1 An Explosion in Brooklyn January 27, 2006. I've stayed awake until 2:30 a.m. obsessively revising a presentation for my new boss, determined to impress him with its elegant clarity in describing the marketing strategy for a new product. When I finally turn on the bathroom faucet to brush my teeth before bed, it issues a screaming jet of air instead of water. With barely a thought, I flush the toilet to check whether all the plumbing is misbehaving. I hear a loud noise, then notice a tiny spray of blood on the wall-brick red against shiny yellow tiles. Whose is that? Not yet alarmed, I glance right to discover a gaping wound in my forearm, about three and a half inches square, all blood gurgling over black Jell-O and pulled-taffy innards. Instantly, I become disoriented. To the sound of blood slap . . . slap . . . slapping against the floor, I stare at the gash, dumbly assuming that the nature of my predicament will become clear. The strategy works; I realize that the toilet has exploded, propelling a sharp hunk of porcelain through the inside of my right wrist, partially severing my dominant hand. This is bad, really bad. And it's happening to me. I look down to see myself standing in a large puddle of blood, whose rapid expansion begs immediate action. Still, my brain insists on one further second of reflection to mark an irreversible transition: The life I've been living is over. The next one, however long it lasts, begins now. Decorating the apartment in red as I go, I tear into the bedroom, lurch for the tabletop phone with my left hand, and dial 911 while heading back to the kitchen. I struggle to keep the phone pressed between shoulder and ear as I yank a dirty dish towel off the oven door handle and crumple it into my right wrist. Saturated with blood in seconds, it lands with a splosh when I dash it to the floor. I fling open a cabinet, grab a clean towel, and try again, but the blood soaks through that one, too. Realizing I'll never get ahead of it, I wrap another towel around the packed wound, one more around that, then stretch both arms overhead and squeeze the sodden wad as hard as I can with my left hand. Concurrently describing the nature of the emergency to the 911 operator, I can only convey its magnitude by verbally tracing the trail of blood, which is sprayed in feathery arcs on the walls, dribbling down the floor molding, gumming up the keys of my laptop, soaking into a basket of clean laundry, painting traffic lines on the rug, pooling in my shoes on the floor. And yet, I feel no pain. The operator reports that an ambulance has been dispatched and instructs me to stay on the line until it arrives. Certain I'll pass out before then, from loss of blood or simply the horror of the experience, I resolve to enlist a neighbor to meet the paramedics in the lobby of our apartment building, rather than risk the trip myself. I go to the door across the hall and start kicking it, unable to knock. "Somebody please help-I've had an accident!" After several such pleas, my neighbor opens the door. "Jesus Christ! Call 911!" he yells over his shoulder into the apartment. "I've already done that," I murmur. "Someone just needs to let the paramedics in when they get here." I drop the phone at his feet and sink to the hallway floor as other neighbors drift warily out of their apartments. Kneeling, head bowed and arms held high like a surrendering fugitive, I shiver in my little nightgown, gripping my wrapped wrist so hard both arms shake. I close my eyes, not wanting to see any more. Adrenaline rush gives way to terror, which has a different quality than other emotions I've experienced. These tend to be a mix-of love and protectiveness, anger and shame, gratitude and relief-just as the color black in a painting is rarely pure black, but rather a mixture of black and another dark color like blue or green, added for depth and nuance. This flavor of fear courses through me undiluted and unchecked, obliterating all rational thought. Sweat-slicked and heart banging, I squeeze my eyes tighter and chant softly: "I'm so scared. I'm so scared. I'm so scared . . ." The neighbors flit around me wordlessly, trying to drape me with a shawl that won't stay on because they won't get close enough to secure it. Strangely, I don't want them to do anything. I, too, am repelled by my blood-spattered body and-regretting the loss of innocence I imagine they've already suffered for seeing me in such a state-don't want to impose on them any further intimacy with it. I feel beyond rescue, like a stricken, twitching deer on the highway that people drive past, saying, "Nothing we can do, have to let nature take its course." And I feel dangerous, as if my trauma were contagious. "Don't touch the blood," I feebly warn a neighbor who announces she's entering my apartment to pack a hospital bag