At least I know I'm an ungrateful little shit?

On feeling guilty about not feeling grateful when there is nothing (much) to be grateful for.

This is the third edition of Bite Back, a new newsletter from Tess Koman.

While I woke up after my second-to-last surgery, my remaining intestines never did. For the next two-and-a-half months, my guts stayed dormant. I lived on the east wing of the ninth floor of a very old and very depressing hospital, and anything that needed to come out of my body had to be sucked the fuck out via tubes down my nose or other…deeply unpleasant mechanisms.

When your intestines don’t work, you don’t really have the option of stuffing food into them. I was placed firmly in the NPO camp (‘nil per os,’ in Latin, ‘nothing by mouth’ in today’s layman medical terms) around September 30, 2024, and spent the next months starving, begging the doctors around me to increase my TPN protein levels if it would satiate me; being told hunger was just a psychosomatic part of how this whole process had to be. I lost almost 30 pounds against my will, slowly at first, and then very quickly, all while being kept alive via this 24/7 infusion of perfectly formulated protein shake. I shook with anger every time my roommate crunched on ice. I looked forward to her twice-daily insulin checks—her husband would sneak in Snickers bars she’d slurp on over the course of hours, and I knew she’d be scolded post-finger prick. I wanted her to be scolded. I wanted to stomp on (and then eat) her illicit fucking Snickers bars.

I was finally able to leave the hospital two days before Thanksgiving. The nurses, all so sweet and so lovely, told me they knew how grateful and excited I must be, to have the opportunity to celebrate with my family. I wanted to throw fucking Snickers bars at their beautiful fucking heads.

Anyway. There is only so much stuffing a very sad and completely NPO gal can stand to watch her family stuff before she snaps. I sat silently as my toddler tried her first licks of gravy. I stared at the table as my parents toasted to my presence. I shook quietly as everyone went for seconds.

…I lost my absolute fucking mind right before dessert!

How we’re doing right now

I chafed reeeal hard at the idea of gratefulness around my situation. I continue to chafe every single day. I hope I don’t have to tell you I am grateful. Like, I am so grateful to no longer be septic. To have had the privilege and the access to the kind of incredible care I did have all those months in the hospital. To have had a safe and supportive family to come home to, one that would continue to be incredibly patient with me as I take teeny tiny baby steps toward “normal.” (This is the part where you, like a real BFF, quickly mutter, “no no, I knooow, and saaame and two things can be true at once, you selfish bitch!!”)

And yet. :)

Things are not the same as they were. Historically, I have mostly been a “lucky” Inflammatory Bowel Disease patient diet-wise, one whose intake rarely had to be too restricted. I mostly ate what I wanted. I really did eat all those fucking things you saw me eat on camera across all those years. (...I assume an overwhelming majority of you are Disney adults nostalgic for 2018 internet times and that’s how you got here. If I’m wrong, lmk!) I ate whenever I wanted without issue. I dreamt of one day baking with my daughter the minute her fine motor skills allowed for it. Food was so important to me I made it my whole fucking livelihood. I spent weekend nights reading Harold McGee to get better at my day job. I planned vacations exclusively around eating for pleasure 100 percent of the time while we were away. My 76k-deep camera roll is split into three equal parts: baby, dog, and poorly lit photos of simple meals that changed my life. Some of the greatest joys, I realized at some point during this forced-fasting journey, are olive oil-topped lemon squares and garlic-laden fontina, baked into fucking oblivion and served with a thinly sliced baguette.

And when everything that made me…me got yanked away in a very quick and unexpected instant (like, I was hot! Then I was skeletal with no hair! And, like, I was gainfully employed with a Cool Job and worked with interesting people who stimulated me! Then I was unceremoniously laid off and back to being alone with my dulled down hospital thoughts! I was a capable and involved mother! Then I was an absentee figure who only caused fear and uncertainty in my household! I COULD EAT WHATEVER THE FUCK I WANTED. THEN I COULD EAT NOTHING.), I found the prospect of recovery with stipulations to be totally and completely maddening.

thanksgiving 2k24!!!! :) :)

