a. Eating Disorders (blog 1): Introduction to the series of blogs

I have decided to write a weekly series of blogs - for an as yet undetermined number of weeks -  about an important health problem:  Eating disorders (ED's).

Why write a series of blogs about ED's?:  

Because I hope that I might be able to help even one person to escape from the hellish nightmare and the soul destroying prison which ED's are.  And I hope that at least one less person will die from an ED as a result of what I write.  And maybe one less sufferer will give in to the illness, defeated - but instead become inspired to fight back and seek help and … do whatever it takes to return to their life again:  Free.  Happy.  Healthy.  

And I hope that my words might be encouraging and helpful to family members and other carers of an ED sufferer - exhausted and frustrated by the relentlessly destructive and recalcitrant mental illness. I hope that something I write might shine a light of hope in the eternal darkness of ED's -  to restore faith that a sufferer of an ED can recover and return to them again.  Sufferers of ED's can and do return into the world and the light after recovery - free from the personality-distortions and the paralysing effects of ED's - which create an intolerable burden on sufferers - imprisoning them away from their lives and their loved ones - and destroying them from within.

ED's are insidious, horrible mental illnesses. They are, unfortunately, also increasing in prevalence in the world.  Between 1995 and 2005 disordered eating behaviours doubled among both males and females. 

At the end of 2012 it was estimated that ED's affected nearly 1 million Australians (about 5% of the population).  It is also estimated that 20% of females have an undiagnosed ED.

In the USA, according to the National Eating Disorders Association, ED's are more common that Alzheimer's disease (10 million people having ED's compared with 4 million with Alzheimer's disease).

Eating disorders are also increasing in non-western countries, although their incidence is still lower than in western countries.  Women in these countries are being exposed to cultural change and modernization and, with increasing globalisation, the western 'thin-ideal' is spreading.  And, with that, ED's are becoming more prevalent.  These changes have been seen in Asia, especially Japan and China.  

Another example of this occurred in 1998, where, 38 months after television first came to Nadroga,Fiji,15% of girls, aged 17 years on average, admitted to vomiting to control weight.  74% of girls reported feeling 'too big and fat' at least sometimes.  Fiji has only one TV channel, which broadcasts mostly American, Australian, and British programs.

ED's have the highest mortality rate of any mental illness.  The mortality rate associated with anorexia nervosa is 12 times higher than the death rate associated with all causes of death for females aged 15 to 24 years.  

The death rates from ED's are also likely to be higher than recorded, as often the medical complications of death are reported instead of the underlying cause of those complications - ED's. Medical complications include death from : heart failure, organ failure, malnutrition, suicide.

It has been reported that 20% of those suffering with anorexia nervosa will die prematurely from complications related to their ED (including suicide and heart problems).

And, even for those who do not die from an ED, the mental illness itself is horribly destructive.

ED's may seem, to some, to be what models and movie stars and cool thin people do. But media stories do not paint a true picture. ED's are not glamorous or cool, and they are not easily shrugged off when one gets bored of them. ED's are a horrible way to live and to die.

Anyone who knows someone with an ED, or anyone with an ED, will know that the illness consumes so much of your mental energy and your life - progress through life, and the achievement of life-milestones (like degrees, or jobs, or relationships)  is so much harder, if not impossible to achieve. Your life will often seem to stand still.  Maturity in life may elude you while you are ill - which can be for years.

Often, for chronic sufferers of ED's,  life mile-stones are never achieved.  Isolation and loneliness and depression push in - and life seems to stop - in a horrible nightmare of calories and weight and … numbers. The ED becomes a horrible prison where the sun never shines. Depression is experienced by approximately 45% to 86% of individuals with ED's.  

Old friends, other family members and, for that matter, virtually everyone else without an ED, move on in their lives - and leave the sufferer behind.  Stuck.  Other people don't mean to be cruel to carry on in their life journey without the sufferer of the ED - but the illness lasts for so long - many years usually. And the sufferer seems lost underneath the illness.  A faint shadow of who they used to be.  Who they were, without the illness, is gone.  The ED sufferer seems, often, paralysed within the mental prison of the illness.

Fortunately, recovery is possible.  

Work is needed.  Patience is needed.  The war against ED's can be won. Permanent recovery can be achieved, and a very happy and healthy life can follow.

So, with this series of blogs on the topic, I feel that I must at least try to do whatever I can to help anyone suffering with an ED: both the sufferer and their carers. 

ED's torture both.  

If I can help even one person, it will be worth any amount of time that these blogs take me to write.

Why me to discuss this topic:  

Because I am a survivor of  ED's:  

Because I suffered with ED's (anorexia nervosa and, later, bulimia nervosa) for four years in my youth - from the age of 13 years.  I have been recovered now, with no relapses, for 30 years. 

And, because I am the mother of a child who suffered with a severe ED (anorexia nervosa) from the age of 13 years, for over three years. My daughter was an in-patient in a large tertiary hospital for over a year during her illness.  She required naso-gastric feeding for two years, and she stopped all nutritional intake, including water, for almost two years. She was admitted to ICU (intensive care unit) twice - and on both of those occasions we didn't know whether she would survive to see the morning; or whether she would develop brain damage or organ failure as a result of these life-threatening events.  We also never knew whether she would ever recover.

However, like me, my daughter did recover from the ED. She has been recovered now for over 18 months  - with no relapses.  She is now 17 years of age and she is currently studying year 12 (her final year of high-school) with plans to go on and study at university next year.  She is happy and healthy and she is back to her old funny and sweet and interesting and wonderful self.  She has a strong interest in politics now!? The distant, emotionally  vacant, depressed and lonely soul imprisoned by the ED has gone.  My darling daughter is now living the life that she is destined for.  More wise from all the traumas that she has endured - like I was when I recovered.

What is possible for a sufferer of an ED?

Recovery!

Happiness!

A great Life!  A long and interesting and wonderful and exciting life!

I want your life to be as wonderful as mine has been!  Or better!  

There's a challenge for you!  

You deserve to have a wonderful life.  Not an easy life. I'll burst that bubble right now.  Life is not easy for any-one.  It is not meant to be easy.  But you can get through the adversity of an ED and recover stronger and wiser.  And wisdom is gained from experiencing and over-coming adversity in life generally.  Not only the adversity of ED's, obviously. And that will be something that  I will address during these series of blogs.  And I will look at 'adaptive coping mechanisms' to give you some tools to cope with adversity - without resorting to 'maladaptive coping mechanisms' - like relapsing with the ED, or turning to alcohol or drugs to cope, or other self-destructive things. 

