TW: talk of disordered eating, pregnancy, infertility, reproductive health. Nothing graphic.
Jon took over breakfast duty while Shawn took over watching every move Audrey made.
Audrey was tired, both emotionally and physically, to the point she was leaning on Shawn for support whether she was standing or sitting.
Shawn couldn't do enough for her.
When Jon was finished cooking, Shawn practically carried her to the table.
Breakfast was simple: eggs, bacon, and toast.
Shawn worried it wasn't enough, but Jon didn't think it was a good idea to push too much on her. Audrey let them fuss. She was too exhausted to argue.
She ate. Slowly.
Shawn counted her bites.
Jon didn't sit down with them like they expected him to. He took the phone and disappeared into his bedroom. Audrey finished eating while they waited for Jon to return.
"Can I get you anythin' else, Mama?" he asked as he took her dishes to the sink.
She smiled at the name and shook her head.
Shawn, overcome with great affection, rushed over to her.
The plate clattered in the sink where he dropped it.
"You're so beautiful. I love you, Mama. I'm sorry I haven't told you that much lately."
"I know, Shawn," she said softly. Her voice was still rough from the night before. "I've always known that."
Shawn hugged her again and kissed her cheek. "Are you sure you don't need anythin'?"
"No, love. I'm good."
The sound of running water coming from the bathroom caught their attention and they exchanged curious looks. Jon walked out of his bedroom with phone in hand.
"We gotta an appointment with Dr. Amdsen at two," he told them. "We need to get outta here as soon as possible."
"We?" Shawn asked, wiping his hands on his jeans.
Jon nodded. "Family appointment."
"Aud," he said softly, brushing her hair over her shoulder. "I've got your bath ready. Everythin' you need is in there."
She nodded and smiled at him. Pushing back the chair she stood up, wobbling enough that Shawn thought she might fall. His abrupt rush to help her knocked her more off balance. Jon grabbed them both to steady them. She wrapped an arm around Shawn's neck and leaned her head against his.
"I'm okay," she told them.
Shawn escorted her to the bathroom door where Jon took over. Anxiously, Shawn waited outside, feeling useless and uncertain.
Jon saw him and said, "Go get ready."
Unhappily he did what he was told.
In the bathroom, Jon showed Audrey where he put her clothes and bath towel.
She stood in the middle of the room looking overwhelmed. "Where did you get my clothes?"
He smiled sheepishly. "After I got the calls made to get us outta school, I went over to your place. Shawn was with you, so I knew you'd be okay for an hour."
She squeezed his hand. "Thank you."
He kissed her forehead. "I grabbed your shampoo and conditioner but forgot the soap. I'm sorry. You're gonna smell half like you and half like me."
"I don't mind," she said with a smile.
"Are you gonna be okay on your own?"
She nodded. When she saw the worried look on his face, she said, "I promise."
"I'll be right outside the door."
Shawn found Jon sitting on the floor resting his back against the bathroom door. He took a seat next to him and asked, "How did you get us all outta school without makin' Feeny suspicious?"
Jon gave him a tired smile. "You didn't hear me this mornin', did you?"
He shook his head.
"I called Alex early this morin' and explained what happened. He called Mr. Feeny and told him he needed Audrey on campus today. Mr. Feeny then called me and told me Audrey wouldn't be in today. I took the opportunity to tell him that you and I weren't feelin' good, so we weren't comin' in."
"I'm surprised he believed you."
"Considerin' how I felt and sounded, I think I was pretty convincin'."
"Jon?" Audrey's call got him on his feet so quickly that he knocked Shawn over.
She was leaning against the sink looking pale. She was dressed but still looked disheveled.
"Hey, what's up?"
"I need my hair washed but I don't feel like doing it. It's just…" she lifted a handful. "Too much."
Without a word Jon grabbed her shampoo and conditioner then slipped an arm around her. When he saw Shawn peeking in, he asked him to grab a couple of towels.
He took Audrey to the living room and had her sit down while he ran up the stairs near Shawn's room. The stairs led to a small attic-like storage space. He grabbed one of the bar stools he kept in there for company. He took it to the sink and raised it high enough that Audrey could sit and lean comfortably over the sink. He placed one of the towels in front of her to lean on and turned the water on.