for me. "Becca. It's David from upstairs. What do you need me to do?" "I've called an ambulance," I reply. "I just need someone to let the paramedics in." "OK. I'm going downstairs to wait for them. I'll bring them up as soon as they get here." I drink in David's authoritative voice, acknowledging his words with a nod. He puts his hand on top of my head for a long moment. The warm, confident gesture ever so slightly weakens my swirling fear, a smudge of lapis into black. I feel a little more human, maybe worth saving. David returns with an army of help from the ambulance service and police and fire departments, the size of the entourage a precaution taken by the 911 operator upon learning my injury resulted from an explosion. The neighbors recede and the paramedics take over, unwrapping, examining, then properly bandaging my wrist, checking my vital signs. Ten minutes later they bundle me onto a stretcher and maneuver it into the elevator. As the doors close I call to a policeman to bring my cell phone and health insurance cards from the workbag beside my bed, and to call my sister, Erica, making him promise to get word to me when he reaches her. As the paramedics lift me into the ambulance, I realize they've never told me I'll be all right. Guessing they aren't sure, I wish they'd lied. The ambulance ride takes just eleven minutes, and the velocity with which we fly over the Brooklyn Bridge creates the sensation of sledding down a steep hill on my back. The sudden lights of the bridge capture my gaze, their glittering strands visible through the back windows from where I lie on the stretcher. My breathing slows as I muse about my love for the landmark. Jerked back to my distress by a sharp turn onto FDR Drive, I hope to lose consciousness, feeling colder and sicker each minute, worried Erica might be traveling on business, dreading my prognosis yet to come. Finally, I start to cry-tired, coughing sobs. Miles, the enormous paramedic attending me, watches silently. With my left hand I grope for one of his, which he lets me hold tightly. When the ambulance comes to an abrupt halt, Miles and his partner haul my stretcher out of the vehicle and push it through a large set of swinging doors. Noting the ceiling change from the poured cement of the ambulance bay to the fluorescent lights of the emergency room, I will myself to stop crying. My pride has poked through the veil of shock, and I want the doctors to think me strong and helpful. My best friend, Jen, has counseled me in difficult times: "Act how you want to feel, and you'll eventually feel that way." So I do. Several emergency room staff catch up with my stretcher and stride purposefully alongside to guide it to an open bay. They all begin to work on me at once, checking blood pressure, unwrapping the wound, taking my medical history, administering a tetanus shot, removing clothing and jewelry that obstruct their efforts. One nurse, almost tenderly, sets about swabbing the blood off my face, chest, hands, and feet. I appreciate the quiet, matter-of-fact way they question me and instruct one another. Leaning my head back on the pillow, I lift my eyes from the tangle of faces and hands surrounding my wrist, and gaze softly ahead of me. A minute later, Erica appears at my feet. Advancing into the bay, she glances at my open wrist, which lies on a table to the right of the bed like a half-carved roast on a platter. She recovers with a wan smile and takes my left hand. Her presence reminds me of our collective strength and resilience, rigorously tested by numerous family crises. She is here. I can handle anything now. Even the prospect of death, if that's what's in store. I smile back at her, and my fear recedes. Then, at last, pain erupts in its place-a burning car parked on my hand, vicious proof of life. 2 Fight or Flight? Our Built-In Threat-Defense Program I regret that, in telling the story of that night over the years, I have destroyed countless people's peaceful relationships with their toilets. I know this because they say so ("Becca, I think of you every time I go to the bathroom!"), before fishing for reassurance that such a catastrophe could never befall them. Sadly, I can't provide it, since the cause of the explosion remains unknown. I can only offer my annoyingly incomplete hypothesis, based on some Google bingeing and the best guess of a plumber's son I met at a party, that it involved excess air pressure in the system that flushed the building's toilets from a giant water tank in the basement. So if your toilet is flushed by water from its own little commode-top tank, you can probably exhale now. What I do know is that my injury posed an existential threat. If I hadn't acted as I did, I might have bled to death, or lost enough blood to suffer permanent damage to my brain and other vital organs. Nobody