Page 8 of In a Pickle

Liana had always struggled with anxiety, especially in college. When the pandemic hit, and Liana had to attend online school from her childhood bedroom, she assumed that her increasingly poor physical health symptoms were manifestations of her anxiety. The mind-body connection was real, right? And wasn’t everyone experiencing anxiety during lockdown? So it stood to reason that her near-everyday stomach pain and occasional vomiting could be symptoms of her already-diagnosed anxiety.

One night early in the pandemic, Liana found herself unable to stop vomiting for fourteen hours straight. Her mom found her hunched over the toilet, clutching a sharp pain in her upper abdomen.

Liana had reluctantly allowed her mom to take her to the emergency room, where the lobby medical assistant took her temperature and eyed her skeptically when she was a perfect 98.6 degrees. In those early COVID days, nurses used temperature to sort patients. The attendant told Liana she probably did not have COVID and gestured for her to sit and wait until a doctor could see her.

Liana puked into a bag for nine hours in the emergency room lobby, waiting as person after person suspected of having COVID was taken into the hospital before she was. Finally, long after Liana had stopped having liquids in her stomach to vomit, the doctor saw her and declared that she likely had a burst ovarian cyst. A technician stuck a probe up her vagina for an intravaginal ultrasound, which revealed scant evidence of any cyst.

“It happens a lot,” the doctor told her, “when the cysts abrupts, it doesn’t leave much behind.” He gave her an IV of Zofran to stop the vomiting and some fluids to rehydrate her. Once she’d successfully eaten one soda cracker, he sent her on her way and advised her to make an appointment with her obgyn, but assured her there would be no lasting effects from the cyst.

The next time Liana had acute stomach pain, three months later, she didn’t bother to see a doctor. If it were just a cyst, the doctor couldn’t do anything to help her, and it wasn’t worth the trouble. Plus, hospitals were overflowing, and she didn’t want to take a bed away from a COVID patient who needed it. Shewas young, in her early twenties, and it was selfish to demand a doctor’s attention when the elderly and those with respiratory problems couldn’t even get into a hospital.

By the third time she had an attack of vomiting and stomach pain, Liana had stopped believing she had ovarian cysts. So she went down the WebMD rabbit hole, trying to determine if food could be exacerbating her anxiety. After all, it seemed that if she simply didn’t eat, she felt fine. She realized that every time she’d had stomach pain in the past few years, it only occurred after eating. Perhaps she was eating the wrong foods. There must be a “healthier” diet that would make her digestive system work right again.

The anti-inflammatory diet seemed to fit the bill. Liana spent hours driving to grocery stores, trying to find the right combination of fresh fruit and vegetables and legumes. But after months of following the anti-inflammatory diet strictly, she found her stomach pain steadily increasing each day.

More googling. Perhaps her anxiety was causing IBS? If so, a diet she found called FODMAP would surely make her feel better. But after a carefully prepared meal of soba noodles sauteed with arugula, bell peppers, and almonds — all on the FODMAP diet — Liana found herself once again vomiting in the emergency room, fearing that her stomach was about to burst. This time, she was screened for appendicitis, but her appendix was intact.

Liana decided to see a gastroenterologist, who assured her that IBS as a result of anxiety was very common. Was Liana sure that she had her anxiety under control? Yes, Liana told the GI honestly, her anxiety was very much under control. By that point, Liana was the happiest she could remember being in a long time. She’d ended up enjoying the time spent at home,relaxing with her mom; she was weeks away from graduating college and poised to move to Los Angeles to try to start a career making movies; and she’d received her first COVID vaccine, making the world feel new and inviting again.

The GI gave Liana a side-eye, seeming to doubt that Liana’s anxiety was under control. But he agreed to run a full abdominal ultrasound to rule out diseases.

The only irregularity that the ultrasound revealed was a swollen liver. The GI told Liana she had fatty liver disease. “Unusual,” the doctor said, “given that you’re underweight. But not impossible, especially if you have diabetes.”

Multiple subsequent tests revealed that Liana did not have diabetes. “Fatty liver disease, then,” the GI said, and gave her a pamphlet on a high-fiber diet. Fibrous foods such as beans and leafy greens would do wonders, he said, as would avoiding simple carbohydrates like white bread.

Liana tucked the pamphlet into a box as she packed up her life for her long-planned cross-country move to the West Coast. Liana and her mom took five leisurely days to drive from Miami to Liana’s new apartment in Hollywood, which she was to share with three other acquaintances from college. All four had dreams of making it big, and Liana felt the excitement run through her each time she saw the Hollywood sign out her window.

Finally, she thought, she’d made it. She had an honors English degree from an Ivy League school and was about to start a highly competitive internship at HBO. Los Angeles was still half shut down due to COVID, but that was all right with her; she was never the most social person in the world, and she preferredsitting on the beach in Santa Monica or driving the curves of Mulholland to clubbing, anyway.