A scary statistic for anyone with an ED is this:  Studies have shown that around 72% of alcoholic women younger than 30 years also have ED's.

Sufferers of ED's are more predisposed to other drug addictions, including alcoholism.  Another reason to learn healthy adaptive coping mechanisms during recovery from ED's.

I think that, for myself, I have been aware, after my ED's, that I have a predisposition for addiction.  And it was for this reason that I don't drink alcohol. I remember in my first year at university, studying medicine, some of the other students told me that they would have me 'drinking' before the end of the year. They set it for themselves as a challenge to get me drinking.  But, I decided that I never would.  So I didn't and I still don't.  I'm fine with other people drinking. My husband enjoys his wine, as do many of my friends.  I drink Coke or Pepsi or Lemonade instead. 

Learning to cope, in a healthy way,  with stress and disappointments in life - is necessary for recovery from ED's and avoiding relapse. It is also a useful skill for everyone - for that matter.  Strong adaptive coping mechanisms increase emotional intelligence: resilience especially. 

And it has been found, in psychology studies, that  Emotional intelligence (EQ) is a greater determinant of success in life that IQ intelligence.  In fact it has been determined that EQ accounts for about 80% of life success while IQ accounts for about 20%.

And, for the record, success in life is not all about status and high grades and becoming a millionaire and being 'better' than everyone else.  It is about finding contentment and purpose and meaning and love and companionship and … enjoying yourself. 

And, along the way, you will develop wisdom. 

And that wisdom will include things like, let me think:  Being kind to yourself.  Loving and accepting yourself.  Giving up on any ideas of 'perfection' in anything.  Learning that 'average' is a wonderful word. Living in the moment.  Being mindful - of a lovely sunset, the soft touch of silk on your skin, the scent of jasmine, the coolness of the ocean on your ankles as you wade along the shore …  

And no, in case you are thinking luck plays a big part in life success.  I have a very interesting psychological study about luck and people who think they are lucky or not lucky - which I will discuss in one of the blogs.  Luck plays not a very big part.  Now, seeing opportunities in life …  And how success is defined …  But that is for another blog discussion.

I will quickly add that some people do have more challenges in their lives.  More hurdles and for some people destiny seems to smile a little more.  But, a goal in life might be to make the most of opportunities which are present.  Work to your strengths.  Learn what in life truly is important for happiness - and a lot of money and high status is not the correct answer, as I have said.  

And, after all of that is said, remember the old adage:  Accept the things that we cannot change;  Change the things that we can;  And find the wisdom to tell the difference.  But, again, a blog for later in this series.

Those people currently sufferering with an ED may not believe me yet - but your path in life will open up for you and your life journey will unfold - once you recover from the ED.  And you can.  You'll also catch up on all those milestones that you may missed out on through being ill.  I have a belief, as well,  that life is a mixture of fate and choice.  I think opportunities present and things happen in life for reasons.  Recovery from this illness and coping as a carer of someone with an ED - will teach you many important life lessons - as it did for me.  

And, amazingly, after recovering from my ED, and after supporting and helping my daughter recover from her ED - the changes in my life which were necessitated by the crises created of the ED's have created a much nicer life for not only me but for my family as well. 

I now realise that these changes in my life were necessary.  But, without a serious crisis in my life, I would not have made them.  I would have drifted along with the status quo - relatively dysfunctional and less happy as that was.  

For example, my daughter's ED necessitated the following changes, to name just a few:  weekly Sunday family outings; sitting at the dinner table for meals regularly; changing my work schedule to be home more with the children; expressing feelings and emotions more and hugging my children more.  And, there are probably even more good changes that followed all the trauma. 

In fact, without changing my work schedule, which I did due to my daughter's ED, I would also have never studied writing (from the books I bought to fill my days and cope - as I will discuss in 'coping strategies' later) and I would never have written anything - stories, blogs, this … whatever I go on to write in the future.  And, I have learned that I love writing.

Many people, likewise, have told me about wonderful changes that have occurred in their lives as well following different crises - health related and others. But these crises demanded the changes be made.  And those changes were wonderful and set these people on different paths in their lives which turned out to be really lovely.  And they also found themselves wiser for the experiences.  That might well happen for you. I will discuss those things further during this series of ED-related blogs. 

But, for now there is a long journey to recovery ahead, for anyone suffering now with an ED.  And for now, I want you to know that you are worth the effort.  You are worth all the time it will take.  You are worth all of that and infinitely more.  

And as the words in the 1927 poem, Desiderata say: 

Beyond a wholesome discipline, be gentle with yourself. You are a child of the universe no less than the trees and the stars; you have a right to be here.

And whether or not it is clear to you, no doubt the universe is unfolding as it should. Therefore be at peace with God, whatever you conceive Him to be.

And you are meant to be here - in life.  You are  important and you are loved.  Even if you can't see that now.  And even if, currently, life seems lonely and unloving - things can and will get better - as you get better and away from the ED.  You will find those souls in the world who are waiting to love you.  As I did.

But, I say again, if I can do anything to promote the recovery of even one sufferer with an ED - then I will do all that I can.  It will take work.  It will take time. It will be hard. But you can do it - if you choose to.  As I say - your life is destiny and choice.  You can choose to be angry at whom-ever you think is to blame for your illness or lack of recovery or misery - or you can choose to fight to recover.  And reclaim the destiny in life waiting for you. And learn whatever lessons recovery will teach you.

I wrote an entire blog about 'victimhood' recently.  I have little sympathy for anyone who chooses to stay a victim.  You will notice that I have deliberately never said, in my discussion so far, that any-one is a victim of an ED.  They are a sufferer of an ED.  A victim implies that one cannot fight to recover.  The power to fight back is out of their hands.  And it isn't.  But, no-one else can fight the battle to get you better.  Only you can choose to do that.  Others may guide and support you.  But if you choose to stay ill and become a victim of an ED - that is your choice. You must own that decision.  

And, in case anyone out there with an ED thinks that I only recovered because I had many people to help me, let me say that virtually no-one helped me to recover. 

