Note: The Nocturnists is an audio-first experience with emotion and sound design that can be difficult to fully capture in text. Transcripts are provided to support accessibility and reference, but may contain minor inaccuracies. If quoting in print, please consult the audio when possible.

Emily Silverman: This is The Nocturnists Conversations. I'm Emily Silverman. Today, I'm joined by Dr. Meghan Rothenberger, an infectious disease doctor whose story we first heard live on stage at Intersections, a storytelling event produced by the Center for the Art of Medicine in Minneapolis in 2024 through our program, The Nocturnists Satellites. In this conversation, Meghan opens up about her adolescence, her struggle with disordered eating, and how her path through medicine helped her rediscover a sense of wonder and gratitude for the human body.

We talk about the confusing and taboo messages around puberty, body image, and food. Her experience in a restrictive eating disorder program, how studying anatomy and physiology reshaped her relationship with her body, the transformative power of pregnancy, and how her lived experience informs her empathy and care for patients today. Meghan is one of the most talented storytellers we've ever had the pleasure to feature on this show. I hope you'll take a listen to her story and enjoy the conversation. Here's Meghan.

Meghan Rothenberger: Roses are red, violets are black. Why is your chest as flat as your back? This lovely poem was written just for me. [laughter] I'm 13 years old in seventh grade. The poet is a boy named Tony. Now, rather than writing the poem on a piece of paper and hand it to me like a normal person, he decides to shout it from the chairlift at our local ski hill. I'm in the chair right behind him. He turns around his body to face me as he recites the poem. I can see his blue eyes. Even though it's 10 degrees and windy as hell, I'm wearing jeans carefully tucked into my ski boots. [laughter] I'm also wearing a mint green ear band so my bangs won't get crushed. I'm trying so hard to fit in.

After Tony recites the poem, he turns back around to face up the hill, so I have to stare at the back of his stupid hat the rest of the way. I feel sick to my stomach with shame and embarrassment, but also oddly like I deserve such treatment, because in reality, my chest is as flat as my back. This memory came to me because I've been thinking a lot recently about my relationship with my body. Maybe it's because my daughter is 10 and I think about her entering adolescence, or maybe it's because I finally started cleaning out my old room.

A task I managed to avoid for over 30 years because I never felt quite ready to face whatever artifacts were left over for my teenage years. Regardless of the reason, I spent many hours over the last few months trying to piece together the story of my myself, my body, and where things went wrong. I go back to when I'm a little girl. As this little girl, my body is not separate from me. It is me. I trust it. I eat when I'm hungry, I rest when I'm tired, I swim and I dance, and I ride my bike.

Then, in later elementary school, things start to change. I'm in fifth grade. Mrs. Clink Hammer's class, that's her real name. [laughter] I look like a child, but there's a new girl in the class, and she looks like a woman. I cannot stop staring at her. My mind is like blown, like, "How can we be members of the same species at the same age?" It just doesn't even compute. At some point, the boys and the girls are separated, and us girls look at this really creepy plastic pelvis model.

There's these fallopian tubes sprouting like mutant flowers from a pink uterus. We learn about periods, and breasts, and pads, and tampons, and I'm terrified, like, "This is going to happen to me." The worst part is no one can tell me when. It's like I realize I'm living in a ticking time bomb that will at some point turn on me. It'll start to bleed, it'll get acne, and hair will grow in places other than my head. It's around this time that I have one of my usual play dates with my best horse friend. We do all things horse together.

One of our favorite things to do is play with these, like realistic plastic horse models called Breyer horses. On this day, I bring my crate of Breyer horses over to her house, and we're sitting on the floor of her room. She's a little girl like me, like we're just kids. It feels so safe to be with her. Then right in the middle of an exciting horse scene that we're acting out, she pauses and she looks at me and she said, "Can I show you something?" I say, "Sure," but I get this little pit of worry in my stomach because she looks so serious.

