Reflections on dying

My father died last week.  I am now the sole surviving member of my immediate family.  My sister died in 2020 and my mother in 2024.  The experience of dealing with three deaths in the family has been... interesting.  There are things I know now that I wish I'd known then, and things I can reveal now that I could not before.  I'm writing this in the hope that someone reading this may end up better prepared than I was, and may even be able to save someone.  Because my sister died in 2020, everyone assumes it was due to covid, and in a way it was, but covid is not what killed her.  She died from anorexia.  And, as it turns out, it goes all the way back to when she was in junior high school.  I know this from a letter that she wrote back then, which I discovered among my parent's effects after my father died.

The entire time we were living together in my parents' house, and even well after we both left to go to college, I had no clue there was anything wrong.  My sister looked healthy, seemed healthy.  She was enormously popular among her peers.  She was literally the homecoming queen in high school.  Among my parent's effects I found a plaque naming her "friendliest person" in her class.  But even then she was already, ever so slowly, killing herself.

She hid her disease exceptionally well.  Throughout her twenties and thirties she looked extraordinarily healthy.  At one point she got into body-building.  She looked like this:

 

Twenty years later she looked like this:

 

That is a photo of her with my father on a trip to Disney World in 2019.  She was 53 years old.   We didn't know it at the time, but that would be our last time together as a family.  Nine months after that photo was taken the covid lockdown began, and nine months after that she would be found dead in her condo.  If the pandemic had not happened it's possible she would have been in the office that day, but instead she was working from home where she lived by herself with her two cats.

I debated with myself for a long time over whether to publish that photograph.  I don't want her to be remembered that way.  I want her to be remembered the way she was in her prime.  But even in her prime she was already sick, and so I decided to show what she looked like at the end in the hopes that others might be able to avoid her fate.  One of the insidious things about anorexia is how slowly it kills.  Irit appeared to be fine for decades.   But she obviously wasn't fine.  By the time it became evident that she wasn't fine, it was probably too late to do anything.  When we saw her in 2019 everyone in the family was shocked.  She had been getting thinner for a very long time, but now she looked like she'd walked out of a Nazi concentration camp.  Moved by her shocking extreme gauntness, everyone in the family tried to intervene, to tell her that she needed to eat more, but it was far, far too late.  We didn't know it, but she was already walking dead, and had been for a very long time.

My sister's disease was born when she was still a teenager.  And one of its roots is something that I could never publicly reveal while my father was still alive.  I don't think he ever realized this, and if he had, I think it would have destroyed him.  You see, when we were children, my father had a pet name for my sister.  He called her, in Hebrew, "shmeine-bumba" which, roughly translated, means "little chubby one."

Of course, she wasn't.  My sister was never chubby.  But that was the self-image that my father's pet name seared onto her soul.

[Interlude] 

I've been starting at the above paragraph for three days now wondering how to finish this post.  I want this story to somehow be constructive, to be a call to action, but the problem is I'm not sure what kind of action to call for.  My wife correctly predicted that my sister was going to die years before she actually did, and wanted to intervene somehow, but even today I don't know what a successful intervention would or even could have looked like.  The problem is that by the time it was evident from looking at her that she had a problem it was probably already too late.  Many people tried to tell her that she was too thin, but she refused to talk about it.  Short of strapping her to a gurney and force-feeding her, I don't know what could have been done.

Normally my advice in a situation like this would be to consult an expert.  But the irony is that my sister was an expert.   She was a psychology professor.  She had a Ph.D.  She actually worked as a consultant counseling obese people before getting gastric bypass surgery.

So I guess my hope here is just to raise awareness.  Be aware, and be kind.  Don't tease your daughters about being fat.  If you are a young person, don't tease your peers about being fat (especially if they aren't) either on-line or IRL.   You could, quite literally, be killing them.

Slowly.

Very,

very,

slowly.

[UPDATE] My wife pointed me to this article, which is based on this research paper.

This quote from the article really struck me:

Up to one in five people with chronic anorexia may die as a result of their illness, either due to the direct effects of starvation and malnutrition or due to suicide, making it the deadliest of all psychiatric disorders.

 Yep.