Growing Up With a Deadline

The handful of children born with the devastating disorder known as Batten disease have a life expectancy of only eight to twelve years. Sammie just turned eight.

Sammie stares out the window, where the sun is just starting to replace the rain. Around her neck: a raspberry, pig-shaped pillow. She groans faintly as her mother places a tissue between her teeth to prevent a bitten lip, then covers her nose and mouth with a clear mask that has jagged pink projections — dinosaur spikes, simultaneously innocent and stern. Her feet are pointed, toes curled. A symptom of immobility, her mother calls them “ballerina feet.” Sammie’s arms twitch slightly as a small compressor starts up, emitting a sound like a muffled lawnmower.

The dino mask administers Pulmicort, a steroid that helps loosen mucus, which accumulates due to Sammie’s lack of motion. The twice-a-day treatment raises her oxygen levels in order to facilitate breathing and minimize the chance of pneumonia.

Sammie’s eight-year-old body is regressing due to a condition known as Spielmeyer-Vogt-Sjögren-Batten disease, commonly referred to as Batten disease, which occurs in an estimated two to four of every 100,000 live births in the United States.

Sammie smiles while on the backyard swing, known as “Sammie’s Oasis.”
Sammie smiles while on the backyard swing, known as “Sammie’s Oasis.”

When I first meet Sammie at her suburban home in Haskell, New Jersey, she is asleep on the living room couch, unaware of the ill-timed rainfall — gloomy weather for Independence Day. Her mother, Kamila Wojcicka, a thirty-one-year-old bookkeeper with curly blond hair and eyes like two swimming pools, is preparing for Sammie’s daily ritual while her fiancé, Matt DePeri, works in the yard. Matt, a thirty-year-old accountant, has been with Kamila for more than four years.

A vast collage of snapshots depicting Sammie at various ages hangs above the couch. Sammie was born on February 1, 2007. Healthy and radiant, blond and blue-eyed, at first she developed as expected, learning to crawl, walk, talk and play. An energetic kid — she cruised around in her miniature VW Beatle, splashed in the pool and pleasantly devoured her most favored food, chicken nuggets – though according to Kamila, “she ate everything you gave her.”

The first sign of illness, sudden and harsh, arrived on Easter, five years ago. Sammie wore her Sunday best, a pink and white dress. There was a family breakfast, followed by church and egg coloring. Later that night, as she drifted off to sleep watching her favorite movie, “Finding Nemo,” Sammie began to tremble and throw up, the discharge streaming from her nose. Her eyes rolled back and she turned purple, lifeless in her mother’s arms. Panicked, Kamila tried to clear Sammie’s airway, assuming that she was choking on her vomit. “Her jaw was clenched so tight,” she recalls, “that she almost bit my finger off.”

Sammie’s dinosaur mask, used to administer Pulmicort, a steroid that helps loosen mucus.
Sammie’s dinosaur mask, used to administer Pulmicort, a steroid that helps loosen mucus. 

Although the seizure lasted about three minutes, for Kamila, “it felt like a lifetime.”

At the hospital, Kamila spoke to multiple doctors, recounting the episode over and over. She got the impression that they either didn’t believe her or were baffled by the events and uncertain about how to diagnose Sammie.

Electrodes were attached to Sammie’s head as part of an electroencephalogram, or EEG, a test that measures electrical brain activity. She showed no irregularities, and after two nights of observation, Sammie was sent home, the seizure chalked up to a one-time, freak occurrence.

Two weeks later, at a local Best Buy, it happened again. This time, the EEG showed a slight aberration, an atypical spike in brain activity. Sammie was diagnosed with epilepsy and issued an initial prescription, unsuccessful at reducing the biweekly seizures.

It took a demanding cycle of trial and error for Kamila to determine a functional combination of medicine to prevent Sammie’s frequent seizures. Today, with the aid of several medications, specifically, Keppra, Onfi and Depakote, the incidences have significantly tapered. Still, Kamila is always prepared. If a seizure lasts more than two minutes, depriving Sammie of oxygen, she administers rescue medication — a large gel-filled syringe to be injected rectally.

* * *

After fifteen minutes, the dinosaur mask comes off. Next, Kamila wraps a pad with two protrusions that resemble PVC pipe elbows around Sammie’s thin midsection and attaches two corrugated hoses. When she turns the machine on, Sammie begins to vibrate and shake. Although not violent or painful, it’s a jarring sight, her slender body starting to blur, the movement a stark contrast to her unconscious, placid face. The resulting sound is similar to a power drill, but their teacup Yorkie, Misiu (“Teddy Bear” in Polish) and Sammie’s nine-year-old cousin, Nikola, visiting from Poland, sit by her side on the couch, unfazed. They see the vest treatment, which pumps and pounds air into her chest, up to five times a day, depending on her mucus build-up. For Sammie, this is just another part of breathing.

Sammie, aged nine months, stands in her crib. (Photo courtesy Kamila Wojcicka)
Sammie, aged nine months, stands in her crib. (Photo courtesy Kamila Wojcicka)

Batten disease is named after British pediatrician-cum-neurologist Frederick Batten, who initially described it in 1903. It is a neuronal ceroid lipofuscinosis, or NCL, which refers to lipofuscin, a fat-like substance that accumulates in the lysosome, the cellular portion responsible for processing unwanted material. In patients with Batten disease, the recycling system of the lysosome is disrupted due to an enzyme deficiency. The resulting accretion of brain cell waste classifies Batten as a lysosomal storage disorder, alongside Tay-Sachs disease.

NCLs are subdivided by onset age into infantile, late infantile, juvenile and adult forms. Sammie is affected with classic late infantile or LINCL, associated with the mutation of the CLN2 gene and the absence of an enzyme known as TPP1. With LINCL, symptoms like loss of sight, speech, motor skills, as well as dementia and seizures, appear between two and four years of age.

It is an autosomal recessive disease, which means that both parents must each contribute a copy of the defective gene. With two carrier parents, the child has a one in four chance of developing the disease and a one in two chance of becoming a carrier.

There is no known treatment that can arrest or reverse the symptoms of Batten disease. The corresponding seizures can be mollified with anticonvulsant drugs and physical and occupational therapy may help some patients slow the decline of motor function. However, the disease is always fatal, with a life expectancy of eight to twelve years for LINCL, Sammie’s form.

It was a daycare teacher who initially spotted signs of Sammie’s receding cognition. A year after her first seizure, she was back in school, her seizures stabilized with the aid of medicine. But the instructor pulled Kamila aside one day, noting that Sammie’s participation in circle time had diminished. More alarming was her sudden inability to recall colors and shapes. Attributing the lapse to a side effect, Kamila adjusted Sammie’s medication, but to no avail. After a visit to a speech therapist proved fruitless, other symptoms began to manifest. Sammie started to trip, constantly, one foot slightly dragging. When the orthopedic specialist found nothing wrong, their neurologist recommended seeking the opinion of a medical geneticist.

Sammie swimming during the summer of 2012 and loving every second of it. (Photo courtesy Kamila Wojcicka)
Sammie swimming during the summer of 2012 and loving every second of it. (Photo courtesy Kamila Wojcicka)

Nine months of rigorous testing followed. Mitochondrial disease was the first to be eliminated from the list of suspected ailments. Sammie spent hours at Hackensack Medical Center in New Jersey, giving blood and muscle tissue and moving down the list of potential diseases, starting with the most probable. Eventually, a visiting neurologist reviewed the file and suggested that the genetic doctor check for Batten disease, a test that was still months away due to the rarity of the condition.

The doctors told Kamila not to worry, to shun Google and to enjoy her upcoming Christmas. After all, the disease was so uncommon that the chances were minuscule; the test was merely a precaution, a checkmark.

Of course, Kamila rushed to her computer. “That was a long Christmas,” she recalls, “I just kept reading about it.”

* * *

Kamila removes the vest and lifts Sammie’s Hello Kitty shirt to plug a skinny, clear tube into a circular plastic opening extruding from her stomach. I notice her daughter’s name inscribed in cursive on the inside of her wrist. Next to the bed, an IV stand holds a transparent bag, milky liquid inside. Kamila presses a button and the tube turns white, initiating a low, intermittent whirring sound.

Sammie’s bedroom and the IV stand that holds the feeding equipment. (Maria Edible)
Sammie’s bedroom and the IV stand that holds the feeding equipment.

This is every meal for Sammie — breakfast, lunch and dinner. The lacteal liquid is PediaSure, the plastic aperture in her stomach is a gastrostomy tube or G-tube, surgically inserted two and a half years ago. She twitches, her eyes gradually opening and closing as her mom carefully wraps a leopard-print blanket around her bare feet.

The blanket, part of a collection, earned Sammie the moniker “leopard girl” at the hospital. Even her custom-made orthotics to realign her pointed feet are leopard. So is her back brace, intended to counteract the severe scoliosis from constant sitting. The rest? Hot pink. Her wheelchair, embellished with her name, is black and pink. “She has the coolest ride,” Kamila says, looking at Sammie fondly.

The famous leopard-print blanket. (Maria Edible)
The famous leopard-print blanket.

The process takes over an hour so we retreat to Sammie’s bedroom, leaving Nikola to watch her. The room is standard little girl territory — pink walls, ubiquitous flowers, glittering princesses. There’s a television guarded by Mickey and Minnie, a small pet bed, a cumulative family handprint. As my eyes adjust to the pink, I start to notice the anomalies in the room. There’s a suitcase-sized tank at the foot of the bed to boost Sammie’s erratic oxygen saturation, and a little camera above the pillow. Previously used to monitor Sammie’s nighttime health, it’s no longer operational due to Kamila and Matt’s new sleeping arrangements — a mattress laid out on Sammie’s floor.

Sammie’s hair accessories. (Maria Edible)
Sammie’s hair accessories.

A massive cluster of hair decorations hangs on the wall – sparkly barrettes, flower-topped headbands, patterned bows. There must be at least a hundred. “I can’t buy her toys so I make up on all her accessories,” Kamila says, “I try to make it cute.”

A white terrycloth bunny is tucked behind a chair, ears flopped forward. “That was her best toy,” Kamila tells me. “It came with us to hospitals, pretty much everywhere.”

On January 3, 2012, Kamila received the long-awaited phone call from the geneticist’s assistant. Clutching the phone, she left her office, a realty company, and hurried to the parking lot. “I heard it in her voice,” Kamila recalls with a deep breath. “It wasn’t good news.” The test was positive.

Frantic, Kamila ran back inside and called Sammie’s father, Luke, from whom she’d separated in 2009.

