Code 309.81 Melissa Cronin © Copyright 2014 by Melissa Cronin

The driver loses control of the wheel. I grip the passenger side door handle. We veer off the road and over a cliff, the car plummeting thousands of feet into a gray canyon. My stomach drops, twists. I try to scream, but it won’t come out.

I wake, clenching my sweat-soaked t-shirt, my chest burning.

The nightmares started two months after an old man sped through a farmers’ market and mowed me down. Diana, my psychologist, said I was suffering from post-traumatic stress disorder. I’m a nurse and knew that not only war veterans, but also those who have experienced any kind of trauma – rape, natural disasters, abuse – are at risk for developing PTSD symptoms. Still, I looked at Diana as if she had three heads. She’s wrong, I thought, definitely wrong. I had hit a tree once while skiing out of bounds. I had hiked within ten feet from bears. I had floated down the Colorado River and got sucked into an eddy. I continued skiing, hiking, swimming. I was emotionally strong – certainly not the type who was at risk for PTSD. But even nurses are not immune to denial. Diana explained that the nightmares, my tendency to startle, even at the ring of a phone, and my hyper-vigilant state were all symptoms of PTSD.

For weeks after I had returned home from the hospital, I slept on the pullout sofa on the second floor, close to the stairs that led directly to the front door. When I returned to my bedroom, I kept the door open. I kept two flashlights, my cell phone, and landline on the table next to me. I kept a pair of shoes and my jacket on the floor next to me. Still, I couldn’t sleep. November wind howled, rattling the windowpanes, as if warning me to get out. Treetops tapped the metal roof. I practiced the visualization techniques Diana had taught me and, behind my twitching eyelids, pictured a buttery field of sunflowers swaying in the summer twilight, as though they were nodding at me, assuring me that everything would be okay. But my scrambled thoughts quickly turned to fire – sunflowers morphing into blue flames, licking the sides of the house. Dense smoke seeping through the cracks in the floors, slowly suffocating me. A burn nurse never forgets children ruined by fire. Green eyes peering through charred faces. Blackened toes and fingers. Odor of burnt flesh.

One night, the wind blew so hard I called Kathleen, a close friend who lived up the street. “Sorry to bother you,” I said, “but I can’t sleep.”

“What time is it?” Kathleen asked.

“One.”

“Should I come over?”

“No. Just talk to me for a while,” I said. “Please.”

Hours later, I woke, the dim sun hovering behind the sheer curtains. The phone was still in my hand.

My doctor prescribed a medication for anxiety, but it made me sleep for endless hours. When I woke, my eyelids felt like knuckles were pressing down on them. My limbs felt like water-filled balloons. She prescribed another medication, but it made my legs restless. At night, they bounced on the bed, like marionettes being pulled by strings. I tried a third drug. My body did not rebel, but the nightmares continued:

I’m in a car with my neighbor. He steers around a rotary, and the car veers off the road. I can’t get the door open. A lot of people are standing around. There’s lots of commotion.

The hyper-vigilance continued. One evening, I called Diana because I thought my foot was infected, and needed her to convince me that I was over-reacting. “It’s red,” I said, “ and hot.” She didn’t say anything. “It’s throbbing,” I continued.

“You sound scared,” Diana said. “Do you think you need to go to the emergency room?”

My rapid pulse beat in time with my throbbing foot. I couldn’t decide; I needed her to tell me what I should do. My indecision was a hallmark symptom of depression related to PTSD. But, at the time, I didn’t know, or believe, that I was depressed.

“I’m on my way,” Diana said.

She drove me to the ER, and when the doctor assessed me, he said, “I’m going to prescribe antibiotics. “We don’t want to take any chances.” What did he mean? Was it possible that my foot could turn gangrenous and I’d have to have it amputated? If I hadn’t called Diana … if I hadn’t come to the ER … then what?

At home that night, I looked at my foot every thirty minutes, watching for the appearance of a red line running up my leg – a sign of spreading infection – just as the ER doctor told me to watch out for, just as I had learned in nursing school.

At my doctor’s appointment the next day, she said, “You’re foot is not infected. The fracture is still healing, so it’s going to be red and swollen.”