Once the water reached a comfortable temperature, he had her lean over and began to soak her hair with water from the sprayer. Her hair took up the entirety of the sink and Jon found it easier to wet thoroughly if he let the sink fill up with water. Recalling all the times she had massaged his head, he tried to do the same to her as he shampooed her hair.
Shawn stood close to her with his arm across her back, worried she might lean back and fall. Once her hair was washed, both he and Jon saturated the length with conditioner and rinsed it.
They did all this without a word.
Audrey's hair took two towels to soak up the moisture in it. They moved her from the stool to the kitchen chair. Jon began to dry her hair with the hair dryer as best he could. He wasn't quite sure what to do with hair so long. Shawn, needing something to do, sat in front of her absently massaging her hands.
Once her hair was dry, Audrey reached for her brush but Shawn and Jon both got to it before she did.
The two locked eyes.
Jon saw the need to help in his student's eyes, so he took his hand away and left to put the towels and hair dryer away.
Shawn picked up the brush and gently ran it through her hair several times over. He'd played with her hair before, but this was the first time he'd really felt it. It was soft and smooth, more so than his own and there was no product in her hair to make it sticky or hard.
It was the prettiest hair he's ever seen.
And Shawn knew pretty hair.
Jon came back and grabbed his keys and Audrey's purse. Shawn ran to his room to grab his wallet. At the front door, Audrey turned to face them. With tears in her eyes, she put one hand on Jon's cheek and one on Shawn's.
She kissed Shawn first then Jon.
"I love you both so much."
Shawn tried so hard not to say anything that might make her feel guilty, but he couldn't help it. "I need you, Mama. I need you so much. I love you," he said as he squeezed her hard.
On the edge of tears, she looked up at Jon.
"I need you, too," he whispered. "And I love you."
She squeezed Shawn tightly back and let Jon carry her to the truck.
Audrey's psychologist had an office on Bleecker Street. Jon told Shawn it wasn't too far from where Audrey's dad once worked and where he had a spent a large portion of his teen years. To pass the time while they waited, Jon pointed out various places of significance to the two of them from their eighth-story vantage point. Two hours later, Shawn had a pretty good idea of where things were located in the Village.
"Mr. Turner?"
Jon and Shawn turned to see a sharply dressed young man holding a clipboard.
"Dr. Amsden will see you now."
The two were ushered into a smaller office that was bathed in shades of gray and orange. An older woman in her late fifties stood to greet them. She was petite with permed black hair, pale makeup, and bright cherry lips.
Shawn, who was used to being overlooked by adults in serious circumstances, hung back as he did not expect to be acknowledged.
"Please have a seat," she said motioning to the visitor chairs as she went to her desk. The doctor caught his attention and smiled. "You too, Shawn."
That she knew his name piqued his curiosity and he warmed to her enough to ask, "Where's Audrey?"
"She's receiving treatment for a suspected electrolyte balance right now."
A strangled yelp of concern escaped him, and he jumped to his feet.
"We're giving her Gatorade," the doctor explained, unperturbed. "And making sure she doesn't need to go to the hospital for an IV."
"Oh," he said sitting back down as she continued to reassure him.
Dr. Amsden was little different from most doctors Shawn had seen. Most doctors didn't pay attention to him. They talked to his parents but never to him. But this doctor treated him like he was capable of understanding what was going on.
He appreciated that immensely.
Talk quickly turned to family dynamics. Surprisingly, she understood their family and did not seem to think it was strange.
Still Dr. Amsden came out swinging with her first question for Jon. "Exactly how serious is your relationship with Audrey?"
Jon stared down at the floor for a moment, unsure of what to say. He felt strange discussing this with a stranger in Shawn's presence when he hadn't spoken to Audrey about specifics yet.
"Well," he sighed, anxiously rubbing the back of his neck. "I'm hopin' for an engagement this summer."
Shawn stared at him, mouth agape, eyes wide.
That was his birthday wish. Well, marriage was but an engagement would do.
"And what about you?"
It took Shawn a moment to realize she was talking to him.
