Audrey T. Carroll

Surviving Survival Mode

Survival is a state. It is an existence; it is existence. It is the continued refusal to expire, cease, wither, perish. It is an act of hope as much as it is anything else, the hope that survival will prove its worth in the end.
 
Survival guarantees nothing, of course, except for the escape of death, and even that is only a guarantee of the current moment. Fight-or-flight only goes so far as the sympathetic nervous system; it doesn’t detail any of the other varieties of recoil, ghosts of the choices we make to wake up the next day in the safest situation that we could forge for ourselves. Surely I must have learned the sequence at some point, the way the reaction traces its way through the amygdala, the hypothalamus, the pituitary gland—but, in truth, hormones and glands were never one of my strengths, in psychology or in biology before it. My interests in the way that one thing affects the other were always more firmly rooted in the outside, in the consequences.
 
It is easy enough not to think about the million little pushes toward survival that we make a day: eating, sleeping, checking the road before we cross it, using a turn signal, wearing a mask, locking our doors at night. Survival is merely part of the human condition—a major part, though, something that sticks stubborn in our guts as we navigate even struggles that seem impossible, even states of the moment that seem like they will be the state of forever. And still we survive. We fight to survive.
 
The first time that I can remember really thinking about survival in the moment was while I was looking down at my baby girl. It was a moment of clarity, a flash, a realization. The power had been out for roughly 60 hours. It was October in Rhode Island, and a cold October at that. I had laid my daughter on the floor on top of a crocheted yellow blanket. The moment came when I was zipping up her dark blue vest, fitted over her onesie and pants and socks. And in this moment, I felt a deep maternal distress, doing what I could to keep my child warm with no power. It was nearly her first Halloween. I took a picture of her in the outfit as she laid there, chewing on the tail end of a Very Hungry Caterpillar toy that was supposed to enrich her life—give her colors, give her textures, help her understand patterns. Our food had spoiled; her bottles would not keep in the fridge. I had a presentation for my graduate seminar to worry about, and we had no heat, and none of these anxieties could exist discretely. 
 
I felt the tenuousness of her survival nearly daily for five months by this point—making sure that she didn’t suffocate in her crib, helping her when she couldn’t even hold her own head up, making sure that she ate enough, panicking when she threw up an entire bottle of formula all over me and herself and the couch and the floor. But I hadn’t thought of it in those terms, not until I was zipping up a vest to keep her warm enough to survive. Survival was a story of winter in the wilderness; survival was the story of escaping a predator or battling cancer. It was verbs more action-oriented than what we were doing. As I did what I could to protect my daughter, I felt the tenuousness of my survival, too. Within days, we would need to drive to family in Pennsylvania to have heat, electricity, wi-fi to get work done. And I would sleep on the floor with my daughter that first night in Pennsylvania, my arm around her so that she could be soothed, convinced into sleep, as I ached all through my back and limbs beside her.
 
It’s likely not advisable for someone with fibromyalgia to sleep on the floor. The neurologist who had diagnosed me before this asked a question: Do you have a history of childhood or adolescent abuse? As I sat next to this man in his exam room, I felt a tug of familiar dread. No one could figure me out—why I started coming into office appointments with a cane, why I needed the bright paper FALL RISK bracelet for my CT scan, why I felt like I could never wake up. I searched for answers with a furious determination to no longer be written off by medical professionals when I wasn’t a simple pregnancy diagnosis; my two strongest contenders were a Chiari Malformation or a brain tumor. (I had hoped for the former, if for no other reason than because brain surgery has long been one of those fears on the border of rational and irrational that burrowed under my skin.) I had a deep-set malaise that made everything feel distant, something that felt like it would never go away, something that felt like it was killing me; all I was trying to do was live.
 
And I thought this question — Do you have a history of childhood or adolescent abuse? — was just another way to explain my body away as psychosomatic symptoms, another way for a doctor to say that depression was the root of it all. But the neurologist was a man with theories, and once the MRI came back clean and the trigger points ignited pain, one of those theories was confirmed, and I had the name for this thing that my body was trying to survive.
 