I fought to recover from the ED's which had tortured me for four years from the age of 13 years. My parents never even noticed that I was ill.   I was never admitted to hospital, or anywhere else, and I had no doctors to help. Or friends to help.  I kept my illness a secret - as many sufferers do. I was horribly alone with my illness.  I was  living in an abusive household.  My sister was put in foster care at 15 years of age - and she never lived at home again.  I obtained a restraining order in the courts against my abusive and violent father at 18 years of age.  And I escaped my horrible house while my terrifying parents were at work one day - when I was 22 years old.  I had arranged a safe house to escape to and I had saved money to pay my living expenses before I left  (All explained in my earlier blog:  Social media - a potential Pandora's box).  

But I did recover.  

I recovered from my ED at 19 years of age and I never relapsed again.  I found a loving husband, lovely friends, a great job as a medical doctor, and so many other wonderful things have happened since then.  

Which, had I not fought to recover from the ED, I would have missed out on.  

A wonderful life was waiting for me - beyond the illness.  Loving people were there - waiting to cross my path.  I just hadn't met them yet. 

And I learned many things from my illness.  Compassion was one of the things the ED taught me.  I understand suffering, and that people often don't choose the hard things that happen to them.  But, as I have said, they do choose to fight to get well again, and they do choose whether of not to fight to overcome other adversities as well. 

As a medical doctor with 26 years experience I can say that without exception life is difficult and filled with disppointments and hard times for everyone.  Everyone! Some people choose to fight to overcome these hard times.  Some people choose to give up - and make excuses - and blame the world - and feel very sorry for themselves.  The latter group miss out on so many joys in life. The latter group often become bitter and angry and depressed.

But they do have a choice on how to face life's challenges. 

Yes - this is tough love.  

I am being tough to say:  Don't play the victim card!  You are only a victim if you choose to be one.  Don't blame anyone else for your choices in your life!   Don't give me excuses why you cannot fight to recover.  I wasn't rich.  I had no rehab facility to recover from my ED.   I had no-one to even help me.  And I was stuck in a horrible abusive house. Although - I will discuss in this series - look for people to help you.  There will be people able to help.  If the first few people are no help - look further.  And read books about recovery.  And, I hope, my advice on recovery might get you started.

Also, with my daughter, I asked for help - frequently.  That was another lesson I learned begrudgingly from my daughter's illness.  I learned to ask other people for help.  And I hated to ask for help.  I loved to help others - but I wanted to be self-sufficient in my life.  But I needed help with my daughter to help her recover from the ED.  I couldn't do it alone. It was a hard lesson.  But, when I asked for help - so many people helped me:  Medical doctors, nurses, social workers, dieticians, psychologists, psychiatrists, friends …

And I needed them - for my daughter.  And I am eternally grateful to them.

But - tough love is needed for your recovery from an ED. I will not listen to your excuses!  But I will tell you that you are lovable and you have a life waiting for you and you are loved.  If I stood next to you now I would hug you and tell you over and over again - how wonderful your dear soul is. I would tell you that you have so much to offer the world.  You will be able to see that later.  But you do.

You are meant to be here - in life.  This is a hard challenge for you to overcome.  But you can and you need to try.  And, ask for help.  Even if you find that hard.  Just think - later you might be able to help someone else with the illness.  As I am trying to do now.

I will spend as long as it takes me - to help you.  Because you are so worth the effort.  You will come to realise that with time.  Low self esteem is part of the ED.  That will improve with work.  We will work on that during these blogs.

Why discuss this topic now: 

I've been meaning to write something which may help  other sufferers of ED's, and their families, for some time.  But, after surviving more than three years as the mother of a daughter who suffered from a severe ED, in the form of anorexia nervosa, which required intensive treatment and over a year in hospital, I needed a break from the illness and the subject.  

I wanted to forget about ED's for a while.  Live in the sun again.  Live, for a while,  oblivious to the daily nightmare of living with an ED.  Blissfully away from it all.

But, finally, after 18 months free from the illness in my life (most recently as a carer, as I've said) - I feel recovered enough to do whatever I can to help others with ED's.  If there is anything that I might be able to write - to help.  And inspire.  And comfort.  And reassure.  And advise - with regards to how I recovered, and things which helped me to help my daughter recover.  

Some final words on the topic of ED's:

For those people suffering with an ED, feeling that no-one understands how they feel, and for those caring for someone with an ED - not able to understand the illness:  these are some words my daughter wrote about the ED (anorexia nervosa) when she was 13 years of age:

It is like I was travelling down a river - with my family and my friends.  And then I was caught up in a large branch of a tree which hung down low over the water.  I'm not sure if I grabbed the branch, as I passed it, or it grabbed me - but I became caught up in its twisted limbs and it carried  me up and out of the water. Away up into the sky.  The river kept flowing and my friends and my family moved along with it.  But I was taken away from them all.   I could no longer move anywhere.  I was trapped. And, I found myself to be so high up in the sky that I was  too scared to jump back into the river.  I was so scared, and distant from the river and everyone else. I couldn't get back.  I couldn't get away from the branch - holding me.  I was too scared to let go … and jump.

In dreams a river is often the symbol of the passage of life.  A river represents the flow and passage of time. 

So, my young daughter's description was very apt, I think.  It still isn't clear how much of an ED is due to genes  (for anorexia nervosa research shows that genes may account for 50%-80% of the variance), choice, and other environmental factors (western media, the 'thin ideal' of western culture).  But, once the illness takes hold, it no longer matters how it all started. In this way it is similar to being trapped by  drug addiction or alcoholism.  The initial drugs or alcohol may have been a choice by the sufferer.  But, with vulnerable genetics, or other factors which we still don't fully understand related to addiction and ED's, the illness takes control of the sufferer - and choice is no longer an easy option.

And my daughter felt like the illness had pulled her from the river - while everyone continued on.

However, recovery is possible.  There are many steps and courage and patience and many lessons are needed to recover.

But - it is so important to try. And seek help to recover.  These are topics I will discuss.

I won't write this series of blogs as a doctor.  Although I am a doctor with 26 years medical experience.  But my medical knowledge is in medical areas other than ED's specifically.  Also, because ED's are primarily a mental illness, with the medical side geared more at keeping a sufferer alive during the illness (obviously crucial)  rather than helping a sufferer to recover - I will focus on  a cognitive approach -  which is geared at recovery.

