Among those cases is an eight-month-old baby…. [Doctor] Hamdo uses a measuring tape to record the circumference of her upper arm, a method used to identify the risk of malnutrition. —Muhammad Al Hosse and Madeline Edwards, “Inside the Childhood Hunger ‘Emergency’ in Syria’s Idlib,” The New Humanitarian, 28 October 2020
I thought I was the only person who checked out women’s upper arms. Over the years it’s become a reflex: see human, assess apparent gender, shift glance to humerus region. Should be cylindrical in shape, with ample muscle on the bone. This may sound like erotica, but it’s actually health assessment.
Early in her teen years our daughter fell off a horse. Three lesson-horses were standing quietly in a rundown ring, each with a student in the saddle, a portly instructor on the ground dispensing advice. From beyond a gate I watched our daughter sag, then slump, then tumble to the sawdust. What came next moved like a dream: a sprint to kneel at her side, voices, shouts, her ashen face, eyes fluttering—at last—to indicate she was coming back to consciousness.
The drive home included questions. After a pause, I asked out of nowhere, “When was the last time you ate?” She responded in her little-girl voice, the voice she’d use when I exposed a secret.
For the next two years, I tuned all my attention to detecting mortal threats because, make no mistake, the mortal threats lurked out there, springing on us with each new doctor’s visit. I learned what to watch for: continued weight loss, a light down on the arms, more fainting, cutting. My brain processed every word from every doctor, the way zebras absorb even the faintest signals from lions on a wide-open savanna. I brought it all to prayer because that’s what our species does: scream for help.
It’s amazing, the things you notice when you’re on watch. Our daughter’s upper arm became, for me, the most reliable gauge of her health—a gauge that hit red alert when the humerus nearly showed through the skin. I took daily sightings, assessed muscle mass, noticed my mood expand and shrivel with the appearance and disappearance of tissue on the bone.
It’s said that prey animals must take care how much energy they expend in threat detection. Too little and they’re lunch for predators; too much and they miss out on critical functions like eating. I didn’t care about that. For two years I expended even the energy I didn’t have.
You were watching out for your child, you might say. Any parent would do the same. That may be true, as far as it goes. But then the humerus watch began to spread.
I don’t recall exactly when, or with whom, or why. It started during the darkest days of our daughter’s illness, probably from force of habit. All I know for sure is that one day I watched my daughter’s upper arm and the next day I checked out someone else’s. Someone else might have been one of our daughter’s school friends, when they switched from parkas to tees in the spring, or her young cousins, whom we saw in swimsuits and wraparounds every summer at a family place on a lake.
Any parent might do the same, especially if they know their research. On average, girls develop anorexia at 16 or 17, says a study cited on womenshealth.gov. Teen girls between 13 and 19 and young women in their early 20s are most at risk. I’d cared about some of these young women since they were kindergarten age, so in every case I had to know: Is she OK? Should I say something?
Even friends and cousins made sense in a way. What never made sense was the next phase, when I began to evaluate the humeri of strangers: young women in the post office, in the grocery store, up the age ladder to those in their thirties, forties. Always the question: Is she OK? Does she need a smile, a lame one-liner about this week’s plums?
I can’t tell you what happened to those women. I can tell you this: After two years of hell—tucked up on the couch watching Barney, reading memoirs of anorexia, trudging sullenly to yet another doctor visit—our daughter latched onto a dream and made it happen. In the space of three months, she read of an arts school fifteen hours from home, applied, was accepted, secured funding from her grandfather, and landed on campus in time for fall classes. Since that point, twenty years ago, she has navigated a way through life that could only be hers, thriving at times, managing at others.
Here is another thing I can’t tell you: whether my humerus watches added anything to our daughter’s well-being, or sustained her health, or kept her alive. They did nothing to help the women at the grocery store, or console our daughter’s cousins. It makes sense when you think about it. I haven’t yet changed the universe by keeping an eye out for AMBER Alerts either, or by reading about Doctor Hamdo’s infant patients and cradling them in my heart.
But I don’t think we do all this because it matters. It’s more primal than that. We are watching out for our children—whether they’re fifteen or fifty, cousins or strangers, next door or on the next continent. Any human would do the same.