Michelle Stewart always knew in her heart that her eating disorder would kill her. What she didn’t expect in its early stages was that she would continue to function - albeit far from optimally - for decades before succumbing to its deadly effects. A conscientious and ambitious woman driven by a desire to make a positive difference in the world, Michelle went on to build a successful career first in journalism and then in communications for the British Columbia Ministry of Health. Michelle devoted her working life to raising awareness of healthcare issues, all the while hiding her own anorexia and bulimia from friends and colleagues. By the time she was 48 years old, more than thirty years of self-imposed starvation, binging and purging had ravaged her organs. In May 2013 she was diagnosed with end-stage renal failure and given only a few months to live.

Determined to come out of the shadows and share her story while she still had the chance, Michelle began writing a very personal and revealing blog in which she chronicled her lifelong struggle with her eating disorder and her experiences as a palliative patient within the very same healthcare system in which she had performed her life’s work. “I have had a 32 year dress rehearsal for the fate I now face,” she writes. This memoir is a collection of the most poignant pieces of writing from that blog, supplemented with previously unpublished pieces of original poetry from the author.

Michelle Stewart’s book stands out against other eating disorder memoirs in several ways. As a middle aged longtime sufferer, she belies the notion that eating disorders only affect the young - or that victims tend to either recover or perish early. According to experts featured in the foreword, medical practictioners who treat patients with eating disorders are seeing rising numbers of long-term sufferers like Michelle. These tend to be high-functioning individuals who keep their disorder underground for years while their bodies slowly disintegrate. Michelle’s advanced years give her a valuable and rare perspective on a widespread mental health problem.

Second, through her years spent in healthcare advocacy and communications, Michelle developed well informed insight into issues around medical services and the relationships between healthcare providers and their patients, including palliative patients. In her book, Michelle shares her personal views on disease-specific funding, patient care and the right-to-die movement, making a valuable contribution to the public conversation.

Finally, the book is a deeply engaging and compelling tale of terminal illness progression that follows one woman from diagnosis to death. Anyone who has been touched by life-limiting illness in their own experience or in their family will be moved by this account of the palliative care journey told from the patient’s perspective.