REBECCA  MAC DONELL-YILMAZ  grew up on Long Island and was educated at Dartmouth College, from which she earned a Bachelor of Arts in French Language and Literature as well as a Master of Public Health, and at Stony Brook University, where she earned her MD.  During medical school, she rekindled her childhood love of writing and composed numerous poems with the poetry group Astonished Harvest as well as a collection of essays chronicling her experiences becoming a physician. For the latter, she was awarded the university’s Berken Fellowship for sustained work in the humanities and the 2012 Award for Excellence in Humanistic Studies.  She is currently a resident in pediatrics at Brown University/Hasbro Children’s Hospital in Providence, RI.  Her work has been published in the Annals of Internal Medicine, The New Physician, the Journal of the American Medical Student Association, and Paumanok II, an anthology of poetry and photography by Long Islanders. She blogs about her experiences in training at The Growth Curve: ruminations of a pediatrician in training, which can be found at www.thegrowthc.wordpress.com.

PROLOGUE

Between my third and fourth years of medical school, I spent two weeks holed up in the mountains, studying for Step 2 of the United States Medical Licensing Exam.  My car broke down just before the test, so I had to rent a car, and due to scheduling I had to drive several hundred miles home that night after taking the all-day exam.  I was exhausted and felt like I was losing my mind, as the story details.  I made it home safely, but the experience stayed with me for a long time.  I went over it again and again in my head, trying to figure out what had caused the feelings that arose that night.  As I often do, I used writing as a part of that process, and from these efforts, “Collision” was born.  This chapter is from a larger work of nonfiction in progress, “In Search of Grace: A Journey Through Medical School.”

COLLISION

            It will end here—
            Somewhere along this stretch of highway, painted black by sky, and winding toward the bridge that will lead me to another hour’s stretch of flat isolation and then, finally, home.  The dark is peppered with flashes of lights from other cars passing and from the edges of strip malls and warehouses, meant to project some semblance of life: the reliable and omnipresent retailer, ready to meet your every need, though at this hour even the covert scurrying of nighttime workers has long ceased.
            It will end in this rental car: economy size, a relatively recent model that never really caught on, painted a white so flat that the color seems stuck onto the outside like a version of the Colorforms from my youth, like perhaps this car isn’t real at all, is actually just a vinyl image pressed against a laminated backdrop of highways and buildings and trees.  It will end in this car or perhaps somewhere nearby if I have to leave it.

