One moment Jeff Brown and his girlfriend were strolling hand-in-hand down a Chicago street, and in the next he was pulling her out of a manhole.
"There was a bit of construction and sidewalk repair going on, and suddenly I was holding her hand above her head," said Jeff Brown, a 34-year-old technology manager. "She's not a tall woman and she would have been up to her waist if she had not caught herself with the other leg."
His stunned girlfriend walked home a bit scraped up and semi-barefoot, her sandal forever wedged beneath the street. For months, the frightened couple avoided manhole covers.
Brown and his girlfriend join many others in their close brush with city hazards. While the National Highway Traffic and Safety Association reports nearly 83,000 pedestrians die or are injured in motor vehicle accidents each year, several thousand suffer the other dangers of urban life.
Felled by fallen scaffolding, electrocuted by grates and maimed by flying debris, pedestrians across the United States sometimes feel like the victims of the national construction boom.
Just this week, a worker plunged 42 stories to his death at a congested construction site in New York City. By some miracle, the falling scaffolding and building materials didn't strike passersby.
In Pittsburgh last year, a steel beam sent a loading dock crashing to the street, the third time at that building site that bolts had failed. The year before in Boston, 10 tons of scaffolding crashed into a shopping district, killing three.
New York City's top building official told the Daily News just last summer that she is afraid to walk under scaffolding because of falling debris from rooftop construction sites.
"I don't want to make you nervous, but ... I cross the street, thank you very much," said Buildings Commissioner Patricia Lancaster.
In 2007, the city launched a task force to address the dangers caused by bolts, beams, two-by-fours and sheets of plywood falling from construction sites.
Jake Clark, a 65-year-old pedestrian, was struck by a 22-inch piece of metal that fell from the Time Warner Center in Manhattan during a windstorm in 2004, grazing his arm and sparing his life by inches.
Clark told ABCNEWS.com he is "definitely shell-shocked," even four years later. "You never get over it."
"There are terrible dangers around when you are out and about," said Clark, who sought counseling after the accident and now avoids all scaffolding. "When I go by there it brings it all back. It's too hard mentally."
City officials acknowledge incidents are rare, but it's easy to develop a phobia about myriad of potential disasters.
"Some phobias are grounded in a bad experience, and others have been with the person as long as they remember," said Dianne Chambless, a professor of psychology at the University of Pennsylvania.
True phobias -- rather than the post-traumatic stress that probably precipitated Clark's brush with death -- are based on imagined rather than real fears, say psychologists.
"People who are really afraid of something collapsing or something falling on them under a window, or trains getting stuck, that's not phobia, that's just fear," said Jerilyn Ross, president of the Anxiety Disorders Association of America.
David Kupfer, a Washington, D.C,. psychologist who specializes in anxiety treatment, has seen numerous patients who are paralyzed by the perceived dangers of city life.
Sometimes their fears become phobias.
"A phobia is an irrational and obsessive fear of a situation that impairs a person's ability to lead a normal life," he said. "When you live in the city, you have deal with skyscrapers, elevators, bridges, heights, traffic, the subway and dirt."
One 46-year-old man -- a Virginia building engineer -- could no longer work at the large building where he was head of maintenance.
"He fears loud noises and driving, because he is afraid he will cause an accident or a building will collapse on him," said Kupfer. "He's afraid of strangers and crowds -- that he will either cause or be the victim of an accident."
About 20 percent of all people suffer some sort of anxiety disorder.
"The urban environment is new to us as a species," he said. "Our ancestors didn't have to deal with scaffolding, high buildings or bridges."
People who are panic-prone often "lack faith," according to Kupfer. Their heart beats rapidly, and they may have trouble breathing and feel as if they are going to pass out.
He treats patients by helping them face the fear. "A lot of people manage it with positive thinking and feeling safe," he said. "But we need to let go of control. We have to accept it's not a safe world."
Generally, therapy can be accomplished in 10 to 15 sessions over three or four months, as Kupfer accompanies his patients to the scene they find most traumatizing.
David Carbonell, director of the Anxiety Treatment Center in Chicago, said his practice is "replete with urban fears."
"There is the necessity to go up into high-rise buildings. People can come to fear elevators, fear heights -- not so much afraid of being high, but being so far from the exit," he said.
Commonly, phobics fear the fear of being trapped or being out of control and embarrassing themselves.
It's the "fear of fear," according to Carbonell. "It crosses the line when an individual's life is impaired."
In the Chicago Loop, where pedestrians are warned of ice falling off buildings, some people just walk around the danger zone. But phobics might panic, putting themselves in more danger by running in the street in front of a bus, he said.
Obsessive compulsives -- those who develop rituals like avoiding ladders and cracks in the street -- convince themselves their routines will help them "dodge a bullet."
These behaviors are much like superstitions -- humming a certain tune or wearing a lucky shirt -- to survive the day.
"They make sure they haven't made a mistake or overlooked something that could have caused a disaster," he said. "They have this drive to be sure, and it causes anxiety."
The goal of treatment is to teach a patient to be "more tolerant of uncertainty."
"It isn't whether the fear is true or false," according to Carbonell, who instructs the patient to ask himself, "Is that fear I'm having a sign of danger or of discomfort?"
But most city dwellers feel neither and go about their daily lives amid the jackhammers and cranes.
"I've survived this far," said Alex Atkin, a life-long New Yorker and mother of two. "On occasion, the thought crosses my mind that something could fly down and hit me or my offspring, but it's another one of those things you get used to living on the edge in the city."
"What really annoys me," she said, "is when cabs don't stop for me and the kids when they see the stroller."
For more information, visit Anxiety Disorder Association of America