"Well," he stammered feeling as awkward as Jon with whom he had not discussed his feelings with much. "I'm kinda hopin' for maybe an adoption this summer. Or somethin' like that."
Dr. Amdsen nodded neutrally. "So you're both in this for the long haul?"
"Yes," they responded passionately.
"Good." She paused. "Audrey will need you both."
Shawn shot his teacher a "see I told you so" look.
Jon leaned forward in his seat. "What exactly are we dealin' with?"
Dr. Amsden sat back and folded her hands in front of her. "Unfortunately, Audrey checks all the boxes of a relapse: episodes of compulsive binge eating, purging episodes involving induced vomiting, use of laxatives, and diuretics. She is unduly negative about her body shape and weight. And she has missed her menstrual cycle for the past three months."
Shawn watched Jon's face drain of every last bit of color with morbid fascination.
His teacher looked ill.
"But that's impossible," Jon stammered in bewilderment. "That can't be! We never…"
The doctor shook her head and put up her hand. "No, no. I didn't mean to imply she's pregnant. Missed cycles are common with eating disorders due to the stress the body is put under. We see this more with anorexic patients, but it can occur in bulimic patients as well." She gave him a sympathetic look. "Audrey does show signs of anorexia in her intense fear of gaining weight even though she is underweight.
"How underweight?"
"She's at 90. For her height of 5'4" a healthy weight would be between 107- 120 pounds."
Shawn watched as Jon put one hand over his mouth while the other maintained a white-knuckled grip on the chair's arm.
He twitched his nose as he returned his attention to the doctor. "How long does she have to stay away from us?"
Dr. Amsden softened as the phrasing of the question reminded her that Shawn was still a kid; a confused and scared one at that.
"She doesn't."
"I mean how long does she have to stay with you? In a hospital?"
"Hospitalization is recommended if the patient is at or below 75% of their ideal body weight. This is due to the dangers of low body weight. Electrolyte imbalance, low potassium or too much sodium caused by purging can be life threatening. Eating disorders also put a great deal of stress on the heart. Audrey has undergone testing for these conditions. Bloodwork has been ordered but I do believe we are looking at just a mild case of electrolyte imbalance."
Shawn stared at her uncomprehendingly. "Can't answer a direct question, huh, Doc?"
She smiled amusedly. "Living with an eating disorder and another co-morbid condition like depression can interfere with patients' participation in treatment. Hospitalization may be needed to stabilize depression symptoms before patients can be successful and therapy only care. Suicidal thoughts or behaviors are also a concern and of course, unwillingness to engage in treatment."
She chuckled at Shawn's annoyed look. His guardian may have wanted all of her information, but she could see the teen did not.
"As far as Audrey is concerned," she said. "While she meets some of these requirements, she is open to treatment. As the presiding psychologist over her inpatient treatment three years ago, there is a marked difference in her mental state then and now. While we are waiting for lab results, the medical doctor who examined her does not believe her physical health has deteriorated to the degree of hospitalization."
She leaned forward and said softly, "She can do outpatient therapy."
Jon put his hands over his face and sank back into his chair in relief.
Shawn could not relax, however. "What kinda therapy?" he asked, eyeing her suspiciously.
"Major progress has been made in the treatment of bulimia since Audrey was last admitted," Dr. Amsden told him. "It's good that she's dealing with bulimia. I know that sounds odd but with bulimia, chances of recovery are high- 60 to 70 percent of patients succeed. Anorexia recovery has a significantly lower success rate."
She turned her attention to Jon. "Studies have found that cognitive-behavioral therapy is the most effective treatment for bulimia. One theory is that depression triggers anorexia and bulimia. If you go on a diet and there's a history of depression or alcoholism in your family, there's a much higher risk of developing an eating disorder."
The word alcoholism burned Shawn's ears. He shuddered involuntarily.
"There's definitely a history of depression in Audrey's family," Jon said solemnly. "Richie obviously, but also Lizzy. I know she battled depression throughout her illness."
"I encourage you both to be optimistic. Studies have shown that antidepressants help patients stop bingeing and purging. The best results were achieved with those who received both cognitive-behavioral therapy and antidepressant medication."