“It was like a death sentence,” Kamila says, her eyes glistening blue under dark lashes. The doctors, including the neurologist, pregnant at the time, were choked up, in disbelief. They had never worked with a Batten child before.

“I don’t even think I go back in my head to that day,” Kamila says, sitting on the edge of Sammie’s bed. “You just grab on to what you have now.”

After the diagnosis, Kamila was contacted by The Make-A-Wish Foundation, which arranged experiences for children with life-threatening medical conditions. Sammie, whose health was deteriorating at a rapid pace, was anonymously nominated. At this point, she could no longer walk without assistance and retrogressed to crawling. Her speech was also curtailed, limited to words rather than full sentences. Sammie started to refuse food, save for one exception: her favorite snack, Lay’s Sour Cream & Onion potato chips. “I’d give her the chips so she’d eat something, anything,” Kamila recalls.

Sammie’s doctors recommended an experimental clinical trial conducted by Weill Medical College at Cornell University. As part of ongoing Batten research that included other children, Sammie would receive a brain injection – a harmless virus bearing the corrected gene. Known as gene therapy, this procedure has been used in an attempt to treat a variety of genetic disorders in a research setting since 1990. The intention was to see whether the introduction would limit disease progression, a hypothesis with no guarantee for Sammie.

The surgery was not without risk. Post-operative infection, surgical hemorrhage, status epilepticus — a continuous or recurring seizure that can be fatal — and a severe reaction to the anesthesia were all possibilities. There was a chance of coma, even death. The operation and the concomitant hospital visits would place tremendous stress on Sammie’s already weakened body.

A hospital stay in December 2013 after a seizure. (Courtesy of Kamila Wojcicka)
A hospital stay in December 2013 after a seizure. (Photo courtesy Kamila Wojcicka)

Although there was no promise of improvement, for Kamila, it was something — a prospect, a glimmer of hope. “When it comes to your child, you think, she could be one in a million,” Kamila says. She knew she had to accept the risks. “I don’t think I’d be able to live with myself if I had an opportunity and didn’t take it,” she says.

After a period of testing to ensure she qualified, Sammie was admitted into the clinical trial, the operation scheduled at New York-Presbyterian Hospital.

Prompted by the hospital staff, Kamila reached out to an Ohio family whose daughter previously had the surgery. She saw the post-op photographs and heard the recovery stories. “The reality hit — these are real people living what you are about to live,” Kamila says. Consequently, she discovered a Batten Facebook group and met parents from the world over. Through their testimonials, she prepared herself for the imminent symptoms of the disease and acquired the proper equipment. The online network of new friendships would prove to be invaluable in terms of emotional support, each family proffering encouragement and at times, sharing the grief of a lost child.

On June 19, 2012, Sammie arrived at the hospital. “She wasn’t scared,” Kamila says of her then five-year-old. Before the surgery, Sammie spoke, albeit much less, but never asked questions. To prepare for the six holes that would soon be drilled into her skull, the medical staff shaved two strips on each side of her head, braiding the top. Then, they put Sammie under anesthesia.

“I’ll never forget the waiting room,” Kamila says, “the people, the smell, the cold.” She sat there for eight crawling hours, in limbo, until the surgeon finally came out. Sammie had made it through the surgery without any complications. They followed Sammie, bandaged and groggy, to the Pediatric Intensive Care Unit. That night Kamila lay awake, listening to every beep.

After the surgery, Sammie stayed at the hospital for a week, the doctor noting her surprisingly quick and promising recovery. In the coming months, she returned for multiple check-ups, each regulated by the same trifecta of tests – MRI, spinal tap, eye exam. Sammie spent hours, both awake and sedated, at the hospital. “She was really tough,” Kamila tells me, “she didn’t complain.”

Kamila brings Sammie into the bedroom so she can monitor her breathing and clear any mucus. She places her on the bed next to a bubblegum pink throw pillow that says “Smile.” Nikola wheels in the IV stand, the bag, now half empty, swinging side to side. The sound of the pump stops and goes, whirring and pausing until it becomes part of the room, almost unnoticeable.

In September 2012, courtesy of Make-A-Wish, Sammie visited Disney’s Magic Kingdom. Although she was no longer walking and had a customized stroller, Sammie was able to go on several accessible rides. She loved the colors and music of the “It’s a Small World” boat ride.

Sammie kissing Mickey Mouse’s nose during her Make-A-Wish trip. (Courtesy of Kamila Wojcicka)
Sammie kissing Mickey Mouse’s nose during her Make-A-Wish trip. (Photo courtesy Kamila Wojcicka)

However, nothing compared to the joy of meeting the inimitable Mickey Mouse. “She looked up and saw him,” Kamila says, beaming at the memory, “grabbed him by the nose and tried to kiss him.”

* * *

The disease progressed in stages, as Kamila learned. It started with haphazard screaming and crying fits, which continued for months. Dystonia came next, a disorder characterized by involuntary muscle contractions. Sammie would twitch and shake, twist and tense, in tears from the fatigue. Eventually, with the aid of medicine, the symptoms abated.

In the three years following the diagnosis, Sammie lost her ability to interact with the world. Completely blind for two years now, her cognitive function has eroded and she can no longer talk. “I can’t remember the last time she spoke,” Kamila says, a pink curtain shivering softly behind her, “I don’t even remember what her voice sounds like.”

As if on cue, Sammie expels a desperate sequence of wet coughs. Kamila is prepared, and in seconds, a large clear wand is inside Sammie’s mouth. There’s a loud jackhammer sound, followed by a suctioning reminiscent of a dental visit. Sammie gurgles and Kamila rubs her chest, which elicits a barely perceptible moan.

I’m told that Sammie’s cough is adequate to expel any mucus, negating the need to deep suction. Kamila brushes a strand of hair from Sammie’s face, brown with a hint of gold, a throwback to her childhood tresses.

I ask about Sammie’s signature expression. Kamila’s Facebook page is full of photographs — images of baby Sammie alongside those of ill, bedridden Sammie, united by one common element: her smile. “She was the happiest baby ever,” Kamila tells me. Even after the disease took hold, Sammie’s grins were abundant, easily generated by a noise or scream. She still smiles, ostensibly unprompted, an arbitrary gift to her family. “I don’t know what makes her smile these days,” Kamila says pensively, mourning the lost ability to amuse her daughter. She looks at Sammie, rubbing her feet – “It’s what we miss the most.”

Sammie can still hear, as confirmed by an auditory test. In response to voices, Kamila notices minor changes in her daughter’s expressions, hints of passing recognition in her eyes. Sometimes, she even plays Sammie’s beloved “Finding Nemo.” “I feel like her eyes get bigger and she’s listening,” Kamila says.

Kamila no longer watches videos from Sammie’s childhood – it’s too painful. Laughing wistfully, her tan face accented with two protracted dimples, she describes an inexorably happy toddler with an affinity for Spongebob Squarepants and inappropriate words. At two and a half, Sammie dropped an F-bomb in the middle of her daycare classroom. Having heard the phrase “What the fuck?” on television, she used it with precocious precision, stretching each word like taffy, hands flung in the air with adorable exasperation.

Today, Sammie cannot walk or even move her limbs, aside from involuntary spasms. In an attempt to recover motor function, she attends daily physical therapy sessions at The Children’s Therapy Center, a school for kids with disabilities.

She also participates in school events like the annual Halloween parade. Last year, using paper and feathers, Kamila constructed a Native American teepee over Sammie’s wheelchair. The previous year, she transformed it into a carriage – Sammie, a little princess, nestled inside. In the evening, the family engages in a modified version of trick-or-treating – a door-to-door distribution of Batten disease awareness flyers.

Sammie, who still visits her biological father twice a week, isn’t excluded from any activities and accompanies Kamila and Matt to restaurants, malls, parks, lakes, movies and even the July 4th fireworks.

The family recently returned from a vacation at the New Jersey shore. They spent hours on the beach in Wildwood – “The ocean air was great for Sammie’s lungs,” Kamila says, noting that her chest treatments were cut in half. Sammie, who has always loved the water, swam in the hotel pool with her mother’s assistance.

As if prompted by the summertime memories, a subtle smile appears on Sammie’s face. “Are you smiling?” Kamila leans toward her, voice elevating in pitch as if talking to a baby. She kisses her daughter and lingers for a moment, a vignette that seems to suspend time.

The field trips are never simple. “How do you change an eight-year-old child’s diaper in a restaurant?” Kamila asks, shaking her head. Sammie, who was fully potty-trained, reverted to wearing diapers at age five, after the Batten diagnosis. Now Kamila always carries a blanket.

Placing her into the car seat is an effort as well – she’s 75 pounds and unable to hold on. There are also travel essentials – suction, feeding, medicine, a portable oxygen machine. “It’s second nature now, like bringing toys or snacks,” Kamila says.

Still, she doesn’t complain. “I don’t find taking care of her difficult. This is my life,” Kamila says. She looks over at Sammie, who appears to be asleep, her head drifting to the side of the pillow, almost obscured from view. “I think what’s going to come after is the most challenging,” she tells me, quietly.

Behind her, two plaques pop from the wall, brandishing the same words: “I love you to the moon and back,” the family’s private saying, printed on blankets, pillows, shirts.

Reminders of love in Sammie’s room. (Maria Edible)
Reminders of love in Sammie’s room.

Sammie’s meal is complete and Matt carries her through the doorway, angling her to fit. She’s 4’3”, tall for her age. Matt, his shaved head generously freckled, is also trained to care for Sammie. His mouth is rigid, tightly drawn – a firm disparity from the affable grin that quickly stretches over his face, tiny crinkles springing up underneath reddish eyebrows.

I follow them outside, down a long wooden wheelchair ramp, through the grass and underneath a large canopy, zippering the mosquito netting behind me. Misiu breaks through the bottom, immediately attacking a soccer ball, almost taller than him. “They are best buddies,” Kamila says. “He always sleeps on her legs and cuddles with her.”

Sammie is laid out on a large swing, known as “Sammie’s Oasis,” covered by her trademark spotted blanket. It starts to drizzle, the drops creating small, dark circles, fleeting polka dots on the canopy. There’s an obvious change in demeanor – she appears more animated, alert. Her eyes open, sparkling, she sways back and forth, in sync with the rhythmic squeaking of the metallic bars. All of a sudden, another smile wanders onto her face, settles for a moment and disappears.

Kamila, excited by her daughter’s expression, strokes her face gently. “At this point, I just want her to be comfortable and happy,” she says.

