I lay on the soggy March ground mixing a mouthful of uncooked oats with my saliva so that when Frank rushed over to me, when he found me lying like that, I would gag and spit the mixture onto the ground, pretending to vomit. Through my squinted eyes I saw his bright red hair and gray sweater bounding toward me, and as he approached I moaned and fake-vomited, oatmeal falling into my hair. Frank looked confused and slightly disgusted as he rolled me onto my left side, the correct position for an unconscious vomiting victim.
Around us other couples were scattered across the sunny slope of the property. Victims were fake-coughing, fake-vomiting, and their classmates were fake-rushing to take pulses, listen for breath, and feel for sweaty foreheads and clammy palms. After a while I regained consciousness, as instructed, and was able to tell Frank my name, the last thing I remember (a herd of giraffes running toward me), and that it really hurt when I took a deep breath. He pressed on my right side and I screamed. He unzipped my jacket and I grabbed my ribs. He held the edge of my fleece and polypropylene layers. “Can I?” he asked. I nodded and he lifted them slightly, spotting, triumphantly, the amoeba-shaped purple bruise painted on my right ribs.
“I found it!” Frank shouted, and motioned for our instructor to come over. “I found the injury,” Frank yelled triumphantly. “My patient was trampled by giraffes and broke her ribs.”
There were 16 of us spending the weekend at an Appalachian Mountain Club hut atop a grassy hill in the tiny town of Russell, Mass. We were there to attend the 16 hours of class that would earn us our Wilderness First Aid certifications from SOLO Wilderness Emergency Medicine.
Different reasons had brought each of us there. There were two women from Boston who worked for a company that ran mother-daughter backpacking trips to raise money for domestic violence shelters. There was Hal from Foxboro, who was taking his son’s Boy Scout troop canyoneering in New Mexico that summer. There was Frank, who was starting a primitive skills school for young kids. I had driven from New York City, where I was pursuing my MFA in writing, to get my WFA for a summer job leading trips on the Appalachian Trail. The weekend course began on a bright Saturday morning, and if it all went according to plan, it would be over by 5:30 on Sunday evening. Until then, we would be splinting un-broken legs, cleaning imagined wounds, and carrying mock-unconscious victims we’d find from the forests around us.
In the second protocol test of the weekend half the group ran out of the hut, backpacks bouncing on our backs, until we found 10 disoriented people running around the hill with fake blood dripping out of their ears. Some of them collapsed. Some of them had third-degree burns drawn on their arms, gooping red stage paint smeared and clotted and clumped. Frank and I tended to a thin blond yoga teacher from California, checking her spine, then cleaned her “wounds” and splinting her arm with extra shirts and bandanas from our packs.
The fake injuries struck a chord with me. I had been blessed with good health—I rarely got sick and had never broken a bone. But an anxiety disorder, which usually hovered at a manageable level, at any time could spiral into full-blown panic. At certain triggers, or at no trigger at all, my body would react with debilitating fear to a danger that wasn’t there.
Nothing happens suddenly, at once. Not a shot from a gun, the click of the phone, or the closing of a door—things may seem to happen in an instant, but the events leading up to those moments have been precipitating, all pieces settling into place, for a long time. I was in my twenties in New York City when I first experienced a panic attack that sent me to the hospital.
Lying on the stretcher I kept asking, Am I going to die?
And they never said, No.
He pressed on my stomach and pushed on my kidneys and listened to me breathe with his cold stethoscope on my back. I was still wearing the thin black sundress I’d been wearing all day, now limp and damp with sweat.
EMTs climbed five flights of stairs to my apartment on the Upper West Side. They took my pulse, and when they found it was 130 they hooked me up to an EKG machine and my heartbeat printed out as a shaky black mountain range on a thin strip of white paper. My skin was hot to the touch. My hands frozen into claws. I was dripping sweat. I was gasping at air but each breath made me dizzier and more nauseous. There was a tingle in my lips, my left eye twitched, my gums felt like they were being massaged by an electric toothbrush. The tingling buzzed up my arms, into my calves, more and more of my limbs went numb and stiff. I felt an overwhelming terror that this was it, this was how it would end for me. I had no idea what was happening, and the paramedics didn’t seem to know either. They hovered over me poised with an EpiPen, an oxygen tank, a stretcher.
