This article discusses eating disorders and may be triggering for some readers. The Canadian Mental Health Association Crisis Line can be reached at 1-800-875-6213.

The story goes that if you put a frog in a pot of boiling water, it will instantly leap out. However, if you put a frog in a pot filled with room-temperature water and heat it slowly, the frog will stay put until it boils to death.

My doctor called in October to tell me that, like the frog, I wasn’t in a lukewarm puddle of water as I’d convinced myself; I was boiling to death.

I’d had a blood test a few weeks earlier, after spending a week confined to the couch in exhaustion, and the results of the test were conclusive: my iron stores were nonexistent, my hemoglobin was half of what it should be, and my red blood cells were small, misshapen, and multi-coloured.

The condition, the doctor explained, is called iron deficiency anemia. This type of anemia is characterized a lack of iron in the body which impacts the health of red blood cells, inhibiting their ability to carry enough oxygen.

Spinning in an office chair in the corner of my bedroom, I thought, scary, but not shocking. The signs that I was unwell were easy to identify, but the possibility of a diagnosis hadn’t occurred to me yet; I had things going on, I was going through things. In spite of the dizzy spells, nausea, and exhaustion, I’d never let myself feel as sick as I actually was.

The doctor sent me a PDF file loaded with information about my blood. When I asked her to explain what it meant, she sighed and told me, “Your body is just trying so hard to be alive.”

Translating the results over the phone, she said I was very anemic. She noted that my hemoglobin count must have gradually declined over a period of months, because a sudden drop to the level indicated on the test would have prevented me from carrying on like normal. No, she assured me, my body had adapted slowly over time to functioning without its most essential element.

A gradual decline like, for example, if I’d had an eating disorder for the last ten years.

***

I have a friend who says it’s bold to assume people know when they have an eating disorder. I agree with her because I didn’t know. I’m in a constant state of not knowing about myself, about how my search for control is manifesting in my habits.

I could list things I’ve thought and done over the years, though I’m not sure it would be helpful; they’re not interesting, not important to this story, and likely shared among women close to my age. I’ve tried—am trying—to get outside of them, push them outside of myself, and pry myself out from under my own scrutiny.

My own experience in mind, I can add it’s bold to assume people know they have disordered eating. It’s bold to assume people know how to find help when they need it most, or to assume people are ever not navigating their own relationships with their bodies.

It’d been a decade and I didn’t know, but my blood has been keeping track.

***

The doctor told me she thinks iron deficiencies should be a public health concern because of how prevalent they are among university-aged women. Women, who are more likely to have low iron because of menstruation, are also more likely to have eating disorders and practice vegetarianism. These are compounding circumstances, and I’ve tried both of them.

Thirteen per cent of Canadian women aged 12 to 19 and nine per cent of those aged 20 to 49 were found to have low iron stores in a study from Statistics Canada, last modified in 2015. It was the first time since the early 1970s such a study was conducted in Canada.

The doctor said iron deficiencies are understudied in part because of how they affect female bodies at a larger rate than those who are biologically male. She said, “The medical system is sexist. If this was a problem for men, everyone would have their blood tested.”

Low iron prevents red blood cells from carrying enough oxygen around the body, causing physical exhaustion that contributes to difficulty concentrating; reduced memory, immune function, cognitive performance and behaviour; decreased ability to maintain a particular body temperature and metabolize energy; and diminished work and exercise capacity. As a whole, the presence of iron correlates with wellbeing and academic performance.

I made the doctor laugh when I said, “I didn’t suspect an iron deficiency would feel this awful, this completely disenabling.” Standing at the top of the stairs, head pressed against the door frame, heart pounding, trying to catch my breath. Scared to collapse in public, then collapsing in private. She said, “No one ever does.”

***

It’s difficult knowing my time at university could have been different if I’d had the energy to participate, and more difficult still to channel how I feel about that into new hope about what the future could feel like for me. I didn’t know other people weren’t this exhausted all the time, but I’m learning.

Right now, my body is so estranged from iron that my bone marrow is releasing red blood cells haphazardly before they’re fully formed. The doctor told me it will take six months or so to recover, but the iron supplements are working, and my hemoglobin has shot back into the normal range. My body knows what to do with iron if I’m willing to consume it.

The underlying causes will take longer to shake out. There are rules to existing in my body, and I’ll be uncovering them all my life.

***

I had my blood tested a few more times, at the doctor’s office, at a lab, and in the hospital.

The doctor held my hands in hers, turned them palm side up, and traced her fingers along them like she might tell me about the stars, his eyes—green or brown—and the names of those four perfect children I’ve been dreaming about.

“Good,” she said, “Your colour is coming back to you,”andI saw what I’d been lacking for years.

***

My family visited me last summer. When their car pulled into the lot behind my house, I danced onto the deck, coffee in hand, to lean over the railing while they stretched their legs. My brother approached me first, grinning.

“Claud,” he said, “You look so vital.”

The first thing my brother noticed about me that day was how alive I looked, a little golden in the sun. My mother likes to remind me about this moment when we speak on the phone, as if to point out there are times when I’m more alive than others. I’ve never known what to say to that.