But he had another theory, too; it was the reason that he posed the question that led to a diagnosis. As the theory goes, a young person undergoes a trauma (sexual abuse, for example). The teenager survives by any means, by whatever psychological and physiological fortifications their body can cook up. The teenager’s brain chemistry changes, rewiring in ways that will become important later. The teenager in this scenario likely comes out of it with PTSD, common among survivors. Even if the teenager, now an adult, is able to get to a point where they can sleep through the night, even if they can be around strangers without spending every second assessing who poses the biggest threat, their brain might still be wired in particular and peculiar ways. And, if there is another instance of trauma with enough weight, then it’s possible that fibromyalgia is triggered, telling a body that every pain is bigger than it is, that pain is there when it isn’t. The body spent too long in survival mode, and the brain doesn’t want to be caught unawares again, and so it becomes oversensitive to the world, a defense mechanism that backfires against itself because of its hypervigilance. (This is paraphrasing the good doctor, of course, but it gets at the gist of things.)
 
Survival one: abuse. Survival two: an SSRI that causes an allergic reaction. Symptoms include black tar vomit, being unable to remain awake, fatigue, and confusion. Withdrawal symptoms from two and a half doses include full body tremors as a person lays in a fetal position on their living room floor. The body survives, but the body shows its wear and tear, too. Survival makes no guarantees about the conditions in the aftermath, the state of days and weeks to come.
 
And so stressors become bigger in the face of this, pain coursing through a body in the face of even the most minor of threats. I cannot remember where I heard it first—Twitter, some news website—but around the time my daughter was two-and-a-half, the water was no longer drinkable from the tap:
 
A boil water advisory is in place for the customers of five public water systems serving parts of Narragansett and South Kingstown because E. coli bacteria was found in the water supply.
 
Approximately 38,000 residents are impacted by this boil water advisory.
 
These recommendations pertain to water used for drinking, cooking, making ice, brushing teeth, washing dishes, and food preparation. Boiling kills bacteria and other organisms in the water. Infants and young children should not be bathed in this water because they may swallow it accidentally. Anyone else using this water for bathing or showering should be careful to avoid swallowing the water.
 
Department or agency: Department of Health
Online: http://www.health.ri.gov
Release date: 08-31-2018
 
It’s like when you take your body for granted—walking without a cane, waking up without hurting in every place that touched the mattress overnight. Until you have to do it, really and tangibly do it, it seems impossible to imagine every way that water is woven into all areas of life. It’s one thing to learn in science class that we’d die without drinking water by day three. But every little thing, every little act of survival, every little act of pleasure—drinking coffee, washing fruits, boiling pasta, brushing teeth, cleaning dishes, showering—goes unnoticed in the daily mess of things.
 
Showering with your mouth clamped shut is easier than showering with no hot water or lights in a windowless bathroom. But going to the fire station and the nearby university to have enough water to make dinner is less than ideal. Bottled water from the convenience store takes care of water for coffee and washing fruit. Everything is more work, more effort, more spoons (as we call them in the disabled community). And each extra effort makes the necessity all the more glaring, the lack all the more distressing. 
 
The worst of it, though, is the fear.
 
This is the state of fibromyalgia, heightened by generalized anxiety: the what ifs make the what is seem like a threat at every turn. It is woven into the brain chemistry, this hypervigilance. Every stomach grumble could be hunger, or could be E. coli sending its condolences to your colon. Every moment of dizziness (often fibromyalgia-induced) becomes a possible sign of dehydration. And the concern sets into the body, a theory made manifest, stress shooting soreness through joints and fogginess through brain and everything becomes more difficult. It’s a kind of defense mechanism, I suppose, to be worried about everything when you’ve been hurt enough that it feels warranted. But it is a self-destructive mechanism, too, making it more and more difficult to handle prolonged stress as though your body and mind have already hit their quota for a lifetime and shutting down might cause some kind of retreat from the trigger of it all. Or that’s a theory, anyway.
 
It is nearly two years later when it becomes obvious how bad the pandemic is going to get. Some of us started sanitizing grocery bags and washing the food inside of them as best we could. Using doorknobs required hand sanitizer, and so did the elevator buttons that I needed to get up from the first floor because my fibromyalgia was flaring. Perhaps my body is so sore because of the tension of coiling, preparing for the next thing to come, the next thing to be survived, the next thing to wear on the physical.
 
Executive Order 20-02: March 9, 2020. A state of emergency is declared for the State of Rhode Island due to the dangers to health and life posed by COVID-19 and the state disaster emergency plan is activated.
 