And, as the mother of a child with an ED - I will also address topics related to:

 - coping as a carer of a someone with an ED, 

 - looking after siblings and not forgetting  them while an ED sufferer demands extra time and care, 

 - keeping a marriage together during the stresses placed on a family during this crisis.  A nurse in the hospital warned me early with these words: 'Eating disorders can break up families', she said sadly as she implored me to believe her.  After more than three years coping with my daughter's illness, I can now see how that would happen.

 - and many other topics I will recall and work out as I go.

One of the keys to surviving ED's is to pace yourself and to learn patience.  The average duration of anorexia nervosa, for example, is seven years.  And those who recover may not return to normal health.

And an ED will not be rushed.  Patience is something which I have needed to learn in my life.  Not the sort of patience where one might sit quietly in a traffic jam, listening to tranquil music and not losing one's temper.  That is a walk in the park compared to what is needed for surviving the frustrations and horrors of ED's. The patience needed to survive ED's is a whole different type of patience.  A life patience.  I will write a blog on the topic of patience.  Patience is a life lesson not easy to master.

A Chinese proverb which helped me learn patience through all the years of surviving was this:

'Don't push the river, it flows by itself.'

Once again the symbolism of a river is used.  As I have mentioned, a river often represents in our minds  the passage of life and time.  The proverb is therefore an apt one for the kind of patience needed to cope.  

The process of recovery from an ED will not be rushed. It is a slow process.  Patience and calm and pacing are necessary.  The journey back to health will be a long one. But don't lose faith.  Many lessons in life will be learned during the recovery process - for both the sufferer and those supporting them.

As I have said, at the beginning of this 'introduction to the topic of ED's' blog - I intend my blogs to be supportive and informative only from my own experience.  My advice may not help everyone and I cannot guarantee recovery.  No-one can guarantee that.  Life has no guarantees.  I will try to help - but I would strongly advise that anyone with an ED should seek the help of their local doctor - as a start.  And, a psychologist or psychiatrist would be very important in recovery - if you can arrange that.  Your local doctor will likely be able to help you here. 

Also, I would advise that you try to find a doctor that you feel comfortable with, and who has some understanding of ED's.

My experience with a GP was as follows:

When I first brought my 13 year old daughter to an elderly male general practitioner (GP): I knew that my daughter had anorexia nervosa.  I recognised it within 3 weeks of its onset - given that I knew the signs well from my own history with it.  I took my daughter to the GP as, in Australia, a GP-referral can give a patient 10 subsidised visits to a private psychologist.  This would save us hundreds of dollars and I couldn't write the 'mental health plan' form myself.   I didn't need a diagnosis of anorexia nervosa, however.  I was certain of the diagnosis. But the GP argued with me, at that first visit, that my daughter didn't have anorexia.  She was only slim, he said.  I told him that I had passed all my exams as a Paediatrician, I'd been a doctor myself for over 20 years, and I had suffered with the same illness at her age. I told him that she certainly did have anorexia nervosa and I needed a referral immediately for her to see a psychologist specialising in ED's.

'Oh, Ok then', he said. 'But I could do with a bit of anorexia nervosa,' he patted his round belly and laughing as he added. 'I could do with losing a few kilograms.'

I was not angry with him.  And I know that he is a good doctor and a kind man.  He just knew little about ED's and how awful they are and how dangerous they are. Many people, some GP's included, know little about the illness and how  debilitating and deadly it is.

However, the GP that I saw with my daughter initially certainly understands now that ED's are no joke to 'lose a few pounds'.   While my daughter was in hospital - and in and out of ICU for over a year - he received all the correspondence from the hospital. He has, since that first visit, been very sympathetic and helpful and kind.  He has learned - just as I have.

But another lesson there:  If you think that your child might have an ED but the first GP you visit disagrees, then see another one, or even arrange to see a paediatrician or a clinical psychologist who specialises in ED's. Not everyone can argue, as I did, with such certainty.

My first blog in this series, next week, will start by looking at the signs and symptoms of ED's and the definition of the three main types of ED's.  And a few other issues - which I will think about during the week.

One last comment: 
In Psychology the definition of hope is as follows - 

Hope: Bad times are not pervasive or permanent.

Remember, outside of the ED illness, there are still other happy parts of your life.  Even if it is a nice swim in the pool, a lovely sunset, or a good joke. 
And bad times don't last forever.  That's why we call them 'hard times'.  The sun will come out again.

And, below I have included the rest of the lovely poem that I mentioned earlier, Desiderata.

                              Desiderata Poem    

by American writer Max Ehrmann (1927)

Go placidly amid the noise and the haste, and remember what peace there may be in silence. As far as possible, without surrender, be on good terms with all persons.

Speak your truth quietly and clearly; and listen to others, even to the dull and the ignorant; they too have their story.

Avoid loud and aggressive persons; they are vexatious to the spirit. If you compare yourself with others, you may become vain or bitter, for always there will be greater and lesser persons than yourself.

Enjoy your achievements as well as your plans. Keep interested in your own career, however humble; it is a real possession in the changing fortunes of time.

Exercise caution in your business affairs, for the world is full of trickery. But let this not blind you to what virtue there is; many persons strive for high ideals, and everywhere life is full of heroism.

Be yourself. Especially, do not feign affection. Neither be cynical about love; for in the face of all aridity and disenchantment, it is as perennial as the grass.

Take kindly the counsel of the years, gracefully surrendering the things of youth.

Nurture strength of spirit to shield you in sudden misfortune. But do not distress yourself with dark imaginings. Many fears are born of fatigue and loneliness.

Beyond a wholesome discipline, be gentle with yourself. You are a child of the universe no less than the trees and the stars; you have a right to be here.

And whether or not it is clear to you, no doubt the universe is unfolding as it should. Therefore be at peace with God, whatever you conceive Him to be.

And whatever your labors and aspirations, in the noisy confusion of life, keep peace in your soul. With all its sham, drudgery and broken dreams, it is still a beautiful world. Be cheerful. Strive to be happy.

Max Ehrmann, "Desiderata".

A lifetime ( a story of fiction)

Henry wrapped his arms around his young wife.  He loved the smell of soap on her skin.  A subtle floral fragrance.  He held his jaw against the soft smoothness of her cheek, and he moved his chin down into the gentle curve of her neck as he leaned in against her.  His arms were wrapped firmly around her small waist which was cinched in with a kitchen apron.  She stood with her back to him while she cooked breakfast at the stove.  She pushed him backward with her elbow - in mock annoyance.

