumbled, between the kiss and an involuntary moan. Connie melted, before Sam tenderly elevated her into his arms and carried her inside.