Executive Order 20-13: March 28, 2020. All Rhode Island residents are required to stay home unless traveling to work, traveling for medical treatment or obtaining necessities (food, medicine, gas, etc.).
 
Hand sanitizers were sold out, and price gouged online; canned goods and toilet paper went quickly. We stuffed our repurposed linen closet with rice, pasta, mac and cheese, canned vegetables. We prepared not to leave the apartment for we didn’t know how long. 
 
And we waited. 
 
Every car on the road by our kitchen window felt like a risk. It was a survival event on a massive scale, one that we could track daily on the local news and on the Johns Hopkins map that turned redder and redder. 
 
It came in phases—quarantine, sourdough starters, rollerblading, sea shanties. We all wanted distractions from surviving. Sitting at home, even with work and childcare, only left time to think about the dangers of the world outside. I know this game well. If I think too hard about surviving, then my body goes into its backwards survival mode, making survival harder, more painful. And so I write and read and plan and make lists. COVID-19 only brings this out for me more, a descent into homebodiness and introversion to protect from the pandemic consuming every thought. It is the whole world in a state where I have found myself before, afraid of the ways that the body might betray you.
 
Not many months before COVID came on the radar—a time before talk of masks and sanitization and quarantines and stay-at-home orders—I was trying to figure out my own pain. For the first time in my life, I had to buy a heating pad for the sharp stabbing in my ovaries that made vision and balance vanish without warning. I knew that I had endometriosis from a post-pregnancy diagnosis, but this was worse than anything I’d had before. It was tests, ultrasounds, blood draws, every attempt to figure out what was wrong. It was fear of cancer, of endometrial tissue taking over, of my body consuming itself. It was falling against walls in my own home because of pangs, it was discomfort and anxiety. And tests came back with a cyst, noncancerous, and then a pill change lifted the pain. But my body would not accept that I was safe, pain in limbs and back and all over still lingering.
 
The summer before this, I woke up one morning with enormous dark bruises all over my legs, an inability to stand without getting winded, getting so dizzy that my vision failed me. More doctor’s visits, more fights to survive, more tests with no real results. But there is a souvenir of this day, a picture that I took. This picture is one of many on the custom coffee mug I drink from each morning. I am sitting on my bed, smiling at my own phone, my chin resting against my daughter. She’s about two, her thumb in her mouth as she wears a watermelon-printed dress. 
 
I remember very clearly taking the picture, deciding to take it. I thought that I was going to be in the hospital by the end of the day. My mobility was the worst it had ever been; I wondered if my leg bruises were blood clots. I didn’t know if I would survive. And so I decided that I needed to take a picture with my daughter, because if I died, I wanted her to have the most recent picture of the two of us possible. I wanted something of me, of us, to survive, no matter how the day might sour.
 
I reassured my students in Arkansas one semester as we read the list of emergency procedures: I had been through every one of the emergencies listed. This was before COVID, but after a shooting at Walmart; before taking care of a baby in a cold October power outage, but after arriving in the university parking lot with tornado sirens blaring not for the Wednesday test at noon but to warn us into a building and away from windows; before boiling water, but after evacuating a convention hall in Austin as an event volunteer because of bomb threats. Until I had to make the syllabus, until I had to include the building’s emergency procedures, I hadn’t thought about all of those moments I’d survived. Even as I tried to reassure my students, I didn’t think of it as survival, I just thought about it as events, as payment to the piper for passing through the world.
 
And maybe this is why I don’t think of survival as survival, because of this little voice in the back of my head telling me You’ve survived worse.
 
Survival is a state. It is an existence; it is existence. It is the continued refusal to expire, cease, wither, perish. It is an act of hope as much as it is anything else, the hope that survival will prove its worth in the end.

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Audrey T. Carroll is a Best of the Net nominee, the editor of Musing the Margins: Essays on Craft (Human/Kind Press, 2020), and the author of Queen of Pentacles (Choose the Sword Press, 2016). Her work has been published or is forthcoming in (mac)ro(mic), Miracle Monocle, The Broken Plate, Elsewhere: A Journal of Place, So to Speak, and others. She is a bi/queer and disabled/chronically ill writer who serves as a Diversity & Inclusion Editor for the Journal of Creative Writing Studies. She can be  @AudreyTCarroll on Twitter, Facebook, and Instagram.