overnight. So young, but needing to run, perhaps without any idea of why, running in the early-morning dark until light infused the sky.
“In the beginning,” Jeanine continued, “she’d come in all red and sweaty, and I’d be making her breakfast and tell her to sit down at the kitchen table. And she would, but she’d keep her mouth tight and turn away from the eggs and bacon or oatmeal I’d serve her. I went out and bought sugary cereals and donuts, but nothing. And last week, when I said, ‘Honey, you must drink enough water. You’re running so much and we live in the desert, it’s a hundred and ten and a body needs hydration,’ she smacked the water glass I’d filled out of my hand. Then every time I offered her water or fruit juice or even the soft drink she used to beg me to buy and I never would, she’d smack the glass out of my hand. Glass everywhere on the kitchen floor. So I went out and bought plastic and I keep trying to get her to drink, but she won’t. All day long I’m spying on my child, to see if she’s drunk something or eaten something without me noticing. Hoping and hoping. I’m checking if glasses are wet. I’m counting the pieces of bread left in the loaf, crackers in the plastic sleeves, cookies in the boxes, slices of American cheese in the fridge, fruit in the crisper; I even counted the Fritos in the bag, but she’s not touching a thing.”
Roma met with the girl every afternoon this week, two hours each time. It is the immersive approach she prefers with a case that has developed this swiftly, to see if she can get to the essence quickly.
The questions in Noelani’s case are: What has speeded this child up? Why is she running so far and so fast? Is there something monstrous she is trying to outrace, and if so, is that monstrous thing within or without? And how is a child so young overriding her natural hunger, imposing on herself an iron-willed discipline at which most adults fail?
Roma has seen elements of this many times over decades in practice, and the causes rarely reveal themselves easily. Noelani is not the youngest patient Roma has had with these symptoms, but what worked with her other patients will have no bearing here. Roma must start at the beginning, treat Noelani as she treats every patient, as the sui generis beings that they are.
When Roma asked if Noelani had any other new and uncharacteristic behaviors, Jeanine began to cry. “She lies about everything. I ask her, ‘Have you brushed your teeth?’ or ‘Did you make your bed?’ or ‘Did you feed your goldfish?’ and she says yes to everything, but it never turns out to be true. She lies about things that are verifiable as untrue with one glance, which Steve and I can’t understand.”
Naturally, the parents are scared and shaken. The cherished daughter they knew, whom they tucked into bed and kissed each night and roused in the morning with hugs, has disappeared entirely, as if she never were.
Everything Jeanine spoke about, Roma has seen in her meetings with Noelani, but she has also seen more. In addition to the girl’s obsessions with running and denying herself food and liquid, she has also seen in her anxiety, anger, and impulse control.
In yesterday’s session, their fifth, Roma was tough, clarifying that if Noelani does not immediately start eating and drinking, she will be hospitalized, sustaining fluids forced into her through a tube in her stomach. Roma pulled out a medical book with pictures of children in hospital beds with tubes jutting into their bellies. She pulled out from a box on her desk the medical equipment that would be used to invade Noelani’s body in that way. The impact Roma had intended to create was deliberate, and there it was—the young face soon covered in sprung tears, snot dripping from the little nose. But Noelani had not given in immediately. Thirty minutes discussing the only outcome had been required before Roma was able to wring out a promise, Noelani writing her name in blocky letters on the bottom of the food plan she agreed to maintain through the weekend. Together they had chosen what she would eat: a banana and yogurt for breakfast; a tuna fish sandwich and apple for lunch; salad, chicken, and rice for dinner; and each day she would drink five glasses of water.
“Just the weekend,” Roma had said, “that’s all you need to promise me now.” And the crying girl, her thin forearms laced with trails of mucus, had carried the handwritten food plan flat on her palms, as if it were an offering on fire, holding it out to her mother in the waiting room, who leaned forward in her chair, her cheeks as tearstained as her daughter’s, until the two were face-to-face. Noelani has her mother’s pretty features, although it will take a few more years for those features to fully emerge, arrange themselves on her face. But where the mother was nicely proportioned, the daughter was gaunt, nearly emaciated, and Roma was certain that Noelani has been running for far longer than only the month the parents believe it has been.
Noelani had tried smiling, a brave barely there smile, and waited for her mother to open the outer door to the parking lot, and then she was taking careful steps to their car. Jeanine had turned to Roma and said, “What now?”
“Make sure she follows the plan. She’ll cry, but remind her she promised. And though she won’t grasp this completely, explain she made this promise to herself, not to me or to you.”
Jeanine nodded and Roma said, “Leave me a few messages over the weekend, to let me know how it’s going. Remember, Jeanine, she chose those meals for herself, so give her only those meals, exactly. Of course, you and your husband, one or the other or both, will have to stand guard to make sure she eats.”
Jeanine nodded again, glancing out at Noelani, still crying copious tears, her careful steps replaced by a frenzied pacing around and around the car.
“What about the running?”
“We have to figure out what the running means to her before we can alter the behavior.”
“And the lying?”
“Health first,” Roma said.
It had taken Jeanine McCadden so much effort to extricate her car from its tight spot, backing in, backing out, turning the steering wheel every which way, that the car seemed to be heaving, as if mimicking the tears of its unhappy cargo inside, and Roma watched until Jeanine finally broke the car free, gave her a sad little wave, and joined the quick flow of late Friday afternoon traffic.
This morning, Roma debates the odds of mother and father having the courage to keep to the plan, of Jeanine leaving the updates she requested on her office or personal voicemail. Impossible to determine, but their actions or inactions will provide her with additional information: a child’s issues are rarely isolated, there is nearly always some sort of tangential cause and effect, and whatever Roma is dealing with here, with Noelani, she likely will have to address the parents’ problems as well.
She rolls onto her side, stares through the gap in the drapes, at the sun spreading across the marble floor, over her body beneath the light duvet. It is Saturday, her work week finished, the morning hours hers alone. By noon, everyone will be here. Phoebe and Simon and his family arriving separately from Los Angeles, Camille from Seattle. Her family all together to celebrate the accomplishments of husband and father. She wishes she had seen Harry this morning, to kiss him, to tell him how proud she is about this honor being conferred upon him tonight. How proud that he righted his ways back then, unwound his wrongs, moved again into the light. They have never discussed that time, but this morning, she would have liked to tell him what an inspiration he is, how she marvels at his devotion to his indispensable work, the magnanimity with which he gives himself fully to everyone who needs him and to those who love him.
Noelani returns to her mind, and then Phoebe pops in. As a psychologist, Roma is used to these jumps in her thoughts, aware there is always a logic to the unconscious leaps she makes, and she considers the connection between her eight-year-old patient and her thirty-eight-year-old daughter, her eldest.
On the phone yesterday, Roma asked whether Phoebe will