The emergency room doctor did not seem particularly concerned. By the time he examined me the oxygen had kicked in and helped me to breathe, unlocked my jaw, gave me some control of my lips, and enabled me to painfully unclench my hands. He pressed on my stomach and pushed on my kidneys and listened to me breathe with his cold stethoscope on my back. I was still wearing the thin black sundress I’d been wearing all day, now limp and damp with sweat. He ruled out anaphylactic shock, appendicitis, and burst organs. He gave me a pale blue minty cocktail of Mylanta, Valium, and Prilosec, which I swallowed hesitantly, and he sent me home with a diagnosis of heartburn and panic disorder.
The hospital discharge sheet:
St. Luke’s Emergency Department
Take-Home Instructions for the Patient
You have been diagnosed as having had an anxiety attack.
You have symptoms consistent with an anxiety attack. Many medical conditions can cause symptoms similar to those experienced with an anxiety attack. If this is your first episode, be sure to follow up with your regular doctor.
Anxiety causes intense feelings of worry and fear. It may also cause physical symptoms such as chest pain, shortness of breath, palpitations (a sensation that your heart is racing), and numbness (around the mouth, in the hands or feet).
Though it was the first time a panic attack sent me to the hospital, it was not the first time I had felt this particular blend of paralyzing terror. I’d had panic attacks on airplanes, in class, at the movies, at readings, in restaurants, in bed, while driving, while reading, while having tea with a friend. I’d had panic attacks at synagogues, in churches, eating dinner, waking from a nap, and at the gym, trainers and floor managers holding my hands until I could breathe again. I have had to leave schools, cancel jobs, and end relationships. I have taken the train across the country six times to avoid the very triggering act of flying on a plane.
Throughout my life I had tried the traditional therapies: behavioral cognitive counseling, mainstream psychiatrics, and psychotherapy. I tried hypnosis, progressive relaxation, Jungian psychology and dream interpretation, and the practice of affirmations. I tried supplements of flaxseed oil, fish oil, borage oil, evening primrose oil, vitamins B6, B12, C. I let homeopathic doses of calcium, magnesium, and phosphorous melt between my inner lip and gum, dropped herbal extracts of motherwort, passion flower, skullcap, wild oat, valerian, ashwaganda, lemon balm, and chamomile under my tongue. I mixed flower essences of violet, sweet chestnut, oak, elm, rock rose, mimulus, willow, and cherry plum into my water. I tried a vegan diet and a raw-food diet and a macrobiotic diet and an ayurvedic diet and a three-season diet and a sugar-free diet. I worked with shamans, herbalists, rolfers, hypnotists, chiropractors, astrologers, intuitives, Chinese energetics practitioners, Reiki healers, acupuncturists, and myofascial-release massage therapists. I studied ecopsychology to understand how the degradation of the Earth and the spoiling of our natural resources impacts our psyches. I sat in forests of logged trees and wailed. I sat alone three days in the desert without food, trying to grasp the root of my problem. I sweated for hours in sweat lodges, covering myself in mud in the pitch-black, airtight heat while men chanted and banged on drums and burned sage, and I emerged to feel wet and new under clear, deep-night skies. I sat several weeklong silent meditation retreats watching tree limbs breathe and the sun travel its daily arcs overhead. I lived on biodynamic farms and organic farms in the mountains of Arizona and the deserts of New Mexico and the forests of California and the hills of the Berkshires to heal any rift between my body and the rest of the natural world. I lived on yoga ashrams. I lived at retreat centers where people come to learn to be the most empowered and happy people they can be. I hiked sections of the Appalachian Trail and climbed down to the flat bottom of the Grand Canyon to listen to wind and rivers. I slept alone in the Superstition Wilderness. I lived in New York City and fed off intellectual stimulation and sex and sushi. I lived in Boston and did nothing but write and read as a way to channel my discomfort. I studied astrology, numerology, the Enneagram, and the Tarot deck to understand what basic influences are contributing to my problem. I experimented with celibacy. I rubbed sesame oil on my body after every shower. I anointed my head with sacred Indian Brahmi oil for protection. I spent days eating nothing but bananas and vanilla yogurt, flavors that are shown to have a calming affect on babies. I carried quartz and amethyst in my pockets for their reputed peace-inducing qualities and wore moonstone rings for serenity and turquoise rings for understanding and aventurine necklaces for bravery. I tried doing nothing and just seeing if my condition would improve on its own. I listened to meditation CDs before going to bed and meditation CDs before getting out of bed. I practiced yoga and tai chi and tapping on meridian points for emotional balance and release. I soaked in hot baths infused with sage and rose and lavender and pine. All of these things have helped. And still.