'Henry,' she said before giggling as he rubbed his chin into her neck. 'I'm trying to cook.  And you'll be late for work.'

'But I'd rather be here with you,' he whispered into her ear.  'It's so much more fun …'

'Well, we need you to earn us some money, Dr Lazy-bones.  And we'll need rather a lot if we're going to finance all of our plans. You do remember our plans, don't you, Henry? All those details which we've mapped out for our entire lives. We've planned everything, I think, except for our funerals in about seventy years.  And we can plan those tonight after dinner, if you like.' 

She laughed. Liana loved to tease her husband.  'All of our plans, Henry. They all cost money. The house renovations.  Our two lovely future children: Little Bartholomew Ponsonby Smythe? He'll play the violin, of course. And lessons don't come cheap.  He'll play croquet, and row with his posh chums at the most expensive and posh private school that your money can buy!'  Liana was laughing again. 'Only the best for our Barty.  And then there'll be our little Henrietta Gertrude Penelope Smythe.  And her pony, and her riding lessons …'

They both laughed.  

'Stop!' Henry protested.  'I hate those two little brats already.  And they don't even exist yet. Don't even joke about kids like that!  A couple of little snobs who would look down their snooty brat-noses at their lowly peasant parents. '

'Speak for yourself!' Liana replied. 'I agree that you'd be the lowly peasant parent they might quite understandably look down on.' She laughed before continuing.  'But I, on the other hand, would fit right in to that snooty world! I'd make a great snob!  I can see myself happily looking down my nose at everyone, darling!' Liana was laughing as she flipped the pancakes in the frypan.

Henry sighed and reluctantly let her go.  

He turned and looked around at the kitchen. The room was shabby, but it was large and sunny, and it had a lot of potential.  It would be elegant and impressive - once it was fixed up.  The kitchen opened onto an adjoining casual dining area in which a birch wood kitchen table sat and, around which, six wooden chairs were placed. A formal dining room existed elsewhere in the house, through one of the three cedar doors leading from the room. The ceilings were lofty, the floors were polished oak, and every surface, other than the floor, was in desperate need of a good sanding and a fresh coat of paint.  Liana, or Narnie as Henry affectionately called her, would do most of this renovating work - while he earned the money to pay for it all.  

The house was a majestic, rambling five bedroom 1890's sandstone villa.  It was situated on a large block of land in a pretty inner city suburb. The young couple had recently purchased it.

Henry walked to the dining table and picked up the morning paper, which his young wife had left for him to read over breakfast. He sat down in his favourite chair and briefly scanned the front page. However, he usually preferred to chat with her, before he left for work, than read any newspaper.

Liana was the love of Henry's life. She was his best friend and his soul mate.  And from the moment when he'd first seen her on a tram, three years earlier, he had known that he would marry her and love her forever.  He couldn't explain how he knew this.  His heart had made all of the decisions on that fateful day. His logical and rational brain had butted out.  In matters of the heart Henry did not rely on rational analyses.

He could still see Liana as she had looked in the first moment that he'd seen her.  The image would stay vivid in his mind always. Partly because he often recalled it. She had worn a pastel-pink cotton frock reaching just below her knees. Her long dark brown hair had been loose and reached just below her shoulders. She'd been reading a book.  It was a nursing text book.  She'd been training, at the time, to be a nurse.  She'd eventually noticed him staring at her from across the aisle.  But, he couldn't pull his eyes away.  He'd worried that if he did she might get off the tram and he'd never find her again. 

'Here you are, dear.' Liana put a plate of hot pancakes in front of her husband.  She opened his paper and patted the page. 'Read.  Eat.  Hurry up.  You're dreaming again.  Chop.  Chop,' she patted his shoulder before she returned to the kitchen.  'I'll make you a cup of tea.'

Henry picked up his cutlery and looked at the front page.  February - 1952.  Almost one year since they had married. Paper, he thought.  The first wedding anniversary was supposed to be a paper gift.  He considered the present that he would buy for his wife.  There was no way that he would give her only a paper gift. He would write her a poem - on paper - maybe. Or copy a poem from a book of Byron poems.  He and Liana loved to read poetry together. They had enjoyed reading poetry on picnics, or while sitting near an open fire in the evenings, or out in the garden under a shady tree while sitting on the grass.  And Byron was their favourite poet.  

But the anniversary gift would be something expensive. Not just paper. Whether it was their first anniversary or their seventieth anniversary, Henry planned to buy Liana something lovely and as expensive as he could afford on every wedding anniversary. Perfume?  Maybe. Jewellery?  Lingerie?  He would give it more thought over the next week. On his income as a surgical registrar at the Royal Adelaide Hospital - he couldn't afford very much - yet.  But for Liana, he would find some way to get her something really special.  

Suddenly, sitting with his paper and pancakes, Henry felt a crushing pain in his chest.  It felt like he had been punched. Hard. The pain grabbed him and it squeezed his chest wall.  It felt like a heavy pile of bricks had been dumped onto his upper body. He couldn't breath.  He gasped and as he did the pain exploded through his torso. It moved up into his jaw, and then it pushed into his left arm and down into his fingers. It consumed him.

And then it stopped.  

The pain just stopped. 

It was gone.  And Henry felt nothing.  Literally - nothing. Not temperature.  Not the touch of his clothes on his skin.  Not the weight of his limbs.  Not the fresh cool air entering his nose and his throat with each breath. Not the smell of pancakes … and his wife's scent.  Nothing.

He felt lightness.  Floating.  He was viewing the room and his body slumped over the table from somewhere up near the ceiling.  The scene he observed was as if he were watching it through a glass window. Away in a world that he could no longer reach or touch or feel.

He could see his own body:  A tall and slim young man.  Dark short hair.  Crisp white shirt.  Grey trousers. Eyes staring. Lips turning blue.

He felt confused and disorientated.

He wasn't sure if he was still asleep.  Maybe this was some bizarre dream.  He wasn't sure how to check whether or not he was dreaming either.  He wanted to escape from the experience.

He watched Liana rush to his side.  She was a nurse.  She was checking his pulse.  She was dragging him from the chair onto the floor.  She was extending his neck … and blowing into his mouth.  She was performing cardiac compressions on his chest. She was leaning over his body.  Her arms were straight and clasped together over his chest as she rocked forward during each compression.  She was breathing into his mouth again.  Two breaths.  She was calling out to him:

'Henry! Wake up! Henry! Come back to me …'

And then he felt himself being pulled away from the room.  From that time. From his body. The scene grew faint and distant and silent. He was being pulled into a time in the future.  Somehow he knew this. He was moving forward in time.  He wished that he could stay.

