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I was 13 when she was hospitalized.

I remember because it was right around the time I had my ACL surgery. We were both laid up at the same time.

I don’t remember how it was explained, except that my mother explained it well. I don’t remember the too-thinness. I don’t remember skin and bones or her finding reasons to skip meals, but maybe it was that despite growing up together, being the oldest of friends, we were in different schools and simply didn’t see each other that much. After school, she’d be off to rehearsal (easy to tell the cast she’d eat at home, her parents she’d eaten at practice) and I would go to soccer games or basketball practice or simply out for a run. She was convinced in a year or two, with enough voice lessons, she’d get the lead. I was convinced if I worked hard enough, I had a shot of making the JV team, though I was just a freshman.

I remember the pumpkin chocolate chip muffins she’d bring over, the soups, her constant cooking. I don’t remember the never eating, but I was 13. Would I have even noticed?

She came home three days after my surgery. I remember her sitting on the crocheted top of the cedar chest that held my parents’ sweaters and ski clothes, eyes sheepish, hair spilling into her face. I sat in the recliner, my knee extended in its hinged brace, the ice pack that came with it filled with ice water that slowly warmed as we sat.

I did not know what to say.

What do you say when your best friend was hospitalized with anorexia, a hunger I could never know? What do you say as you mentally compare your invalidities, realizing while also not knowing at all just how close the hospital is to dying of self-starvation.

How did I not see it?

And yet—how could I help now?

I don’t know if we ever talked about it again after she went home that afternoon.

Flash forward to my first month of intern year. He perches on his bed, cross-legged, watching something on Food Network. Hospitalized with abdominal pain, he’s been on our team for a little under a week. He tells me about the blueberry muffins he makes, how many of the blueberries he likes to eat as he bakes.

It’s anorexia, the cardiologist who reads his EKG tells us. No question.

How did we not see it? Is it because he’s nine? Male? Did we not track his weights? Did we ever actually see him eat? Or did he just talk in detail about the trays he was served, comparing them to various things he’s made, all blending into food, just food.

Who emptied his tray each day?

What demons, what hunger is he staving off at nine?

We try to talk to his parents. Me, my senior resident, our attending. We try individually and together. We try to coax him to eat. His parents say no, no, no. They take him out of the hospital. Will find doctors who will find actual answers.

I look at photos on social media of my friend, wonder if she looks too thin, wonder if it will ever come back or if she’s truly ok now.

I wonder what happened to him, the boy. If his parents ever accepted his diagnosis. If he got help before it was too late. I can’t even remember his name.

I wish I had known how to ask about the hunger. How to ask why? How to help.

I still am not sure I know.