Liana was convinced that, with her GI’s food advice in hand and her anxiety nearly nonexistent, her health challenges were finally behind her. She was 22 and in L.A. working at HBO — what a dream! But the next year was hell. Liana awoke each day excited, only to find herself in pain each night by 8 pm. She found herself gradually refusing any and all social invitations.

Each day, she was convinced that she just wasn’t following her diet closely enough. Hadn’t she eaten strawberries yesterday? Those were high-fiber, but they also had carbs, and weren’t carbs evil? Yes, the solution must be to cut out all carbs.

By the one-year anniversary of her move to L.A., Liana had an epiphany. When she didn’t eat, she didn’t feel sick. So there was a simple solution: she would just stop eating.

She decided that she would survive mostly on a liquid diet of chicken broth and vegetable broth, with the occasional juice or smoothie to give her body some nutrients. She would allow herself a bare minimum of solid food to try to make the diet sustainable long-term: 800 calories per day of solid food, eaten in increments of 200 calories apiece every four hours. (Eating too much at a time seemed to be a consistent cause of stomach pain.) Most of her solid meals would consist of white bread, white rice, or peeled potatoes — the only three foods she found that never seemed to cause her pain, unless she ate too much of them at a time.

The diet worked — at least in one aspect. Liana no longer had what she called the “attacks,” those hours-long fits of 10-out-of-10 stomach pain and vomiting.

But try as she might, Liana couldn’t recover her health. In fact, even as her acute symptoms improved, her overall health declined. She felt constantly fatigued. Her brain felt sluggish each day, shrouded in a fog she couldn’t escape. Even worse, she found that her brain-fog was affecting her career prospects. By that time, the HBO internship had ended. After applying unsuccessfully for dozens of jobs, she took a job in a studio mailroom, which many people had told her was a common path to success.

But in order to move up from the mailroom, Liana soon realized she had to schmooze. That meant happy hours every night, not to mention working lunches and being seen at the right parties. Liana was an introvert, and while that didn’t mean she was incapable of social events, going out was draining. She liked happy hours generally — especially when her producer idols attended them — but she needed a lot of energy to put herself out there in the best of times. Given Liana’s constant fatigue and stomach pain, she simply didn’t have the energy to attend the necessary happy hours and social gatherings. She also felt extremely self-conscious about having to avoid alcohol and most foods.

If she couldn’t attend after-work events, she resolved to be as social as possible during working hours. But she couldn’t quite push herself to network as much as she should. She knew, on an intellectual level, that she was far from her best at work, her brain as deprived of calories as it was. Her mind betrayed her by loving her size-zero figure, but Liana knew that starving herself was probably costing her a good shot at a job. Still, she couldn’t make herself eat, and she resolved to continue to look for work while eating the bare minimum calories to maintain a somewhat intelligible conversation with a potential employer.

Desperate to make rent, Liana took a position with a smaller studio. The gig sounded somewhat exciting, despite the below-market pay and the fact that it was a contract position.

Finally working fulltime and unwilling to lose her job because her brain was starved of calories, Liana forced down small meals. But as soon as she started giving herself enough calories to function mentally, the excruciating stomach pains started again. And paradoxically, even as she was eating more, she became more and more tired each day, especially by the end of the day. She left the office promptly at 5:30 pm each night, desperate just to make it home and collapse into her bed by 6:30.

Her contract position afforded her no health benefits, but at age 24 Liana was luckily able to use her mom’s health insurance. She decided to try a different GI. After describing her symptoms of stomach upset, upper abdominal pain, and acid reflux, the GI told Liana she surely had an esophagus or stomach condition. An upper endoscopy followed, which also failed to uncover any medical diagnosis.

For the next few months, Liana hardly had time to work, much less schmooze, as she dutifully underwent dozens of tests to solve her medical mystery. At her doctors’ urging, she took obscure medical tests that sounded like things out of a sci-fi novel. She swallowed a radioactive pill and held a scanning machine to her body as it passed through her digestive tract. She had more than 20 different blood draws. Multiple imaging scans. Another nuclear test, this time eating a radioactive egg-and-jam sandwich. All inconclusive. Nothing abnormal. When she wasn’t avoiding eating, she was fasting per doctors’ orders in advance of some medical procedure or another.

Her health worsened.I must be subconsciously anxious about work,Liana thought.I don’t think my anxiety is bad right now, but what do I know?

Finally, this past summer heralded a breakthrough. A super-niche GI specialist thought to do a colonoscopy: a basic, regular procedure for anyone over 50, regardless of their health, but a procedure no one had thought to perform for Liana.

Liana still remembered the doctor approaching her, in her post-colonoscopy anesthetic drug-induced haze: “I think you have Crohn’s disease.” When the drug fog cleared, Liana thought she must have heard wrong. Wasn’t Crohn’s a disease where you had diarrhea several times per day? She’d never had diarrhea once throughout her years of sickness, not that she liked thinking about those kinds of things.