Henry found himself moments later in the same room.  Although he sensed that it was some time into the future.  The room had changed very little from the earlier scene.  The paint was still peeling from the cupboards. The room was still unrenovated.  However, the fridge and the stove were different.  Smarter.  More modern or 'futuristic'.  The room had been sunny moments earlier.  However, now, with the kitchen curtains partially open, Henry could see that it was dark outside.  He could hear noises coming from beyond the doors which led deeper into the house:  Voices and laughter and music.

A loud noise rang out from a heavy black telephone in the room, and suddenly a door burst open.  A woman rushed through it.  She appeared to be in her mid 30's.  Henry realised immediately that it was Liana.  She was pale and thin. She looked tired. She wore a white dress which reached to her knees, a short red cardigan, flat brown leather shoes and white stockings.  On her chest was pinned a nursing-watch and a hospital name badge which read:  Nurse Liana Smythe.  Royal Adelaide Hospital. Senior nurse.

She walked briskly to the telephone and picked up the receiver. 'Hello, Liana speaking … Yes … Yes, of course … Yes, that would be fine. No, you didn't interrupt dinner.  It's just me. I was watching television. I tend to eat just a sandwich for dinner.  It's hardly worth cooking when it's just me here … Yes, I can work next Tuesday.  I understand …  Yes, it is harder for women with families.  The orthopaedic ward at 7am Tuesday.  Sure.  No problem. Bye.'

Henry watched Liana replace the telephone receiver.  He found that he could walk beside her now.  He still felt floaty and light and distant.  But, he could move down inside the room and he wasn't stuck up on the ceiling, as he had been moments earlier.   He followed Liana to the calendar, which hung on the back of a door in the kitchen.  She was writing down the orthopaedic shift time for the following Tuesday.  Henry looked at calendar. It was now March - 1962.  

Henry stood next to Liana.  She was oblivious to his presence.  He thought that she looked so cold and small and sad. She was looking out into the night through the kitchen window.  As she did she twisted her wedding ring around her finger.  He'd given her the diamond ring almost a year earlier, for him, although, apparently, it was now almost 11 years earlier for Liana.  

'I  miss you Henry,' she whispered into the darkness beyond the window.  A tear formed on her lower lid and then it rolled slowly down her cheek.  She brushed it away.  'Henry, sometimes I feel so lonely ...'

Henry wished that he could hold her.  He longed to be able to tell her that he was still with her. It felt terrible for him to see her so sad.  And, while he knew that it would hurt him deeply to see her with someone else, remarried and starting a new family, this is what he wanted for her now. Her happiness was more important than his own.  He loved her so much. 

He moved closer.  He could no longer smell the floral fragrance of her skin.  He could no longer touch her or hold her. He felt useless and powerless to help her in any way.  He longed for the bizarre nightmare, in which he now found himself, to finish. And he longed for things to return to the way that they had been - in what felt like - only a few moments earlier.  

He whispered into Liana's ear: 'Move on from me, Narnie.' He hoped that in some way she might hear him. 'Move on and find happiness with someone else.  I love you so much ... I can't bare to see you so sad and lonely. Let yourself find happiness.'

Henry looked into Liana's face. He knew that she couldn't hear him. He knew that she had no idea that he was standing next to her. It pained him so much to see how he had ruined her life by loving her … and then leaving her. 

Henry felt the pain in his chest again.  Although this time it was worse than before.  This time it was due to grief. Horrible gut wrenching grief.  He watched Liana turn from the window and walk from the room.  She closed the door softly behind herself as she disappeared from his view.

Soon after this, Henry again felt himself being pulled away into a future time.  This time, however,  he was not sad to leave.  And this time he wished, and he prayed that his wife would find happiness and love in her life.  Even if it was with someone else. He had been gone from her life for over a decade - in her time.  She had suffered too long already. 

Moments later Henry found himself back in the kitchen, at a time once again in the future.  The kitchen was painted now but otherwise it appeared much the same. The kitchen window curtains were open again and the late afternoon sun filled the room with a gentle golden light.  A newspaper was left open on the kitchen table with a cup of tea half finished next to it. A packet of biscuits sat opened in the centre of the table on a plate. Henry moved over to the paper and read the date.  March - 1973.  

He became aware of foot steps marching up the passage beyond one of the dark cedar doors.  The door opened abruptly and a woman, appearing in her mid to late 40's entered.  It was Liana.  Her hair was now grey, her face was lined, and she was still thin and pale.  But to Henry she was the same as she had always been.  Her soul was unchanged.  Her soul, the essence of who she was, had not aged as her body had aged. And that is what he could see - somehow.  In her eyes maybe. In the way she moved and spoke.  Her voice.  Her words.

'OK, Sarah,' Liana was speaking to a small child, five or six years of age, who followed behind her traipsing mud on the clean polished floor boards.  'You can get your ball again.  But you do need to stop throwing it over my fence.  This is the fifth time this afternoon. Maybe you could throw it toward the lawn and not toward my fence.'

'I'm sorry, Mrs Smiff.  My mum learned me how to frow the ball.  But I'm still practicing.  And it keeps going too high.'

'OK, Sarah.  Where do you think it landed this time?' Liana had walked through the kitchen and out another door toward the back yard.

'Ooh!  Biscuits!' The child had detoured from the path that she had been following behind Liana.  She pulled out a kitchen chair and climbed onto it, with her muddy shoes, to reach the packet of biscuits on the table.  The chair she chose was, in fact, the one that had been Henry's favourite more than 20 years earlier. She then sat in the chair and pulled a biscuit from the packet. 'Can I eat this, please?  I love biscuits. My mum said I could.'

Liana, returned to the room and sighed as she watched the child making herself comfortable in the chair with the biscuits.

'Will your mother say it's OK for you to eat biscuits?' Liana asked as she stood in the doorway. She looked at her watch.  'It's 5 o'clock Sarah.  Biscuits might spoil your dinner.'

'No, my mum won't care.  She's sleeping. She had her medicine and she's sleeping.'

'Is she alright? What medicine, Sarah?'

'The medicine in the green bottle.  She likes her medicine.  But she gets a bit sleepy.'