She stands up and she walks across her room to her wooden dresser and she opens the top drawer, and she takes out this pink elastic band-looking thing. I say, "Is it a belt?" She said, "No, it's a training bra," and I want to throw up all over the black and white horse that I hold in my hand. I feel so betrayed by my friends, and then so confused as to why I feel that way. Over the next several years, my relationship with my body starts to shift. I start to think of it as separate from me, like a box that carries the real me around.

It just seems easier that way, like my body's going to do what it's going to do, but I'm still here, the same old person I've always been. I have to wait a while for my body to change because I'm a very late bloomer. When it finally does change, it is not good. The place that I most notice just how bad it is is in the shower. The shower I use has these ugly tan speckled tiles, and there's a drain in the center that big hairy spiders would sometimes scuttle out of. I'm standing in the shower letting the warm water run over my body, and I looked down.

You all know that really awful perspective of your body. I'm looking down, and my body looks so different. My stomach is out more than it used to be, and it looks soft. My thighs used to be really straight, and they're curved. Then I look at my breasts and they're so small, but they're still lopsided. This is really all I get. Then I try like move them around, and no matter how much I squeeze them together, like there is no cleavage, nothing, none. Then, with like the greatest sense of horror, I look down and I see a single hair sprouting from the darkened skin around my left nipple. [laughter]

I want to die. At the mall with my friends, I stare longingly at the posters of the beautiful models plastered all over the Abercrombien fish walls. I would do anything for their twiggy little thighs, their plump breasts, their flat stomachs. I would take just one of their boobs and divide it between mine, and I would be great. I buy the most padded bras I can find. I even have a bra that's called a water bra, like each cup has a little mini waterbed in it, so you get like the right kind of jiggle. I feel so awkward and abnormal. I start restricting my eating when I'm around 15. I don't really know why.

It just feels good to starve my disappointing body a little. I heard it in other ways, too. I'm a runner and cross-country skier and I push my body so hard in those sports. I run on swollen joints and pulled muscles. I do hill workouts when I have a fever. I no longer trust my body to tell me if it's hungry, or tired, or sick. I lose a lot of weight when I go to college, so much that my family intervenes. I have to spend the summer after my freshman year in an eating disorders program that I not so lovingly refer to as anorexia camp. It's the worst camp in the whole wide world.

I was in the adult camp, which is some ways is good because I didn't have to be with whiny 13-year-olds. I was in the adult camp, which meant that I had some old women in the group with me, like really old, like 40 or even 50. [laughter] We eat our meals in the program, the room we eat in smells like fake maple syrup. A chipper therapist tries to carry on a conversation while me and the other skinny campers panic trying to figure out how we'll eat the big mounds of unappetizing food sitting in front of us on thick plastic plates.

We all hate the counselor because she's skinny and cute, but she doesn't have to eat five pancakes and three scrambled eggs every morning. She just sips her black coffee and chit-chats, and acts like she has no problems in the world. A woman named Kelly always sits kitty corner from me. Kelly's in her 40s. She's missing a lot of teeth and has incredibly thin hair. She's so skinny I can see all the dents and crevices in her skull and facial bones. She waves around her fork and sasses back at the therapist. At break, she chain smokes and teaches all of us how to smear the butter.

We're served with every meal under the table, so we don't have to eat it. I don't fit in. I want to be a good student like I've always been a good student. I definitely don't want to be old and up like Kelly, [laughter] but I don't really know how to get better. The things they teach me just don't seem to work. I gained enough weight to go back to college thanks to all the pancakes, but I remained divorced from my body. My physical self is not my real self at all. Then I go to medical school, and immediately we start learning about the human body. How did I not know that was going to happen?

At first, it seems really abstract. There's like diagrams and cartoons of cells and organs. Then I go into anatomy lab, and I look out, and there are bodies laid out. I look at the elderly woman laid out in front of me. These are bodies. Over the following weeks, we explore it all from the outside in. These are not empty boxes. Inside, I see nerves branching like rivers and muscles tracking and beautiful bundles. I think of these things inside of me. Then we move into the clinical realm.

