“Mom, of course I’d forgive you, but it would be really horrible if you did it. You just have to be strong, Mom.”

I could hear in Barrett’s voice that he was trying to be strong himself. “You’ve overcome some really hard things in your life and climbed some really big mountains. You’ve never been a quitter, no matter what. You’ll figure this out, Mom. I know you will. I mean, like, there are guys who come back from wars in Afghanistan, Iraq—wherever—with half their bodies blown off, like from the waist down, and they learn to live with what happened. And you will too. You’re strong, Mom. You’re unbelievably strong.”

Barrett called frequently to check up on me. During each phone conversation, he took on an uncharacteristically stern voice, as though he was a father talking to his five-year-old daughter. “You mustn’t do it, Mom. It’s not right. You’d be setting a bad example for your patients, especially for the ones who are having a rough time like you. And besides, you’d be abandoning them. Who would they go to for help if you did it?”

Barrett referred to committing suicide as “doing it,” as though the “s” word might elicit too much pain if he said it out loud.

Each of his many lectures remain engraved in my mind. I understood why he needed to talk to me sternly. The helpless feelings Barrett undoubtedly endured while he continued his college studies on the other side of the country—knowing I was on the verge of leaving for good—surely created a need for some kind of control in this out-of-control situation.

With each lecture, Barrett appealed to a different aspect of my character. For the competitive side, he talked about veterans who manage to cope with trauma and therefore I could too.

For the hyper-responsible and caregiving side of me, he invoked the specter of abandoning my patients. He never once mentioned his own feelings of abandonment.

In an attempt to resuscitate the optimistic side of me, he said, “Do you remember when we sat on the couch together and watched those medical mystery programs when we were little—I mean, when I was little? Do you remember how those people who were really sick with horrible conditions spent all their money going from doctor to doctor and never got any help but then they finally found a doctor who figured out their problem and they got well? Do you remember that, Mom? Well, that’s what’s going to happen to you. You’ll find a doctor that can help you. If you don’t hang in there, then you’ll never find out what’s going to happen next.”

After trying to convince Barrett that suicide presented the only solution to my hopeless and unbearable condition, he said, in a commanding voice, “You CAN’T do it, Mom. You have to stop thinking about it. Ok? I love you, Mom. I love you so much.” He quickly ended the call at the moment he started to cry.

Oh God, I have to find some way to live with this nightmare and stay alive for my son.

Consumed in despair and hopelessness, I went behind my house to the river to look for solace. I walked along the bike path with my eyes closed to avoid seeing the alarming visual distortions, but opened my eyes every couple of minutes for a second or two to make sure that I stayed on the path and had not veered off toward the embankment. Fortunately, I was the only person on the path. I spoke in a loud voice—without inhibition—as I tilted my closed eyes toward the sky, with tears flowing freely.

God, please help me. How can I live without sleep? How can I live with the panic attacks, the pain, the pressure, and the unbearable anxiety? There aren’t any specialists that I can refer myself to. No one can help me. The only referral left is to you, the ultimate healer. Show me the way.

At that moment, my eyes opened and suddenly I noticed—as though seeing for the very first time—the startling beauty of the Sangre de Cristo Mountains with their mantle of snow and the cobalt blue sky framing two snow-white cumulous clouds drifting over the peaks. Over 3,000 times during the past twenty years I have walked along this stretch of the river and never seen such a luminous sight. I gasped. For a nanosecond I felt joy—free of misery. At that moment, I knew that my question to the Great Spirit had been answered.

There’s no reason you can’t feel joy—in spite of the torture, in spite of everything.

A little path led me to the bottom of the dry riverbed. A slight breeze gently caressed my face. The winter sun felt warm on my skin. I took a deep breath and watched my chest rise and fall. The crisp air smelled pure and invigorating as it flowed into my nostrils and expanded my lungs. I took off my shoes and felt the cold sand squish between my toes as I continued walking upriver, taking care not to stumble and fall. After a few minutes, I sat down on a large, smooth-surfaced boulder and pondered what had just happened. I had gone approximately ten minutes without thinking about suicide and felt about two minutes of inexplicable joy.

Maybe there will be a way to navigate this disaster after all.