My whole body was crying wolf, continually screaming danger when there was none. I know I feel like I can’t breathe, but can I breathe? I know I can’t open my jaw or unclench my fists, but can I will the adrenaline to stop making this so? I’ve practiced listening to the smaller, deeper voice that says, You’ve felt this way before, you’re probably fine. Yet often in the throes of a closing throat or shaking thighs it crosses my mind that one of these times it may be a real sign of impending danger—a heart attack, anaphylactic shock, death—the familiar litany I sing to myself when the physical symptoms arise, and if I try to talk myself out of it that’ll be the end of me, because this time it was real, this time, the wolf had come.
Just before 5:30 on Sunday evening, we were exhausted but smiling despite ourselves, as our instructor called us one by one to the front of the living room to solemnly hand us our business-card-sized certifications from SOLO, our names printed neatly across the top. He shook each of our hands and pronounced we were now certified in Wilderness First Aid, good for three years. We thanked him for the course, said goodbye to those we’d become friendly with, and slid our SOLO cards into our wallets between licenses, library cards, and receipts. Then we filed through the door, carrying the coolers and sleeping bags and backpacks we’d come with.
I walked out on the hill and sat on a rock, overlooking the valley. It was one of the first warm spring days, and I thought about the summer when I would leave the city and take my campers backpacking on the Appalachian Trail. I wondered if I would need to use any of the skills I had learned that weekend—in some ways I hoped for a minor injury, dehydration or a sprained wrist or ankle, so that I could practice rehydration therapy and splinting. I leaned against a white birch and closed my eyes.
It grew darker on the hill and the wind grew in its intensity. I breathed in one more deep breath of spring air, swept my eyes across the valley below me, and thought I should walk down to the parking lot before it got too dark. I used the outhouse one more time, then gathered my luggage in my arms and walked downhill to the muddy parking lot. It occurred to me that after a weekend of anticipating every possible catastrophe it wasn’t the smartest plan to leave last. What if my tires were too mired in mud to spin out of the grooves they’d sunk into? What if the car didn’t start? There was no one around for miles, and my cell phone didn’t get service.
When the paramedics got to him he was dangling out of his car, airbag distended in his face, blood dripping down his forehead. He was screaming, “I’m human! I’m human. I am a human being!”
My car did start. I drove through the gathering dusk toward the Mass Pike that would lead me to Interstate 95 back to New York City. There were very few cars on the highway, and there were gray woods on either side. After driving for about an hour I began to feel the darkness take on a heavy quality. I felt nauseous, my mouth went dry. My eyes stung as I realized how exhausted I was, and how long the four-hour drive I had ahead of me suddenly felt. Why had I left so late? I had a headful of visions of people lying in faux-mangled positions with fake blood oozing from them—wouldn’t it have been smarter to leave earlier in the day? OK, I thought, Don’t get anxious now. You just need to get home.