Then, for the first time in my life, I see dozens of real bodies, bodies of all shapes, and sizes, and ages. Bodies with all different diseases, bodies with all different stories. Of course, I know my patients are alive, but I'm somehow struck by the power of that aliveness, even in the state of sickness. My patient's skin feels warm under my hands, and I can hear their hearts beating in my ears. I can't help but feel my own ribs expand as I take a deep breath. Then, as I move along in my training, something happens.

I start to pay attention to how often things are normal, even in my sickest patients. Imagine you order labs, and you look through your labs, and you're immediately drawn to the ones that are highlighted or the ones in red. Did you ever take the time to stop and look at all the numbers that land just in that little range where they're supposed to be? Or you order a CT scan, and you immediately scroll to the part that's messed up. Did you ever look slowly down here and see, oh, the colon, it's going up and across and down, and the bladder's right there, and the abdominal wall is holding it all in.

Then I get to thinking about all the people walking around in the world with their toenails growing and their guts digesting and their eyelids blinking. I think about my own body and how it stuck with me through the punishment I doled out. How I conserved energy when I fed it too little form, perfect scabs when I cut it, healed broken bones, torn ligaments. Then I find I'm at this weird intersection where the loathing that I've had for my body for so many years has come face to face with the realization that my body may actually be a miracle. That all bodies may actually be miracles.

Finally, I start to heal. I spend well over a decade, and I can now say that my relationship with my body is in a much better place than it was during those hard years. That doesn't mean I love my body every day. There are definitely days I look in the shower and I'm like, "Oh god, what's going on down there?" Then I remember that these little lopsided boobs fed three kids, and these legs bike me to work, and these fingers type ridiculously long clinic notes. [laughter] When my sail J.Crew suit arrives and I quickly put it on and look in the mirror, and I'm like, "Oh gosh, you do not look like the online model."

I take my hands, I put them on the Lycra, and I think about my blood and guts doing their everyday miraculous things under them. I care a whole lot less about my lack of cleavage.

[applause] [music]

Emily Silverman: I am sitting here with Dr. Meghan Rothenberger. Meghan, thank you so much for coming back on the show. Actually, this is your second time on the show.

Meghan Rothenberger: Yes, thank you so much for having me back.

Emily Silverman: Meghan, this is the second story that you've shared on the stage. I have to say, each time you're getting better and better. Do you have a theater or career blossoming in the future?

Meghan Rothenberger: Oh my gosh, definitely. Definitely not. I feel so sick when I think about getting up on a stage. I like the storytelling part, but maybe not the performance part.

Emily Silverman: Well, you have a knack for it.

Meghan Rothenberger: Thank you.

Emily Silverman: Let's dive into the story. I love this story as usual. In true Meghan style, it manages to be both hilarious and thought-provoking. I was wondering if you could start with this awkward time of adolescence. You give us a couple of stories about that, the person shouting at you on the ski lift, and the friend showing you the training bra, like it's kind of a secret. Just tell us more about that awkward time. Specifically, I'm curious, like we talk a lot about how women are portrayed in the media, like on TV and in magazines, and also just subliminal messages that we get as young girls in the world.

I'm wondering if you remember seeing any of that stuff and if that informed the way that you experienced pre-puberty and puberty or if you don't remember experiencing any of that. The reason I ask is I personally can't think of concrete examples. I'm sure it was in the water, but anyway, I wonder if that was your experience too.

Meghan Rothenberger: Yes, it's funny because I've thought about this a lot. Now watching my children go through adolescence, it brings back some of the feelings that I had during adolescence, which was just a deep feeling of being unsure and unsettled. Where I got the cues around my body issues, it's not really clear to me. It's funny because I think when I went into treatment, you're given ideas as to where this may have come from. Part of me, I wonder, did I rewrite my history to say like, "Oh yes, it was the '90s, like being super skinny was like the thing."

Certainly, I looked around and saw images of really, really thin women. You think of Kate Moss of the heroin chic look. That was everywhere. I don't know if it was quite that direct. I think for me it was more of a sense of a complete lack of trust or understanding of my own body and what was happening to my body and how it was different than I had envisioned it to be. I can't pin it on media in particular. Of course, we're all bathed in it all the time. I'm sure it had something to do with it.

