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Florida feeding-tube case casts a light on eating disorders

TAMPA -- Before she was the severely brain-damaged patient at the center of a legal dispute over whether she should live or die, Terri Schiavo was a young woman who desperately wanted to be thin.

At 26, she was strikingly beautiful with delicate features. But she had spent her childhood and high school years as a chubby, shy girl, standing 5 foot 3 inches and weighing 200 pounds at her heaviest.

When she finally lost 65 pounds in her late teens, men started to pay attention -- including the man who would become her husband, Michael Schiavo, who was tall and handsome.

But keeping the weight off was a struggle for Terri Schiavo. Years later -- after her heart stopped briefly, cutting off oxygen to the brain -- a malpractice case brought against a doctor on her behalf disclosed that she had been trying to survive on liquids and was making herself throw up after meals. The Schiavos' lawyer said her 1990 collapse was caused by a potassium imbalance brought on by an eating disorder.

It is a twist lost on no one close to the case: A woman who is said to have struggled with an eating disorder is now in the middle of a court battle over whether her feeding tube should be removed so that she can starve to death.

Gary Fox, a lawyer who represented Terri and Michael Schiavo in the malpractice case, said the disease is the ''lost lesson" in the Schiavo case.

''While there is no cure for bulimia, there were things that could and should have been done for her that would have controlled it," he said in a recent interview.

Terri Schiavo, 41, is locked in what some doctors say is a persistent vegetative state, with no hope of recovery. In one of the nation's longest right-to-die disputes, her husband is fighting with her parents to have the feeding tube removed; a court order preventing its removal expires at 5 p.m. today.

Like almost every element in the case, whether Schiavo actually was bulimic is in dispute. Her father, Robert Schindler, said he does not believe his daughter had an eating disorder and thinks her husband had something to do with her collapse. Michael Schiavo has denied hurting his wife.

During the malpractice case, at least one of Schiavo's friends testified they suspected that she was bulimic because after meals out, she always immediately excused herself to go to the bathroom. Her husband also knew she had peculiar eating patterns but did not realize they were dangerous, Fox said.

Medical records from the hospital where Schiavo was treated after her collapse note that ''she apparently has been trying to keep her weight down with dieting by herself, drinking liquids most of the time during the day, and drinking about 10 to 15 glasses of iced tea."

Fox said that in the months before her collapse, Schiavo went to the doctor because she had stopped menstruating. It was a silent ''cry for help," the lawyer said. But the doctor did not record a complete medical history that might have indicated an eating disorder.

The jury put the damages at $6.8 million but reduced the verdict to about $2 million because it felt Schiavo was partly at fault for her collapse.

Fox said Schiavo was a victim of medical negligence, but also of societal pressures to be thin. ''She didn't want to go back to where she was from," he said.

Eating disorders have long been known to cause heart failure. According to the National Eating Disorders Association, the binge-and-purge cycles of bulimia can lead to chemical imbalances that harm major organs.

David Herzog, founder of the Harvard Eating Disorders Center, said medical science is only in the early stages of tracking the long-term effects of eating disorders and there are no good statistics on how many people are killed or permanently disabled. Herzog said that even when someone dies from an eating disorder, medical examiners often do not list it on the death certificate.

Specialists say the serious health risks exist long before a victim looks sick. In Schiavo's case, Fox said, she was not excessively thin when she went to the doctor.

Psychologist Doug Bunnell, president of the National Eating Disorders Association, said while he could not comment on the specifics of the Schiavo case, it is often impossible to predict which sufferers are in immediate danger.

''Paint me a picture of an eating disorder -- it's an emaciated woman," he said. ''But that's not the reality. They don't get down that low. The face of eating disorders is your next-door neighbor's daughter or maybe your own."

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