Jon nodded. He was silent for a moment then asked, "So what's next?"
Dr. Amsden pushed her chair back and studied them seriously. "The first goal of treatment is to help Audrey establish regular eating habits with good nutrition. Then in therapy she will identify the physical signals of emotional triggers that lead to bingeing. Once those are identified, strategies for handling them are created while also addressing distorted attitudes toward body shape and weight. We want to get rid of the underlying irrational belief, such as that of 'if I'm five pounds overweight, my boyfriend won't like me'."
This felt like a personal attack to Jon who defensively said, "I've never said anythin' to make her think that. Most of the time I keep my thoughts to myself, but I thought she understood that I have to because of the school situation."
"It's not about you, Jonathan," she assured him. "It's about her thinking patterns. Tell me. When you noticed weight was an issue did you try to counter her thoughts in any way?"
"Of course, I did. I told her exactly how attractive I found her."
"Did it make a difference?"
"No," he said slowly. "It was like I was sayin' the opposite."
"It's not about you," she said again. She picked up a file on her desk. "Now therapy for bulimia usually lasts up to 25 sessions, with meetings more than twice a week in the beginning. At the end of treatment, she will have her own maintenance manual based on these sessions. That way, she has strategies she can use on her own."
"Okay," Jon sighed. He still looked sick to Shawn. "That's not bad. But I'm concerned about her being here on her own."
"Why would she be on her own?"
"I can't leave my job and I need permission to take Shawn out of state for an extended time."
"She doesn't have to receive full treatment here. We have a sister clinic in Philadelphia. Since Audrey is my patient, I would prefer to keep her. She can see Dr. Norris Walker for most appointments, but I will need her here twice a week for the duration of treatment."
Shawn gripped Jon's arm and looked at him imploringly.
"We can do that," Jon said firmly. He wasn't sure how, but with Shawn he was sure they could come up with something.
It may not be sane, but it would be something.
"Before you leave there is one last thing I need to ask you, Jonathan."
"Yeah?"
"Have you discussed having children with Audrey yet?"
That was another question Jon was not prepared to answer.
It made everything suddenly very real.
No more "make it to May".
No more marriage and family being at some arbitrary time in the future.
It was real. And it was now.
"I take it you mean kids other than Shawn," he said slowly.
She nodded.
"Not really. But I know havin' more kids is important to her."
"Then you need to know that women with a current or historical eating disorder have more fertility problems, higher incidences of unplanned pregnancies, and often have negative feelings about having a child."
Jon was suffering from information overload. He couldn't imagine Audrey having negative feelings about having a child. As for himself, if it wasn't for Shawn and Audrey, he was fairly certain he would not want children, but he hadn't really thought it through either.
"Are you sayin' she can't have kids?" he asked worriedly.
"I'm saying that eating disorders can cause havoc with a woman's endocrine system which in turn disrupts ovulation and can result in irregular menstrual cycles or, as in Audrey's case, stop them completely. All of these factors can affect fertility and can increase the risk of miscarriages."
"Does she know about this?" If depression was already a concern, Audrey learning this would worsen things considerably. He knew it would devastate her if she couldn't have kids. "I think she's already promised Shawn a sister."
Shawn felt extremely conflicted about all of this. He wanted Audrey to be healthy more than he wanted a sister, but a small part of him was bitterly disappointed this might not be possible.
"There is hope," she said kindly. "Plenty of women go on to conceive after being successfully treated. Audrey's young and that helps. But it's something you need to be aware of for the future."
"Yeah," Jon mumbled pinching his bottom lip. "Yeah."
After a few more minutes of Dr. Amdsen compiling Audrey's paperwork and treatment schedule, she left them and returned with Audrey.
After leaving Dr. Amsden, the trio returned to where they were staying for the weekend- Audrey's childhood home, a brownstone on West 10th Street in the Village.
Jon sat on the couch with Audrey in his lap and Shawn at his side.
"I really appreciate you guys doing all this for me," she said wearily, resting her head against his collarbone. "I'm sorry I've put you through so much."
"You haven't, Aud." Jon kissed the part of her hair. "We're worried about you is all."