Back in my shrunken world of anxiety on the couch in the living room, I realized that, in order for my spirit to survive, I needed to resume practicing medicine so that I had an anchor, a reason to get up each day, a feeling that my life still had some meaning beyond mere suffering.

Since the angiogram of my head in Albuquerque just before Christmas, the message on my answering machine said that I was sick and would be out of the office for an indeterminate period of time. Toward the end of January I changed the message to say that I was back in the office on a part-time basis. The false rumor that had spread around Santa Fe—that I had retired due to a fatal brain condition—turned out to be a blessing because the return of the patients began as a mere trickle at first, few enough for me to manage, given my impairments.

Against the adamant advice of my friends, I saw two to three patients a day for the first few weeks and then gradually the numbers increased over the ensuing months.

My first patient that returned to the practice looked at my eyes then looked away and said, “I’m praying to God that you won’t die—even though I’m an atheist and don’t believe in a god. I don’t know what I—or your other patients—would do without you.” She pulled out a tissue from her handbag and wiped the tears from her eyes and blew her nose.

After watching the discomfort of my patients, not knowing where to put their gaze, I tried wearing a patch over the left eye—the one with the most pronounced deviation—but I found the patch to be distracting. Instead, I got a pair of glasses that made it more difficult to see my eyes.

In the meantime, I had begun training my brain to only pay attention to the image produced by my right eye—the real image. But, with fatigue, the brain slacked off and caused me to make some embarrassing visual mistakes. A patient handed me a check at the end of the appointment. I reached out to take the check but there was nothing there. I had reached for the false image that appeared two feet to the left of the actual check. Each time the visual confusion happened, I briefly explained that the nerves in my head had been damaged—the ones that control the muscles that move my eyeballs.

One time a patient repeatedly looked up and off to her right as I talked to her, as though she was trying to see something on the wall. I wondered why she kept doing that and then it dawned on me that I had been looking at the false image of her, the one that lay above and to the left of her. Fortunately, the patient had a sense of humor and could laugh after I explained what happened. For the rest of the appointment, I put my index finger on my closed left eyelid as unobtrusively as possible.

One patient voiced what might have been on many people’s minds. “Does your brain still work?” I assured her that the part of my brain that controls cognition had not been affected at all, thankfully. I explained that the structural damage in my brain affected my eyes and the limbic system, the part of the brain that is involved with producing PTSD and other anxiety disorders.

Between patients, I lay on the floor in the office with my head on a pillow and rested. It seemed that no matter how exhausted I felt, no matter how sleep deprived, no matter how damaged my body was, practicing medicine was just like breathing for me. It was part of my fabric. It gave me meaning and sustenance. Someone once joked that I could still practice good medicine from the coffin.

I looked forward to seeing each of my patients. When I sit in the room with a patient, nothing exists beyond that sacred space between the two of us. My full focused attention rests with the patients and their problems, giving me a reprieve from my own problems—in this case, the ever-present anxiety and intrusive thoughts of suicide.

A patient said half-jokingly to me, “Dr. Elliott, I think that you have such total devotion to your patients that you probably made some kind of agreement with the universe to have all these terrible things happen to you so that you could really deeply understand the nature of suffering and gain even more tools for helping your patients get well.” I don’t know about any agreement with the universe, but I do know that I have to find my own meaning in this never-ending nightmare.

If I have to continue suffering, then may it serve some higher purpose. I don’t want this suffering to be for nothing.

Well-meaning people in Santa Fe talked to me about how I was burning off karma from something I had done in a previous lifetime. Whether the belief system of karma applied to me or not, I did not find that explanation for my current condition to be very helpful. I wanted to create my own meaning out of the suffering, a meaning that would actually be helpful and serve to guide me toward a higher good.

As I cast about for meaning, I remembered what the old Navajo woman had said when her granddaughter told her about the mountain lion that sniffed me as I lay in my sleeping bag, alone on a slab of red rock in Utah, when I was a young school teacher on the Navajo Reservation. The grandmother said that I was “really lucky” that the mountain lion came to me because I got to meet my spirit guide. She said that the lion came to give me his courage, strength and intense focus because I would need that for what lay ahead. She said that I would face big obstacles in my life—some of them life-threatening—and, if I lived through them, I would have a “strong heart and powerful medicine to give to the people.”

That sounded like a good meaning, although this time, the obstacle was too big for me to overcome.

