Triggers

I've been thinking a lot about why this is all coming up now, after all this time.  If everything I've learned is true, and I believe it is, I've had PTSD for 20 years. So why is it only now that the symptoms have become unbearable?

There were several years, back at the beginning, where I knew something had happened to me and I was changing from the person I'd been to someone with a lower emotional range, more fear, less spontaneity, more physical discomfort. I knew it. But even at the time, it just seemed like something to tolerate, not something to tear my life apart trying to fix.

Since then, as memories have faded and the incident was put into cold storage, I haven't spent much time dwelling on it. I've gone months without thinking of it, years without mentioning it. I don't see my scars anymore.

I don't feel sorry for myself. I never have. 

So why now?

I think I know. I think the final trigger was the birth of my daughters.

The pregnancy and birth itself were a bit fraught with peril. As anyone who's been there knows, pregnancy under the best of circumstances is a surreal, sort of overwhelming experience. Your body is doing crazy things, your hormones are going nuts, everything suddenly seems amplified and you're scrutinizing every bite of food, every sensation, every move you make. Everything else comes second to the odd new relationship you have with your body and its new tenant. 

Or tenants, in my case.

On top of that, pregnancy is such an utterly unique experience that it's impossible to believe it has ever happened to anyone else-- you feel like you're the only person in the world who has ever gone through it. In that way, it's a strangely lonely and isolating thing, especially if your family lives far away, as mine does. 

So my boundaries were already being pushed with all of this when I learned that there was not just one, but TWO babies in there (identical twin pregnancies are quite rare, at 3 per 1000 live births worldwide), and that I was now considered a high-risk pregnancy and had a longer list of things to worry about during gestation. After the initial shock (and oh god, was it ever a shock! I completely lost my shit, which is, duh, very unlike me. First chink in the armor, this.), I managed it well. We got all the tests we needed for peace of mind, and after a very tense six weeks of doing that, everything looked good, so we just held on for the ride.

And then I got gestational diabetes, which, I was assured, was "rare, but more common in twin pregnancies." Another (rare?) blow, but still manageable. I got competitive with myself about my blood sugar numbers and keeping them under control was like a game. And I was winning.

And then I got preeclampsia at 32 weeks, which is a lot more rare and a lot more scary. I wound up in the hospital for the last three weeks of my pregnancy, trying to keep the babies in for as long as possible without my organs shutting down or my blood pressure causing a stroke. 

Through it all, I was pretty serene. I recognize it now as typical of my PTSD behavior that I disengage during emotionally-charged times, and this was certainly one of those. Paired with the relaxin and the other hormones that kick in at the end of pregnancy, I was calm, relaxed, steadfastly refusing to dwell on the danger of the situation. I felt like I was floating above it all, forgetting most of the time that there was something to worry about.

Chink in the armor, part two: the day I was wheeled down to the hospital basement for chest x-rays because I was coughing too much, the only day in the entire 3-week stay that my husband went into the office to work... 

(and more on THIS miraculous man later. He often suggests, jokingly, that all my blog posts should be about how awesome he is. Let me state for the record: they are. Even when I don't mention him, they are. He's the reason I'm able to do this work. Dr. Oz once asked me when it was that I first felt safe again after the accident. I thought back to the weeks and months after it happened, then expanded the search to years, and couldn't pinpoint a moment. She suggested that it wasn't until 13 years later, when I met the man I married. And you know what? She was right.)

... but anyway, where was I? Oh yes, chink in the armor: somehow, I started crying on that trip to the basement, and couldn't stop. I bawled my head off. I freaked out. It was all the more strange in that I wasn't having an emotional experience at all, which could be more easily chalked up to pregnancy hormones (hellooooo, PTSD!). I was just... crying. Heavily. Uncontrollably. Inexplicably. And all the while, even then, I was watching myself from afar, completely detached, as if it were happening to someone else.

In the end, three weeks in and two weeks later than the doctors expected, my blood pressure skyrocketed and we had to pull the babies in an emergency c-section. They were relatively robust at that point and I'd been assured there was little to worry about, and then there was morphine and who knows how typical my experience was or wasn't after that. 

I will say this about my detachment that day, whether drug- or PTSD-induced: during the 20 or so minutes between the commencement of the surgery and the first wailing cry of my daughter, I actually forgot what I was there to do.

I was lying there on the table, numb from the arms down, and I'd asked my husband to distract me from the noises of the people rooting around in my abdomen and he and I were chatting with the anesthesiologist about the hazards of street parking in San Francisco, and all of a sudden, there was a tiny little kitten-mewl of a sound and I was jerked abruptly back into the reality of the moment. Holy shit, wait a minute, what was that?! What just happened?! Is this real?!

Thunderstruck.

So there I was with two tiny little babies, one a shade above 5 pounds and one a shade under, who I was told were fine but who were attached to all kinds of tubes and wires and inside of an incubator with little space helmets on. I should have been freaking out. I wasn't. The next few days are a blur.

The girls stayed in the NICU for another 3 weeks, as their respiratory and digestive systems kicked in and proved themselves able to operate without help. They improved daily, and although there were a few hiccups along the way, they never had breathing issues or anything life-threatening, and I remember those weeks fondly for all the help we got from the NICU nurses. 