“Are you sure?” I asked. I lifted my pant leg. I could have sworn I saw a red line.

“I’m absolutely sure,” she said.

Two days after my appointment, the redness disappeared. But the throbbing continued, for a long time.

Three months later, when visiting my father in Florida, he said, “Let’s go to the farmers’ market in Delray.”

“I’m not up for that,” I said. I envisioned the old man’s car racing toward me, bodies flying, smacking against the ground. I imagined glass shattering, people screaming, blood mixing with smashed fruit.

“Come on,” my father said, his round belly jiggling. “Let’s go.” He promised that I’d enjoy the art displays.

I wanted to ask why he persisted in asking me to go to the market, why he could not understand my reluctance, but I didn’t feel like explaining something I did not want to acknowledge myself – that I had been assigned an anxiety disorder, code 309.81 of the Diagnostic and Statistical Manual of Mental Disorders.

At the market, I scanned my surroundings, like one searching for the closest fire exit in a movie theatre. My eyes settled on the far end of the street, fixed on the wooden sawhorses – the only barriers in place to stop out-of-control cars.

“Why are you walking so fast?” my father asked as I hurried into a tent of watercolor paintings, as if doing so would protect me from cars. An eleven-by-fourteen painting saturated with swirls of reds, greens, and purples made me light-headed. The painting looked wet in the humidity, as if the colors were about to ooze down the canvas, like Dali’s dripping clock. I stepped back from it, but the smell of acrylic polymers followed me. I had to sit down, soon. “Dad, I think we need to leave.”

“Maybe you just need some lunch,” he said, and suggested an Italian restaurant two blocks away.

We squeezed our way around people. I tried to take a breath, but the air was thick. We stopped at the bridge overlooking the inlet and, as I leaned over the railing, I inhaled the ocean, a tepid breeze blowing aside stray hairs from my forehead, the salted mist coating my face. I swayed back and forth, in time with the ebb and flow of jade-green waters. The ocean whispered – hush, hush, hush.

At the restaurant, people kept bumping into my chair. A waitress passed us with a tray of meatballs that smelled burnt. I couldn’t catch my breath. My heart beat in my neck. I ate bread dipped in olive oil and garlic, thinking my father was right – all I needed was food. But the bread caught in my throat and I had to cough hard to get it out. “We need to leave,” I said. “I don’t feel right.”

On the way back to my father’s place, we hit every red light and, at one point, got stuck behind a car bouncing to indecipherable rap music. I checked my pulse. One hundred? One hundred-twenty? Too fast to count. I thought I was having a heart attack. “Maybe we should go to the hospital,” I said.

“Really? my father said. I stiffened, groped for the car seat. “Okay,” he said. “Whatever you want.” Staring straight ahead, he tightened his hold on the wheel, turned right, away from the traffic, in the direction of Delray Medical Center.

“How far away is it?” I asked. “How long will it take to get there?” More red traffic lights. Ten seconds of red. Twenty, thirty seconds. Hurry up. Change. Even when the lights turned green, I still saw red – red dots, red halos.

My father pulled into the hospital parking lot. “Maybe we should wait a few minutes before I go in,” I said. My heart rate had come down to a countable beat – eighty per minute. My breath had slowed enough that I could finally feel it pass through my upper airway into my lungs.

My father laughed. “Whatever you want to do.”

I wanted to trust that his laugh indicated that I was okay, but it probably meant he didn’t understand what I was going through. Why would he? After all, I was not at risk for a heart attack. I was a non-smoking thirty-seven year old who pedaled on a recumbent bicycle five days a week, ate fish three days a week, and ate leafy green vegetables every single day.

Mandeville flowers lined the outside of the emergency room entrance. Fat, long petals bowed in the exhaust left behind by cars pulling up to the curb. The flowers were deep purple. No. More like navy. Like deoxygenated blood. Stagnant blood. My heart started beating hard again, too hard, as if it were a fist punching through a wall. I wanted to tear apart my skin, peel it open, run away from myself. My breath grew rapid again, and my fingernails turned the same navy as the Mandeville flowers.