Sammie will likely continue to regress into a vegetative state throughout what is predicted to be the final third — or less — of her life. However, she also faces the risk of sudden epilepsy-related death, as well as an increased chance of fatal infection, particularly pneumonia.

The gene therapy clinical trial, initially supposed to be eighteen months, was extended with regular phone interviews. The official results are not issued until a study ends, and although Sammie’s condition has indubitably worsened, it’s difficult to conclude whether the surgery actually slowed the rate of deterioration.

Kamila is no longer fixated on experimental treatment options. Due to her participation in the Cornell clinical trial, Sammie is barred from inclusion in others, as multiple treatments would confuse the outcome, rendering the results invalid. For LINCL, in addition to gene therapy, there are several ongoing studies that focus on stem cell transplantation and enzyme replacement.

The advancement of Batten research is hindered partially by limited government appropriation for rare diseases, says Dr. Margie Frazier, executive director of the Batten Disease Support and Research Association. Additionally, uncommon disorders like Batten are less known, even in the research community. According to Dr. Danielle Kerkovich, the principal scientist at the Beyond Batten Disease Foundation, an organization created in 2008 to accelerate research for diagnosis and treatment, there is simply little data for new scientists to put together solid hypotheses and subsequent research proposals.

Kamila has felt the effects of this. “You have no idea how many doctors I came across who didn’t even know what Batten was,” she says. As a result, she runs her own website, bringingsammiesmiles.com, a campaign for awareness, attention and research, with baby blue wristbands for sale.

. “At this point, I just want her to be comfortable and happy,” says Kamila. (Maria Edible)
. “At this point, I just want her to be comfortable and happy,” says Kamila. 

Batten recently made unprecedented headlines when movie producer Gordon Gray, known for inspiring sports films like “Invincible” and “Miracle,” launched a website campaign, curebatten.org, to fund research for treatment options and ultimately, a cure. In March, Gray and his wife, Kristen, learned that both of their daughters have a variant of LINCL, distinguished from Sammie’s classic form by a specific gene mutation. Although multiple celebrities have promoted Gray’s cause through social media, the immediate clamor of publicity has since ceased.

* * *

A week later, I visit The Children’s Therapy Center where Sammie attends her daily therapy classes.

After a dimly lit and relaxing yoga session nearly puts Sammie to sleep, she’s back in her chair for music therapy.

The instructor plays an acoustic guitar, its dark wood mirroring her hair. “Everybody’s smiling,” she sings in a silvery voice, calling out each child’s name. There are drum sets, xylophones, bells and tambourines. Sammie waves a wicker shaker, with help from her therapist, Kelsey. It makes a frenzied scratching noise, a distinct addition to the orchestra. The room is filled with sound – clangs, clinks, bangs, jingles, rattles and twangs. There’s laughter and encouragement and with Kelsey’s assistance, Sammie claps, stomps, shrugs, nods and wiggles. She seems to come alive with the music, wide awake now.

When I leave, I pass through a little garden, part of the school’s horticulture program that Sammie participates in. It’s a sensory, hands-on experience, a chance to create something. Tin watering cans, painted stones and bird feeders are sprinkled all over. There are white clusters of flowers that resemble snowflakes and fiery marigolds. I think about Sammie, who received her First Communion two days ago, and wonder which flower is hers. It begins to rain again, and when I drive away, I can’t help but send Sammie one more smile.

I’m Married. I’m a Woman. I’m Addicted to Porn.

Countless couples have tackled the taboo subject of racy videos and illicit orgasms. What happens when it’s the woman who can’t stop watching?

This story features explicit situations that may not be suitable for all audiences.

It’s past two a.m. and my husband’s breathing has become long and even. An opportunity presents itself. I slip my right hand down my pajama pants and move slowly, careful not to bump my elbow into his side rib, or bring my hips into it. Too much movement or sound will wake him, and to be found out for something like this is not just embarrassing but potentially destructive. He’ll think he doesn’t satisfy me, and men do not like feeling inadequate, especially when it comes to matters of the bedroom. Or maybe he’ll feel sorry for me. And who wants to fuck someone they pity?

Even worse, maybe he’ll finally say the words I’ve been waiting for him to say since I first told him that I am a sex addict. That he’s bored with it. He’s disgusted. He’s had enough.

I lift my wrist away from my body. I’m careful to keep my breath from becoming a pant, even as my pulse quickens, but this takes much concentration. The body desires the convulsion the mind denies. There is no letting go here though. This orgasm is a controlled, measured, calculated experience.

I have masturbated in this way next to the sleeping bodies of all my serious, committed partners who came before my husband. In some cases, as expected, it was because I wanted more sex than they could give me. I’ve been called “insatiable” and “demanding” one too many times. But this has not always been the story. Yes, I have an incredibly high sex drive, but even in relationships where I have great sex multiple times a week my nighttime stealth for self-pleasure has persisted.

My college boyfriend, burgundy haired and tattooed, had the high sex drive typical of most nineteen-year-old males. We fucked all the time, but even still, I wanted more, something only I could give me. One afternoon, after he’d fallen into a deep post-sex slumber, I serviced myself with my second, third, and fourth orgasm beside him. That was the first time I’d experienced such a level of both secrecy and shame.

I made a promise to my husband and to myself, long before we were even wed, to be austerely honest. He knows I’ve been a compulsive masturbator since I was twelve years old. He knows about my extensive fluency in the hardcore categories of various porn sites. He knows about the bad habit I used to have of hooking up with not-so-nice men because they were available and I was bored — and that I rarely used protection with any of them. And that I believed, for a really long time, that my addiction made me a broken person, a disgusting person, a person unworthy of love. I told him these things from the start because I met him at a time in my life where I was ready and open for change. Because I liked him so much that I wanted to love him. Because I knew that the only way to love him, and be loved by him, was to be myself.

* * *

“What’s your favorite porn scene?”

The man who will become my husband in less than a year asks me this question as he lies naked and vulnerable beside me. We’ve just had sex and although I am naked too, it isn’t until this moment that I feel just as vulnerable as him. While it might seem absurd to some, I know immediately this is a moment of great significance for us. It is an opportunity to finally do things differently.

The possibilities run through my head.

I can describe something vanilla: This one where a busty blonde gets banged by her personal trainer. Or perhaps something a little more racy: These two hot teens swap their math teacher’s cum after he made them stay late in the classroom. Chances are he’ll get hard again and we’ll end up abandoning the conversation for a second round. These are harmless answers. Expected answers.

They’re also lies.

The possibility of revealing the actual truth not only makes me nervous, but also physically sick. I feel a constriction in the back of my throat, a flutter in my belly, a tremble in my extremities. After all, we’ve only been dating a couple of months and he doesn’t love me yet. If I tell him, will he ever?

“Why do you ask?” I reach for the sheet, damp with sweat, a tangle of 300-thread-count cotton across our limbs, and yank it up to cover my breasts.

“I don’t know,” he says. “Curiosity?” He turns over on his side and props his head up on his left hand. His green eyes are wide with wonder.

“Seems like a weird question.” I tuck the sheet into my armpits and scoot my body a little to the left so we’re no longer touching. The tone of my voice has become defensive and he can tell.

“It’s just that I usually pick the porn,” he explains. “Do you like what I choose?”

I see what he’s doing. He’s trying to be considerate since we just had sex while staring at the laptop screen after searching terms of his choosing: Latina, real tits, blow job, threesome.

Maybe he feels guilty for getting off to them instead of me, even though I’m the one who suggested we watch porn in the first place. Even though I’m always the one who suggests we watch porn while we have sex.

“Yeah, sure.” I look up at the ceiling. “They’re fine.”

“Are you sure?”

I wish he’d stop prying, but I realize something else is happening here. Not only is he trying to be considerate; he’s also trying to get to know me. The past couple of months has allowed us to cover most of the basics — what ended each of our most recent relationships, what our parents are like, what we hope to do with our lives in the next few years — but there’s still a longing for something deeper, and I can’t think of anything deeper than knowing a person’s favorite porn scene.

It can speak volumes. For one scene to stand out amongst the rest, when so many others are available, there has to be something below the surface. What maintains its appeal? What keeps a person returning in the deep, dark recesses of a lonely night? Perhaps the answers to these questions are a great source of shame. I never thought of revealing such answers to anybody, and especially not somebody like him, somebody I could really like. It seems far too risky, preposterous even.

It also seems necessary. Too many of my past relationships were doomed by my inability to tell the whole truth, to fully be myself. Now I have the opportunity to go there, and to say to a person, “This is who I am. Do you accept me?”

“Well, there’s this one gang bang,” I start, looking over at his face to see a reaction of surprise and interest register at once.

“Go on.”

I take a deep breath and proceed to tell him, first slowly, then progressively faster about the scene. Like a busted dam, I can hardly hold back the rush of descriptors fumbling from my mouth: “Two women in a warehouse. One dangling from a harness. The other just below her. Both are waiting to take on fifty horny men…” and on and on.

I watch his face the whole time, not pausing when his smile becomes a frown and his eyes squint as if it hurts to look at me.

“Afterward, the women exit the warehouse through a back door while the men applaud.”

For a long moment after I’ve finished talking, there is silence between us, but there is also a sense of relief on my part. I have revealed something so dark, so upsetting, so impacted in shame, and he hasn’t immediately disappeared. He is still here beside me, propped up on his left hand, naked and vulnerable, and so am I. He sees me and I see him seeing me and we are in new territory.

But then he says, “I kind of wish I hadn’t asked.” It’s all I need to hear to send me into tears. Not just tiny, embarrassed sobs, but humiliated wails. I have myself a tantrum. He is confused now as he pulls me close to him, laughing nervously at my abrupt shift in disposition. I try to pull the sheet completely over my head, but he pulls it back down and covers my face with apologetic kisses. He can’t possibly understand why I’m crying. He can’t possibly know what I’ve just revealed to him. “What’s going on? Baby, what’s wrong?”

And so I tell him.

* * *

Addiction to porn and masturbation is often grouped under general sex addiction because they all have to do with escape via titillation, pursuit and orgasm, but I’ve always felt more pathetic about my predilections. Going out and fucking — even someone you don’t really like — is wild, dangerous, but essentially social and shared. Though I had periods of promiscuity throughout my twenties, my biggest issue has always been with what I do alone.

There’s something so sad and humiliating in imagining a person locked away in a dark room, hot laptop balanced on chest, turning the volume down low, scrolling, scrolling, choosing, watching, escaping, coming.

And then realizing that person is me.

