An Accident on Mount Washington: Now I understand what it’s like to have panic attacks.

From Peaks Island, I scanned the horizon twice before identifying snow-capped Mount Washington playing hide and seek in the mist 70 miles to the west. The bay was flat, the sunrise softening the shadows extending out to House Island.  Brad Burkholder, his son Wyatt, and my daughter Kate, both high school freshmen, and I boarded the Island Holiday ferry, lugging backpacks and skis, snow-boards and boots, incongruous gear for early April even in Maine.

Several hours later, we arrived in the parking lot at the base of Mount Washington and gazed upwards towards Tuckerman’s Ravine, a favorite destination for spring skiing and snowboarding. Then we shouldered our backpacks for the two-hour ascent. Mud and clumps of fresh grass and Mayflowers and wind anemone rimmed the trail, as we trudged slowly upwards.  Spring flowers soon gave way to patches of snow, then deep drifts and frozen streams. When we arrived at the relatively flat plateau at the base of the ravine, it was mid-winter. The wind cascaded over the summit of Mount Washington, sending tendrils of snow down the headwall. I glanced at the thermometer dangling from my pack: It was 12 degrees.

As the least experienced skier (probably on the entire mountain), I was content to clamber my way part way up the headwall and ski warily down. The others, well, they went higher up the mountain, much higher.

A small avalanche off to the left caught my eye as it swooshed down through an off-limits chute. Then a Volkswagen-sized clump of snow dropped from an overhanging rock formation at the lip of the summit, picking up small boulders and debris as it fell. Someone shouted “rock!” Helmeted skiers glanced up, judged the trajectory, shrugged, and scrambled safely to the side.

Several hours later, I was profoundly relieved when my daughter Kate announced that she was exhausted and wondered if we could start to head back. Her eyebrows were caked in ice, and her voice a croaky whisper. We chose a different trail to descend, slightly uphill on the west side of a stream pouring out of a snowfield. The trail was well trodden above the stream, but an old saw of mountaineering came to mind: Most accidents happen going down the mountain. Kate was chattering away with Brad’s son when, out of concern, I skied ahead and cut in between her and the stream. Then, I abruptly lost my footing and fell over the lip of the stream into the water and backpack still attached, was swept downstream.

Brad dropped his pack and ran along the banks of the stream to keep up with me. I floated over a ledge, collided with a boulder, lost the backpack, spun into another boulder, and then, in the churning, shallow water, came to a stop, pinned against a third boulder mid-stream. I was on my side, my upper torso barely above the waterline when I realized I had stopped at the top of another five-foot drop. I glanced downstream, beyond the small waterfall. There was no downstream. A roof of ice, thick enough to walk across, bridged the stream for as far as I could see.

From the bank, Brad shouted my name, but I was aware of only the water pouring like liquid glass over the ledge and into the black hole. Brad had taken off his belt and was in the water, calf-deep, straining to keep his balance. “Take my belt! Grab the end of my belt!” He stumbled and caught himself; the water threatened to sweep him off his feet.

I could feel the pressure of the current against my hand as I felt for the bottom, aware that any shift in my position might send me over the ledge and beneath the ice. I tried to reach out with my other arm, but it didn’t seem to move normally. A wave washed over me, and I briefly shut my eyes. That’s strange, I thought, I don’t feel cold.

“Chuck! Grab the end of my belt!” Brad’s voice seemed far away. The belt hit me in my shoulder. It lashed at me again. “Grab it! Grab the belt!” He yelled. I reached up awkwardly. There it was again, a deep, gnawing, pain in my left shoulder. With my good hand, I closed my fist around the end of the belt. “Put your feet under you.” I shifted my weight and found bottom.

Everything seemed to be in slow motion. “Don’t look downstream.” Brad, now knee-deep in the current, braced against an overhanging tree limb. “Hold onto my goddam belt.”

I pushed away from the boulder, and balancing in the surging water, realized I was only a few steps from the bank. “Look at me!” Brad shouted. I raised my head. “Good. Angle upstream. Small steps. Take your time.” He pulled me in to shore. I told him I wasn’t sure if I was going to pass out. “There’s a hut up the trail,” he said over the din of the roaring creek. It’s not far. Can you make a quarter mile?”

“Maybe.”

With Brad supporting me, I walked stiff-legged up the bank to a snow-packed trail and held my injured arm across my chest, supporting it with my free hand. We met several skiers who wanted to carry me before recognizing that my right shoulder was badly dislocated. When Brad moved my arm, I definitely felt that I was going to pass out.  “How far is it?” Brad asked.

“Maybe 200 yards,” the taller of the two men answered. “We’ll go ahead and notify the hut crew. I’m sure they have a First-Aid kit. We’ll build up the fire inside the hut. The crew can call for a snowcat.” He looked at me skeptically. “Can you make it that far.”

“Shit, yes.”

