by Matt Samet
“Here, let me help you up,” Scott said. He moved me onto a dining-room chair, a cheap, wobbly-legged thing. I felt its upholstery cool beneath my hamstrings.
“I need water,” I managed. “So … thirsty.”
Scott called 911, then brought water. I slouched in my personal darkness, raising the glass feebly to my mouth, dry enough to drink a lake yet only able to take anemic sips. Only had someone shoved a garden hose down my throat might it have made a difference—between the ambulance ride and the ER, they would push six bags of saline drip. With help on the way, I seized on the blindness. Bargaining with God, as one does at these times, I said that I’d be willing to sacrifice my vision if He just let me live. That I could adjust to this. I was so thirsty; perhaps if I took just another sip everything would be okay.…
The EMTs arrived in minutes and laid me flat on my back. I could hear them bustling around, and felt something cold slide into my arm. Slowly, my sight returned.
“Has he been drinking?” they asked Scott. “Drugs?”
“No,” Scott said. “We both got food poisoning or the flu or something.”
“No bingeing? You sure?” They busied themselves holding up the IV bag. While I knew they meant bingeing with alcohol—we were CU students—I felt guilty, like maybe I needed to confess that yes, a week ago I had eaten an entire Domino’s large pepperoni pizza followed by a quart of ice cream. However, it had only been rice cakes and greens since then, so I’m not sure “bingeing” factored in. As I cogitated on this minor semantic distinction, sizzling rods of pain began to shoot through my limbs, especially the big muscles of my buttocks, quadriceps, and biceps, and along my spine.
“Nice veins,” one said. “You’re strong.”
“Yeah,” I croaked. “I’m a climber.” It was a lucky thing; anyone with less pronounced vasculature would have been a harder stick.
“No. No drinking, no drugs,” said Scott. “We were out climbing and drove home because we got sick.”
The pain quickly grew worse, forming itself into some cruel entity, a shadow body trying to crowd me out of my skin. “It hurts!” I groaned at the EMTs. A few firemen stood behind them in full garb, ready to help with the carry. Then my back arched off the floor. “It really, really hurts!” I said.
“It’s okay,” someone said. “What you’re feeling is shock. Just try to breathe and stay calm. Just try to breathe through it.”
My hands and feet had gone icy white, stone-dead numb. All of my muscles were cramping and seizing. It felt like something was trying to crack me open from the inside while another something clenched me in its colossal fist. I took sharp, shallow, hiccupping breaths, my eyes tearing up.
“Fuck … just fucking hurts all over,” I said. “I can’t get a breath.”
“Let’s get him out of here,” one of the EMTs said. “We gotta go.”
The firemen held the condo doors open while the EMTs carried me on a stretcher to the ambulance. Lying there scared and helpless, I looked closely for the first time at the two men. They had buzz cuts, gym builds, clean-shaven faces: macho types who probably rode Kawasaki Ninjas up the canyons on weekends, who thrived on the ripping adrenaline of situations like this. In a way they were the polar opposite of climbers, who practice our art with as much control as possible, who aren’t, despite media portrayals, “thrill seekers.” We avoid adrenaline rushes and instead consider them the hallmark of bad form: of pushing too hard on a dangerous lead, of going too far into the danger zone on a mountain. Climbers instead crave the sense of accomplishment and relief we feel after resolving a hairy situation, having shown poise and mastery despite the possibility of death. We like to sidestep, not confront, the reaper in what is actually a methodical and meditative dance. In climbing, risk is acknowledged—but rarely courted without forethought and preparation. That’s another reason I love the sport—it’s a fear you can understand and control.
The paramedics loaded me into the ambulance, and it’s here, at some unseen intersection, that I almost died. With the vibrations from the siren pinging through the metal, my heart slowed to fifty, forty, thirty beats a minute, bip-bip-bip—bip—bip—bip on the little green screen and my blood-pressure dropped precipitously: 90/60, 85/55, 80/45, 70/40. The EMTs shared a look, and I sickened with panic as I saw a grim message transit wordlessly between them: We’re losing him. He’s going. He’s not going to make it. I heard their hushed conversation as they worked over me and urged the driver to go faster, faster, faster!
Bad salsa had toppled me.