And to be honest, if any of that calm was attributable to my emotional disengagement, I'm grateful for it.

Ten days or so after the birth, I was still bleeding heavily and had begun having uncharacteristically wild mood swings--always a sure-fire clue something is up, with me-- and it turned out that I had yet another, (this time "extremely") rare complication: a piece of the placenta had been left behind and was still generating blood and pregnancy hormones, and would need to be removed in an emergency D&C before it went septic ("Ever had an abortion? It's the same procedure," the super-awesome ER doctor with the most sensitive bedside manner ever told my hormonal, terrified, hysterically-sobbing, new-mommy self with a smile. A smile! No kidding. That happened.).

A few horrible hours later, I'd had the procedure (thankfully, quite anticlimactic), and things finally began to even out again. Eventually, we got the girls home, and my mom and sisters were taking turns visiting, and we were beginning to settle in as new parents and figure things out. 

And then I woke up late one night with intense pain high in my abdomen. 

Like, seriously intense pain. Some of the worst pain I've ever had. It was too high to be a kidney stone (THE worst pain I've ever had), too high to be related to my uterus, and unlike anything I'd ever felt. I writhed around for a while, and then it stopped abruptly after an hour or so.

Exhausted new mom that I was, I just went back to bed.

But it happened again a few days later, and then again, and by then it had become scary, so we went to the ER and I was told it was gas.

A month and a few episodes later, it turned out that my gallbladder had failed-- wait for it: a  "rare (how I'd grown to dread that word!) complication of pregnancy"-- and it would need to be removed.

This was discovered during a 48-hour hospital stay away from my 2-month old nursing twins, who I was terrified would reject my attempts to breastfeed them again after getting bottles all that time, and who I was convinced would forget who I was (in my defense: new mom).

(In the end, they seemed unphased by the whole thing, and though we did have our ups and downs with nursing, I didn't completely wean them until they were 19 months old and had started offending my dignity by offering their stuffed animals turns at the breast. Crisis waaaay averted, there.) 

So. During all of this, there were two moments that stand out as clues to how and why my PTSD was triggered. 

When I was beginning to breastfeed, I learned that there were two kinds of milk secreted by the mother's body: "foremilk" and "hindmilk." Foremilk is the light, watery stuff that comes out first, while hindmilk is the creamier, much more nutrient-rich stuff that comes after the baby has been nursing for a few minutes, and requires a bit of work to get to. 

Since I was nursing two tiny little things without the strength or stamina to get to the hindmilk and I had to use a pump to get it out for them, I remarked to my husband that it seemed like an evolutionary flaw, since the little ones needed the hindmilk more. I thought it should come first, to help them out. 

As I said it, I suddenly remembered how evolution works: survival of the fittest. And after all we'd been through, that certainly wasn't us. Without relatively recent medical technology, we would have been in a great deal of trouble in those final three weeks of the pregnancy and in the weeks afterward when my little preemies were struggling to eat unassisted. All three of us could have died, and would have under different circumstances.

That thought planted a seed of unease that stayed with me for a few months, even though preeclampsia and 34-week preemies are nowhere near as dangerous now as they once were and at no point had we been in distress. Still. It was unnerving.

Not long afterward, a friend sent me an article about how twin mothers live longer than other women, on average. Cool, I thought. And then I read it. 

It was based on data from the 19th century to avoid skewed stats because of medical intervention or fertility treatments. And it didn't say that women who had twins lived longer, exactly. It said that women who had survived twin births lived longer, suggesting, rather unsurprisingly, that these women were already naturally hardier.

Again, that wasn't me.

Even though it was a moot point-- we live in the 21st century, we have access to excellent medical care, I'd had a complication-rife but true-danger-free experience-- somehow, the fact that we'd probably survived because of these things and not because of our natural ability to do so freaked me out.

It wasn't so much a fear of the what as a fear of the what if, which, and I'm sure I'm not alone in this, is MUCH harder to overcome as a mother than it was before I had children.

In fact, as I'm typing this, I'm realizing exactly what was unleashed when I became a parent: the fear of the unknown happening to your babies and not being able to protect them from it, paired with the soul-deep knowledge from my own experience that the unknown can actually happen to us, even if we do everything right.

I've done many, many things to avoid facing my fears since my accident, including structuring my life and my very consciousness in a way that requires a diagram to explain to you (watch for this in an upcoming post!), but having children allowed the fearful portion of my brain to do a little end-run around the barricades and have at me in a way it hasn't been allowed to do in many, many years.

This near-brush with death, however exaggerated or imagined (so much easier to do now that so much more is at stake!), triggered my subconscious mind because it has been on the lookout for exactly such a thing, expecting it every day, all this time.

And so, in addition to the intense, mostly irrational fears I had for my children and their safety--and still have more often than I'd like, truth be told (they could fall out of my arms and off a tall building! They could get hit by a car right in front of me! They could get swept out to sea! They could choke to death while I'm in the bathroom! They could blind themselves falling onto a knife! They could fall down a well! They could be eaten by Rottweilers!)-- my reptilian brain started taking advantage of the renewed connection and sending me little jabs, too:

The claustrophobia attacks. The ones that got me back into therapy. The things that got this whole ball rolling in the first place.