As I walked in the dry riverbed, I spoke out loud to the Great Spirit. God, put me back a grade. This spiritual path is too advanced for me. It’s not true that “god only gives you what you can take.” This is beyond what any human can endure.

During my morning walk in the riverbed, I made sure I patted every dog I came across and hugged it as though it was my long lost friend. I learned the names of the dogs, but never learned the names of their owners. In fact I often forgot to look up and greet them. Instinctively, I knew that patting the dogs made me feel calm. When Barrett came home for spring break, he wanted to get me a dog from the local shelter. I declined his thoughtful offer because I could barely take care of myself, not to mention a dog.

In addition to patting dogs, I had a growing list of the activities that lessened the anxiety. The list included being in nature, lying on the earth, treating patients, hot soups, getting and giving hugs, getting acupuncture and massage, listening to books on audio, and listening to classical music. The music of Mozart filled my house and drowned out the dreadful pounding in my head. Before the accident, I had read studies showing that MRI scans of students listening to various types of music revealed that Mozart’s music topped the list of sounds that had a calming effect on the brain.

One of my patients who knew all the details about the damage in my brain said, “When you’re in Hell, just keep walking.” And that’s exactly what I did, both literally and figuratively. I kept walking.

I longed to be high up in the mountains again. My friend, Nancy, took me up to a favorite hiking trail. Since it was strewn with rocks and my vision blurred, double, and lacking depth perception and peripheral vision, I fell down frequently and had bruises in various places on my body. Nancy suggested that I walk behind her while holding onto her shoulders. We slowly made it up and down the mountain in that fashion. After several hikes that way, I eventually could simply walk a few inches behind her—without holding on—and step wherever she stepped. Nancy carefully watched out for any branches that could come in—unseen—from the side and stab my eyes.

Over time, with diligent eye exercises, the left eye gradually moved more toward the center as the ocular nerves regained some strength. With the improvement, the falls lessened and I was able to navigate the world more comfortably. People who spoke with me no longer averted their gaze in discomfort. In fact, many people no longer noticed that my eyes did not line up with each other.

My friend and IT person, Rob, helped me to purchase an iMac computer with a very large screen. My world began to expand back into cyberspace as the blurry vision lessened.

Another friend, Leah, drove me to see the neuro-ophthalmologist in Albuquerque. After countless pages of forms to fill out and countless tests of my eyes, the results showed exactly what had been obvious all along—limited peripheral vision, decreased visual acuity due to swelling in the cornea from the pressure in my head, diplopia (double vision) due to weak ocular nerves in the brain, related to the pressure on them in the cavernous sinus from the expanded veins. The neuro-ophthalmologist suggested that I use glasses with prisms to correct the double vision. But when he tried to fit me with the correct prism, he said that the diplopia was too severe to correct. Even the visual acuity fluctuated based on the level of pressure in my head, making it difficult for me to find regular glasses that worked throughout the day. When he told me I needed surgery on my brain, I let him know that no one was willing to operate on my brain because of the assumption that I would die from the surgery, due to the presence of hundreds of fistulas.

While I worked diligently on my eyes with specific exercises every day, my sleep problem remained intractable. Night after night I lay in bed wide awake, exhausted but unable to turn the switch off and fall asleep. Then I overheard a conversation that my sister, Veet, had with a neighbor during one of our community meals at The Commons. She said that when she lived in India, she heard about a group of yogis who intentionally kept themselves awake all night so that they could meditate.

From that day forward, I meditated all night while in bed lying on my back. I simply followed my breath in and out. My mind wandered every other second into the ditch of fear and anxiety. I simply reeled the mind back to the breath, over and over and over again. I took extra large breaths and held them with my chest expanded for five counts, then let the breath out ever so slowly and silently.

I knew that when the chest expands, it triggers the phrenic nerve under the diaphragm, which in turn, triggers the vagus nerve. The vagus nerve controls the parasympathetic nervous system, a part of the autonomic nervous system that has been nicknamed the “rest and digest” system—as opposed to the sympathetic nervous system, known as the “fight or flight” system. I desperately needed some parasympathetic stimulation to counteract the hyper-functioning sympathetic nervous system.

After the eight hours of nocturnal meditation, I got up in the morning feeling as though I had gotten some rest—even though I never fell asleep.