What we’re (maybe) trying to do about it

…And immediately on the heels of that anger, that lack of ability to be a chill, Stockdale-ian queen, I feel crushing guilt. Which may be the worst part? Why can I not be grateful for or accepting of the progress I’ve made? Because “societally and culturally, we do a disservice to folks who are facing health complications and chronic illness in terms of trying to perk them up and paint this rosy picture,” says Dr. Hannibal Person, MD, FAAP, and Assistant Professor of GI & Hepatology at Seattle Children's Hospital. (Dr. Person also specializes in psychiatry and runs the Brain-Gut Health program for the hospital.) He explains that many of his patients dealing with medicalization are met with ‘Oh, you're so lucky, we’re so glad you're here-” type language from those around them, so they’re “shaped and coerced into being grateful. But it's very hard to experience gratitude when you've been to hell and back and [you’re not even back yet].”

As for the actual knee-jerk guilt? The one that pops up every time I can’t just be totally fucking thrilled to eat a hot dog, but am instead mad that my bowels won’t allow for relish on it yet and because that’s! how! I! want! to! eat! it!? “After someone has a major medical event or just deals with chronic illness, there's an opportunity for the brain to create this post-traumatic stress-type reaction,” Dr. Person continues. It can take the form of hyper-vigilance “where you're constantly monitoring your body and worried about this internal threat of what's going to go wrong next?” It can also be sleeplessness or irritability or hyperactivity. Or! Or!! “It can look like guilt, where folks question their participation, activities, diet, whatever: I did too much, I smoked a cigarette, or whatever and that might have contributed to what occurred.” He sees a loTttttttt of people struggling with perseveration and reliving past events over and over and over again.

OK, great! So now I’m an entitled little shit who understands why she is this way but hasn’t done anything about it.

I asked certified mindset and life coach Mara Powers how to even start dealing with this. She suggests “tiny little thought-shifts” with the goal of eventually eking your way toward positivity: “If you find yourself wanting to be positive and grateful when you are in a shitty headspace, you can't go from zero to 100 in one thought, especially if you've been in a negative thought loop for a long time and you have that deep neural pathway already created.” That’s setting yourself up to feel even worse! In fact, she says, the idea that anyone could fix this problem with head-on positivity is “fucking crazy.” (I love her!!)

Still, she notices this impulse often, and notices we are usually doing it to ourselves. “Any time we're using the word ‘should,’ there's automatic guilt associated,” she says, “so if you're not somewhere you think you should be or thinking the way that you think you should be, you're going to feel guilty about it.” So don’t even try to go from zero to 100! Try going from zero to…one. For example: “If you were thinking, ‘I hate how I'm feeling right now, this is never going to get better,’ a tweak toward neutrality (rather than total gratefulness and pure positivity) would be, ‘I hate how I'm feeling right now, but I want it to get better.’” But the expectation you put on yourself when you are feeling shitty and are beating yourself up for not even attempting positivity? “It's simply too big of a jump.”

And assuming you are dealing with that kind of guilt that comes (unintentionally) from other people? Dr. Person encourages bluntness in real time where appropriate: “Limit-setting is so important, as is defining your boundaries on what works for you and what doesn't. You can do this in every interaction,” if it feels worth it to you. For example, on the heels of a gratefulness jab, he suggests using the following template:

When you make a comment like that, I know you intend for it to be positive and motivating, but in fact, [insert nauseous-making feeling here] is the effect it has on me. I'll let you know when I'm ready for that sort of coaching or motivation, but I’m not at this moment.

How we’re eating through it

At the time of writing, I’m not supposed to be eating any sugar. Anything with sugar is rushing through my remaining guts like…oh god, I don’t know. Like Anna Kendrick on a red carpet fielding questions about Blake Lively? That’ll be an irrelevant reference by the time this sends, but please know it was an incisive one when I first came up with it. Anyway, my food is moving so quickly through me that it’s not really absorbing, meaning it’s not contributing to any kind of meaningful nutrition or weight gain right now. So! I, a person who, in my real life, eats about four sweet meals a day, am on day nine of no sugar. It’s hurting me. I’m dumping soluble berries into vats of yogurt and pretending it’s doing the same thing for me that a quarter of a cheesecake would. Otherwise, next week is YouTube launch week, and I’m eating forbidden seed-laden bagels to celebrate. :) Staaaay tuned, my sweet lil sickos. :) :)

Art by Amanda Suarez