KENAI — Nearly five years ago, Margaret Stroup’s brain changed.
The change mirrored the physical damage to her body as she lay under her desk at Central Peninsula Hospital, wounded by two bullets a former hospital employee fired into her at point blank range.
Outwardly, the physical wounds have healed — though the web of scars on her abdomen will forever reflect the trauma and she is plagued with fallout from the damage. On the inside she learned what it was like to be afraid, to be paralyzed with fright as her body physically reacted to her memories as though she was being hunted down and shot again.
Stroup lived with trauma and constant tension that were born from the attack until 2013, when a Chicago doctor gave her a modified stellate-ganglion block procedure known as the “Chicago Block” and injected a minute amount of local anesthetic into an area in her neck.
The process took about ten minutes, but in the weeks since the procedure, Stroup said she cannot imagine living without it.
Now Stroup can talk about the frightening events of Nov. 26, 2008, when Joseph Marchetti walked into the hospital and shot two of his former supervisors, without reliving the experience. She can recall the day, without the physical and emotional trauma becoming too overwhelming to handle.
For nearly five years, it has been her memories of that day that betrayed her.
Sometimes, it’s the memories that she doesn’t have; she can remember the comfortable brown ankle boots she wore the day Marchetti tried to kill her — Liz Claibornes with a side zipper and a little chain across the front. She loved those boots.
But, she doesn’t remember everything.
“One of the things that really bothers me is that I don’t know what I was wearing that day,” she said.
Or, how she couldn’t remember her blood type as she was taken into the emergency room.
“I could remember that it was type O, but I couldn’t remember if it was negative or positive. And I was so frustrated by that,” she said
Other times, her memories help her recall specific details. As she sat on a couch at the Kenai River Hideaway in Soldotna on a recent weekday she could easily list the names of the doctors she had seen in three states since the shooting. Her fingers traced patterns in the air as she delved into specifics like the number of staples they put in her abdomen at CPH — 44 — or how long it took the surgeons to reverse her ostomy — 12 hours — and the whole myriad of other difficulties that come along with having a bullet ricochet inside the body.
But sometimes, memories don’t fade and those are the ones she said shattered her inner peace.
“I was constantly looking for someone with a hidden gun. ... I closed every curtain, every blind in the house, the doors couldn’t be opened,” she said. “We were (living) in a gated RV park, and I felt safe inside the park, but I didn’t want to go out anywhere. ... I can’t go into a restaurant without looking, checking out all the exits, and I want a booth with my back to a wall so I can see a door.”
There are the memories of being hunted and the anxiety triggered by her terror-heightened hearing that fixated on the “whoosh” and “click” of her office door sliding shut when the hospital triggered a code red — a code to evacuate the building — and the fire doors closed in the main hallway; it triggered one of the first flashbacks she remembers. Then there are the memories of the bullets pushing her to the floor. She felt no pain but remembers the shock, vibration and pressure of being hit when Marchetti pointed his rifle under her desk. She remembers slapping the barrel away from her face before she was shot in the chest and abdomen.
These are the memories she has learned to cope with.
“The mistake is shutting your eyes,” she said. “Because when you shut your eyes that allows the movie to start and the noise to be amplified. If you can stay in the moment and talk yourself through it and keep your eyes open, the chances are it won’t be as bad or it’ll go away completely.”
Stroup has post-traumatic stress disorder, or PTSD.
Her psychiatrist, Dr. Frank Ochberg, a prominent PTSD psychiatrist and professor of psychiatry at Michigan State University, said the key to Stroup’s recent change lies somewhere in her body’s physical response to her memories.
“I think in PTSD there’s a connection between a trauma image and a whole lot of arousal. So, when you return to the memory of being raped or being shot or having your child die in your arms, a part of you gets terribly aroused (with) dread, fear, terror, all those extreme arousal feelings,” he said.
For people, like Stroup, the memory comes back in an abnormal way, he said.
“If you try to think about recovering a smell of something that you smelled, you cannot remember,” he said. “My trauma patients, the odor comes back. They smell the body odor of the man who raped them. My Vietnam veterans smell Vietnam. That’s part of trauma memory . your brain dials it up and you’re flooded with fear.”
Ochberg said he treated Stroup’s PTSD as well as he could until early 2013 when he found Dr. Eugene Lipov using a half-a-century old injection in a new way.
Lipov pioneered the Chicago Block in 2005 as a way to rewire PTSD patient’s brains.
While the physiological responses to stress are complex, Lipov breaks his treatment down simply.
When a person experiences significant anxiety their nerve growth factor, or NGF, levels spike.
“They’ve done studies where you measure the NGF of soldiers and then you take them and when they’re about to jump out of an airplane, measure them again,” he said. “They found the NGF level doubles.”
That growth factor causes the stellate ganglion — a mass of nerve cells on the right side of the neck — to promote “sprouting” which ultimately increases the body’s production of norepinephrine — a stress hormone — and kicks the body’s “fight or flight” response into action, he said.
The anesthetic in Lipov’s Chicago Block seems to halt the body’s overproduction of NGF.
“NGF is the fertilizer, if you take away the fertilizer, you take away the nerve growth,” he said.
When the nerve growth slows and the body stops overproducing stress hormones, a person’s physical response to their traumatic memories changes, he said.
However, his process has not yet achieved widespread use and has been rejected by the Department of Defense for further study at least three times, according to Stars and Stripes, a U.S. military publication.
Lipov has had varying levels of success in the 125 patients treated with his methods during the last eight years, he said.
Lipov said the next major step in getting his treatment onto the market is to get a major study done on the effectiveness of the injection.
Until then, he said he has two corporations, a non-profit and a for-profit. Under the shell of his for-profit he treats people with various types of pain, while he uses his non-profit to help people like Stroup, or treat soldiers.
“I treat most soldiers at no cost,” he said. “They need it the most, I think.”
The injection procedure costs about $1,000 and usually takes an average of two procedures to be effective, he said.
He is still pursuing funding for his non-profit and said it frustrates him that no benefactor has stepped forward to bankroll the technique.
“It sounds too good to be true to people,” he said.
For Stroup, however, the procedure has been ground-breaking.
The years of hiding away in Florida and Virginia, afraid to leave her home or to put the shades up, the years of living in fear of being alone and being unable to sit with her back to the door are gone and she is free to sit alongside the Kenai River, watch the neighbors fish and enjoy life again.
“I kept waiting for it to wear off, but it didn’t wear off it just got better,” she said. “Now I can hear people shooting and it doesn’t bother me. I can hear loud noises and it doesn’t bother me. All of the effects of the shooting are gone. I went up to the hospital twice since I’ve been here. I walked around. I felt that joy again when I first came here to work.”
She calls it her miracle injection.
“I would go get another one, hands down. If I had to get an injection every month for the rest of my life, I would,” she said. “I was living in a bubble. I could see life going on, but I couldn’t feel it. I had no emotional feelings at all.”