“Maybe I should go in,” I said. Why couldn’t I make up my mind? Was I afraid of what the doctors would tell me? Yes, you’re having a heart attack. Or, you have an abnormal heart rhythm and you need a pacemaker. “Okay, let’s go in,” I said, and whipped open the car door. My father trailing behind, I quickly walked toward the entrance, pushed open the heavy glass door, away from car exhaust and into the sterile air.

Nurses and doctors hurried past me in the E.R, their stethoscopes swaying around their necks. Within seconds of sitting down in the waiting room, my fingernails changed from navy to pink. My father waved at a nurse, told her that I was a nurse and could she please see to me soon. I held my head in my hands, as if I could hide from my embarrassment. Maybe I don’t need to be here, I thought. The nurse guided me to a triage room, then took my blood pressure and heart rate. The red numbers on the machine blipped for a long time, my arm going numb, my fingers turning dusky. Finally, the machine stopped at 118/66 and seventy-nine. Average. Healthy. Or, as we health professionals say, “Within normal limits.” I felt anything but normal.

“You’re set to go,” the nurse said, as if I were at a doctor’s appointment for a routine check-up. Did she believe I was lying about my navy fingernails and shortness of breath? Did she think I was crazy? Maybe she saw something in my dilated pupils and rapidly blinking eyes that I could not.

Back at my father’s place, I called my doctor in Vermont. “It sounds like you had a panic attack,” she said. She called in a prescription to a local pharmacy for Xanax, an anti-anxiety medication. That night, I lay in bed, rolling the miniscule white pill between my fingers, wondering if I should take it. Maybe I should take half, a quarter. The longer I played with the Xanax, the longer I looked at it, the more I imagined the power the tiny pill possessed. What if it put me to sleep for good? I knew this was a ludicrous question, especially for a nurse who had administered far stronger medications to patients and had witnessed them wake in the morning. Finally, I placed half a pill on the front of my tongue, held it there for several seconds, its chalky coating melting into my taste buds. I curled back the tip of my tongue, flipped the pill into my throat, swallowed. I slept the entire night, dreamless.

Two years after the accident, the ever-present anxiety and panic attacks continued, so Diana referred me to a different psychologist who specialized in treating PTSD. Diana explained that she would use a method called Eye Movement Desensitization Reprocessing, or EMDR. The treatment is meant for individuals who have experienced severe trauma that is ineffectively stored in their memories. I had no memory of the accident, but Diana said I was still a good candidate. The theory is that EMDR induces an orienting response – an individual’s immediate reaction to something new. The patient focuses on a disturbing thought and image while following the lateral movement of the therapist’s finger, or listening to hand tapping or audio stimulation. Eventually, the patient becomes less disturbed by these negative thoughts and images. Following the same process, the patient then focuses on a positive thought and image until they have replaced the negative ones. The patient is asked to identify any lingering tension in the body, which is then targeted with the same desensitization techniques. Even though controlled studies investigating EMDR and its effects on PTSD where conducted as far back as 1989, I had never heard of it. The process seemed Pavlovian, and that’s because it is. Pavlov, too, used the orienting response with his dogs.

Walking into my first appointment, I hoped I would leave as a magically changed Melissa, with an even heartbeat, steady breath, and calm body at the tweet of a bird. But I feared that I would leave the appointment as a re-traumatized Melissa, with a fluttering heartbeat, shallow breath, and hyper-startle at the drop of a coin. Madeline, my new psychologist, said it could take several treatments before I noticed improvement in symptoms. But I did not know then that it would take a year of bimonthly treatments. She also warned me of the potential risks of EMDR: distressing memories of the trauma, and intense emotional and physical sensations.

With my feet up, I reclined in the leather chair in her den. Beneath the backs of each of my thighs, she tucked thera-tappers, devices that look like transistor radios. I held the handles attached to wires extending from the devices and, over a three-minute period, at regular intervals, fine vibrations alternated beneath each hand. Madeline said if I began to feel anxious, I should recall what she named a “safe place” – suspended in a warm bath. While sensing the vibrations, I tried to focus on a part of the accident that still disturbed me. But my memory of the accident remained empty, like a hollowed-out pumpkin.