Tears welled up. "I don't know what I'd do without you." She reached for Shawn's hands and held on tightly.
Jon was quiet for a long time, tracing slow circles on her lower back. "Dr. Amsden said we can keep you."
She smiled. "I'm glad."
He looked at Shawn and said pointedly. "We need a plan."
The teen perked up. "A secret one?"
"A secret one."
Shawn picked up Audrey's schedule that was on the coffee table. "What's the problem?"
"We can get to Aud's Philly appointments, no problem," Jon said. "She's never taken her allotted sick days so she can use those for the appointments during the school day. The problem is the New York appointments."
"What about Uncle Alex?"
"What about him?"
"Can he give Aud a cover when she's in New York?"
"Yeah, he's willing to, but I don't wanna lie if we don't have to. We need to save him in case we get backed into a corner."
"Can't she use those sick days for the New York trips?"
Jon shook his head. "In order to have all the mid-mornin' appointments covered, she'll have to take half of a sick day each time. New York will be all day."
Audrey listened to them bounce back and forth between questions and ideas. "What about using my dad as a cover?" she suggested. "He wouldn't mind."
"But going up twice a week? Feeny might call the hospice out of concern. No, we keep Richie for an emergency, too."
Audrey bit her lip, feeling discouraged. "This isn't going to work, is it?"
"Yes, it will!" Shawn cried jumping up. He began to pace. "We just haven't hit the right idea yet."
Jon exchanged looks with Audrey. He was beginning to have his own doubts. "I think we're gonna have to tell Feeny."
They stared at him in horror.
"Jon?"
"Maybe honesty will work," he said slowly trying to sort out his thoughts. "We tell him you need accommodation in your schedule. You're supposed to finish in May. Maybe George will let you spread out the rest of your student teaching until the end of our school year."
"What about us though?" Shawn pushed back in frustration. "You tell him, and you can bet he'll be keepin' an extra close eye on Audrey and us. We're toast as a family!"
"It would only be until the end of the school year."
Shawn crossed his arms over his chest and glared at Jon. "First May and now the end of the school year. You keep movin' the goalpost."
Jon shot him a disgruntled look.
Audrey tapped her fingers against Jon's palm. "Do you think he would let me spread out my student teaching to June?"
Jon slowly shook his head in defeat. "No. I think he'll make you stop and come back next year. And you'd be alone for treatment because we'd be watched even more closely."
A devious look gleamed in Shawn's eyes. While they were talking, his mind was spinning. "I have a plan."
Jon looked at him suspiciously. "You do?"
He nodded and smirked, pleased with his own cleverness. "Uncle Alex suddenly has more papers due so Aud can't be on lunch duty. More requirements will mean less time for afterschool stuff."
Shawn walked back and forth in front of the television.
"Aud needs to be in New York Mondays and Fridays. It's only two days. We have three Monday holidays left and two Fridays. Then there's the end of the year. It's always crazy. Feeny's gonna be so occupied with that it'll be easy to distract him if he asks why she isn't around."
Jon didn't see how that would work. There were too many variables to account for. Too many things that could go wrong. "I dunno…"
"C'mon, Jon." Shawn sat on the coffee table. "We can do this. Cory and Topanga will help."
"No, no!" Jon was adamant against this. "The more people involved the harder it will be to keep stories straight. I don't like all this lyin'."
"Okay." Shawn puffed his bangs out of his eyes. "We bring them in only if we have to."
Jon arched an eyebrow. "What am I gonna tell Feeny if he wants her in his office and she's in the City?"
"We'll come up with somethin'. We'll say she went to a weddin' or to the museum."
"Museum?" Jon rubbed his temple. Trying to follow the teen was giving him a headache.
"Yeah, tell Feeny she went to see the T-Rex skeleton for a lesson plan or somethin'."
Jon pinched the bridge of his nose. He wasn't convinced any of this was going to work. All he could see was them getting caught by Feeny and losing everything. But they didn't have much choice. Against his better judgment, he leaned into the plans Shawn was making and started to contribute his own.
Thanks for reading and spending time with me. I hope you are enjoying these. :)