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90837

Image credit here.

Image credit here.

I have known Avril for precisely 203 hours. I have known Avril for 8 days and 11 hours.

I have known Avril one hour at a time for 6 years and 8 days. She was barely out of childhood when we started our secret meetings. She had to sneak around so that her grandma wouldn’t learn about me and kick her out of the house. Now she is a career woman, a single parent, and a home owner. I am her therapist.

Today when Avril left my office, I dashed for the ladies room in the darkened part of the building. My swollen heart was near bursting. I drew a few quaking breaths, grabbed it in both hands, and wrung. When just enough of it had squeezed out my eyes to ensure that it would fit back into my chest until lunch, I allowed myself one luxurious minute more. Maybe two. Another client was on her way. I dabbed my kohl and returned to my post.

I was not sad. The culprit was gratitude. It had been welling and swelling all morning, and Avril’s face had set me off.

Four weeks ago, Avril had returned after a six-month break. She was aware she was starting to falter. I had held up the mirror and shown her how far she had come. She had curled into herself:

“Stop!” she had cried, “Stop it now!”

Two weeks ago, she knew was flirting with disaster. She was scared because she had stopped feeling scared. Would she grasp for the help she needed before she was all used up? Avril had been taught that depression is not real, that medication is an affront to Jesus. She had gutted it out before–but the stakes had seemed smaller back then.

Avril was but a nub that day. Her face was stony, her voice a near monotone. I thought I spied a spark of “Fuck You” simmering behind her eyes but I couldn’t be sure. It both reassured and alarmed me. The starving, the cutting, all those games.…These had been her tools, both comforting and despised, to secure her care. They had been friends once upon a time. Now they fit her like a too-small skin. Weary from trying so hard to embrace her new size, she sought solace in the familiar. She panicked when she realized she couldn’t go back, and this made her strain even harder. In trying to force matters, she had nearly done herself harm.

She had not yet become small enough for me to intervene. I was worried but I would not mother her. Avril had become a woman, and she had to choose for herself.

Today, Avril arrived with a gaunt face, a giant mug of tea, and no hello. She started talking and left me to fill in the blanks:

“The medication is making me really tired. But I stopped trying to avoid food. I know my appetite will come back if I wait.”

Her face was soft and almost shy.

90837 is the billing code for a therapy session lasting 53-60 minutes.

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