On the fifteenth day that Marietta had not eaten, the psychiatry team knew they could no longer take care of her. With each day, her body grew weaker, her blood pressure softened, and her heart beat faster to keep her alive. By the time the medicine team was consulted, her heart was laboring at 130 beats per minute. The psychiatrists could not get her to eat. Nor could her elderly mother shuffling in each morning, pulled along by her cane and blinking black, wet eyes. Nor could her priest, who knelt daily at the side of her bed. Each day for six hours at a time, Marietta closed her eyes and sang a prayer, summoning her remaining strength to hold her shaking arms open toward the sky. White film grew thick on her tongue. Yellow crust that had not been cleaned from her eyelids and eyelashes was congealing them shut.
Every morning and afternoon we visited her and every morning and afternoon she would not tell us who or what was keeping her from eating. We asked if it was God, if it was herself, if it was a voice in her head. Was she hearing voices? Was she taking her Risperidone? She answered without hesitation; I understand I will die, I will not eat. I know it will be slow and it will be painful, I will not eat. I want to be at peace, I will not eat. And praying resumed.
The Bible condemns gluttons. Children who haven’t finished their vegetables will be made to sit at the dinner table until their bedtime. Fraternity men present pickles and crushed cigarettes to their pledges for the ultimate punishment. Since the beginning of time, the concept of force-feeding has disturbed something deeply innate in us — we recoil at its mention. Feeding Marietta against her will was something no one wanted to think about for very long.
When the decision was made to place a nasogastric tube, Marietta cried and gurgled and bucked. It snaked further, further, and further still; a hand pressed against her forehead to keep steady, a chaperone at her bedside to keep her from pulling it out. Afterward she lay there, breathless and damp. Her suppliant arms were now tied down by wrist restraints, so she prayed out loud to Heaven.
For many situations in medicine, there is no guidebook on how to proceed. When we pledge we will do no harm, who decides what harm means? For now, it is not me. For now, I am learning and watching and thinking of her.
Image credit: Natural Sculpture (CC BY-NC 2.0) by Shawn Harquail
Contributing Writer
Rutgers New Jersey Medical School
Casey is a medical student at Rutgers New Jersey Medical School in Newark, NJ class of 2025. In 2021 she graduated from Washington and Lee with a Bachelor of Science in Neuroscience and Classics. She enjoys spending time with her two sisters and friends, reading, and surfing at the Jersey Shore. After graduating medical school, Casey would like to pursue a career in general surgery.