But my proclivity for solo pleasure has strong, stubborn roots. I lost my virginity to a water faucet when I was twelve years old. I have Adam Corolla and Dr. Drew to thank for this life-shaking experience; it was their late-night radio show “Loveline” on L.A.’s KROQ that served as my primary means of sex ed during my pre-teen years. This technique is one of the many things I learned, but I had a whole other kind of education going on, which had long filled my head with other ideas — sex is something that happens between a man and woman who love each other; masturbation is a sin. You know, your typical run-of-the-mill Catholic guilt stuff.

Just as oppressive as the Catholic guilt was my femininity. Girls weren’t talking about masturbation and sex. I had no company with whom to share my new activities and interests. And so this silence morphed into shame. I became a pervert, a loser, a sinner.

I tried to stop myself from taking long baths, from late-night undercover activities, from being alone too long, but the more I obsessed about stopping, the more I could not. I joined shame, secrecy and pleasure in a daily orgy, whether I was tired, bored, angry or sad. Whether I was single or coupled, it didn’t matter. Getting off required all of these components and I needed new, more extreme methods to stay engaged — more hours sucked away watching progressively harder porn like the warehouse video, complemented with dabbles in strip clubs, peep shows and shady massage parlors. It became impossible to get off during sex without fantasy, my body over-stimulated to numbness. I was irritable unless I was fucking or masturbating or planning to do either of these things. Life revolved around orgasm to the detriment of any kind of real progress in my professional or social existence.

I was out of control.

* * *

Little did I know that describing my favorite porn scene would be the first of many future admissions that would help peel back, layer by layer, a long and exhausting history of self loathing. My future husband and I quickly learned that watching porn during sex wasn’t a harmless kink for us; it was a method I’d long used to remain disconnected from my partners. It took much discipline and patience for us to expel it from our relationship altogether, though every now and then we slip up.

Talking about my habits led me to examine them, which ultimately led to my desire for change. Holding a secret for too long is like being unable to take a full breath. I didn’t want to feel this way anymore. I needed to share — often and fully — what had for too long been silenced in order to reclaim who I was underneath my addiction. I needed to breathe again.

I found relief in Sex and Love Addicts Anonymous meetings, seeing a therapist I trusted, attending personal development courses like the Hoffman Process and writing about my journey. I’ve managed to move away from porn for the most part, but when it comes to this addiction — to something I don’t have to seek out or purchase — control is like a wayward horse and my ass is always slipping off the saddle.

I constantly struggle with whether or not I should give up porn completely, but until I find a way to have some moderation with it, I avoid it as best I can. I wish I could just watch it occasionally, as some sort of supplement to my active sex life, but the whole ritual of watching porn is tangled up in too many other negative emotions. Watching porn takes me back to being that little girl alone in her bedroom, feeling ashamed and helpless to stop it. I can’t just watch one clip without needing to watch another after that, and another, until hours have passed and I’m back to binging every night.

If my husband leaves me alone all day and idleness leads me to watching porn, it’s the first thing I confess upon his return. Sometimes I don’t even have to say it. He can tell by my downturned eyes and my noticeable exhaustion. He shakes his head and takes me in his arms as I make another promise to try to leave it alone. When I visited a peep show on a recent work trip out of town, he seemed more amused than upset about the whole thing.

Unfortunately, I have yet to be as generous. If I find he’s been watching porn without me, when I’ve struggled to abstain for a stretch of time, I react with what might seem like unjustified rage. This frustration is only rooted in envy.

* * *

Masturbating beside my husband while he sleeps is the last secret I’ve kept from him. Although I’m beginning to fear that it’s actually just the latest secret. My resistance in telling him only proves how fragile recovery is. This week it’s masturbation. But maybe next week it’s back to porn binging. Or obsessive scrolling through Craigslist personals. Or lying about my whereabouts. And so forth. Abstaining from these habits, when so readily available, without abstaining from sexual pleasure completely, or the shame I’ve long bound to it, is a challenge I face daily.

That’s why I need to tell my husband.

Not because I need his permission, his forgiveness or to offer him some act of contrition. But because I need him to see me. To witness. The act of telling the truth, especially about something that makes us ache, is often the only absolution we need.

Want to know more? Check out our behind-the-scenes interview with Erica Garza on Continuing the Narrative.

The Day My Therapist Dared Me to Have Sex With Her

My analyst and I grew more intimately connected each week of treatment...but I never saw this indecent proposal coming.

It’s the waning moments of my fourth session with a new therapist. I’m holding back — and she knows it. My entire body feels tense, not ideal for the setting. I try to relax, but the plush leather couch crumples under me when I shift, making the movements extraordinary. I’ve barely looked into my therapist’s blue eyes at all, and yet I think the hour has gone very well. Of course it has. On the surface, when the patient has been highly selective of the discussion topics, therapy always resembles a friendly get-together.

“Well,” my therapist, Lori, says, the millisecond after I become certain our time is up and I might be in the clear. “I don’t think I should let you go until we’ve at least touched on what was put out there at the end of last week’s session.”

I so supremely wanted this not to come up. My eyelids tighten, my mouth puckers to the left, and my head tilts, as though I’m asking her to clarify.

“When you said you’re attracted to me,” she continues.

“Oh, yeah,” I say. “That.”

Back in session three Lori was trying to build my self-esteem, the lack of which is one of the reasons I’m in treatment. Within the confines of my family, I’ve always been the biggest target of ridicule. We all throw verbal darts around as though we’re engaged in a massive, drunken tournament at a bar, but the most poisonous ones seem to hit me the most often, admittedly somewhat a consequence of my own sensitivity. I’ve been told it was historically all part of an effort to toughen me up, but instead I was filled with towering doubts about my own worth. And since 2012, when I gave up a stable, tenured teaching career for the wildly inconsistent life of a freelance writer, I’ve had great difficulty trusting my own instincts and capabilities. I told Lori that I wish I was better at dealing with life’s daily struggles instead of constantly wondering if I’ll be able to wade through the thick.

She quickly and convincingly pointed out that I work rather hard and am, ultimately, paying my bills on time, that I have friends, an appreciation for arts and culture, and so on. In short, I am, in fact, strong, responsible and “pretty good at life.”

Then Lori heightened the discussion a bit. “I also feel that it is your sensitivity that makes you a great catch out there in the dating world,” she said, to which I involuntarily smiled, blushed and quickly buried my chin in my chest. I was too insecure and too single to handle such a compliment from a beautiful woman.

“Why are you reacting that way?” Lori asked.

I shrugged my shoulders, only half looking up.

“Is it because you’re attracted to me?”

I laughed a little, uncomfortably. “How did you know?”

She gently explained she could tell the day I walked into her office for the first time, after I flashed a bright smile and casually asked where she was from.

Now, a week after dropping that bomb, Lori asks, “So, why haven’t we talked about it?”

“I was hoping to avoid it, I suppose.” I tell her the whole notion of having the hots for a therapist is such a sizable cliché that I was embarrassed to admit it. “For Christ’s sake,” I say, throwing my hands up, “Tony Soprano even fell in love with his therapist.”

Lori snorts, rolls her eyes. “I knew you were going to say that.”

I smile, shake my head and look around the room, denying acceptance of my own ridiculous reality.

“It’s OK,” Lori says, grinning. “We can talk about this in here.”

I look again at her stark blue eyes, prevalent under dark brown bangs, the rest of her hair reaching the top of her chest, which is hugged nicely by a fitted white tee under an open button-down. She jogs often, I’d come to find out, which explains her petite figure and ability to probably pull off just about any outfit of her choosing.

I still can’t speak, so she takes over.

“Do you think you’re the first client that’s been attracted to their therapist?” she asks rhetorically. “I’ve had other clients openly discuss their feelings, even their sexual fantasies involving me.”

“What?” I cackle, beginning to feel as though I’ve moseyed onto the set of a porno.

“It’s true,” she says, acknowledging her desk. “What’s yours? Do you bend me over and take me from behind?”

Nailed it.

“If that’s what you’re thinking, it’s OK,” she goes on, earnestly, explaining that she’s discussed sexual scenarios with her clients before so as to “normalize” the behavior and not have them feel their own thoughts are unnatural. By showing the patient a level of acceptance, she hopes to facilitate a more comfortable atmosphere for “the work” — her painfully accurate pseudonym for psychotherapy.

I take a second to let the red flow out of my face, and ponder what she said. I’m a little unsure about this whole technique, but the more I think about it, the more it makes sense. So I go home, incredibly turned on and completely unashamed.

* * *

One of the great breakthroughs I’ve had in the thirteen months since I began seeing Lori (who agreed to participate in this article, but requested that her full name not be published) is a new ability to accept the existence of dualities in life. For instance, I’ve always had a tremendous sense of pride that, if it doesn’t straddle the line of arrogance, certainly dives into that hemisphere from time to time. I’m great at seeing flaws in others and propping myself up above them by smugly observing my character strengths. I’ve never liked that about myself, but the harder concept to grasp is the fact that I can be so egotistical while also stricken with such vast quantities of insecurity.

In treatment I came to realize that all people have contradictions to their personalities. There’s the insanely smart guy who can’t remotely begin to navigate a common social situation, the charitable girl who devotes all her time to helping strangers, but won’t confront issues in her own personal relationships. In my case, my extreme sensitivity can make me feel fabulous about the aspects of myself that I somehow know are good (my artistic tastes) and cause deep hatred of those traits I happen to loathe (the thirty pounds I could stand to lose).

My next session with Lori is productive. We speak about relationships I’ve formed with friends and lovers, and how my family may have informed those interactions. One constant is that I put crudely high expectations on others, mirroring those thrown upon me as a kid. I’m angered when people don’t meet those expectations, and absolutely devastated when I don’t reach them. Lori points out that it must be “exhausting trying to be so perfect all the time.” I am much more comfortable than I was the week prior, and can feel myself being more candid. I’m relieved that the whole being-attracted-to-my-therapist thing doesn’t come up.

Then, a week later, Lori mentions it, and I become tense again.

“I thought I’d be able to move past it,” I say, adding, “We aired it out, and it’s fine.”

As definitive as I’m trying to sound, Lori is just as defiant.

“I’m glad you feel that way,” she begins, “but I think you owe yourself some kudos. This kind of therapy,” she shares, “isn’t something just anyone can take on.” Such honest discussion doesn’t simply happen, it takes tremendous guts, and Lori can see that I am dealing with it relatively well, so I should praise my own efforts.

“Shit, we both should be proud of ourselves,” she says. “It’s not easy on the therapist either, you know.”