I gripped the Thera-tappers, then recalled my last memory before the car hit me – holding a peach, its lanugo flesh tickling my palm. As Madeline instructed, I closed my eyes and imagined the rest: screams, flickers of something, like heat lightning or a camera flash. Steel poles slamming against the ground as the car speeds toward me, its engine revving. The taste of blood. Impenetrable blackness. Pop. My body flies forward, and my hands reach out to brace myself. I hit the pavement. Gravel and glass scrape and cut into my legs and arms. Something snaps. My back? I’m curled up on the hot asphalt.

Those three minutes of EMDR felt like twenty before Madeline turned off the thera-tappers. I shared with her the images of me lying curled-up on the ground, and the physical symptoms I had experienced during the session: shortness of breath, and a fist-tight gut and chest. She instructed me to replace the images with positive thoughts. I’m alive. I survived. I’m okay. Another three minutes. The vibrations ran deep into my palms, into my lifelines. I pictured myself immersed in a bathtub of warm water sprinkled with lavender beads. My legs rise from the bottom, float, unencumbered. The room fills with steamed lavender, unclogging my sinuses. I rub my hands along my arms, slide them over my belly, down my legs, feel the satin finish of my skin.

Foggy-brained by the end of a few sets of EMDR, I couldn’t articulate an exact emotion, but when I exited my imaginary bath, my skin felt taut, as if it might split apart. As I walked out of her back door into the damp air, my stomach and chest still felt tight, but not fist-tight. I recalled what my doctor had told me soon after the accident: “The hard part will come later.” At the time, I didn’t understand what she meant. Or maybe I didn’t want to know what she had meant, because accepting that you have PTSD is tantamount to saying you’re mentally unstable, incapable.

The hyper-startle has not gone away. I gasp at beeping cars, and recoil at falling autumn leaves because the colors are too bright, making me feel as if I’m in an Imax theatre with no exit. The hyper-vigilant state continues: watching for runaway cars, smelling phantom gasoline leaks, random buzzing that no one else hears, and the intermittent itch of my thigh, where a sliver of glass from the smashed-up car emerged. I itch it and itch it, scraping my leg, leaving me with raw skin and an oddly shaped bruise.

At least EMDR taught me to cope. When I’m consumed by irrational thoughts, like the fear of my husband dying in the middle of the night, or that I’m suffering from a heart attack when the hyperventilation, rapid pulse, and blue nails are really symptoms of yet another panic attack, I do as Madeline encouraged: I say, “STOP” and they stop. EMDR also helped me control the nightmares. When my voice strains against the pressure in my chest, I think my way out of the tornado-like swirl. This is not real. This is not real. And when I wake up, lying in a pool of sweat, panting, I say out loud, “This is not real. This is not real.”

After a few panic attacks, I finally started carrying Xanax with me wherever I traveled: when flying, on road trips, or even when grocery shopping. Simply having it with me is a remedy. In the pouch of my backpack, in the front pocket of my jeans, in the secure compartment of my pocket book, the Xanax still provides comfort. All I have to do is look at the amber bottle, shake it, hear the Xanax jingle against the plastic walls. Occasionally, I twist off the cap to be certain they are still there, first eyeing my surroundings to make sure others are not looking because I don’t want them to know I’m not normal like them. I don’t want them to know that I fall on the far end of the bell-shaped curve. Then I pour the pills into my palm, count them, twice. Eighteen miniscule white pills, the shape of life rafts, which rescue me from heart attacks, allergic reactions, and infections. They are with me all the time, except during my nightmares. Someone is driving a car. It flips up in the air, hits the ground, flips onto its side, glass shattering. It flips again, rolls toward me. I run, faster, faster …

Melissa Cronin holds an MFA in creative nonfiction from Vermont College of Fine Arts. Her work has appeared in Brevity, Hunger Mountain Journal, Writerland, Humanthology, and Chicken Soup for the Soul: Recovering from Traumatic Brain Injuries. She has written a memoir, and hopes to find an agent soon. Melissa lives in South Burlington, VT with her husband John, where she plays the Irish fiddle, rides her bicycle, and practices her hula-hoop routine.