would have come looking for me in time to prevent any of that. My neighbors, conditioned to ignore mysterious, big-city noises, slept through the brief blast. Colleagues and friends would have assumed they'd missed some explanatory email from me when I failed to show up for that Friday workday or a weekend meal, and my family wouldn't have expected to hear from me for days. For all anyone knows, then, I saved my own life. Or at the least, life as I knew and wanted it to be. People admire me for this feat. I admire me for this feat. I've inwardly gloated about it in infuriating or demoralizing situations, like when I had to sit with my "feedback is a gift" face on for fifteen minutes while a boss explained that I am not a creative thinker (I disagree). Ah, so that's what you think of me? No matter. I've saved my own life. But while the admiration feels good, it also discomfits, and not only because so many people dislike women who own their achievements. More so because it implicitly credits me with consciously orchestrating every step of my escape from danger, ignoring the extensive role of factors beyond my control-beginning with the brain's built-in threat-defense program. Nerve cells, or neurons, play a starring role in the threat-defense program. Neurons' raison d'tre is to relay data, in the form of electrochemical transmissions, throughout the brain and body. While they take slightly different forms depending on their location and purpose, you can imagine their fundamental anatomy as that of a dandelion gone to seed: there's a cell body (dandelion head) covered in dendrites (the fluff on the head) and a skinny, stemlike projection from the cell body called an axon, which has branches at its end, like roots. (This is an imperfect analogy, as dendrites are actually thicker than axons, but it's good enough for our purposes.) The structures we call nerves are actually bundles of axons. When adjacent neurons communicate, one neuron generates an electrical impulse that travels from the top of its axon through to its branching ends. There, the impulse stimulates the release of chemicals, which diffuse across a tiny, fluid-filled gap to react with the dendrites of neighboring neurons. Reactions above a certain threshold cause those neighboring neurons to generate their own electrical impulses, leading to stimulation of other neurons in their vicinity, and so on. Such communication transpires on an unfathomably large scale. Estimates peg the number of neurons in the human nervous system at around 100 billion, and a single neuron typically communicates with ten thousand others. The result is trillions of neuron-to-neuron connections. If we could hear it, the chatter among them would be deafening. Neurons are the workhorses of the central nervous system (which comprises the brain and spinal cord) and of the peripheral nervous system (the network of nerves that permeates the skin, muscles, and organs). Communicating via neurons, the central and peripheral nervous systems form a feedback loop that enables collection and processing of data about the body's internal and external environment, and coordination of the body's responses to it, whether automatic or consciously deliberated. Within the brain, different groups of neurons-neural neighborhoods, if you will-specialize in processing particular types of data, for instance that related to visual stimuli. And specific neural neighborhoods routinely collaborate to carry out specific processing tasks, like the threat-defense program. How did all this work to my advantage? At the instant of the explosion, several neural neighborhoods involved in the threat-defense program leapt to work, crunching data about the sights, sounds, and bodily impact of the event to synthesize a detailed account of it. One of them-the amygdala-also compared rudimentary facts about the event to situations tagged "dangerous" in my evolutionary programming and memory. Discovering troubling similarities, it triggered a full-body response to help me cope with the danger I faced. Muscles all over my body contracted, freezing me in readiness to assume whatever posture the situation demanded next. Natural opioids flowed into my spinal cord, blocking pain-triggering sensory nerve signals en route to the brain for processing. My breathing quickened and adrenaline flowed into my bloodstream, boosting supplies of blood glucose-muscles' main source of energy. My heart pumped faster to speed distribution of the surplus energy throughout my body, and blood vessels channeled it into my limbs (where it would likely be needed most) by constricting themselves in my abdomen and skin, and relaxing in my arms and legs. Excerpted from Beautiful Trauma: An Explosion, an Obsession, and a New Lease on Life by Rebecca Fogg All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.