“Why not?”

“Because talking openly about sex is risky at any time, much less with a client.” She explains that therapists are warned any semblance of intimacy can be easily misconstrued. “We learn in our training to not personally disclose, for example,” she says, but adds that, occasionally, transparency can be helpful.

“Still, with you,” she continues, “until I raised the question, I didn’t know for sure that you would go with it; for all I knew you’d run out of here and never come back to risk being so uncomfortable again.”

She’s building my confidence more, and I’m learning that I play a much bigger role in how my life is conducted than I often realize. My treatment wouldn’t be happening if I weren’t enabling it.

Then she says, “And don’t think it’s not nice for me to hear that a guy like you thinks I’m beautiful.”

Crippled by the eroticism of the moment, and combined with the prevailing notion that no woman this stunning could ever be romantically interested in me, I flounder through words that resemble, “Wait…what?”

“If we were somehow at a bar together, and you came over and talked to me,” she says, then flips her palms up innocently, “who knows?”

I laugh again and tell her there’d be almost no chance of me approaching her because I’d never feel like I had a shot in hell.

“Well, that’s not the circumstances we’re in,” she says. “But you might. Who knows?”

I’m confused — Is she really attracted to me or is this some psychotherapeutic ruse? I’m frustrated — I told her I didn’t really want to talk about it. Shouldn’t she be more sensitive to my wants here? I’m angry — Is she getting an ego boost out of this? Most of all, I don’t know what the next step is — Am I about to experience the hottest thing that’s ever happened to a straight male since the vagina was invented?

There were two ways to find out:

1) Discontinue the therapy, wait for her outside her office every day, follow her to a hypothetical happy hour and ask her out, or

2) Keep going to therapy.

* * *

A week later, I’m physically in the meeting room with Lori, but mentally I haven’t left the recesses of my mind.

“Where are you today?” she asks, probably noticing my eyes roving around the room.

“I don’t know.”

“Are you still grappling with the sexual tension between us?”

Here we go again.

“Yes,” I say, with a bit of an edge in my voice, “and I don’t know what to do about it.”

Lori, ever intently, peers into my eyes, wrinkles her mouth and slightly shakes her head.

“Do you want to have sex with me?” she asks.

We both know the answer to that question. All I can do is stare back.

“Let’s have sex,” she announces. “Right here, right now.”

“What?” I respond, flustered.

“Let’s go!” she says a little louder, opening up her arms and looking around as if to say the office is now our playground, and, oh, the rollicking fun we’d have mixing bodily fluids.

“No,” I tell her, “You don’t mean that.”

“What if I do?” she shoots back. “Would you have sex with me, now, in this office?”

“Of course not.”

“Why ‘of course not’? How do I know for sure that you won’t take me if I offer myself to you?”

“I wouldn’t do that.”

“That’s what I thought,” she says, and tension in the room decomposes. “Mike, I don’t feel that you would do something that you think is truly not in our best interest, which is exactly why I just gave you the choice.”

Her offer was a lesson in empowerment, helping me prove that I have an innate ability to make the right choices, even if I’d so desperately prefer to make the wrong one.

I see what she means. I’m awfully proud of myself, and it’s OK to be in this instance. I’m gaining trust in myself, and confidence to boot. But, as the dualities of life dictate, I’m successfully doing “the work” with a daring therapist, while at the same time not entirely convinced she isn’t in need of an ethical scrubbing.

* * *

I don’t have another session with Lori for nearly three months, because she took a personal leave from her place of employment. When our sessions finally resumed, I could not wait to tell her about my budding relationship with Shauna.

Ten minutes into my first date with Shauna — right about the time she got up from her bar stool and said she was “going to the can” — I knew she would, at the very least, be someone I was going to invest significant time in. She was as easy to talk to as any girl I’d ever been with, and I found myself at ease. Plans happened magically without anxiety-inducing, twenty-four-hour waits between texts. Her quick wit kept me entertained, and I could tell by the way she so seriously spoke about dancing, her chosen profession, that she is passionate about the art form and mighty talented too. Shauna is beautiful, with flawless hazel eyes and straight dark hair, spunky bangs and a bob that matches her always-upbeat character. She is a snazzy dresser and enjoys a glass of whiskey with a side of fried pickles and good conversation as much as I do.

Things escalated quickly, but very comfortably, and since we’d both been in our fair share of relationships, we knew the true power of honesty and openness. So upon the precipice of my return to therapy I told Shauna about Lori, and admitted to having mixed feelings about what I was getting back into. I told her I was at least moderately uncertain if my mental health was Lori’s number-one concern since she always seemed to find the time to mention my attraction to her.

The first two sessions of my therapeutic reboot had gone great. Lori appeared genuinely thrilled that I was dating Shauna and could see how happy I was. I wasn’t overwhelmed with sexual tension in the new meeting room, though it wasn’t actually spoken about, and in the back of my mind I knew it was just a matter of time before it would start to affect my ability to disclose my thoughts to Lori again.

Then, while attempting to ingratiate myself with my new girlfriend’s cat by spooning food onto his tiny dish on the kitchen floor, I hear my phone ding from inside the living room.

“You got a text, babe,” Shauna says. “It’s from Lori.”

“‘I’m so impressed with you and the work you’re doing…’” Shauna reads off my phone from inside the living room, inquisitively, and not happily. I stuff the cat food back into the Tupperware and toss it into the refrigerator. I make my way into the living room, angry at myself for not changing the settings on my new iPhone to disallow text previews on the locked screen. Shauna’s walking too, and we meet near the kitchen door. “What’s this?” she says, holding up the phone. “Your therapist texts you?”

I take the phone from Shauna and say the most obvious, cliché-sounding thing: “It’s not what it seems.”

As I text back a curt “thanks,” Shauna tells me she’s going to ask her sister, a therapist herself, if it’s OK to text patients.

“Don’t do that.” I say, a little more emphatically. “I promise, this is nothing to be worried about. We’re not doing anything wrong.” I explain that Lori’s just trying to build my self-esteem.

“The only reason I’m even bringing this up is because you said you weren’t sure about her in the first place,” Shauna reminds me. I can tell she regrets looking at my phone without my permission, but I completely understand her feelings.

At my next session I tell Lori that Shauna saw her text and wasn’t thrilled about it.

“She probably feels cheated on to some degree,” Lori says. “A relationship between a therapist and a patient can oftentimes seem much more intimate than the one between a romantic couple.”

Lori goes on to point out that the reason she feels we can exchange texts, blurring the lines between patient/doctor boundaries — a hot topic in the psychotherapy world these days — is because she trusts that I’ll respect her space and privacy. “You’ve proven that much to me,” she says.

On my walk home, instead of being angry at Lori, I understand her thinking behind the text. But I’m also nervous about how Lori and Shauna can ever coexist in my life.

Isn’t therapy supposed to ameliorate my anxiety?

* * *

A week later, Lori begins our session by handing me a printout explaining the psychotherapeutic term “erotic transference” written by Raymond Lloyd Richmond, PhD. It says that erotic transference is the patient’s sense that love is being exchanged between him or herself and the therapist — the exact sensation I was experiencing with Lori, of which she was astutely aware.

According to Richmond, one of the primary reasons people seek therapy is because “something was lacking in their childhood family life,” perhaps “unconditional nurturing guidance and protection.” Upon feeling “noticed” and “understood” by a qualified therapist, sometimes a patient can be “intoxicated” by their therapist’s approval of them. A patient may in turn contemplate that a love is blossoming between them, and, in fact, it sort of is.

From an ethical standpoint, Richmond argues all therapists are “bound” to love their patients, for therapists are committed to willing “the good of all clients by ensuring that all actions within psychotherapy serve the client’s need to overcome the symptoms” which brought them into treatment. This takes genuine care and acceptance on their part. However, a patient can easily confuse the love they feel with simple “desire.” They’re not quite in love with their therapist, so much as they yearn for acceptance from someone, and in those sessions they just happen to be receiving it from their doctor.

Lori tells me that, all along, she has been “working with what I gave her” and that because I flirted with her a bit, she used that to her advantage in the treatment. In employing countertransference — indicating that she had feelings for me — she was keeping me from feeling rejected and despising my own thoughts and urges.

“There’s two people alone in a room together, and if they’re two attractive people, why wouldn’t they be attracted to each other?” says Dr. Galit Atlas. A psychoanalyst who’s had her own private practice for fifteen years, Dr. Atlas has an upcoming book titled The Enigma of Desire: Sex, Longing and Belonging in Psychoanalysis, and I sought her as an independent source for this essay to help me understand Lori’s therapeutic strategies.

Dr. Atlas explains that there are certain boundaries that cannot be crossed between therapist and patient under any circumstances — like having sex with them, obviously. But many other relationship borders can be mapped out depending on the comfort level of the therapist, as long as they stay within the scope of the profession’s ethics, which complicates the discussion surrounding erotic transference.

“As a therapist, I have a role,” Dr. Atlas says. “My role is to protect you.” She says it is incumbent on the therapist to not exploit the patient for the therapist’s own good, but admits that the presence of erotic transference in therapy brings about many challenges. “[Attraction] is part of the human condition,” she observes. In therapy, “the question then is: What do you do with that? Do you deny it? Do you talk about it? How do you talk about it without seducing the patient and with keeping your professional ability to think and to reflect?”

I ask her about the benefits of exploring intimacy in therapy, and Dr. Atlas quickly points out that emotional intimacy — though not necessarily that of the sexual brand — is almost inevitable and required. “An intimate relationship with a therapist can [be] a reparative experience — repairing childhood wounds — but mostly it’s about helping the patient to experience and tolerate emotional intimacy, analyzing the client’s anxieties about being vulnerable and every mechanism one uses in order to avoid being exposed.”

Dr. Atlas says this topic speaks to every facet of the therapeutic relationship, regardless of gender or even sexual orientation, because intimacy reveals emotional baggage that both the patient and therapist carry with them into the session. But this isn’t a symmetrical relationship, and the therapist is the one who holds the responsibility.

“Freud said that a healthy person should be able to work and to love,” she says. “In some ways therapy practices both, and in order to change the patient will have to be known by the therapist. That is intimacy. In order to be able to be vulnerable, both parties have to feel safe.”

After I briefly explain all that has gone on between me and Lori, Dr. Atlas steadfastly says she does not want to judge too harshly why and how everything came to pass in my therapy. “I don’t know your therapist, and I don’t know your history,” she says. But she offers that I should “explore the possibility” that I might have created and admitted my sexual adoration of Lori because one of my fears is to be ignored, not noticed.

