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Your scissors are much sharper than mine. They are in my kitchen now, in a mug on the windowsill. And I have all your dish towels, too. Why an anorexic girl who seldom ate and never cooked had all those nice dish towels is a mystery to me.

It has been 4 years now. You used to say that if you died, we would be sad for a little while, and then our lives would be better. There would be no more desperate calls in the night. We would not have to spend hours sitting in emergency rooms or celebrating holidays and birthdays in hospitals. If we wanted to go out of town for a weekend, we would not have to wonder who you would call if things got bad, if the black helicopters were circling your building at midnight, and they were going to land and come in to kill your cat.

We told you for 20 years that our lives would be diminished forever without you whatever the problems that came along with loving you. We said we would bump along like a wagon on three wheels. And we were right. This is a life sentence. We were four people who had a history together, however imperfect; we had the memories and the in-jokes and knew what the shorthand meant. You and your sister were our past and our future. This is impossible: how could you not be here? Where are you? What is our family now?

Here’s what it felt like donating your furniture and clothes and selling your car: it felt as if we were looting your life. We were dismantling the stage set you had carefully constructed, a stage on which we hoped that one day you would stop acting and start really living a life, however you defined it, however much smaller it would have been than we had all dreamed in the beginning. We had the weird feeling as we were doing it that one day you might come back and wonder where all your stuff went. As if we could have been that lucky.

You spent an awful lot of time in hospitals, both on long- and short-term units. I used to wonder why there seemed to be so little to do there. I knew that you needed to be protected from the world and yourself for a while, and sometimes you were too overstimulated by noise and conversation and TV to be able to benefit from yoga and computer classes even if there had been any. But I always thought it could not be good for someone to live entirely inside her head 24/7 with no distraction, no chance to learn something new. I couldn’t do it. And it’s not as though you were too busy being seen by doctors in this era of managed care.

Sometimes there were groups and community meetings. Most people on general psychiatric units tended not to contribute in groups. When you happened to be on an eating disorder unit, those girls talked a lot, as I assume you did, too. As the years went by, the other girls got younger and younger; you started to hear your story coming out of their mouths. The doctors who saw you on the unit were residents, and they got younger, too, until you were being treated by people with considerably less experience than you, although, theoretically, more perspective.

And it hurts to think of the patients you knew in hospitals, girls who had been in reform school and prison, girls who had been abused in ways I do not want to contemplate. You once had a roommate who was a hooker. You once had a roommate who was literally catatonic. Another roommate was a middle-aged woman who believed that her son was the Messiah. (I said to you, “When he comes to visit, it couldn’t hurt to talk to him.”) And you were the person who had wanted to be a doctor, who made your bed every morning, who called when you were going to be late, who did your homework. You were a graceful skier, the designated driver. You kept your checkbook balanced. I came to understand that at your most symptomatic you were as sick as they were. But what about the rest of the time?

When you were an outpatient, your doctors, who always started out with great optimism, soon became as puzzled as the rest of us. At times you were hypomanic. You were always anorexic. When life became too stressful for you, the voices appeared. The doctors would treat one symptom with medication, sometimes successfully, only to have it morph into another. When they would treat the depression, you were calmer, better able to sleep, and let yourself eat a little. But then it would take you hours to get out of your apartment because suddenly everything had to be wiped down with bleach. When your team targeted the obsessive-compulsive disorder, you would develop a whole new galaxy of symptoms. It made me hopeful that your doctors seemed to be aware of the newest medications and patiently tried out various combinations. But what you became was a state-of-the-art science experiment.

You always wanted to finish college. You took courses over the years and did well in some but had to drop out often to return to the hospital. Even though we all knew you were smart and very hard working, there was something keeping you from doing as well as you wanted. Finally, you were tested for learning disabilities. It turned out that you had a bunch of them and could have gone to school with the help of the college disability office; you could, for instance, have been allowed untimed tests. The report came after the funeral. You missed the validation of having an expert tell you that it was not your fault.

We dealt with your furniture and your clothes. What do we do with the things we were saving for you until you wanted them? What do we do with your baby book and the little bronzed baby shoes? How about your great-grandmother’s candlesticks? What do I do with your photo album that I rescued when you were going to throw it out? Or the pearls you got for your 16th birthday?

What do we do with the terrible, fierce love we have for you? What do we do with our hopes for your life when that life is gone but we are still here? I am looking out of my kitchen window, watching snow blanket the garden. I know where the bulbs are planted, where the daffodils and tulips will appear. They are not dead. They are only sleeping. I always used to look forward to the spring. Now, though, everything I love will wake up again except you.

Address correspondence and reprint requests to Ms. Ratner, 3806 East-West Highway, Chevy Chase, MD; [email protected] (e-mail). Accepted for publication November 2006 (doi: 10.1176/appi.ajp.2007.06091543).