Not this way, not now, not at age twenty when I’d barely lived, when I hadn’t yet slept with a woman—or redpointed Dumpster BBQ! I could not allow it. A steel cladding of fear from eyebrow to toe tip, then anger: This will not do! Piss off! Go find someone else! A transparent death-cloud hovered in the cramped ambulance space, all of us trying to swish it away like a swarm of hovering gnats.
Shoo, shoo, beat it!
One of the EMTs changed out the IV bag and fussed with the tubing, to speed up the flow, while the other said, “Hang in there, buddy, you’re doing great,” though clearly he meant anything but. The ambulance rattled over the city streets as I spooled back toward blindness, the pain slipping away, looking up at the white metal roof and tiny gold running lights along the equipment bays, seeing them fade, feeling colder, thinking, This is the last thing I will see, and it’s not so spectacular. The gnats aggregated into an oxygenless miasma, the ambulance interior flattening into two dimensions, cartoonish, derealized, and distant as if projected onto a receding movie screen.
This cannot be happening. And then: Here we go. This is it. You win.
Then suddenly I felt a shifting, a crystallization, the running lights becoming crisp again. My heart began to pick up as did my blood pressure, and I felt one EMT squeeze my forearm as he said, “We’re almost to the hospital, buddy. You’re doing much better. Hang in there, keep fighting.” This time he spoke with conviction.
At Boulder Community Hospital, they pushed fluids, had me void in a big steel bowl so they could test for pathogens, and then sent me home with a diagnosis of food poisoning. Another friend, Pete, came to collect me and I had him stop at Walgreens so I could buy three one-gallon jugs of Gatorade. That night I hardly slept I was so waterlogged with the sports drink, up every ten minutes to pee, terrified of dehydrating again. I’d seen just how fragile I was, how suddenly death could bust down your door. I walked around campus for the next two weeks like I was made out of glass—tentative, shambling, a one-liter Nalgene bottle in my book bag, hyperattuned to any minor thirst or dizziness, constantly guzzling fluids. (To this day, my climbing pack is often heavier than my partners’ because I pack so many water bottles.) It never occurred to me that I’d fallen ill due to privation and overtraining—that my body and immune system, depleted of vitamins, minerals, and electrolytes, stood little chance against the invasion. And so I went right back to starvation. Two weeks later, I redpointed Dumpster BBQ and almost climbed another 5.13c the very next day. I kept on limiting food well into the winter, ever pushing toward 5.14. And then I had my first panic attack.
A “panic attack.” I’d had a panic attack. Five weeks would pass before I sought treatment, during which time it flared into a “panic disorder.”
* * *
Put clinically, a panic disorder is a type of anxiety disorder in which you suffer recurrent panic attacks—or, in the words of the National Institute of Mental Health (NIMH), “an anxiety disorder characterized by repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress.” Most people will never know this hell: According to NIMH, only 2.7 percent of adults in the United States will, over a twelve-month period, experience a panic disorder, with 4.7 percent experiencing one over their lifetimes.3 Panic disorders feed and are in turn fed by an insidious fear cycle: You have an attack, obsess over the possibility of the next attack until you’re wo
rked into a snit, predictably have that next attack, and so on. I don’t care for psychiatric labels, but in this case they’re useful in understanding where panic disorder falls on the anxiety spectrum: It often occurs in conjunction with depression and other anxiety conditions like generalized anxiety disorder (GAD: a diffuse, nameless dread that leaves you constantly fretting over routine life events), obsessive-compulsive disorder (intrusive, repetitive thoughts that drive ritualistic behaviors), and post-traumatic stress disorder (PTSD: an agitated, irritable, flashback-prone state upon surviving some profound trauma).
