It starts in my chest: a tearing, a tightness, a burning. The more I think about it, the more it grows; tiny claws scratching against the inside of my ribs, slicing through my intercostals as it burrows outwards. It worms beneath my skin, down to the tips of my fingers, the soles of my feet, activating my reflexes; my triceps and hamstrings and biceps jumping at its touch. My arm twitches, a leg jerks and I kick at the blankets that try to hold me fast to sleep. But there will be no sleep tonight.

Thoughts flutter like a bird in spring; landing on every branch but resting long on none. I think of my classes, my boyfriend, my parents, my never-ending To-Do list, written in swirling cursive on a bright pink sticky-note. Each thought drags my breath from me; my chest, my lungs, my alveoli collapsing in the vacuum of hope.

And then the tears come. Unbidden and uncalled for, they fall from my eyes like sand through an hourglass, marking not time, but thoughts. Each grain an idea, a conversation, a memory. They pass by too quickly for me to catch, burying me in their sea of minutiae.

I know what I should do: get up, medicate, meditate, repeat. I’ve been practicing for a reason, right? But for every step I could accomplish, there are a thousand ways I might go wrong. My mind catches on the whirlwind of what-ifs, tossing me, battering me, severing me from any vestiges of motivation.

A scream rips from my throat, rending my voice to the air. With that sound, I channel all my frustration and fear, my reasonable rage and irrational neuroses. The fury and terror of knowing that I am once again in its thrall. For this is not the first time, nor will it be the last.

I scream again, this time soundless, building the pressure in my lungs until they threaten to burst. My muscles knit; every sliding filament, every head of myosin bent to the task. And I reach inside, yanking and pushing and tugging, wrenching the knot of evil that has sunk its microscopic fingernails into my heart. I pull and I pull and I pull until suddenly, something gives way. My sternum cracks open, the pain transformed by my elation as I drag the discomfort from my body. Its claws scratch useless against my bloody fingers as I throw it to the floor. Dark and wrinkled and smelling of rancid meat, it stains the carpet crimson as if flails beside the tattered remnants of my viscera. I close my eyes and listen to its high keening, to the accelerating thump-thump-thump of my heart against the battered floor. Then, there is silence. I open my eyes.

There is no evidence of its passing. No stain on the floor, no lingering putrid stench. I touch my chest, run light fingers over the smooth skin where a scar should mar my flesh. I breathe in, tasting the sweetness of the air as it slips past my lips, filling my lungs like a prayer. I will sleep now: long and deep. At least until it comes again.