Emily Silverman: What about expectations? I know there are some girls who grow up, and they get their first period, and they have no idea what a period is. There are other girls who grow up, and their parents have been reading them books forever, and they're hyper-educated on the topic. What was your experience? Were you prepared for the changes of puberty? Did you have any cheesy-

Meghan Rothenberger: Oh God.

Emily Silverman: -puberty books.

Meghan Rothenberger: No, I was so unprepared. My parents did a wonderful job raising us. I'm one of three girls, but I was raised Catholic, and my mom was raised Catholic, and I think there was a lot of taboo around anything having to do with sex at all. I really didn't get a lot of education about it. I had a friend-- that's funny because I can picture her in my head. Her name was Heidi, and she had this sex book at her house. When I was in probably fourth or fifth grade, I loved going to Heidi's house because we could look through this book. It was stuff that I really wasn't exposed to. I think my lack of education and just concrete guidance around adolescence and puberty made it particularly hard for me.

Emily Silverman: There's a line in your story that stood out, which was, "I start restricting my eating when I'm around 15. I don't really know why. It just feels good to starve my disappointing body a little." I was wondering if you could dig into that for us, even if you don't know exactly why you started restricting. People talk a lot about like control with restrictive eating, and did that feel like a way to take control, or maybe bring us into that experience?

Meghan Rothenberger: I think it was in many ways about control and feeling like that's one of the few things you can control about your body. You can't control how tall you get. You can't control a lot of things about your body, but how much food you put into it, you can. There was definitely that. Then there really was this sort of-- it makes me so sad to think about now, but there was this sense of like, "I hate this body." You don't treat things you hate very well. That was a clear way of punishing my body despite the fact that it was working so hard for me. It does. It's just a little heartbreaking when I think about that.

Emily Silverman: I'm sure that's a really common experience that so many young women have gone through this feeling of, "I hate my body." Is it like I'm fat, or is it more like it feels foreign? I don't understand it. Or is it like people look at me in a way that I don't want to be looked at? What exactly was underneath that? I feel like sometimes we think it's about like, "Oh, I'm fat." That kind of stuff. I imagine it's a little bit more complicated than that.

Meghan Rothenberger: Yes. As I was going into adolescence, I never really had a period of time when I was overweight at all. It wasn't even about people telling me that I was overweight or comparing my weight. I think it was more about it just didn't look the way I wanted it to look. I know that doesn't make sense. There's not a direct, like you starve yourself and then you get bigger boobs. It doesn't work that way. Somehow in my mind, it was this sense of like, my body is wrong, and I am doing something to my body, whether it's to punish it or just in some misguided way of thinking, like I can turn it into a body that I want.

Emily Silverman: Was there ever a moment when you realized that your relationship with food and restriction had gone beyond what you originally intended?

Meghan Rothenberger: I think the time when it really hit me was when I had come back from my freshman year in college, because I had really abnormal and restrictive eating patterns, like all through high school. I think because I was living at home and I was eating meals with my family, I didn't lose a ton of weight. Then I went to college, and I was completely on my own, making my own choices about what I ate and when I ate, and lost a lot of weight that year. When I came home, I think I didn't see it in myself. I had no concept of what my body really looked like, but I could see it in all my friends and family when they would see me. That was hard.

Emily Silverman: You could see that they were concerned.

Meghan Rothenberger: Yes.

Emily Silverman: Then in the story, you talk about your family staging and intervention of sorts, and then you end up at this place you jokingly refer to as anorexia camp. Tell us about the intervention, and then tell us about anorexia camp.

Meghan Rothenberger: It's funny that my memories of the intervention are a little foggy. I don't know how much is right or not. If, for some reason, I feel like we were in a bedroom at my parents' house, I don't think we probably were, but in my mind, I'm sitting on the floor of a bedroom. I have no idea if that's true or not. I think it was my sisters and my parents just saying we need to do something about this. We're really worried you're sick and you need some help. Then the program was so interesting.