Almost worse than the attacks themselves is the hypervigilance cultivated in sufferers, like Londoners cowering in air-raid shelters during WWII. When will the next attack occur? What if it’s worse than the others? What if my heart gives out? What if this is the one that finally kills me? are common refrains, and are certainly thoughts that I’ve had. The sufferer muddles through his days beset by a simmering, low-grade terror that threatens to boil over at any moment—the anticipatory anxiety before the next attack, plagued by racing, obsessive “what if” thoughts. He might complain of body aches, muscular soreness from unconsciously tensing, or a twisting, hollow gut. He might grow further depressed over his lack of control, the way the attacks have shrunk his world to the borders of his home or the few places in which he still feels comfortable. Keen to defuse what feels like an overwhelming situation, he’ll begin to pay undue attention to normal, autonomous physical processes like heartbeat and respiration, monitoring for abnormalities or any spike in “attack symptoms.” In my case, it manifested as constantly checking my distal pulse and feeling that I had to breathe for my body. Restak nicely describes this shift from the “outside to the inside world,” and how it perpetuates panic anxiety: “Even a slight shortness of breath leads to the fear that one’s ‘throat is closing over’; [and] a minuscule increase in pulse rate foreshadows a deadly heart arrhythmia…”4 When the next attack inevitably comes, fed by the fear cycle, the sufferer gains further proof of his frailty. In time agoraphobia can develop and you can find yourself confined to your home.
On the drive home to New Mexico that Christmas break, 1992, I had another attack, a big one: a panic storm that waxed and waned for hours. Finals-week chaos came on the heels of my ER visit, so I hadn’t looked for a psychologist. As I drove through the long, black solstice night, having starved all day, I sank into a deep blood-sugar trough. (Foxman asserts that underreating and bulimia increase anxiety via episodes of low blood sugar “experienced as weakness, irritability, visual fluctuations, impaired attention and concentration, headaches, and fatigue,” all cues for an anxiety reaction—think of the last time you subbed coffee for lunch, for example, and how edgy you felt all afternoon.)5 Somewhere on the inky plains north of Las Vegas, New Mexico, I began to sense an intruder—almost a form or presence—surrounding the car, keeping pace with it. My heart sped up until it was slamming perceptibly, and my hands shook as they gripped the wheel. I felt so far from help, from any hospital where they might “save” me. I was hypoglycemic; I’d probably been hyperventilating for hours, a classic trigger—paradoxically, the more you overbreathe, the higher your body’s CO2 levels and the more difficult it is to draw a full breath, producing a cascade of “air hunger” and suffocation sensations.
Pleading with God, making pacts and promises as I would do so many times, I rolled down my window and stuck my head into the night. A wintry blast lashed my face, a black fist that pummeled the car. Must. Get. More. Oxygen. I weaved across the vacant lanes, gulping frigid night air. Had I become dehydrated again? Would I pass out and crash? Was this another, what was it called … a panic attack? I was too poleaxed to pull over, terrified that I’d simply perish alone in the breakdown lane under a cold bath of stars. I counted the miles to Las Vegas, pulse hot in my throat, my heart thrashing against my rib cage, marking off mileage numbers white and garish on the green highway signs. There I pulled into a gas station, wobbling inside to buy brownies and a Gatorade. The food helped, a little. I got back on I-25, quivering again mere minutes along, my head half out the window for the final 120 miles.
Mortal terror most aptly describes a panic attack: I was sure I would perish at any instant. Until you understand what panic attacks are (and that they don’t just come from nowhere) and perhaps even once you do, this will be their imprint; they’re that powerful. Your body screams of imminent threat while it floods you with fear chemicals, leaving you no choice but to listen. You’re certain you’re about to die. For comparison, let me share a true near-death experience in which I felt the same sensations, both physical and metaphysical. It was on a Boeing 767 over the North Atlantic in 2008, the night of July the fourth. That evening, my wife, Kristin, and I had boarded a plane from DC to London, en route to a week’s vacation in Ireland. As we dozed around midnight, the captain’s voice came over the intercom.
“Well, folks, I have an announcement,” he said, in that chummy, Midwestern drawl they all have. “In case you didn’t notice, I’ve turned the plane around and we’re headed back toward land. It looks like we’ve developed a hydraulic leak of some sort—we’re not sure where—and we need to get back to an airport pretty quick here, so we’re headed to Logan International in Boston. That’s about an hour and twenty minutes.” Then he added, “I’m sorry for the inconvenience, but had we continued we would not have made it.…”
Pause. Pause. Pause.
“Anyway, we’ll have you on the ground shortly.” And then: “And we anticipate a normal landing.”
A normal landing.
