My cousin died during the Coronavirus pandemic for reasons unrelated to COVID-19. When I first heard my cousin had been hospitalized, I immediately attributed it to the virus. She would get through it, I was sure – she was young, healthy, and strong. But slowly, as her brother entrusted me with more information, I realized that wasn’t the case. “You’re a doctor,” he said, knowing full well I was just a medical student. In hindsight, it was more than that. I was a source of support. Someone to share the burden with. But even with this relay of information, I struggled to make the pieces fit. My uncle was forced to unhinge her bedroom door when she failed to answer his calls. Inside, he found her listless and unresponsive. I was told she weighed a meager 89 pounds on admission and her glucose level was 10. Rumors drifted through the family, born of disbelief. She was suffering from depression and anorexia. I could not understand how we could have collectively let it get to the point of required intubation. To the point of total parenteral nutrition. To the point where she coded twice and required dialysis.
Eventually, her body failed her. And in many ways, it felt like we did too.
As someone training to be in the medical field, I found myself fraught with grief and regret. I should have seen the signs. I should have asked. Eating disorders have the potential to be life threatening. Often, they’re a source of jokes in mainstream media and I didn’t understand the full impact it could have until it truly hit close to home. As someone who wants to go into primary care this motivates me to do proper screening and aim for early intervention if possible. The American Academy of Family Physician (AAFP) suggests reviewing not only clinical factors but also psychosocial factors because there are additional things to work on such as self-worth and coping with emotions and stressors (Klein, 2021). Though eating disorders are often diagnosed in teenagers and young adults, it’s important to keep in mind that it can occur in people of all ages. My cousin was in her thirties when she passed.
Treatment options include cognitive behavior therapy, family-based therapy, and pharmacotherapy such as antidepressants like fluoxetine. What’s important is that health related goals be emphasized and not strictly weight. The AAFP defines some markers of recovery as eliminating harmful behaviors, reducing body dissatisfaction and valuing actual health more than weight and numbers (Klein, 2020). I wish there was less of a stigma on talking about mental health and eating disorders and a wider air of acceptance that fostered an environment where people felt comfortable talking about their troubles and maybe my cousin would still be here today. This experience further fueled my desire for better follow up, screenings, and preventative measures for patients.
Hinal Patel, MS4
Drexel University College of Medicine
Klein DA, Sylvester JE, Schvey NA. Eating Disorders in Primary Care: Diagnosis and Management. Am Fam Physician. 2021 Jan 1;103(1):22-32. PMID: 33382560.