Again, I don't want to say like, oh, it was the wrong thing for me because it was what was available, but wow, it was a weird experience and took away-- if control was part of the problem, they really stripped away all control. You walked in there, and you had to get weighed in the morning, and they'd say you can't drink anything before you come in. You have to wear clothes that aren't bulky heavy. We'd get to pick what food we wanted, but it was a huge quantity of food, and you were just supposed to sit there and eat it.

It was an experience unlike anything I've ever done before. You kind of felt like you were part of this team of people that were all in this similar situation. I felt like I had nothing in common with them, if that makes sense. Here we are all together, and clearly we have some of the-- we must have the same problem because we're all here together. I was like, "Who are these people? I'm not like these people." It was really weird and even more unsettling, I think, than the whole-- just finding myself in that situation was actually what the program felt like on a day-to-day basis.

Emily Silverman: This was a residential program?

Meghan Rothenberger: No, I got to go home at night, which was nice.

Emily Silverman: They would present food and have you sit there and monitor the group as they ate? Was there other programming? Was there individual therapy or group therapy, or anything like that?

Meghan Rothenberger: Yes, there was both. I had an individual therapist. There was a nutritionist, I think, that we met with. Then we did a lot of group work, too. It was funny because when I was at my parents' house, I found this notebook. I found this box of stuff from that summer, and there was this notebook that like-- I don't even remember this, but I had to write a letter like, "Dear Anorexia." It was the most awful thing. I started to read it and I was like, "Oh God, I got to stop right now. It was terrible.

Clearly, it was like one of those exercises, like write a letter to your anorexia and tell it what you think it needs to hear. There was a lot of that. Then there was like a little bit of movement. We did some yoga and stuff. I remember because you couldn't otherwise exercise, people would do the most strenuous yoga they possibly could. I would just be like, "I have to move my body, I have to burn some calories." It was a funny scene.

Emily Silverman: You mentioned feeling like you didn't have a whole lot in common with the other people in the program, aside from having an eating disorder. You also mentioned age difference, that there were some women in the program who were quite a bit older than you were at the time. Did everybody more or less keep to themselves, or were their friendships formed, or what was the social element of the program?

Meghan Rothenberger: It seemed maybe a little like cliquey. There were a couple groups of women that seemed to bond, and I didn't really bond with any of them. There was one younger woman that I did spend most of my time with, and she was just really, really quiet. There were some of the women that were pretty tough. They would yell sass back at the facilitators. They were the ones that do all the tricks for how to get around, like the weigh-ins and eating all the food, and they would go out and just smoke like crazy.

It wasn't like I didn't experience any sense of social support, I think, from the group. Probably because I was in that weird in-between stage. Most of the women in the group had been struggling with eating disorders in many cases for over a decade. Then I would look at the adolescent group, and they just seemed like little children. I was stuck, I think, in the middle.

Emily Silverman: Did you find the program to be helpful, or effective, or not?

Meghan Rothenberger: That's a good question. I think one thing that stands out-- two things I just wrote. Something else just came into my mind. One thing that was really good about it is it did because you were forced to eat some foods. I had restricted to the point that there were certain foods that I just didn't feel like I could put in my body, and they made you do that. In some ways that exposure therapy made it a little less scary, I think to broaden as I went further along in my life, to be like, "Okay, I can eat this stuff and it's okay." It feels silly that you could be deathly afraid of butter, but that's where my brain was for a while. It helped me get over that.

It's funny now that I think about it, but one thing that really stuck with me that I found weirdly helpful is that we learned the science behind starvation. They had us read about the Minnesota starvation study, where they took conscientious objectors from the war and then basically starved them and then studied what happened to them. I like remember a lot about that. That was really helpful for me in the longer term.

I think at the time, it was like it messes up everything. In the longer term it was helpful to reflect on that and how, when I was in that state, things weren't working right in my brain. The reason why some things went off the rails was, I think, in great part because my body was starving, and being able to look back at that study and think like, "Okay, I do understand that now." That was helpful.

Emily Silverman: Did you know that you wanted to go into medicine at that time?