Kristin turned to me, her eyes wide, and said, “I love you.” I said the same thing. We locked hands and squeezed hard, both of us staring out the porthole at the black ocean and sky death-world whipping by at 500 mph, at this unchanging eternity surrounding our thin tube of thrumming aluminum. We avoided eye contact after that—it just magnified our terror, bouncing it from one of us off the other. The cabin had gone silent, the passengers whispering if they talked at all. The frenetic (and frankly, terrible) Michel Gondry film Be Kind Rewind played on the seat-back screens, and Kristin and I tried to distract ourselves with its inane movie-parody skits, though I just kept thinking, Am I really going to die watching this piece of shit? Every ten minutes or so, the pilot would interrupt the audio feed to announce things like, “Well, ladies and gentlemen, just four hundred miles off Boston now, and we’re still looking good,” or, “The folks at Logan know we’re landing soon, and are standing by. We still anticipate a normal landing.”
We still anticipate a normal landing.
Consider it: 4,800 zombie seconds during which you might, with each one, coast toward oblivion. You look at your watch every five minutes and will the time to pass, or flip to the on-screen sky map to track landward progress. Time oozes stubbornly, if at all, like an oil slick through mangroves. At long last you feel the plane shudder over Boston Harbor, the flight attendants frantically clearing the exit rows because, as you overhear one steward tell a passenger, “We don’t know what’s going to happen.” Twinkling orange sodiums to the side and below, and then, the velvet peninsula of Deer Island slips by on the right: landfall. Bonfires and fireworks in the park, people celebrating the Fourth of July, oblivious to your foundering jetliner.
We don’t know what’s going to happen.
We touched down as the 767 imperceptibly lost velocity, a banshee howl coming off malfunctioning ailerons that had raised but barely. The crosswise runways were blocked by ambulances and fire trucks, red and blue lights flashing off skid-mirrors of tire rubber. The plane lumbered to a taxi much too far along, well past the airport, everyone on board applauding when we finally slowed. Eighty minutes of We don’t know what’s going to happen. That’s a panic attack: X number of minutes of We don’t know what’s going to happen, of an unending fear-filled present. As with a bad fever, you cannot imagine feeling any other way, whether reaching into your deepest past or on into the future: It’s a moment in which you’re sure,
no matter how much evidence is produced to the contrary, that you’ve locked horns with the reaper himself.
The June 13, 2011, issue of The New Yorker ran a heartrending piece by Aleksandar Hemon about his infant daughter’s rare pediatric cancer. Meditating on mortality, Hemon devotes a paragraph to the psychological barrier we erect between ourselves and imagining the instant of our own passing—we must, Hemon argues, in order to live, to avoid the paralyzing “attendant fear and humiliation of absolute helplessness” in the face of being eternally but one breath from oblivion. “Still, as we mature into mortality, we begin to gingerly dip our horror-tingling toes into the void,” Hermon writes, “hoping that our mind will somehow ease itself into dying, that God or some other soothing opiate will remain available as we venture into the darkness of nonbeing.”6 As I’ve grown older, lost friends—even had one pass as I held his hand after a battle against lymphoma—and had the myriad near misses of any lifelong climber, I have, in Hemon’s words, “matured” into my mortality; I now accept it. But the panic-attack sufferer has no such luxury. Before I beat this thing, every attack, no matter how many others I’d endured, felt like the end—like being back on that 767 but one breath from oblivion.
It’s no wonder that panic sufferers will do anything for a little peace.
Home that night in Albuquerque, I sat at the kitchen table trying to explain what I was feeling to my father and stepmother. I could see the concern writ in the creases of my dad’s brow as he asked questions. Though he was only in his mid-forties, his hair was almost totally white. My father had originally wanted to go into psychiatry, and I’m sure feared I’d had a psychotic break. Was I seeing things? he wanted to know. Hearing voices or commands?
No, of course not, I told him. I just felt tides of tremendous, sourceless fear that seemed to worsen when I was alone. And maybe, also—it was time to confess—I wasn’t eating very well. Which, of course, having seen my mother’s eating disorder and how skinny I could get on climbing trips, my dad had suspected all along. “You don’t have much subcutaneous fat,” he’d say when I returned from the road gaunt and ravenous. “I worry that you’re not getting enough calories for being out climbing all day.”