Out of a mother's tenacity

The News & Observer

October 9, 2003

Out of a mother's tenacity

Susan Kinzie Staff Writer
John L. White Staff Photographer

Jennifer and LucyIt was when doctors told her it was the end -- that her daughter was dying of anorexia nervosa, starving to death, and they couldn't help her anymore -- that Rita Robbins got started. She knew there wasn't a treatment center in North Carolina that could save her daughter, her insurance had maxed out, and she couldn't possibly pay for months of intensive treatment at a private center. And Jennifer McLamb had gotten so thin that even the muscles of her organs were wasting away.

This morning, Rita Robbins and her now-healthy, laughing daughter Jennifer McLamb will walk around the new eating disorders program at UNC Hospitals, the only comprehensive inpatient treatment in the state, and enjoy the launch of two remarkable things.

Robbins will savor what a single-mom real-estate agent from Chapel Hill can do if you get her started. And McLamb will smile, and tell people look -- you can recover from this disease and have a new beginning.

McLamb's slow deterioration from a thin teenager to a young woman with anorexia nervosa started slowly, late in high school and in college. But the near-ending came suddenly, when McLamb was a senior at UNC-Greensboro. She passed out on campus and had to be rushed to the emergency room, her 5-feet-9 frame 40 pounds underweight.

Doctors told Robbins it was hopeless. But she overheard a fragment of a conversation in the hall; someone said at least McLamb had just turned 21. Robbins had no idea what that meant, but when she asked, she found it was the beginning of a chance: McLamb might be able to get Medicaid coverage.

In the next seven days, Robbins had found exactly how much a desperate mother could accomplish. She persuaded reluctant government workers to speed the Medicaid application through. She found a hospital in New York with a specialized program for eating disorders and stayed on the phone until she persuaded someone to find a way to admit her daughter. Then a blizzard hit. She called a legislator and persuaded him to make sure the people who had to process the piles of paperwork would get to work to finish, despite all the snow. She got her daughter out of the hospital and onto the last plane before the airport shut down.

"It's like when a car rolls over on someone and you think, 'How in the world did this person lift the car off that person and save her life?' " Robbins said.

It was the very beginning of a long, long recovery process for McLamb. She would cross off the days on her calendar confined in the New York hospital, thinking that after two weeks, she would probably be able to leave the hospital. After the 72nd mark, she stopped counting.

They forced the weight back on her, making her drink vanilla liquid supplements several times a day from plastic bowls. Always the same flavor, always the same thing, for eight weeks. They watched everything she did, every moment, to make sure she wasn't purging.

They saved her life there. But they didn't cure her complicated disease. Seven months later she left, physically healthy again but still emotionally starving.

She lost the 40 pounds again. She had gone right back to her old habits, searching for the lowest-calorie foods, eating sauerkraut or wheat puffs or celery. Over the next several years, she went in and out of treatment in New York and Florida, her life consumed by anorexia.

Robbins saw her daughter drop to as low as 86 pounds as doctors and others kept working to cure her, always knowing that the recovery rates even at the best places weren't high and that more people die of anorexia nervosa than from any other psychiatric disorder.

Robbins started working to prevent other parents from having to go through this. She started by thinking it would be great to have a way to teach people to recognize warning signs and know when to help; she wished someone could have helped her daughter before the disease got so severe. Robbins talked with Dr. Diane Ranes, then the director of The Women's Center in Chapel Hill and a therapist, about how to reach people.

And then Ranes started treating McLamb, not just forcing calories on her, but using all sorts of things to challenge McLamb to change what she was thinking and what she was doing.

Slowly, together , they began to add things back. McLamb tried yoga and found it relaxing. She began to change what she ate, cautiously, uncomfortably. Instead of purging as a release, she started exercising.

"It was scary, but it was amazing," she said, "when I realized that recovery was possible."


Looking for an expert

Meanwhile, Robbins' plans had become even more ambitious. She launched a fund-raising effort to recruit an eating-disorders specialist to North Carolina, and start a comprehensive program in Chapel Hill. Dr. Robert Golden, chair of the psychiatry department at UNC School of Medicine, and Ranes helped Robbins as she created the Anorexia-Bulimia Foundation of North Carolina. UNC Hospitals hired Dr. Cynthia Bulik, a psychiatrist with an international reputation in research and treatment.

And McLamb got back to her healthy natural weight. She had learned to enjoy food again -- chocolate, fresh vegetables with olive oil, and french fries. She had learned that when people said, "Wow, Jennifer, you look great!" they didn't really mean, "Wow, Jennifer, you look fat!"

She finished college -- which seemed ridiculously easy after everything she had already challenged herself to do -- threw herself into volunteer work and went on to graduate school.

McLamb just started working at a community mental health center in Eastern North Carolina.

"I feel like I have this super-deluxe toolbox," she said, with so much experience and empathy for her patients to draw on. "I feel so grounded," she said. "I feel so healthy. ... I am so excited to help people."


For the toughest cases

And she's coming to Chapel Hill with her mom today.

Together they'll tour the 10-bed unit, where patients will have access to all sorts of help -- psychological, medical, nutritional -- like the network that Ranes crafted to save McLamb. Anorexia is such a complex disorder, Bulik said, with so many causes, from genetic to environmental, that it takes a combination of therapies to help.

Patients will spend lots of time in cognitive-behavioral group therapy, learning to recognize some of their distorted, unhealthy ideas and to change them. They'll go through therapy with their families. They'll take psychiatric drugs if needed. As they progress, they'll choose what they want to eat, just as they will when they leave, and cook together.

Last year, Duke University Medical Center started a comprehensive outpatient eating disorders program. And now UNC adds to what's available in the area -- not only outpatient and transitional treatment, research and training, but long-term inpatient treatment for the toughest cases, research.

Just what McLamb needed. Just what Robbins wanted for her.

Golden sees it as just the beginning, with education for teachers and coaches and others to come in the future. They hope one day that families will have a place to stay during treatment.

Robbins has already started thinking about how she'll help in the future: as a volunteer, as a fund-raiser. She'd like to establish financial help for families because the treatment is so expensive. It can cost as much as $1,000 a day for patients staying at the hospital to get such intense help.

McLamb is looking ahead, too. They're just getting started.

"I'm excited about living life," McLamb said, and laughed. "I'm excited about whatever life brings me."




If you think you or someone you know might have an eating disorder, don't wait to ask for help. For more information about warning signs and resources:




UNC HealthLink at 966-7890.

Duke Eating Disorders Outpatient Program at 668-7301.

An opening ceremony for the new program at UNC Hospitals will be held at 10:30 a.m. today at the Neurosciences Building.

Copyright 2003 by The News & Observer Pub. Co.