Meghan Rothenberger: I was thinking about it, but I think I hadn't committed at all. I was actually more interested in being a veterinarian, which is funny because infectious disease, maybe a little bit like the animal connections, are there. It's funny now, thinking back and being like, "Oh yes, the medical part of it was the part that stuck with me the most.

Emily Silverman: Yes, that is striking. Do you remember anything in particular from the Minnesota starvation study or any of the medical pieces like these are the impacts of starvation on the body, and then thinking, was it like fear, like, "Oh, I don't want that to happen to me, or was it more like fascination?

Meghan Rothenberger: It was more fascination, like, huh. When I was in high school, I started getting subscriptions to so many cooking magazines, which it was weird. You don't eat any of the things in the cooking magazines, why I would get these cooking magazines, and I would just like pour over these cooking magazines. In the starvation study, they found that a lot of the men just became very obsessed with food, thinking about food all the time, reading about food, and that was definitely like-- I spent so much of my brainwaves focused on food. That was really striking to me. It was like, "Oh, that's a biological chemical thing." It's fascinating.

Emily Silverman: How did you get from there to medical school?

Meghan Rothenberger: I went back to school, I went to Colorado College, so I went back. I had planned on taking some summer school courses so that I could get all of the requirements I needed. I missed that. I ended up having to-- after I graduated, I moved to Boulder, and then just took some time off and took some courses so that I could take the MCAT. That was a real growth year for me. For the first time, I wasn't studying all the time. I spent a lot of time in nature thinking about things, and I still was not healthy in any way, but I think that was when I started to feel maybe a little more comfortable with myself, and then ended up going to med school after that.

Emily Silverman: In your story, it sounds like there's a lot of healing that didn't quite begin until you were in med school. There was something about turning the body into the object of study that actually was healing for you. Wondering if you can walk us through that a little.

Meghan Rothenberger: Yes. I think it is a little bit like learning about that starvation study. There's something like, wait, that's not just those individuals' experience. This is me too, this is my brain, my body, my organs. That's a weird thing to be reading about something that you have been carrying around with you your whole life without really even thinking about it. I think when I went to med school, I don't think I even knew what a spleen was. You start reading about it and you're like, "Holy shit, that thing's been in there the whole time."

It's kind of amazing. I think as I started to learn more about the amazing steps that happen inside of our bodies just to keep us going every day, I started to shift a little bit in how I thought about my body, and it was definitely gradual. It wasn't like someday I was like, "Oh my god, this is amazing." It was just this slow recognition of like, "Oh well, I didn't realize that." It's pretty cool.

Emily Silverman: Yes, there's a part of your story where you say, when we get labs back, we focus on the handful of labs that are abnormal, but we don't think about how much goes right every day that it's a miracle that people don't just get illness every day from something going wrong. People live a long time, and homeostasis is amazing in the way the organs communicate with each other to maintain that homeostasis is amazing. Was there a spiritual component to this new reverence that you had for the body, or did it feel more science-based?

Meghan Rothenberger: I am not a religious person in any way, but it did feel more spiritual than scientific, I think. Nature has always been really important to me. Animals have always been really important to me, and I've always loved just watching animals and how they move. Then you realize, like, "I'm an animal too." I think that was that weird like, huh, like I do sort of belong. I have the same blood coursing through my veins that that little squirrel does running up that tree. It is this weird sense of like from a body perspective, belonging as a creature of the earth.

Emily Silverman: Was it anatomy lab that catalyzed this, or was it more cardiology, hepatology, learning about the organ systems? Was it more cognitive, or was it more like, "Oh, I'm cutting into this cadaver, and look how amazing this is?" Or was it both?

Meghan Rothenberger: Anatomy it was an interesting experience. God, this sounds terrible. It felt very dead to me. You see this stuff, but it feels not like it was a living, breathing person. I think it really wasn't until I started actually taking care of patients. Realizing like-- you start looking at scans and you start listening to people's hearts and feeling their organs, and that's when it was like, huh, this is a living, breathing person with all of this stuff happening inside of them.

