11: Neurogenic shock.

[4-minute read]

The idea of running into the hotel lobby, with its fluorescent lights and New Year’s Eve chaos, was a visceral no.

On some unconscious level, my body pulled me in the opposite direction. I fled the sensory overload and found a dark, quiet stairwell, folding myself into the shadows as I hyperventilated.

When other guests appeared and noticed me, I fled again — caught between the stairs, the lobby, and my hotel room.

Years later, in therapy, I would recognize what lived beneath that instinct. Long before the Netflix documentary or the Hulu special, the story of Amanda Knox had lodged itself somewhere deep in my subconscious.

Here I was, a foreigner in Italy. Perhaps also unlikely to be seen compassionately as a victim of domestic (or in this case foreign) violence. The idea of involving the police felt like danger wearing a uniform.

There was very little logic moving through my mind. I’d later learn that the thinking part of my brain — the prefrontal cortex — had lost regulatory control under a surge of stress hormones from the amygdala. I wasn’t making decisions so much as reacting.

I wasn’t choosing safety.
I was surviving.

When survival eclipses cognition, the nervous system shifts gears. The body may first mobilize into fight-or-flight, but when escape feels impossible, another response takes over. Parasympathetic pathways associated with dorsal vagal shutdown can predominate, slowing everything down.

This is where collapse and compliance emerge — not as choices, but as biological strategies designed to preserve life.

Neurogenic shock, distinct from spinal shock, often occurs when injury to the spinal cord above the sixth thoracic vertebra disrupts the body’s ability to regulate itself. It occurs in roughly half of people with spinal cord injury within the first 24 hours and can last days, with autonomic dysfunction sometimes persisting weeks or longer.

When this happens, the sympathetic nervous system becomes disrupted or inaccessible, leaving parasympathetic tone to dominate. In that state, the body defaults to survival functions: rest and digest, or involuntary feed-and-breed responses.

My body needed rest — and I wasn’t going to get that in the lobby or with the police.

With logic and reason offline, I did something that confuses most people. I returned to the room. But not before turning my phone to record. Some part of me believed that if anything else happened, at least there would be evidence.

That may not make any sense to everyone. It took years of therapy for it to make sense to me.

Understanding the science helped. Though, like climate science, it’s knowledge that many resist — especially in courts of public opinion.

As I approached the door he’d kicked down, I saw him sitting at the foot of the bed. He looked as exhausted as I felt. Small. Suddenly feeble. Not threatening.

I slipped inside, trying to make myself smaller still. Curled inward. Quiet through the sobbing.

The autonomic nervous system operates largely outside of conscious awareness, governing heart rate, breathing, digestion, arousal, tears, and elimination — all the functions that keep us alive without asking permission.

That knowledge helped explain what followed the next morning.

Why my body responded the way it did.
Why intimacy occurred without enthusiasm or keen consent?

Understanding that the parasympathetic nervous system can activate feed-and-breed or involuntary reproductive reflexes gave language to something I had lived without words.

After that, he rushed to the front desk to pay for the damage and returned with a receipt.

I rushed to pack, leaving behind a winter coat I would later have mailed back to Canada. One that I would eventually have to get rid of because it became such a reminder of the event.

Have you ever been in shock?

Within half an hour of waking up on New Year’s Day, our bus pulled out of the hotel parking lot. Florence for the morning. Pisa for the afternoon. Lucerne by evening.

It’s like moving through the world behind glass. You can walk. You can speak. You can follow the instructions. But none of it feels like agency. The body is driving. You’re just along for the ride.

In the weeks that followed, my body deteriorated. I lost between ten and fifteen pounds. A rash spread across my skin. My eyes swelled and darkened to deep purple. I didn’t recognize myself, and it would take years before I did.

I looked like an orc from The Hobbit — a creature hardened by terror. I felt hollow, like something essential had been taken.

Years later, imaging confirmed injury to my cervical spine at C4–C5 — the region that gives rise to the phrenic nerve, which controls the diaphragm and breathing.

Medical literature now shows that non-fatal strangulation can cause delayed stroke or death days, weeks, or even months later. Some autopsies reveal fatal injury long after the initial assault.

My body knew this long before I did.

Buried inside me was a message I didn’t yet have language for:

Hold on to that last sip of oxygen.
Beyond that edge is something you may not survive.

I was in shock for weeks.

My body knew the truth long before my conscious mind could name it.

That’s why the first question the police asked, Why didn’t you go to authorities right away? — missed the point entirely.

If I’d had the language for it then, I would have said:

Parasympathetic dominance.
Neurogenic shock.
Survival.

Up Next >> Chapter 12: New Year’s Day, 2015