            There’s a shaky sensation that started awhile back: a wave of humidity arising beneath my skin followed by a round of prickly chills that rippled from my neck out to my limbs.  I recognized it as a drop in glucose and realized a single peanut butter sandwich consumed three hours before might have been insufficient. 
            But there is more now—a  vice working inside my head, not crushing but widening, pushing out, closer and closer to bursting my skull with each turn of the wheel.  My brain is pulling in on itself, dissolving all contact with its shelter, and I am doing the same, receding from any grasp I have on the universe or it on me.  The clenching in my core threatens to clamp down with finality.  I need to hold things together. But my brain  is now operating without me.  It is sucking my skin inward to collapse on my knotted core.  I want desperately to throw a switch, to release the pressure mounting in my skull, but such an unraveling can only mean death.  Is this what people feel when they are about to cross to the other side?  I am going to pass out or die or explode, I don’t know which; and they are all the same.
            I thought I just needed to eat.  For years, if I didn’t eat at regular intervals, I’d pass out.   The first episode occurred when I was twelve.  After a rowdy afternoon in a friend’s pool, I grew shaky and the circles of my vision telescoped down to pinpoints.  My parents thought that I must have played too hard and too long following an early, apparently inadequate, lunch.
            The second came to pass when I began a summer internship. I watched the doctor perform a very bloody procedure.  Instead of looking on in excitement, my field of vision and ability to regulate body temperature collapsed and I nearly did, too.  Since that episode I have carried emergency snacks wherever I go and developed a habit of prophylactic eating, filling up before I am really empty, just in case a twinge of hunger might arise and threaten my stability.  But what I had always neglected to recall were the games that day in the pool: competitions to see who could swim more lengths without coming up for air, and the terror that I felt as I followed that doctor into the exam room, terror that this early step toward becoming a physician might involve seeing something disturbing and possibly involving a lot of blood.
            Just in case this shakiness is fixable with food, I forage in one of the bags spilling into the passenger seat and grab an apple, taking quick bites despite its sour kick.  I had bought green apples, forgetting that while my husband preferred these, I was partial to sweeter varieties.  I had also forgotten that I would be spending two weeks alone studying and didn’t need to consider anyone else’s taste.
            Next I reach for the trail mix, divided into individual plastic packets that are difficult to tear open while driving.  But the small serving size that had handily limited my snacking while studying—just a few cashews and almonds mixed with dried cranberries that glom together in sticky clumps in the corners—does nothing to stop my shivers.
            I am third in line at the tollbooth before the bridge, and I don’t know that I will make it.  I need to get out, I need help, but I don’t know where to find it.  To my right is a large building with lights on—a hospital, perhaps?  No, some sort of administration building, for police or the toll collectors.  Stupid.  Even if I pulled over and went inside, even if I could muster the wherewithal to get myself over there and explain myself, what could anyone do but look at me like the crazy person that I am?
            Searching for my wallet, my fingers find my phone.  I am close enough now, only forty or fifty miles from home.  I could call my husband and he’d come and get me.  He could collect me and any essentials; everything else—the car, the box of books, the suitcases—could be left for later.  The car would not make it back to the rental office on time and some of my things might be stolen but somehow everything would—as  he tells me over and over—turn out all right.  It’s late but he is awake anyway, set to pick me up when I return the car.  He will be confused, at first, when I tell him of this change.  Confused and perhaps irritated, even incredulous.  But when he hears the alarm in my voice, the tremor that I will only let creep into my throat once I have him on the line, I know he will come.  He will save me. 
            I remember, when I thumb the screen up to reveal the keyboard, why I haven’t already called.  The battery power in the corner of the screen has become a tiny red sliver, almost depleted.  I should have bought the charger for the car.  I shouldn’t have let our precarious finances tilt me toward such neglect.  I rationalize trips to the coffee shop and dinners out as things we need in order to stay balanced, but the extra dollars for the car charger felt wasteful and extravagant. 
            If I call and tell him that something is wrong and the phone dies before I can describe my location, he won’t be able to come and he’ll be left in a panic of his own.  If I describe my location but do it wrong … I know where I am for the purposes of following the route home, but if I had to direct him, really pinpoint where to find me, I might fail. I will not be saved.  If I use up the remaining battery life and then encounter something even worse along the way, if I have to pull over and someone comes along and tries to hurt me, I will wish that I had saved those few seconds to call and scream out even a subpar cry for help.  The remaining rays of life must be conserved. 
            The car ahead of me pulls through the tollbooth and I roll up slowly, carefully, lowering the window.  I turn my eyes toward the person in the booth, hoping to convey with the intensity of my gaze that I need help.  Please ask me if everything is ok.  Please figure out what to do.  She states the amount without lifting her eyes from her register and with unwieldy fingers, I pull out a few bills.  Better to give her too much and wait for the change she already has waiting in her other hand than to count out the wrong coins, and then have to dig and count again, because if she cannot help, then I must keep going.  I need to break down but I will not do so in a way that inconveniences those around me.  I readjust my gaze for one more try, but her eyes turn toward the steady trickle of lights behind me as she thrusts back my change. I pull back onto the road.  It narrows to three lanes and sweeps gently right as I work toward highway speeds.
