Vasovagal

I usually have about a minute before it happens, but even when I know it's coming, there's nothing I can do to stop it.

It's happened 14 times in my life before today, and tonight was the 15th.

The first time was down a manhole cover at the Boston Science Museum when I was six, then at sixth-grade lunch in the school cafeteria, then in science class when I had to prick my own finger to sample the blood, then in eighth grade at a friend's house when I sprained my ankle playing basketball, then three times in high school (twice getting flu shots and once after a blood test), then in church on Christmas Eve when it was hot and crowded, then alone in the shower when I woke up naked on the cold tile floor with the hot water running behind the curtain, then after taking a shot of absinthe on a bar stool in Prague, then twice having hand warts burned off by a dermatologist, then on the Manhattan sidewalk on a hot summer night when the doorman was talking about getting tattooed, and then at Tanglewood during Beethoven's Seventh, after drinking mushroom tea with some friends.

But tonight was easily the scariest.

We'd just walked across Walden Pond, seen a statue of tiny Thoreau, hiked up an icy Mount Monadnock, and eaten a big dinner of baked haddock, clam chowder, and cake. We were driving back to Boston, and I was at the wheel. We were on the highway, which was dark and full of headlights, and I started to feel nauseous. Suddenly every breath was only half a breath, like something was blocking my esophagus or strangling my lungs, or like I was gasping for thin mountain air. Then my head went bobbing faraway, my stomach emptied out and got hollow, my heart fluttered, and all of the sounds started to echo.

I know this feeling and I can tell when it's about to happen and about how long I have until it finally does. Knowing this and not being able to stop it makes me sick.

It was hot in the car, and my friend was talking about her Lasik eye surgery. I could feel myself descending into that horrible and familiar hole, which is like a black hole. I interrupted her and said I was not feeling well, and that sometimes I faint, and that if I do faint, please not to worry, because sometimes it happens.

I put on the blinker and pulled to the shoulder of the road, with cars and trucks buzzing by. I put the car in park and put my head in her lap and said that yes, I was about to faint, and please not to worry, and then suddenly it was all black and bright and it felt like forever and I did not know who or what or where I was, but only that this was something very bad, and I felt scared and sick and was in some awful place I could not recognize and I wanted the lights to come on and the mystery to say what it was.

I could hear my heavy breath, slow and deep like when the doctor has the stethoscope to your chest, and I could feel her holding my head and trying to know what the hell was going on, but it was all foggy and I didn't know where I was so I couldn't tell her. I felt panicked like someone had just beat me up and put me in prison and I had to get out, but that was just a feeling and I knew it wasn't right even though I didn't know what was.

Slowly I realized I was in a car on the highway and that I had fainted, and I started to remember who and what and where I was, but only very slowly. Then I just felt sick and weak, and started groaning, and then I remembered how lucky we were that the road had a shoulder and that there was enough time to get over to it and that there were not sirens and flames and people slowing down and staring and other people wailing.

This is one of the things I hate about myself, and I cannot understand or control it or say why it happens to me. I know it has to do with heat, and usually involves thinking or talking about bodily harm. There is this thing in biology called the fight or flight response where, when faced with fear, animals either fight or run away.

For me, when a threat is external, like a Costa Rican robber with a gun to my head, my instinct is to fight. Everything is slow and lucid, and the adrenaline feeds me, and lets me shake him off and wriggle free, but only after he hands my bag to a runner and rips open the blisters on my sunburned shoulders. But when a threat is internal — when I feel like my body's been breached and especially when it seems to be my fault, I freak out and faint.

Then it's like a computer crashing, and you lose all your unsaved work, because when you start up again it takes a while to get back to where you were, and you know that every time this happens you're probably shortening the life of your hard drive, because it's not right to shut down like that with no warning, and you think you should probably find a doctor who can tell you why this happens and what you can do to prevent it, because you're getting older and these things start to matter.