Then I offer: “Maybe this essay is being written for the same reason.”

“Exactly.”

Maybe I wanted to interview Lori about erotic transference in my therapy sessions for that same reason as well…to stand out as the most amazingly understanding patient ever.

* * *

“I want to be very clear that this was never about feeding my own ego,” Lori says about her approach to my treatment. “We were always doing this in your best interest.”

I’m in Lori’s office, a tape recorder rolling and a pad and pen in my hands.

“I felt I was doing a disservice to you if I didn’t ‘out’ what I felt was weighing on us, which, honestly, felt like a heavy secret,” she says, pointing out that she discussed my therapeutic process for many hours in her required supervision meetings.

In order for Lori to advance in her field as a social worker, she has to attend 3,000 conference hours with another professional to go over casework — kind of like therapy quality control.

We talk about all of this during one of my scheduled sessions, for the entire hour — and go over by a few minutes, too.

Lori says that when she began her career as a social worker, she decided she wasn’t going to shy away from any subjects. “It’s typical for a client to [have] a habitual desire to sweep things under the rug,” she observes, especially about taboo topics. It can become a cycle of behavior that Lori seeks to break.

I refer back to the time when, unprovoked, she brought up my attraction to her.

She says she mentioned it to avoid what therapists call “door-knobbing,” which is when a patient will purposely mention some huge reveal right at the end of a session so as to sidestep a lengthy conversation about it.

“My only question for you is, was I wrong for bringing it up?” she asks. “Only you can answer that.”

Lori’s great at forcing me to reflect.

“I guess when I said I was over it and could move on, that was an example of my strict black-and-white thinking,” I say, throwing back some language she’s used often to describe my challenge in accepting dualities. In my mind, I was either attracted to her and shouldn’t see her anymore, or I wasn’t attracted to her and could still have her be my therapist. There was no in between.

I realize now that she wasn’t wrong for mentioning my feelings for her, even when I didn’t want her to. Lori noticed that I was frustrated with myself and wanted me to know that an attraction to a therapist is so normal and happens so frequently that there are technical terms for it.

I turn my attention towards the presence of countertransference in our session. I’m trying to come up with an actual question here, but, really, I just want her to confirm her feelings for me are real. So I say, referring to her feelings, with a great degree of difficulty, “It’s funny that they seem genuine to this day.”

“They are genuine,” Lori says, adding a moment later: “I think it might be a good idea if we explore why our discussing it suggests a lack of authenticity.”

“It doesn’t, necessarily,” I begin, then stammer through a few sentences, worried I might offend her by implying she’s been dishonest. I finally settle on, “I guess it comes back to my self-esteem issues. Why would a beautiful woman think I’m attractive?”

Lying in bed with Shauna a few months into our relationship, I ask her what she thought about me the moment she first saw me. I’m fishing for a compliment. But we met on Tinder and I just hope that seeing me in person wasn’t some kind of letdown for her after swiping right on my hand-picked glamour shots. Obviously she isn’t going to say something so awful after having committed to me for so long. It’s a slam-dunk ego boost.

She says she liked the fact that I was wearing a blazer and a tie on a first date. She adds that I was a little shorter than she anticipated, but was content with the two of us at least being the same exact height.

“What did you think when you first saw me?” she asks, turning it around, naturally.

Staying committed to my honesty-at-all-costs policy, I say, “I thought you were really beautiful, but not to the point where I was intimidated by you, which was very important because if I was, you would have gotten a very unconfident version of me, and we probably wouldn’t have hit it off as well as we did.”

Shauna thinks about that for a second, and eventually nods “OK.”

I explain that my insecurity could often get the better of me in dating situations. It was easy to convince myself that I’d be rejected by the girl I was with, especially if I thought she was out of my league. I would then slip into a nervous and reserved state that isn’t at all reflective of my true self.

I’m essentially saying that I was so thrilled to not find Shauna so extraordinarily pretty that I couldn’t accept her being on a date with me. That thought made so much sense at the time I said it, but I’ve since come to realize it is as ridiculous as it is insulting. After ten months of being with Shauna, I’m still completely floored by her, on every level, including a physical one. It gives me great pride to walk into a room with her, and I don’t imagine that changing. Therefore, she actually did meet a confident “version of me.” The way people look doesn’t drastically change in ten months but a person’s perception of self can. It seems my emotional workouts in erotic transference were just beginning to produce results.

* * *

“People fuck up,” Lori informs me during one winter session. “Therapists have slept with clients before, just like politicians have had sex with their interns. But, so you have a full understanding of how this works, we can date.” She explains the parameters as outlined in the social worker’s code of ethics. One of the many stipulations is that we wouldn’t be able to see each other, under any circumstances, for at least two years before dating. She tells me she loves her job, and there’s no way she would ever sacrifice my safety or her career for anything, so she would strictly follow all the dictated rules. “If you truly want to date me, there is the option. But it’s ultimately up to you.”

I know what she’s doing here — putting the onus on me, just like last year when she said we could have sex. The difference this time is the answer I want to give is on par with all of my involuntary urges.

“I don’t want to stop the work we’re doing,” I say. “At this point, it’s far too valuable to me, and, really, I know very little about you.” She’s beautiful, exercises, is smart, funny, professional, enjoys good TV…and that’s about it. Aside from whether or not we’d even both be single in two years, and if we’d be in the correct mind frame to explore a relationship, there are several other things I’m considering here: Would Lori and I really be compatible in every way? Would she ever see me as a lover, a partner, an equal, and not a patient? Could I ever reveal a detail about myself, or even just a shitty day of work, without wondering if she was picking it apart and analyzing it?

Frankly, all those questions could be answered in the positive. But, even if I wasn’t in a happy relationship — Shauna makes this choice much easier, for sure — I wouldn’t go that route. I’d be out a therapist.

* * *

It’s a beautiful spring night in New York and only sidewalk seating will do. Shauna and I are out to dinner at a restaurant near her Queens apartment, and we’re both in good spirits. The weather and the alcohol consumption are partly to blame for that, but, on cue with the season’s change, I feel I’ve turned an emotional corner. Work payments that were past due are finally finding their way into my bank account. As it turns out, my short-term money troubles were not an indication that I had no business being a writer, or that my life changeup was as irresponsible as unprotected sex at fourteen years old.

I’d told Lori as much that afternoon. I took a mental step back from my current situation and realized that in spite of my recent hardships, I was succeeding. I summarize my session for Shauna, who nods in agreement, lovingly pointing out that she’s had the same challenging freelancer experiences as a dancer.

“You’re doing great, babe,” she says matter-of-factly.

“Thank you. That means a lot,” I respond. “I guess if I’m going to be a writer I just have to accept all this and have faith in myself. The way Lori put it was, ‘You just have to go all-in.’”

“Good,” Shauna says. “You should listen to the women in your life.”

* * *

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I’m a Fifty-Year-Old Mom. I Just Had Sex in the Back Seat of a Car.

Sometimes acting like a teenage rebel is the only way to feel in control.

On a hot and humid night last June, I steered my car over twisting country roads toward a small lakeside town for a romantic rendezvous. I had spent the day at a funeral, reflecting on the fact that at fifty, I had more miles behind me than ahead. Oddly, my paramour had also spent the day at a funeral, and as the summer sun disappeared we made plans to meet halfway between our towns for a drink.

It was nearly eleven when I turned my car onto Main Street, and James was growing impatient. We were speaking on the phone when I caught a glimpse of him. Strikingly handsome, he looked at least a decade younger than his 61 years. Running and doing chores on his rural property kept his body lean and muscular, and his face betrayed few traces of the anguish I knew lay in his heart.

James met me at my car, and as we walked toward the restaurant he put his arm around me. I felt a shudder of excitement run down my spine and I pushed in closer to feel his body. When we sat at the bar he swiveled his chair, pushed his knees against mine, and leaned in close to talk. Our faces were pressed within whispering distance and I inhaled his scent. The drinks we ordered were superfluous; this was all a graceful dance of foreplay.

The bar was teeming with a coarse-looking crowd of men and women who had deeply lined faces and leather jackets. The fact that we were completely out of place only heightened our excitement. We huddled and made witty comments about the antics of other patrons, parting only to fling our heads back in hysterics. We sat at the bar laughing and kissing, and before long James ran his hand up my leg and under my skirt. On previous dates he had teased me about being a Puritan in public, but X-rated in private, but that night I made no attempt to be discreet.

It felt mischievous to be strangers in a raucous tavern far from home in the middle of the night. We reveled in escaping the constricting bonds of our everyday lives – him a lawyer, me a divorced single mother. Our behavior was an unspoken act of defiance against the taunt of age, and the gloom of funerals that had become a common part of our lives.

Outside the restaurant James kissed me deeply and with a new fervency. We were passionately entangled while patrons passed by, and I whispered that we needed to go somewhere private. James began walking me to my car, and I assumed I would follow him to the adjacent hotel, or to his house an hour away.

When we got to my car he told me to get in the back seat. I refused, saying that my kids had left a mess in my car. James took my hand and led me across the lot to his immaculately clean Mercedes.

“Get in,” he said again.

“I’m not having sex with you in a car,” I replied laughing, while thinking of how improper it would be for a middle-aged mother to do so.

“Just get in,” he repeated, smiling mischievously as he opened the rear door.

There was no point in arguing; I knew I’d get in, so I slid onto the back seat. James was right behind, and before I heard the click of the door closing he was kissing me. It was futile to fight the longing we had been feeling for the past hours. Soon, all thoughts of motherhood and what was proper disappeared. We had been together many times before, but that night we devoured each other.

“I can’t believe I just had sex in a car in a public parking lot,” I said afterward, as I searched for my bra in the front seat.

“It was exciting, like in high school,” James replied, looking flushed and exhilarated.

As I drove home in the wee hours of the morning I felt furtive pride that James and I had taken a rebellious stand against the inevitability of age, and society’s expectation that we go gently into the night. In the days and weeks that followed we frequently reminisced about our romp in the car, and how it brought us back to our adolescence; a time of freedom and endless promise, a time before responsibilities and painful regrets.

How It Feels to Be the Biggest Woman at a Clothing Swap

Great, actually.

