Chapter Twenty Three: Treatment

Remus and Sirius sat nervously in the conference room on Harry's floor. They had been waiting here for a while when Lucy finally came through the door and greeted them. "Hi there, how are you two? It's been awhile since the three of us have talked!"

Sirius shuffled nervously, "We're fine. How is Harry? You were gone for a long time… I'm assuming that means he actually talked to you?" he asked worriedly.

Lucy smiled and sat down across from them. "Yes, Harry and I talked. He wasn't particularly open or forthcoming, but I didn't really expect him to be." She took a pause to sip the coffee that she had managed to grab before coming in. "But I would really like to talk about how you guys are doing for a minute."

Sirius rolled his eyes, but Remus put a hand on his arm. "Thank you Lucy, I think we are both very worried… and stressed."

"Understandably."

Remus nodded, feeling himself relax a bit as he spoke. "I just don't know how it got this bad without us seeing it.. I know he was wearing glamors… but shouldn't we have sensed that something was wrong? I just… we failed him." He dropped his hands into his lap.

Sirius put his arm around his friend. "Remus," he said quietly. "It's not your fault… I should have seen that he was lying to us… I've been in his shoes enough times to have spotted it, and I didn't."

Lucy shook her head at both of them. "Please stop beating yourselves up. Harry has been hiding his problems for years, unfortunately that didn't just stop the day that he got out of the Dursleys. He is very skilled at it, that's why he was able to hide the abuse for so long. Perhaps we should have had more safeguards in place, in anticipation of this. But we can't dwell on what we could have done differently, we need to focus on helping Harry now. How we respond to this is going to be critical. Harry did a lot of hard work over the summer, learning to trust you guys. This is the first time that he has really made poor choices that have consequences."

Remus shook his head "We aren't mad at him, of course we aren't. We just want to help him!"

Lucy smiled, and chuckled a bit. "I know that, Remus, but it doesn't change that fact that Harry messed up, he lied, and broke the agreements that we put in place when he first came out of the hospital. Harry hasn't had normal parent-child relationships, so you need to be careful how you react. Of course you don't want to punish Harry, but you two are the authorities, you are in charge in this relationship, and you need to show Harry that. That's going to be hard for Harry, children of abuse are often terrified of people having authority over them, because they expect them to abuse the power. But it's important that you show Harry that it is possible to have a healthy relationship with authority. If you are consistent, this will become comforting thing to Harry because he can learn that he doesn't have to be in control all the time, that he can just be a kid."

Sirius nodded, connecting all too well with her words. "But how exactly do we do that?" He asked desperately.

"Well…. It's not easy… and there is no one answer. But I think we need to come up with a plan to keep Harry safe, and address some of the most pressing needs. It's going to take a lot of patience and consistency on your part."

"Some of the doctors mentioned wanting to do an inpatient program? It doesn't sound like that's what you're recommending?" Remus asked.

Lucy sighed "I'm torn about that. Harry is very sick, he clearly has an eating disorder, but he doesn't fit the typical presentation for anorexia. It looks as though it was a sudden onset, but my gut is telling me that this has been brewing for a long time. I think it was simply magnified when he went back to school, and the realities of this past summer sunk in. I think he would benefit from treatment at an eating disorder inpatient program, but I also think he would benefit greatly from staying home with you two."

She paused, looking conflicted. "I just can't help but think that these initial weeks are crucial to setting the tone for Harry's recovery. If we send him away right now, he may very well recover faster… but I worry that he will be able to avoid facing his fear of authority, that he will not be forced to confront his attachment issues, and I think that is probably a big key in helping him to truly recover."

Sirius nodded "Okay, so we take him home."

Lucy sighed "Well, it's a bit more complicated than that…"

He sighed, rubbing his forehead "But you said that he needs to be home. We can do this Lucy I know we can!"

She nodded "I believe you Sirius, I really do. But Harry has done real damage to his body… and in a program he would have the support that he needs to not allow that damage to go any further. If we send Harry home, and he refuses to eat… what would you do? What can you do?"

Remus and Sirius glanced at each other. "I have no idea," Remus admitted.

Lucy nodded "Listen, I would like to consult with a colleague, who actually runs a program… It's the only one that I'm aware of that has the ability to take on a wizard as powerful as Harry… But they are very focused on treating the family unit. You and Harry's situation is a bit unique, but she may have some ideas for us."

Remus and Sirius nodded "Great, thank you."