            The bridge is next, with its elegant sloping cables and expansive views of the water.  Only one bridge has ever troubled me: the one in southern Connecticut where the Merritt Parkway overlooks the Sikorsky plant. For years the bridge’s surface felt corrugated.  A worrisome grinding sound would overpower the radio while the ridges jerked my car from side to side.  The bridge before me is smooth and flat, but as its massive stanchions lengthen against a background of emptiness, announcing that this is a structure of consequence, I know from the vacuum in my stomach that it portends my demise.  I could drive over the edge due to my own loss of control, but even if I keep my eyes straight and my hands at ten and two, another car could careen into mine.  I want the inside lane, where I can pretend the edge isn’t there.  But if someone hits me I may be forced through the middle barrier into the oncoming stream of cars, taking someone else out with me.  I compromise with the middle lane, breathing fast and covered in chills but unable to reach for food or water because even with both hands I can barely keep the car straight.  There is no whirring of grooved surface beneath, yet I feel shaken back and forth, hurtling at a speed that is well below the limit but feels much faster.  I cannot measure my progress or watch the darkly reflective bay pass beneath.  It’s not there and I’m not here.  Cars shoot out around me and pass in a frenzy, far too fast for this bridge, this night.  “Don’t you see, I’m not trying to block your progress!” I call in my head.  “I’m trying not to kill any of us.  I’m trying to hold on until it is safe to finally let go.”
            Relief makes the exit sign register almost too late.  I dart over and down the ramp that will spin me east.  As I change lanes I look over my shoulder, but out of habit, not caution, and I register the headlights as an observation rather than a danger.  I cross the dashed lines and think, “ This car might hit me if I don’t speed up; I’d better speed up right now.”  There is adrenaline, but instead of a rush, it is a sinking feeling.  When I pull forward enough that the car behind me is no longer bearing down, there is no great relief –simply the sense that one more task has been checked off a Sisyphean list.
            Through a layered consciousness, I am acting, aware of my actions, unable to cut through the strata to reach the me. I watch myself now.  I feel the hot-cold and the tightness, the sensations that pierce my brain while leaving everything around them soft and indistinct, and I observe myself feeling them.  But I don’t know how to make it stop.  Maybe if I just pull over and lie down on the asphalt and close my eyes… 
            I used to close my eyes while skiing sometimes, just for a few seconds, just to see how it felt.  It was exhilarating and eerily calming, and I only did it out on the wide-open trail when no one else was around.  Until I casually mentioned it to my dad one day as we headed into the lodge for lunch, and he told me sharply that I should never do it again.  Now sometimes it feels like my eyes never shut.
            I’m here with my eyes pried wide open because I ran away.  Because there are things I needed to escape.  There are the things I have to do: things like taking a medical licensing exam, completing residency applications, and making plans for the future.  Then there are the things that get in the way.  The husband who still can’t pinpoint just what he would like to do with his life and continues to sample a variety of options, never quite committing.  A father whose routine check-up led to blood tests, which led to a biopsy and a new entity in our lives, a cancer that keeps me wondering whether it is related to the habits I alternately rail against and ignore.  Is it here in place of the other outcomes I had feared or has it merely arrived first, as an omen?  A mother who never had a good memory but who, in her advancing age, has the endearing candor to reveal each time a thought has slipped away.  Each admission leaves me tortured, on edge to see if she will be visited by the same disease that ravaged her own mother.  And there is my own life, with the deafening collision between what I am told I should desire and what I think I might actually—if  I have even retained the ability to pick my own thoughts out of the din—want. 
            I ran away to a vacation home in the mountains to try to focus my efforts on just one task: preparing for the exam.  I went alone, hoping that the complications might stay behind, and assured everyone who would listen that I would be fine on my own.  As I arrived and unpacked, the corner shadows grew murkier than I had remembered and the evening settling noises in the walls rang unfamiliar.  I dug through closets stocked with homey items, outfitting chairs with flowery cushions and the bathroom with toiletries.  I moved the bottle of nail polish out of sight, praying I would not want to drink it.
            The emptiness echoed in both daylight and dark, begging to be filled.  Ideas that had no business being there began to crowd my head.  They inhabited the space that my going away had left open, space that I had intended to pack neatly with medical facts and the side effects of drugs.  Sitting outside with a review book, I brushed away hovering bees and it occurred to me that I had no idea if I was allergic.  Suddenly this hole in my knowledge felt egregious, dangerous.  If I should happen to be stung and happen to be allergic and happen to feel my throat beginning to close, there would be no one nearby to summon help.  Even if there were, the nearest hospital was surely unreachable in time.  I retreated inside.  From the couch I noticed holes in the screen door.  No amount of tape used to bandage them could quiet the buzzing that taunted my ears through the night.
            When it was time to take the test and come home, there was a funny smell and drips of gasoline pooling beneath my car.  A tow truck had to be called and repairs arranged, but it was the weekend and things would have to wait.  And so there is this rental car and this drive late at night.  And within it, this unraveling. 
            I flick on the radio and search through the stations.  Each holds my attention for seconds before the panic comes crashing through.  I try to sing the words, but it is a sad farce.  I land on the John Tesh Radio Show just as he is offering a helpful fact to his listeners.  I move to flip past it, but his voice is like a blanket, inviting me into its folds.  I pause, then begin to answer aloud— “Is that right?  How very interesting!”—swiveling the knob so that his voice blares back, filling the space around me. I make another reply and then it is his turn.  We grow loud, yelling now, the sound wrapping me tightly.  Back and forth we go, call and answer, traveling together through the boundless night.