I remember the first time I fell asleep. The moment occurred during an acupuncture appointment. My siter, Veet, drove me twice a week to see Dr. Jason Hao, a highly regarded Chinese practitioner who did scalp acupuncture for neurological conditions. The needles that he inserted into my scalp worked immediately and allowed me to drift off to sleep for twenty minutes—the duration of the appointment. I felt marvelous for a few minutes. The anxiety came down to manageable levels, but the effects wore off quickly.

Veet continued to drive me to the acupuncture appointments twice a week for over a year. She brought with her a huge bag of food for me to eat in the waiting room. The receptionist looked at us with curiosity. I explained to her that I had to eat constantly to keep from fainting, given that I did not digest my food. I also explained to her why I had to take off my jacket and then put it back on every few minutes. With my brain damage, I could not adjust my internal thermostat—the one that’s located in the hypothalamus in the brain. The trauma seemed to have impacted that part of the brain as well.

Veet also brought me to the grocery store so that I could buy some food to have in addition to all the meals that had been prepared for me. The first time she brought me to the store, she said that she would wait in the car for me while I shopped. Within two minutes of entering the store, I had a panic attack and had to leave the store immediately. I jumped into Veet’s car and breathlessly told her I couldn’t do it and to please take me right home.

Being in the grocery story created massive sensory overload. My brain could not process all the different colors and items and boxes and fruits and sounds and smells and movement of people. At that moment I understood why combat veterans with PTSD sequester themselves at home and don’t go anywhere.

The specter of me curled up in a fetal position and never leaving the house on my own motivated me to make a plan for overcoming the problem I had with going into stores and shopping.

I asked Veet if she’d be willing to drive me to the store every few days while I attempted to stay in the store a few minutes longer each time. She agreed. We drove to the store and this time I intended to walk into the store calmly and pretend that I was a normal person.

I walked straight over to the apples and tried to keep my focus exclusively on them and not let my gaze wander and induce a panic attack. I touched the red apples, pretending I was looking for just the right one. I fiddled with the apples until the requisite five minutes had passed so that I could get the hell out of there and go home.

I doggedly stuck to my commitment to desensitize my brain around going into stores. From the apples, I graduated to moving from one bin of fruit to the next and worked up to 15 minutes at one time. The next time I made myself actually pick up a piece of fruit and go to the cash register and buy it.

My heart raced and my breath became shallow. I waited in line at the registry while doing deep, slow breathing and keeping my gaze focused downward toward my feet.

I remembered what the Vietnamese Buddhist monk, Thich Nhat Hanh, told his students when Barrett and I visited him in Plum Village in 1997. He said that if you smile—even if you feel terrible—the act of smiling will change the brain. Well, if it’s really that easy to trick my brain, then I’m going to smile all the time. It worked. I smiled at the lady at the cash register. She had no idea—thankfully—that I was having an anxiety attack.

Periodically, I assessed my situation. My left eye had become less deviated. My brain had started to adapt to the visual impairments and I wasn’t falling down as much and had less bruises on my body. My brain was learning how to ignore the false image and only pay attention to the image produced by my right eye. The nocturnal meditation allowed me to function during the day. Resuming my medical practice helped me to feel like there was some meaning to my life.

But I still felt horrible. The anxiety felt like poison in me. I longed to go to bed and fall asleep. I longed for silence in my head. I dreaded the pain and pressure. I lived in terror of having a panic attack. My life had become a shrunken sphere of misery.

My friend and colleague, Bruce Gollub, came over to check on me periodically. He offered kindness and compassion. One day when he came over to check up on me, I said, “Bruce, I can’t do this anymore. I can’t live like this. I’m just barely hanging on. There’s no hope for me. Would you ever consider helping me end my life?” Without hesitation, Bruce gave the perfect answer. He did not say “no,” which would have been devastating to me since the thought of death gave me comfort. He said, “It’s not time yet, Erica.”

Shortly after that conversation, Bruce and another colleague, Forouz, called and sent my records to neurosurgeons throughout the country—and even contacted specialists in Europe—in hopes that one of them would take me on as a surgical patient. No one agreed to do the surgery—just as the neurosurgeon in Albuquerque had predicted.

Then, in June of 2009, Bruce got a called from the Barrow Neurological Institute in Phoenix, Arizona.