"Just to be clear, you two are willing to take Harry home if we decide that is what is for the best?"

They both nodded eagerly.

"And you would be willing to follow whatever program we come up with to help Harry recover?"

Again they nodded, and she nodded back, "Okay, then I'll go talk with Maggie quickly, and I'll meet you back in Harry's room, if that's okay. I think he is struggling with feeling very out of control right now, so I think it would be helpful if we all discussed the options together. After all, we can make all the plans we want, but Harry is going to have to put in the effort and work with us if he truly wants to recover."

None of them said what they were thinking, what if Harry didn't want to recover?"

Remus and Sirius were sitting on either side of Harry, chatting quietly with him (although Harry didn't engage much) when Lucy came back in half an hour later. She smiled warmly at the scene. It was really amazing how these two men had stepped up to help the boy. The lunch tray sat on a counter to the side of the room, untouched.

"Hey you three" She said with a smile, leaning on the door frame for a moment.

Harry smiled nervously at her "So, what's the verdict?" He half joked, but she could see the fear behind his eyes.

She came in and pulled a chair from the corner of the room so that she could sit facing all three of them. "Well, I have some things I want to go over before we talk about plans. I have some options for you… that the four of us can discuss together. But like I said earlier Harry, we need to make choices to keep you safe right now, so the final choice will lie with Remus and Sirius."

All three of them nodded, looking very nervous.

"I spoke with your Doctors Harry, and the results from the tests that they did have come back. We were mostly concerned with your heart, it appears that you have done some lasting damage to your heart… it is not pumping as strongly as it should be. This is because of electrolyte imbalances due to being malnourished for too long. As well as the effects from the caffeine pills" She paused to let that sink in. "At this point it is too early to tell if this damage will be chronic, or if it can be reversed. The hope is that by providing adequate nutrition now, and preventing further damage, we can help your body to heal. You've also lost a lot of muscle mass, and bone density. The muscle mass can be rebuilt, and the bone density should be able to be rectified."

Harry seemed to have tuned out, but Remus and Sirius were nodding "So what does that mean for right now?" Remus asked level headedly.

"Well, right now those are things that we need to monitor, and your doctors are going to prescribe you some medications and supplements to help your body to heal. But what it really means is that Harry needs to get proper nutrition again from here on out."

Harry bit his lip at this, staring at his hands and saying nothing.

Sirius glanced worriedly at his charge "So does that take us to the plan?"

Lucy nodded "It does, I have two options for you… After talking with each of you, I have diagnosed Harry with an eating disorder."

Harry scoffed, "That's ridiculous, I'm not anorexic."

"No, you're not," Lucy confirmed "You have been diagnosed with what's known as unspecified feeding and eating disorders, or UFED. It's a sort of catchment of eating disorders which do not follow the normal patterns of the more well known eating disorders. It's actually the most common eating disorder diagnosis." She paused to let that sink in. "The treatment for UFED involves a combination of therapy to help address the underlying behaviors and thought processes that contribute to the condition, and nutritional support to restore health."

"Sounds like a blast," Harry muttered angrily.

Lucy decided to ignore that. "So there are two treatment options that I am going to present to you. The first, is an inpatient program, designed specifically for magical teens who are struggling with eating disorders. I have a good friend and colleague who runs the program and has told me that they could make a place for you within the next week or two if you choose that route. It would be an inpatient program, so Harry would live there. Generally the patients take several months to go through the program. It is very intense, in the beginning all meals and snacks are chosen for you, and closely monitored. If you do not complete your meal in the allotted time, it is fed to you through a tube. There is a system that you work through, where they support you as they give you more and more freedom in choosing what you eat and taking back control of your life. Eventually you can earn day passes, and weekends home, that sort of thing." She paused, but could see immediately that no one liked this option.

"The other option" Lucy said carefully "Is for you to go back home with Remus and Sirius… You would have the same support of the team from the treatment center, but the system would be implemented at home. We would work with their nutrition team to come up with a meal plan, and we would set up safeguards, of how we would proceed if you were unable to finish the meals as required. You would continue to have therapy with me, but at a higher frequency, probably two or three times a week."

She paused and waited until Harry met her eyes "This option only works if you work with us Harry, I understand that it will be hard, I expect it to be hard. But we need you to work with us. If at any point I, Remus or Sirius feel it's not safe to keep you at home, or if your team determines that your health is deteriorating, then you would be readmitted to St. Mungo's and we would re-evaluate the plan."