My bedroom is completely ransacked – clothes are thrown everywhere, purses piled high on my bed. I’m frantically throwing nearly all of my clothes into large plastic bags. Some are still wrapped in the plastic they came in, hanging from metal hangers, as if embalmed and exempt from the passing of time. First to go are the tight designer t-shirts, then the dresses – so many dresses. The black satin cocktail number that once made me feel sexy, but that I could never zip up now. The turquoise one with animal print from Century 21 and the red flowered dress that knocked everyone’s socks off at the company party ten years ago. I used to be so audacious with my wardrobe. Now, I want fewer eyes on me.

I planned on walking, but the load becomes more than I can carry. Instead, I throw the clothes in my car and take off, headed for my first ever clothing swap – where women get together to trade things they no longer want. I’ve been invited by my new friend Sarah to participate in this feminine ritual. This is more than the usual spring cleaning for me; I need to get rid of these painful reminders of the woman I outgrew, literally and figuratively. I no longer want to feel body-shamed by my closet, which is stuffed with clothes that are literally six sizes too small, some that have hung there, unworn, for over a decade while I tried to convince myself I could be someone else.

As I schlep my bags of clothes up to Sarah’s pre-war walk-up, I start to worry that, as a size 12, I’ll be the biggest woman there and nobody will want my offerings. But there’s no turning back now.

* * *

My obsession with fashion started when I was a teenager, when adolescence brought with it a horizontal growth spurt. I didn’t object to my new breasts and butt, but the rapid increase in my thighs and belly made me want to buy every piece of fabric ever made just to cover them up. I was convinced that buying the tightest jeans possible could stymie my out-of-control thighs and shrink them back to their original size. If my clothes were cool enough, stylish enough, expensive enough, everyone would just focus on them and not the fact that I had blown up underneath them.

At 16, the author playing dress up at a friends’ house in Park Slope, Brooklyn. (Photos courtesy the author)

By the time I was 14, I was a size 12, and no fashionable clothing could hide the discomfort I felt. It wasn’t enough to have nice clothes, I still wanted to be thin like the other girls. To be what I thought was normal. Through my teens and 20s, I tried every trend: cleanses, the lemonade diet, the cabbage soup diet, no carbs, low carbs. I tried taking diet pills, Dexatrim every morning with endless glasses of water, but it only gave me headaches and constant trips to the bathroom. Nothing worked.

Finally, I spent one full year when I was in my thirties eating pre-portioned frozen food out of a box and getting up every day at 5:30 in the morning to work out. It worked. I dropped to a size six; in certain styles I was even a four.

I had always hated dressing rooms – the bright lights zooming in on my imperfections, the dread of nothing fitting right. But then, the first time I went shopping after the weight loss was a revelation. Almost everything fit. I remember the moment I pulled a red cotton Brooklyn Industries dress over my head and caught sight of my new self in the mirror; it was as if it was made for me, and I looked incredible. Even though I was thinner, I still had feminine curves, and this dress brought out every one. The cleavage, the thin waist. I wore it out of the store, crumpling up my old clothes and having the cashier cut the price tag off of me at the register. I felt taller, sexier. I bought a whole new wardrobe for my new start. At 38, for the first time, I began to love the warmer months, when dress season was in full bloom.

But the sacrifices I made to get into those dresses meant, ironically, that I rarely went out to dinner or parties because I was afraid of gaining weight. It’s amazing how often people commented about me not drinking or eating, often making me more self-conscious. When I did give in and go out I’d gain weight instantly. Every single time. It was a total Catch-22. The whole purpose of those clothes was to show myself off, to push me to socialize more, but in reality, they kept me in my studio apartment, away from the world, afraid to live.

The author, far right, during the last week of senior year in college.

Eventually I tired of the restrictions and disappointments and took a break from a life of deprivation. The weight crept back on and then some. Most of my favorite clothing no longer fit, regardless of how many pairs of Spanx I wore. Still, I held onto them for over ten years, hoping to someday return to that size, that woman. I had tried to stick to discipline, but eventually being a certain size just wasn’t worth how hard I had to work. It was one thing to say no to dessert or put the bread basket away, but to constantly be hungry and depleted felt at odds with my energetic personality. I wanted to go out, socialize, travel and taste different foods, have different experiences. Being thin without enjoyment defeated the purpose of trying so hard to look the part. I wanted to be part of my own life.

Now, at 47 I’m packing up all of these dresses that belonged to a woman I’m no longer trying to force myself to be. A woman who needed to give up everything for how others might see her. A woman whose biology was never destined for the petite rack. I still miss how I looked in those years of denial, but I don’t miss how I felt.

* * *

I carry three large bags filled to capacity; the plastic handles digging into my skin, turning my fingers red. I walk up four flights of stairs to Sarah’s apartment, where there are tall green plants in every corner and books falling off the shelves. Sarah comes to greet me, her brown hair flowing down to her shoulders, bouncing as she cheerily introduces me to her friends. My heart sinks as I realize most of the women here are in the size six range, a zone I hit just once, and briefly, in my life. I doubt there’s going to be anything here for me.

Sarah pours wine into small glass jars and spreads out homemade pesto sandwiches with brie and bacon marmalade. As we sip our wine and scoop up the melted cheese, the swap begins. Each woman takes a turn presenting her items to the group. Even though everything is being donated, you still want to make sure someone takes home your once-treasured goods with a little pitch. Great color but I have outgrown it. Perfect for summer but too revealing for me. It says, “Love me I’m a Vegetarian,” but I eat meat now so…

A thin brunette with a lot of energy bolts up to the front of the room. As she begins to describe her clothes, all the attention is on her. People start raising their hands and laughing, this is actually kind of fun. “This is the one I got when going to the holiday party last year,” she explains. “And this one my mother-in-law got me but is clearly not my style.” Some of the women talk of ex-boyfriends as they explain the stories behind their clothes. Some of their new jobs. Everyone here wants to get rid of their pasts too. Hearing each story – vignettes about their items, their lives, brings me closer to the women. I feel connected. While they physically appear different than I, they too have stories of wanting to move on in their lives and away from a time that has passed. The clothing swap allows us all the opportunity to release our nostalgia.

I’m surprised at how comfortable these women are in their own bodies. One short woman with a black long bob actually takes off her blouse and begins to try on the clothes right in front of us, her white cotton bra bright like neon lights. She throws on blouses, sweaters and even dresses as if no one is watching. Some of the women know her and her fashion show just blends into the background for them. But I can’t stop staring. I am no prude, but how can she take off her clothes in front of all of these people like she’s in a Loehman’s dressing room? What is that like, to be confident enough in your body to strip down in front of strangers like it’s no big deal?

Eventually it’s my turn to present. My palms begin to sweat. I want the ladies to love my clothes as much as I once did, to realize how important these items were to me in my life – my nostalgia, my years of trying to change myself, and this final moment of release as I let all of that pressure go. Each garment on display represents my sense of self when I bought them. I almost feel like if they reject my clothes, they will be rejecting a part of me. I’m afraid they might ignore me because of my current size, like some men do when we meet for the first time.

The author today.

I take a deep breath and go to the front of the living room. I open up my shopping bags and begin with an apology. “I used to be a variety of sizes from six to 12, so hopefully you will find something you like,” I say, as I start to pull out one meaning-laden item after another. I take out long flowy dresses that I wore when I first lost considerable weight in my 30s, when friends had asked if I had an eating disorder, but it was a combination of Jenny Craig and 5:30 a.m. workouts. I pull out my favorite red dress and it’s snatched up immediately. I feel much better about being here. Then I pull out a black strapless dress I never even wore. It was my “just in case I get invited” dress for parties I never went to, wanting to be someone’s plus one but often being passed over for a younger, more petite date. Someone takes this one, too, and I can feel the load lighten, all of those years of watching and wishing, falling away as I give away one too-small dress after another.

It’s a bittersweet feeling to let them go, knowing that I bought these clothes hoping for a different type of life. Now I am saying goodbye to the woman who wore them, or hoped to. Maybe wisdom really does come with age, but whatever finally let me let go of the insecurities of my youth, I’m no longer willing to base my self-worth on an arbitrary standard that I’m biologically incapable of attaining. All of my old insecurity isn’t going to disappear overnight, but passing along my clothes, my past, and my younger self feels noble, graceful, and it leaves room in my life for me, the real me.

Secret Life of a Search and Rescue Volunteer

When someone goes missing on a frozen mountaintop or in a wildfire, my team heads out to help when no one else can — even if all we can do is bring back their bodies.

Three kids are missing on the mountain. They missed their check in, and search and rescue (SAR) has been tasked with finding them. It’s what we do. We track down the lost and injured and bring them home. I’ve been a member of this unit, primarily based around Mount Hood, Oregon, but working wherever we are needed in the Pacific Northwest, for about three years. Given my profound lack of experience at the onset, I’ve only actually been useful for about a year, maybe two.

We have a general idea of where the three kids are, or at least where they are supposed to be. At the base of the mountain, where most climbs start, is a climbers’ register where parties write down their intended route, expected return date, and what equipment they have – vital information in just this type of situation.

It’s cold and windy. Visibility is low. No one wants to be in the field on days like this. But, as Rocky, a veteran member once told me, only half joking, “We’re mountaineers. We suffer. It’s what we do.” That suffering is accepted because this is what we volunteered for (and almost all of us are truly volunteers – only the sheriff and a few others are paid). It’s made tolerable knowing that there is someone worse off, someone who needs us.

We will trace the most likely path and hopefully find them hunkered down in a snow cave or some other shelter, but alive. Bringing a victim home alive is why I go up. The satisfaction is like no other. After more than a decade in medicine, as an EMT initially and now as a physician assistant in a busy urban ER, I have revived cardiac arrests, treated trauma and dealt with just about every other medical calamity, but mountain rescue is different. People get injured in the mountains and back country, we get them when no one else can or will. Even if all we can do is bring back their bodies.

And I know how important that can be.

On the night of my first high school dance, the police showed up bearing somber news to my mother. She took me into the back room of the house. “There’s been an accident. Dad’s dead,” my mother told me, barely a quiver in her voice. She was trying to hold it together, but saying that out loud, she couldn’t. My brother, mother and me stood in that back room, with the lights off, and hugged and cried and lost track of time.

He fell while out hiking two states over. Local SAR was bringing the body out of the canyon. They couldn’t save him, but they could return his body to his family. We grieved while we waited for his return, which would take a day or two. It didn’t become concrete or tangible until we had the body. A tremendous service was done for my family by strangers.

Now it is my turn.

I will do for others what had been done for us. I will bring them home, do what I can to prevent further backroom suffering. Paying a debt to the universe makes the insufferable tolerable.

* * *

We are a team of 15 – physicians, general contractors, business executives and even an animal chiropractor, with personalities as varied as the professions. But there is a core tenet among us all: to help those in need.