Emily Silverman: Where do you think you got your love of nature and animals? It seems like taking that natural love that you have and expanding it to include yourself in your own body is one of the main ways that you found healing, but that initial gravitation toward animals. For example, I have someone in my family who loves animals, and I think a panda bear's cute, and I'll pet a dog, but he loves animals; he really loves animals. There are just some people out there who have that passion, and I'm just curious about that.

Meghan Rothenberger: I think I was just born that way. It's funny. My sisters they like animals a lot too, but I don't think they have it the same way I did from when I was just a little kid. I look at my own children, I always thought I'd have a child that loved animals, so I could buy like a million pets, but they're not really into it, which makes me so sad. Growing up, I just begged and begged and begged every kind of animal I could have. I had snakes, and hermit crabs, and hamsters, and we had a couple dogs and a rabbit. Whatever I could talk my parents into getting me, I would try. I spent a lot of time, like I'd go to the Humane Society or I'd go up to the really awful strip mall pet store and just gaze at all the animals longingly. Yes, from the time I was little, it was just part of who I am.

Emily Silverman: Was there a point in med school or later where you felt a little bit more of a concrete shift toward healing? I know you said it wasn't sudden, that it was gradual. Was there a moment or a season of life where you realized I think I'm in a better place with my eating disorder?

Meghan Rothenberger: Yes, I think pregnancy was a big shift for me. That's a breathtaking thing to look at your children and be like, "Oh my god, that I grew that child in me."

Emily Silverman: I made that eyeball in my uterus.

Meghan Rothenberger: I made that. That happened inside. It's amazing, and I was really lucky I was able to breastfeed. the food that I was putting in my mouth was no longer just to nourish me, but to nourish my child. I think it's really hard to think about your body in the same way once you've grown a child and fed a child and realize what your body is capable of.

Emily Silverman: Do you think of your eating disorder as something that went away or is cured, or is it something you live with and that you manage where it flares up from time to time, and you deal with the flares, and it's always there? Do you feel like you've moved past it?

Meghan Rothenberger: I wish I could say like, "Oh, I'm totally cured." It is funny because I do find at times when I am most stressed or I feel like life is really chaotic, sometimes those old thoughts randomly come back. I'm very aware of it now, I can listen for them. I have to consciously say, like, "No, that isn't helpful anymore." It's interesting how-- relatively recently, I got a terrible GI illness, and so I didn't eat for a couple of days. There was this weird sense of like, "I haven't eaten for like 48 hours, maybe I should see if I can't eat for 72 hours."

Isn't that up fucked after this many years, where I was like, "Wait, no wrong answer. The right answer is like, no, your poor body needs nourishment. Take care of it." It's weird that that's still there, and it comes almost automatically. Yes, it makes me feel like not proud of that, but at least I can turn it around really quick and hear those voices pretty clearly and know that the warnings of when, like, "Oh no, I got to pay attention."

Emily Silverman: In the culture these days, we hear a lot about body positivity or body acceptance or body love. There's all these different terms, and we see people speaking up about this more with in commercials or fashion shows. We're seeing a little bit more variety in body types. I'm wondering how you see that movement. Does that resonate with you? Does that feel connected to or different from your journey and your experience? Do you find that stuff to be effective, or do you have different ways of thinking about it?

Meghan Rothenberger: Yes, I love that you can see all different body types, and it makes me so happy for particularly my daughter, that you can look around and see women who are proud of their bodies regardless of their shape or size. I do think that is such a good thing. Just the visualization, being able to see it around you. I have a weird hesitancy to talk about anything related to weight. It's an area that I struggle with. When people talk about veganism, I just back out because I can't have those conversations in a way that doesn't feel like it.

I'm somehow biased or not able to have healthy conversations around those things like dieting or extreme exercising. People want to talk about those things often, like, "What do you think about this diet or that diet?" I just kind of can't. I don't know if I'll ever get over that. That's been a little bit of a challenge for me. Even with my patients, too, when trying to counsel patients about dietary choices and everything else, it hits a nerve for me, and it can be really tough.