In the water I didn’t feel the cold. Now, I shivered uncontrollably. A few minutes later, inside the log hut, the crew stripped me down and sat me in front of the wood stove. I looked groggily at my shoulder. The upper part of my arm was displaced a third-of-the -way across my chest. I was barefoot. Did I lose my boots in the water? Or did they take them off when they cut my clothes off? I withdrew into my suffering. I’m not sure if I lost consciousness.

A snowcat arrived. Brad helped me to my feet and the crew, after wrapping me in blankets, laid me down. I couldn’t stop shivering. I noticed that my arm was in a sling. On my uninjured side, Kate laid her head against my shoulder. She’d been crying, and I willed myself a smile. “I’m fine. I’m going to be fine,” which I absolutely believed.

But I wasn’t fine.

After a bumpy snowcat ride down the mountain, after the 30-minute ambulance ride to the North Conway Hospital ER where the emergency room physician reduced my dislocated shoulder, the pain dramatically improved. The intravenous pain meds and a warming blanket reset my outlook. I wanted to go home. The ER doc saw no reason to keep me. My daughter Kate, herself traumatized, sat in silence in the back seat of Brad’s car with me for the two-hour drive back to Portland. “Once they popped my shoulder back in, my shoulder feels great.” I lied to her. “I loved watching you ski.”

We barely made the last ferry to Peaks Island that night. Back home, I retied my shoulder sling, swallowed several pain pills, and spent the first of many fitful, uncomfortable nights, in and out of bed, taking hot showers to relax.

The nightmares began several nights later. In my dreams I dropped repeatedly over the ledge and disappeared under the ice. In the inky blackness, I pounded against the undersurface, trying to break free. In some of my nightmares, I could hear the frantic voice of my daughter and Brad close by.

I developed a fear of darkness and panic attacks. Racing thoughts and flashbacks occurred when I least expected them, but most often in the half-darkness when I would awaken at night. In our bedroom, we kept a nightlife on. We still keep a nightlife on. I kept an anti-anxiety medication on-hand. More times than I can count, deep within a dream, I would become aware of Sandi shouting, trying to pull me back from my terror. Night after night she watched over me, repeating the same message as she remained out of reach of my flailing arms. “Honey, you’re okay. You’re in bed. Wake up. Wake up.”

Thankfully, in-between the panic attacks I seemed okay. I didn’t suffer from chronic anxiety and continued to practice full-time in my rheumatology practice. My ability to process information, to formulate a diagnosis and take care of my patients seemed unimpaired. I never saw a counselor.

A year later, I signed up for a leadership retreat in rural Maine. I did well during the day, but without Sandi, when the lights went off in my cabin, and I couldn’t see the hand in front of my face, I jumped out of bed like a rabid animal and stumbled outside. Never mind that it was pouring rain and there was no porch. I spent the night huddled under a tree in my raingear, awaiting first light.

A few years later, I forced myself to revisit the site of my accident and felt a familiar surge of adrenalin. I sat down in the snow and watched the water drop over the ledge and appreciated its beauty, it’s power. Probably some trout in there, I thought. In some inexplicable way, the stream lost its power over me. Over time, my panic attacks became less frequent. Last year, for the first time since my accident, I spent the night alone in a tent. At one point I awakened and could barely see my hand, but behind it, through the mosquito netting I could make out the stars. I relaxed and went back to sleep.

Facing my fears helped, but the accident remains with me, just beneath the surface. Despite not having a panic attack for more than a decade, it would be misleading to say that I “got over” my trauma. A scar from a serious wound doesn’t disappear. The tissue heals, but the skin is fragile, more susceptible to re-injury. I’m fortunate that by and large, I’ve adjusted to a new landscape, a new me.

There are benefits. Putting on my physician’s hat, I now realize that before my accident, I didn’t truly understand the challenges my patients with mental illness faced. I wasn’t completely tone-deaf. I have always taken time to identify emotional problems—particularly if they interfered with medical management. In my recommendations, I checked off the usual boxes: exercise, counseling, and medications, but inwardly, I was frustrated by my patients inability to Just Get Better. Now that I myself suffer from a mental illness—a form of PTSD—I hope I do a better job.

Today, I hope I’m perceived by my patients as more empathetic, more accepting, perhaps kinder than I was before the accident. I know what it feels like to experience frightening symptoms and lose control. Over time, I’ve worked out a truce with darkness and tight spaces. Just don’t ask me to go caving and navigate through a black, constricting tunnel.

This past summer, I’m down on the beach with my 5-year-old grandson, Frank (Kate’s son). Water is flowing from a stream down to the water’s edge, and he’s busy repairing the damage where the water breaks through his carefully constructed dams. It’s growing dark. It’s time to go inside. He looks up at me and asks, “What’s more powerful, wind, water, or an earthquake?” Then, without pausing, he declares, “Water. I think it’s water.”

I think back to my accident, to the stream, and nod my head in agreement. Then, I look up at the moonless night sky, and for a moment, a cold chill drapes over me. “Darkness too,” I add.  “Water and darkness. That’s what I think. Did I ever tell you that I’m afraid of the dark?”

Frank reached over and placed his hand over mine. “It’s okay, I’m afraid of the dark too.”