There was a long silence, as they all let that sink in, and waited for Harry to respond.

Harry tried to think through what she was saying. I… I don't want any of these options… I can't, they can't send me to some treatment center… where they shove tubes down my throat? But if they're going to do the same thing at home? He shook his head "I don't want to do either of those." He complained.

Sirius rolled his eyes "Harry, you need help, I know you don't really want it right now, but we need to help you, and we need to make a decision. Do you want to give us your opinion? Or should we just decide?"

Harry was impressed with how calm Sirius sounded, it worried him. They're really serious… "What did you mean…" he asked carefully "about the safeguards if I wasn't eating?"

Lucy smiled softly, she had a feeling he would ask about this. "Well, Remus and Sirius and I would have to put together rules for what would be expected of you… but the general idea would be that we would set a certain amount of time in which you would be expected to eat all of each meal. If you weren't able to finish your meal in say, an hour for example, then you would be required to drink a nutritional supplement. If you couldn't do that you would come into the treatment center and be fed through a tube. That's just a for-instance though" She added quickly "We will need to conference with the treatment team about exactly what the guidelines would look like."

So they're going to make me eat no matter what? Ugh, this sucks… Harry thought desperately. But still, I'm probably better off at home… Sirius and Remus will calm down in a few days and maybe this will all go away. I'm definitely not getting locked up in some stupid treatment program for months on end, I would miss the second term! "I would rather stay home." he said quietly, hoping that he looked serious and compliant.

Remus and Sirius exchanged glances. "So we would be following a program outlined by the treatment facility?" Remus clarified.

Lucy nodded "yes, and you would have the support of the staff at the facility. They, along with myself, could help to support you two as well as Harry."

After another glance they nodded, "then I think we would like to bring Harry home." Remus said, sounding less than certain. "We would at least like to try bringing you home… if possible."

Lucy's smile broadened. "I was hoping you would choose that. It's going to take a few days to get everything in place, and prepare you all for the transition home, but I think we could probably get you home by the end of the week."

Remus looked relieved, but Sirius chewed his lip. "What about while Harry is still here in the hospital? Is there an expectation that Harry eats while he is here?"

Lucy sighed, she had been dreading this question. "Well," she said carefully. "Given Harry's current medical status… his team feels that he would benefit from close nutritional management for the next few days. Unfortunately there is a dangerous situation that can occur when someone who has been very malnourished starts to eat again, where the body becomes overwhelmed if they are given too much food too quickly, it's called refeeding syndrome."

TW: descriptions of tube feeding & physical restraint use, & a flash back

Harry smiled triumphantly at this, so they aren't going to make me eat.

"Because of this" Lucy continued carefully "they are recommending that Harry be fed through a feeding tube for the next few days… so that they can closely monitor how your body is responding, and increase the amount as tolerated."

Harry paled. That is not what I was expecting. No… no…

Remus and Sirius turned to Harry, sensing his rising panic. "Try to breathe Harry," Sirius said quietly. "This is just temporary, just for a few days to get your body used to things again." He paused, squeezing his godson's hand, his heart going out to the panicked boy. "And maybe it's for the best? You don't have to fight about it anymore… you can get some rest."

Harry closed his eyes, embarrassed to realize that tears were filling his vision. "Please," he said quietly, hating the desperate sound of his voice. "Please I'll eat, you don't have to…"

Lucy had stood and come to Harry's side as well. Having anticipated this response, she had brought a calming draught with her. She handed it to Harry now. "I'm sorry Harry, I didn't want it to come to this… but we have to keep you healthy. That has to be the priority right now."

That seemed to trigger something in Harry. His eyes opened, the room vibrating as magic rolled off of him. He threw the vial that she had offered him across the room. Feeling a slight shiver of satisfaction as it shattered against the wall. "No! I won't let you do it, I won't! Get out! Get the hell out of my bloody room!" He yelled.

Vials and glasses were shattering all around him. The windows cracked on either side of the bed. Harry was losing control but he didn't care.

He was vaguely aware of other staff running into the room with wands out. He felt hands on him, the faces swimming around him, yelling things. Uncle Vernon was there, grabbing him and shaking him, yelling "freak!" At the top of his lungs. Harry fought with all his might "Please, don't… don't touch me please!" A nurse pushed something through his IV, and then his vision went black.

End TW