A resort at the base of the mountain provides a Sno-Cat that transports us up through the groomed ski fields. National forest regulations prohibit mechanized travel beyond certain boundaries, but occasionally, we get permission to ignore them, to save a life. The driver takes us up as far as we can go before the Cat starts to backslide.

This is where the hard work starts. From here on out, we will be on foot. Once over the ridge and onto the next glacier, we break into smaller teams of three or four and separate to search different areas. Bob, a tall, slender guy who made some wise business decisions and retired early, is my team lead. He is tasked with interacting with the other team leads and Incident Command, as well as making sure all of us come home alive. Then there’s Keith, an engineer who makes dad jokes without being a dad; Christopher, an occasional school teacher who’s fond of instigating shenanigans and watching his work unfold; and me, the newest member of the team – the low-man on the totem pole.

The winds are up. The temperatures are down. Visibility is minimal. Freezing fog deposits a thin layer of ice on clothing. Beards freeze and develop icicles. Any exposed skin quickly turns red and raw. The moisture from my breath freezes my goggles. Periodically, I use the rubber handle of my ski pole to scrape the ice out of the goggles. This only provides a brief window of clear vision.

We follow the kids’ intended route up the mountain, up the gentle snow slope, bearing west. It’s a short distance, but it takes us an hour in these conditions. We come up into a bowl, relatively protected from the wind. The route travels up from the bowl and over a ridge. Once on the other side we must be hyper-vigilant. We will be travelling across a large crevasse field, hidden in dense fog. The route leads up a snow and ice gully from the far end of this crevasse field. This is one of the two more common routes for teams to take after they have previously completed the standard route. It represents a step up in technical difficulty, presents complicated route finding, and is an overall longer route. Most of us on the rescue team have climbed this route before, individually or as a team, but not in these conditions.

A fall from their route could have spit the kids out onto this crevasse field. We must search it exhaustively. First, we rope up – tying ourselves together so that if one of us falls into an unseen crevasse, theoretically, the rest of the small team can arrest the fall and retrieve the teammate. A rescuer becomes a liability if he is dead. As the newest, least-experienced member, I’m in the middle of the rope. Bob, on point, has to choose a path around the crevasses. The man in the back is the last hope if the first team members can’t arrest their own fall. Bob scans the snow for signs of weakness indicating a crevasse. I follow the footsteps exactly.

Slowly, methodically, we spread out to search the area. Ice axes are at the ready in the event a rope mate goes into a crevasse. My eyes strain to look for clues through fogged-up goggles. Even a light snow can cover vital clues. We move westward toward the terminus of the route the three kids were attempting.

“I need to search that area down by the big crevasse. Keep eyes on me,” Bob says. Rather than continue with our roped travel, Bob will move more cautiously down towards the crevasse on his own. I head up a ridge and plant myself in a vantage point where I can maintain constant visual contact. The area looks lousy with crevasses, with more likely hidden. Bob is belayed down into the field by Keith, who is anchored to the snow. Any fall should be terminated quickly. Should be. Our gloves have a layer of icy grime, so holding the rope during a fall would require more effort than in more pristine conditions.

He goes out, searches, and returns. No incident, but no evidence found of our three kids either. We’re preparing to keep moving when our radios start crackling and we hear someone from one of the other teams say, “I think I’ve found something.” We all stop and put lift our radios to our ears.

“Should we head up to you?”

Silence. Crackle. “…Yeah.”

My team was searching the lower end of the glacier, so we are some of the last to get to the scene. As we approach, I see the other teams standing around a body. If it weren’t for the people standing around him, I might have walked right by; he was nearly invisible in the waning day, under a fresh layer of snow. I see that no one is frantic. No one is pulling a medical kit out. Our kid must be dead. His mouth is open, in the shape of an “O” and full of snow. I get to him and place my hands on his body. He is stiff and frozen. His base-layer shirt and soft shell jacket are unzipped. There is blood on his thigh, though no obvious deformity or injury. I see no grossly apparent signs of blunt trauma. Some distance away, there is climbing gear strewn at the bottom of the route. One of the other teams had continued searching and found it. It looks like he walked some distance away from the debris field.

Maria, a newly minted ER doctor, digs a little bit of the snow out of his mouth. Not much, just a little. I’m not sure why. It is an image that will stick with me.

“Hey, why don’t I package the body? Not everybody needs to see this,” I offer to the overall rescue leader. Some of the team members have never seen a dead body before.

He pauses for a moment. “Yeah, do it.”

I’m new to mountain rescue, but seasoned to life’s grim realities. The body must be packaged for extrication. He will be covered with a protective plastic tarp and placed into a litter. The litter is like a backboard with small walls and rails. It proves difficult to package him. He is frozen and did not have the foresight to die in a position conducive to packaging. But, I make it work. I have to.

Looking at what’s in front of me, I know what is ahead for the family. I know the sound. I know the dark, backroom scene, huddled in a private anguish that comes after the authorities deliver the news. There’s a wail that comes with unexpected death. It comes from the gut. It’s a sound I heard time and again in those first few days after my father died. I lost a parent, but they have lost a child. I package him as gently as I can. We will get him back to his family. The importance of our task is visceral. I cannot fathom what mourning without the body is. This family will not have to try.

* * *

The radio crackles again. The sheriff is thinking that we should package the body, anchor it someplace safe, and mark the location on GPS. This would allow us to keep searching for the other two. The freezing fog has turned to heavy snow. It was early afternoon, a time in the Pacific Northwest when the sun begins to set, and we are worn. We wouldn’t have more than a few hours of daylight left and still had to get off the mountain.

This is a dilemma. He’s dead, but the other two kids may not be. Until we find them, there’s no way to know. The weather forecast calls for continued lousy conditions for the rest of today and the next few days. Extrication is a lengthy process. Under the best conditions, in more easily accessed terrain, extrication by foot takes half a day. Do we begin the extrication of the body and leave our other two kids to try to survive another night? Do we try to place our first kid somewhere we can find him later and keep searching? In these conditions, among the crevasses, with the accumulating snowfall, it’s unlikely we would be able to find him again. Even anchored in a corner somewhere, location marked on GPS, any manner of event could prevent us from retrieving him. Avalanches could change the landscape of the entire field. There is the risk of continued snowfall and burial. An anchor could fail, leaving the body free to slip into one of the crevasses below.

It’s unbearable, in my mind, to leave him to keep searching. The thought of having to tell the family that we found the body, but left him on the mountain, is crushing. It seems inhumane. But then what would we tell the families of the other two kids if we left the mountain without knowing whether they were alive or dead?

I’m supremely thankful not to have to make that call. There are benefits to being a rookie.

The medical team, my other team, has setup nearby, in an area safe from crevasses or avalanches. There is a tent to escape the wind and warm drinks are being brewed. The medical team is solely concerned with the living. In the absence of proof of life of the other two, the medical team bears watch over the rescuers. The tent is for the rescuers. The warm drinks are for us. Periodically, people have to take a breather, to warm up and mentally recharge. It’s amazing how beneficial something as simple as a warm cup of tea can be in these situations. As one of the new guys, I still feel like I have to prove myself. I stay in the crevasse field and suffer.

Conversations between the rescue leaders in the field and the sheriff’s SAR deputies have been ongoing since we packaged the body. I haven’t been listening. I have no input to offer. Just feet to carry me to wherever I can be useful.

“The sheriff wants us to keep searching.” Word is spreading. My heart sinks into my stomach. I am exhausted. There is no good decision to be reached. I look at my teammates and can tell many are feeling the same. We don’t want to keep searching, but we will.

“SAR base from Team One.”

“Go ahead Team One.”

“Yeah, hey it’s Rocky. We’re not going to do that. It’s cold, it’s late. We’ll never find the body again. We’re bringing the teams in.”

A respected member and veteran of decades of mountain rescue has shut down the sheriff’s plan. Ultimately, it’s the sheriff’s call, but a good leader knows when to listen to experienced heads.

“O.K. Team’s coming in.”

We re-cross the crevassed glacier, this time with a sled with a body in it. Once at the eastern end of the glacier, we raise the whole package up and over the ridge, which is accomplished with ropes, pulleys and brute force. Eventually, we reach the waiting Sno-Cat. The packaged body lies between two rows of bench seats. The seats are full of rescuers. The layers of ice that had been our constant companions begin to melt. Steam rises off each living person’s head. Some people are looking through the camera we found among the scattered belongings. Perhaps a clue will be found to lead us to the other two kids. Perhaps there will be some indication as to what went wrong.

We reach the familiar transition point at the base of the glacier. We get out of the Sno-Cat and unload the package. A short distance below, snow meets parking lot. Rescuers meet sheriff. I head inside. There is to be a debrief. We are reminded of the resources available to us, should we need them, if anyone is experiencing grief or stress from recovering a body.

The body is brought inside the lodge. I can hear the family. By the end of the debrief, the family of our first kid should be well on their way to the city with the deceased. They are not. Word is traveling. The family of our first kid is staying on the mountain to support the families of our other two kids. I can’t imagine how they came to that decision. Their boy is dead. Yet, they remain with the other two families, while the body of their boy travels back to the city.

When I hear this, I remember that the ache I’m feeling all over is just physical pain. It is temporary.

* * *

I return to my warm apartment. The two kids are still up on the mountain. I’m mentally preparing for a return to the cold and misery tomorrow when the page comes through. We are grounded. No searchers will be deployed tomorrow on account of the horrendous conditions. Officially, this is still a “rescue.” The longer our other two kids are out there, the less likely they are to survive, if they are still alive at all. But they are up there, somewhere. I have little faith that this is going to be a rescue.

I feel utterly helpless, sitting in my kitchen, in a worn-out old chair, head back, staring at the ceiling. The debt I set out to pay remains. I am unable to provide the service that was done for my family. Logically, I understand it is out of my hands. The dangers and risks are real. This is a rational decision. In my gut, though, I have failed. This was my task. Bring the bodies home. Yet they remain on the mountain. There is only failure now.

So, I get drunk, the only solution I can think of.

Over the next few days conditions continue to deteriorate and eventually I have to go back to work. Finally, the search gets called off completely.

The following summer, I’m returning from a wildfire when the text comes through from my good friend Bob G., a member of the medical rescue team.

“multiagency effort. found the other 2.” He gives me no context. He doesn’t need to.

There is a great deal of discussion and speculation as to what happened. It doesn’t matter to me. I don’t particularly care how they got there, just where they end up – back with their families.

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