Liana looked concerned. 'How about we both go to your house and check that your mummy is alright.'

'Can I take another biscuit, Mrs Smiff?  My mum won't mind.  My mum said I could.'

'Sure,' Liana said handing the packet to the child.  She looked worried and left the room briefly before returning with a medical bag. 'Let's see about your mummy, Sarah.'

Liana left the room first and the child followed.  However, before the little girl walked from the room she turned and looked directly into Henry's eyes.  He felt shocked. He'd felt entirely like an observer, until that moment, as if watching events on a screen but remaining completely separate to any of the action. However, he felt sure that the child was looking directly at him as he stood near to the table.

'Bye, Mister,' she said as she waved to him. 'We have to visit my mum. But she's probably still sleeping.' 

Almost immediately after Liana and the child had left the room, Henry felt himself being pulled away from the scene and again into a future time. Although, this time he felt that the time he moved ahead was shorter than in the previous time-jumps, which had each been a decade in length.  

Once again he found himself in the same room.  But this time the kitchen was completely unchanged from his previous visit.  And, again it appeared to be mid afternoon. Golden sunlight was streaming into the room through the kitchen window.

As Henry observed the room, he noticed that while the furniture and the room per se were unchanged, the room was markedly different in another way now. For the first time since his passing, the room appeared to be cheerful and homely.  

In previous visits the room had appeared neat but cold and sterile.  There were no signs of life, or happiness within the walls of the room.  This time, however, the room appeared warm and joyful and lived-in.  For instance, there were two large bunches of brightly coloured flowers filling a couple of crystal vases: one on a kitchen bench, and one in the centre of the kitchen table.  Another nice feature was the white linen table cloth which covered the kitchen table, and upon which sat a home-cooked cake and home-cooked biscuits arranged on two pretty white serving platters.  In addition, two small white plates, with cake forks resting next to them, sat neatly on the table, along with two empty glasses, and a large jug filled with red cordial and ice cubes. The appearance was one consistent with the imminent arrival of an important guest. 

At that moment one of the cedar doors opened and Liana walked into the room. She appeared much the same as she had during Henry's last visit.  And following her was the same child from the previous visit.  Although, now she appeared to be a couple of years older: seven or eight years of age, possibly.

Liana walked around the table and poured two glasses of the red cordial and handed one to the child and placed one in front of herself.

'Yum!' said the child.  'I love your banana cake.  It's the best in the world, Mrs Smythe.  And your vanilla drop biscuits!  Yum. Yum.' The child licked her lips and rubbed her stomach with her hand. 'I made them biscuits for my mum last week.  She has diabetes - but she said that one biscuit would be OK. She's being more careful with her diabetes now.  And she's going to the doctors - like she's told to.'

'Did she like the biscuits, Sarah?'  Liana was cutting two slices of the cake and placing a slice on each plate.

'Yeah.  She said she's proud of me.  I'm the best helper in the world, she said.  And I'm a really great cook as well.  Maybe the best cook in the world - my mum said! Well, she said that ... anyway. And you taught me!  And I learned it!  And I turned the oven on myself.  And I remembered to turn the oven off as well!'

'You are a lovely cook, Sarah.  And I agree that you are a wonderful help to your mother.  Did she put the meals I made for her into the freezer?  I put them all in tupperware containers and I wrote the days of the week on them for her.'

'Yeah.  Thanks, Mrs S.  She said to say thanks.  And she told me to tell you she's in AA now.  She's been going too!  Every week … nearly. She hasn't drunk her wine in a month. She said to tell you that.  She hasn't either.  She threw it down the sink.  I tipped some down too.  And the social worker lady helped. We got her to stop drinking.'

'You're a brave girl, Sarah.  Did you bring any homework over tonight?  Do you have any homework tonight?'

'No, because it's Friday silly. But I like that poetry story stuff you and I read under the trees sometimes.  On the grass.  Could we read that instead of television tonight?  I love that Byron man's poems.  I love you telling me about your old husband,Henry, as well.  And how you read them poems with him.  And how lovely he was.  And now you and I read them poems together. Don't we? And I love them too. And I love his old favourite chair as well.'

Henry smiled.  Clearly Liana loved this child.  And it seemed that her feelings were reciprocated.  He felt a weight lift from his mind and, for the first time in a while, he felt some joy.  Liana had someone to love … and someone to love her.  And that was what he had been waiting for.  He wondered if he would now leave her and this house.  Maybe that was what he had been returning to see? 

Liana put her glass down and walked toward one of the cedar doors.  As she walked she spoke again to the child: 'Sarah, I'll get the Byron poetry book now.  We might sit outside under one of the trees and eat our cake there, if you like.  We can eat and read in the sunshine. And I bought you a little chocolate for helping in the garden so much lately.  I'll get it and I'll be back in a moment.'

The child ate another mouthful of cake while she waited.  She looked across to Henry and again she looked directly into his eyes. 'You look foggier now.  I remember you from a long time ago.  You were standing over there then, too.  But I can't see you so well now.  Are you Henry?'

Henry was again shocked.  Surely, the child should be the one spooked by him, rather than the other way around. He wondered if she might be able to hear him.

'Yes, I am Henry.  I was married to Mrs Smythe a long time ago.'

'I know,' the child smiled to him.  'She talks about you all the time still. And she told me that she'll love you forever and ever. That's what she says.  Lots of times she says that. She's so lovey-dovey about you sometimes.' The child giggled into her hand.  'She showed me your picture too. That's how I remembered that I saw you.  And that's how I know what your name is. I told her that I saw you in the kitchen before … but I don't think that she believed me.'

Henry wondered if it would be wrong to ask the child to give Liana a message from him.  He wasn't sure, but he couldn't imagine this child getting too bothered by things very much.  She'd already had a pretty tough life, by the sound of it. 'Sarah, could you tell Mrs Smythe a message from me?'

The child took another bite of her cake. 'Yep,' she mumbled through a mouthful of crumbs. 'I could. What?'

Henry could already feel himself being pulled away from the room.  And, he could hear the approaching footsteps of Liana in the passage beyond the cedar door.

'Could you tell her … that I will always love her … and I will wait for her. I will wait for my darling  Narnie'

Henry felt himself disappear from the scene as he finished the last words of his sentence. He was being pulled into the future again.  The scene was fading before his eyes and the noises and the colours were disappearing.  He wondered if the child had heard the end of his sentence.  He wondered whether or not she would give his message to Liana, and whether Liana would believe her.  

