Walking with a Friend Toward Her Final Days: A Review of Shell

41A4sbETFyL._SX331_BO1,204,203,200_By Lisbeth Leftwich

How would you react if you found out you only had a year to live? It’s a hypothetical question we can ask ourselves, but rarely are any of us given the knowledge that our time left on Earth is so limited. For Michelle Stewart, author of Shell: One Woman’s Final Year After a Lifelong Struggle with Anorexia and Bulimiaa routine visit to the doctor left her facing this exact reality.

At 48, Stewart was told that decades of living with anorexia and bulimia had left her body into end-stage renal failure. Rather than go on dialysis and wait for a kidney transplant that may never have come, Stewart chose to forgo treatment and instead have her doctors focus on making her as comfort as possible during her final year. Stewart’s doctors were unsure of exactly how much time she had left, only that it wouldn’t be much.

So Stewart began blogging about her day-to-day life. It became a way for her to process her emotions and to experience some kind of catharsis during her final months. After Stewart’s passing, her blog was edited and turned into Shell.

To say that Shell is a devastating read is a gross understatement. The reader moves with Stewart as she makes preparations for the end, doing everything from finding the right drugs to lessen her pain to selling the house she and her husband had waited their whole lives to buy. Throughout the whole book, there is no escaping the reality of Stewart’s situation. She knows—and the reader knows—that she is going to die, and all she can do is try to be ready for it.

It would be perfectly reasonable for Stewart to focus on her death, and she does this, but she also discusses her current circumstances and what factors led her to them. In this way, she is highly relatable and causes the reader to question our understanding of the “eating disorder narrative.” In one of the book’s most insightful passages, Stewart says:

“We understand—or think we do—the physical indications that a person is living with anorexia, but even then you would be mistaken in thinking that its sufferers are wholly a parade of skeletons. And you would not be alone, upon seeing a televised interview of a sufferer, in thinking to yourself, ‘but she/he doesn’t look that thin.’ Even I must admit my guilt in this area.”

This condemnation of the way we view eating disorders is accurate. The overwhelming societal view is that eating disorders are visible illnesses, and that we can tell a person’s health just by looking at them. For Stewart, this is one of the most troubling parts of the problem. Even when someone says they have an eating disorder, we still feel like we can look at them and judge exactly how “sick” they are.

At the same time, Stewart does not dwell at length on her eating disorders. While there is some of this, anorexia and bulimia more often maintain their status as looming specters in Stewart’s life—they play a huge part in what she does and where she is, but are very rarely addressed directly. Still, Stewart does not discount their severity, at one point saying: “I am not a victim, but I do have an illness, one that dwarfs my kidney woes by a thousandfold. The truth is, this disorder’s continuing grip on me is also the reason I am actually not a credible candidate for transplant. Nor would dialysis have a legitimate shot at success.”

The fact that Stewart, in the face of eventual kidney failure, still considers her eating disorders to dwarf everything else speaks to the nature of this illness. Eating disorders are commonly viewed as normal and unfortunate, but not terribly serious. We acknowledge them, but rarely talk about the long-term health consequence that come with them, or the fact that they can be fatal illnesses. But Stewart underlines the reality of living with them. She writes, “There was a part of me for which it wasn’t too late even before treatment began…there was a stubborn, unmoving part of me that wasn’t prepared to face the consequences of giving up what I knew…and having to cope with this life without my deeply flawed safety net.”

While Stewart’s attitude toward her eating disorders is troubling, it is, in the end, honest. Stewart doesn’t pretend to feel things she doesn’t, and that’s part of what builds trust with the reader. When Stewart is having a particularly bad day, she says it. She does not sugarcoat her experiences or carve her story into one that readers might find more palatable. Stewart finds peace in the good days, but doesn’t cover up when things are hard.

This becomes especially important as the memoir nears its end and Stewart honestly expresses her interest in the Death with Dignity movement. As her kidney function declines and Stewart grows sicker, she begins to identify with those struggling “for the right to a dignified death assisted by a physician.” In her last entry, Stewart says:

“I seem to lack the capacity to take comfort in what many people envision about the end of life…I should be grateful for these days, and yet I feel nothing but resentment now…it just seems so patently unfair that we can’t make decisions for ourselves. Without professional help, the options that exist are risky and, for the most part, unrealistic.”

Whatever your opinion on this movement, it is hard not to have empathy for Stewart’s feeling of powerlessness when reading the intimate details of her life. At this point in the memoir, Stewart feels like a friend. You begin to feel helpless yourself as you desperately want Stewart to get through the most painful moments, while at the same time knowing what everything is moving toward. This experience mimics the feelings we have when we watch a loved one struggle with an eating disorder. We want moments of peace for them, but, more than that, we want them to recover because we know there will be dire consequences if they don’t. Reading this book with the awareness of exactly what happens at the end is heartbreaking.

With all this heartbreak, though, there is plenty of beauty in Shell. Stewart’s perspective is one we rarely get to read, and the memoir’s open nature provides room for moments of revelation. Near the beginning of Shell, Stewart says:

“From the beginning of my journey, with every birthday that passed, I would foolishly pray for rock bottom, because I earnestly believed that magic moment would miraculously bring me the will to get better. Well, I have found that place, and while I may not be healed, something transformative is happening…

We are all a collection of our stories and insecurities. Stories of our childhood wounds, of the bodies that intersected with ours at some point along the road, of the voices that destroyed us and those that lifted us up. Scarred and scared on the inside, we walk through the world as if none of this damage exists. We are the walking wounded…but still putting one foot in front of the other.”

This sums up Stewart’s attitude better than any other words could. There is an enormous amount of pain and the knowledge that she cannot undo her past; there is also bravery, love, and hope. Stewart goes through everything and, while she in no way sugarcoats her experience, she is also able to express the healing she finds in the process. And, in the end, Stewart is able to say, “It was worth the pain.”