Shivering from rushes of adrenaline beginning to flow through my blood, a familiar numbness crept into my fingers. What if I couldn’t feel my hands and steered my car off the road? What if the dizziness intensified and I passed out while driving? There was nothing but blackness around me, unbroken darkness punctuated only by long trucks that rattled by unsettlingly close. I tried to fight the growing panic, after all I had just learned countless ways to save people, couldn’t I use some of them on myself?
To distract myself I thought about SOAP notes, the forms we learned to fill out when arriving at the scene of an accident. On the top of the SOAP note is a space to write in the patient’s primary complaint, which is whatever your patient is complaining about when you get to him. For instance, people with severe spinal injuries will often be yelling about their scraped-up arms and legs. Even though the scrapes and bruises aren’t the serious part, they are the primary injury, according to the patient. We learned about a drunk man who had wrapped his car around a tree. When the paramedics got to him he was dangling out of his car, airbag distended in his face, blood dripping down his forehead. He was screaming, “I’m human! I’m human. I am a human being!” When they asked him what hurt he shrieked, “I’m human. I am HUMAN!” Two paramedics tried to calm him while another filled out the SOAP note. In the space left blank for primary complaint he wrote, “Victim is human.”
My shaking and nausea worsened and I knew that while a panic attack couldn’t kill me, a car accident could. I spotted an exit with a glowing tollbooth a few miles ahead, and promised myself I could make it at least there. Every breath was a conscious effort, as my grip on the steering wheel tightened and my tongue rubbed the top of my mouth like a dry sponge.
At the tollbooth I told the man working there, “I can’t breathe.”
“You want me to call an ambulance?”
As much as I wanted to be whisked away to safety, I knew that if EMTs were called they’d just be confused by my pulse at 120, by the lack of oxygen in my blood, but they wouldn’t find any cause.
“No, I just need to sit a while,” I told the tollbooth operator.
If he called an ambulance they’d be obligated to take me to the hospital and they would give me Valium or Ativan or Xanax and then I wouldn’t be able to drive home. The operator left his booth with the guardrail up and led me to a small parking lot by the side of the highway. He leaned against my car and whispered to me, “Breathe baby, just breathe.” He brought me cups of water in paper cones from his tiny office. I am not in danger, I kept telling myself. This is just protocol, my body going through the motions. Despite all the improvised splints and makeshift carry-outs I’d seen, all I needed was the most basic thing I couldn’t seem to get: air.
After about an hour the shaking did pass. There’s only so long the body can sustain that level of panic. I’d drunk several conefuls of water, I’d gone to the bathroom, I’d stared at my face in the mirror under the fluorescent lights of the tollbooth office bathroom, confirming it hadn’t burnt, or shriveled, or turned green, that I was still recognizable from the outside, even if the inside was a chaotic and ravaged foreign city. I convinced myself I could make the next two hours of the drive home. It ended up taking another five. My speed hovered around 35 miles per hour, and as I neared the city I got out at every rest stop I passed, so grateful to be around light and other human beings.
At one rest stop there was a police car, and I parked behind it and followed the officer into a 7-Eleven, comforted to have him near me, this man of protection and order. Fluorescent light glinted off the points of the star badge on his chest, and I trailed him through the store, ducking behind the whirling Slurpee machine while he filled his coffee, lingering over packages of gum while he eyed the pastries on the counter. I fantasized that if my panic started again I could turn myself in. “My body’s acting up,” I could say, “It’s killing me.” And I could offer him my wrists and with the slap of cold metal and a toss in the backseat of his car I could be off to safety, where people could watch me constantly, and under their watch I wouldn’t lose my mind.
“Being human,” the man who wrapped his car around a tree complained despite his broken, bleeding body. At certain points, the Heimlich and CPR and remedies for hypothermia and snake venom don’t do us much good. At times, it’s simply being human that hijacks the body, blocks our own breathing. Most often, the first aid I need is not caused by the wilderness around me, but by the wilderness inside.