Henry again found himself in the kitchen of the villa.  He sensed, however, that his most recent time-jump had been the largest so far. The kitchen had changed a lot since his last visit.  It was extremely modern now: with shiny new white cupboards; the walls had been re-painted a pretty dove blue; the floorboards were covered with large square white tiles, and the dark cedar doors had also been painted white for the first time. And, strangely, Henry was aware that for the first time a number of objects in the room, both large and small objects, were so modern that he had absolutely no idea how they functioned or for what purpose they were used.

A warm golden light shone through the kitchen window once again - giving the appearance that the time of day was mid-afternoon - as it had been during his previous two visits. Henry moved over to look at the calendar which still hung on the back of a kitchen door. It was March - 1991.  Henry realised that Liana would now be 60 years of age.

A door opened and Liana walked through it.  Henry never thought that she changed much.  Sure, her hair was now almost white, and her face was lined, and she seemed to have developed a slight stoop.  However, in her eyes, and in the way she moved, and the way she spoke … the nature of her soul …  that remained the same.  And for that reason, he always recognised her.  Even though it was now almost 40 years since he had passed. 

Liana appeared to be returning to the kitchen from the letter-box.  She put a pile of letters onto the kitchen table. Henry was aware that while the kitchen had greatly changed, Liana always kept the old kitchen table and the old chairs.  He wondered whether these objects were, for Liana, a physical link to Sarah and him and, as such,  she could not part with them.  No matter how much they clashed with the white decor of the room. And they did clash.

Henry watched Liana sit down in her favourite old chair and flick through the envelopes.  She stopped when she came to a large white envelope with hand-writing that she seemed to recognise.  She tore open the paper and pulled out a folded sheet of paper and a post card. She smiled as she looked at the colourful pictures on the post card: Red double decker buses. Big Ben. The London bridge.  She then opened the folded paper and read the contents aloud:

Dear Liana (or Mrs S), 

I still miss you.  I have my copy of Byron and I read our favourite poems every morning and every night - but it's not the same without you sitting next to me.  You know that you are like a mother to me.  Especially after mum died.  I know you know that I love you. But I will tell you again and again anyway.  I love you and I miss you.  I'm over here for another 6 months and then we can have our lovely walks and our banana cake under your tree and we can read Byron together again.  

Michael is finishing his research project and his advanced registrar training in thoracic surgery, and I am nursing in one of the large teaching hospitals in London.  When I do my double shifts and I'm so tired - I remember your funny stories about your time nursing in the Royal Adelaide Hospital.  And I keep going.  You certainly pushed through the tiredness. 

I'm still getting used to being a married woman.  Although it is now nearly our first wedding anniversary.  I can just imagine you reading this post card aloud - you funny thing. I know you so well.  You told me that after all the years we read poetry to each other aloud - reading aloud has become something that you link with me and my letters and our time together. So, I'm right aren't I? You're sitting in your chair in the kitchen reading this aloud. Possibly with a cup of tea.  Yes, I am psychic.  No!  You're just too predictable. 

Well, I'd better go - but I think of you every day my dear Liana. Mum. xxoo

  

Take care 

Love Sarah.

Henry watched Liana wipe her face with a tissue.  She had placed an entire box of tissues on the table next to herself - before she even began reading the letter.   She looked at the post card picture once more, and then she began to read the letter again.

Henry's visit was a short one this time.  Before Liana had finished reading her letter for the second time - he could feeling himself jumping ahead in time again - and leaving this bittersweet scene.

Henry found himself in a different room of the house for his next visit.  He was standing in his old bedroom and he could see an elderly woman lying in a single bed.  The bed was neatly made with clean white sheets and pretty coloured blankets tucked in around her.  Her hair was white and she appeared frail and ill.  Her cheeks were sunken and her breathing was laboured.  Henry had been a doctor for a number of years before his untimely death.  He could see this woman was near to death now.  He had seen it many times in his medical career.

The time seemed to be the early hours of the morning.  The curtains were drawn but a sliver of pale dawn light managed to creep into the darkened room. There was enough light for Henry to see the interior quite well:  A woman, who appeared to be in her early 40's, lay asleep in a chair next to the elderly woman's bed.  She had a woollen rug over her lap, and she clutched a copy of Byron poetry.  A bowl of cold soup sat on a bedside table - seemingly untouched.  A spoon rested idly against the edge of the bowl. A newspaper lay folded on the end of the bed.  Henry managed to read the date on the paper.  April - 2006.  He noticed a picture of himself next to the reading lamp on the bedside table.  

He understood now the situation in this visit.  His Liana was now 78 years of age.  The younger woman was likely to be Sarah.  He suspected that Liana had been quite ill in recent weeks or days … and Sarah had taken care of her. Liana now appeared to be close to death.

He stood watching as the frail elderly woman, lying in bed before him, opened her eyes.  Henry could see her adjust her vision to the dim light in the room.  She then looked across at the younger woman sleeping next to her.  She smiled and slowly dragged her thin wrinkled hand from under the blanket before resting it gently on the younger woman's hand.  She then continued to scan the room ... and when her gaze reached Henry she smiled again.  She was looking directly into his eyes and Henry knew that she could see him.

Liana attempted to speak - but the effort required to make any sound was now beyond her.  Instead, she managed to smile weakly ... before she took a final shallow breath ... and then she exhaled for the last time.

Her body moved no more.

At that moment Henry felt a hand holding his. The touch was soft and gentle. He turned toward the source of the sensation and his eyes met Liana's - looking up at him.  Her appearance was again as it had been on their last morning together -  when she was only 24 years of age. A lifetime ago. Although, for Henry the intervening years had felt more like only a few hours.  

'You waited for me!' Liana's face glowed with happiness and she clutched Henry's hands tightly in her own.  'I got your message.  Sarah gave me your message ... so long ago. She said that you called me Narnie.  And, then, I knew it was you. No-one else ever called me that.'

'I would wait an eternity for you,' Henry wrapped his arms around her shoulders.  'And I will always love you.' He rested his jaw against her cheek and he held her close - as he'd longed to do on every visit since he'd passed. He then whispered softly into her ear, 'I only feel complete when you're with me, Liana.'

'I will always love you, too,'  Liana said, wrapping her arms around her husband. 'I've loved you all my life, Henry ... For a lifetime.'

                                         The end.