Emily Silverman: We did a series on the emotion of shame in medicine, and we had this amazing story from a-- I think she was a dietician or nutritionist, and her job is to counsel people with diabetes about their diabetes and nutrition, and their weight. She said in the story that a lot of her patients are addicted to food and have unhealthy relationships with food, and the other direction, where they overeat, for example. She said that even though her issue was the inside-out version of that, like to restrict that in her mind, they were two sides of the same coin. She felt like she had a lot of empathy for her patients and understood them in a way that maybe she wouldn't otherwise.

For example, she said something in her story about, like, I know what it's like to wake up in the morning and feel like, "Oh, how am I going to be around food today?" She doesn't disclose her anorexia to her patients because she feels like that's not helpful. She says that it gives her a unique insight into the challenges that they may be dealing with. I'm wondering if that's something you've ever experienced when you're talking to patients. Even if you don't disclose your personal story, if you find that it's a way in to understand things in a different way.

Meghan Rothenberger: Oh, definitely. I think not as much around food, but around addiction and other mental health struggles. I think I do understand to some extent what it can feel like to practice pretty self-destructive behaviors. When you could rationally say like, "That's not good for you," but you still do it. I think that just basic understanding of human behavior can be really helpful when talking to patients.

Emily Silverman: You mentioned your daughter, given your experience, how are you thinking about bringing up your daughter in this world and talking to her about these issues?

Meghan Rothenberger: It's funny because when she was like two I was like, "We are going to sail through puberty because I would be so open, and we're going to have books and resources." It's tough it's embarrassing as a kid, but I try really hard just to be open and available to talk about things. I bring up stuff just in front of her that I'll chat with my husband about things just so she can hear like, these are normal conversations to have. It's funny I think back to-- just remembered this, this is like embarrassing.

When I was probably 10 or maybe 11, I remember looking at the newspaper like our local newspaper, and there was a headline that said like, "Most couples practice fidelity." I took that article because I didn't know what fidelity meant. I thought it was something having to do with sex. I was like, "Fidelity, is that like a position? What is that?" It's so funny because like I had no idea. I don't think my parents knew that I was that completely clueless. I think that's part of it too is just giving your children the language to use, and you don't need to talk about sex all the time.

I think just like what are the things they're going to hear at school, what are the things they're going to hear and not understand, and be curious about? I would so much rather that they come talk to me rather than Google it. I would've Googled fidelity, and then I would've been like, really, really disappointed. [laughs] I think trying to be open and make things as shameless as possible. I think shame is such a big part of adolescence and feeling weird and trying to normalize things and recognize that like you may think this is weird, but this isn't weird at all. I wish someone could have just said that to me. "You're not weird. It's totally fine. You're not weird."

Emily Silverman: Is there anything else you'd like to share with our audience about your story from the stage or your story in general?

Meghan Rothenberger: The one thing I guess that I would say is it was really nice after how many people, both men and women, had said that it resonated with them that they too have struggled with issues around their body, the challenges of adolescents, eating disorders. I feel like that is so good for me to hear that clearly, I'm not alone, and I think we forget the struggles that so many people around us face.

Emily Silverman: Absolutely. Well, thank you so much for sharing the story. I know that it connected with a lot of people in the audience and will with a lot of the people listening today. Thank you, Meghan, for coming on the show.

Meghan Rothenberger: Yes, thanks so much for having me.

[music]

Emily Silverman: This episode of The Nocturnists was produced by me and producer and head of story development Molly Rose-Williams. Our executive producer is Ali Block, and Ashley Pettit is our program director. Original theme music was composed by Yosef Munro, and additional music comes from Blue Dot Sessions.

The Nocturnists is made possible by the California Medical Association, a physician-led organization that works to ensure the doctor-patient relationship remains at the center of medicine. To learn more about the CMA, visit cmadocs.org.

This episode of The Nocturnists Conversations is sponsored by The Physicians Foundation, which supports physician well-being, practice sustainability, and leadership in delivering high-quality, cost-efficient care. The Nocturnists is also made possible by donations from listeners like you. In fact, we recently moved over to Substack, which makes it easier than ever to support our work directly. By joining us with a donation of $2, $5, or $10 a month, you'll become an essential part of our creative community.

I'm your host, Emily Silverman. See you next week.