I knew, unfortunately, the symptoms as they began to manifest. Racing heart, irresistible urge to leave the room, difficulty in expressing my discomfort. This was not my first panic attack and realistically not my last.
I spent the past weekend traveling to Cape Cod and back, returning with a deep deficit of sleep and quiet time needed to recharge my batteries. Before that, Prologue had already drained my reserves. The weekend prior to Fourth Year starting, I spent three days in an intensive Balint training, diving deep into complicated relationships with patients. The day before the training, I spent a very weird day in Philly talking to Standardized Patients for Step 2 CS. Before that, I had the Surgical Care Clerkship Shelf exam. And leading into the Shelf, I had a week of nights.
This is all to say that perhaps this panic attack was an inevitable result of these stressors piled onto one another without reprieve. The nebulous nature of mental health is prone to speculation and feelings of guilt. Myself included.
I told Mackenzi that very morning I’d been feeling very frazzled. That I would like to resume a meditation practice I’ve put on hold for the past few weeks. The exhausting and constant pace of Prologue left me feeling like I do not have time to meditate, to take that quiet space for myself. I wonder if a few sessions of breathing in a quiet place would have prevented this event.
No particular trigger, nothing that would provide a strong cause for the cascade of panic and anxiety. I had spoken, without issue or problem, about the risks for physicians in prescribing medical cannabis in front of the class as well as debated gun control in small groups. As we broke for lunch, I felt a swell of anxious energy. Perhaps the tense atmosphere with as charged a topic as gun control, without discharge of that tension, provided the trigger for my panic attack.
The symptoms arose while waiting for my partner to finish writing an email. She wanted to send the email before we left to grab lunch off-campus with a friend. While she wrote, I felt a static build inside my chest, which radiated down to my feet and hands. My heart began to race and I had trouble standing still. I realized what was happening to me and I told Mackenzi I had to go. She stayed for the free lunch, put off by my brusque exit.
I left the lecture room and traveled to Whole Foods with the close friend. He drove and listened to music as I Wim Hofed to reclaim some semblance of composure. I selected my lunch-to-go in a haze, attempting to joke with him and keep the subjects light. I’m grateful for his compassion and space.
When we returned to lecture, I still felt the edge, the jitters around the periphery. I felt like a balloon loaded with static electricity that just needed to discharge. The activities for the afternoon? Delivering bad news to standardized patients such as the death of a loved one or a terminal cancer diagnosis. I knew that I needed to discharge my static before these emotionally draining encounters.
I went to my car and sat in the back seat. I took a few deep breaths and from a place deep in my chest, I began to scream. I chose my favorite four letter word to carry my static. I felt my chest tighten with the exertion and my throat rub with friction.
I took three more breaths.
I screamed again. Longer, louder, and with more of my body from my calves to my hands.
Another three breaths.
One final scream, the longest and loudest by far. With my voice hoarse and my hands white from clenching, I felt lighter.
Drained and tired, but lighter.
When I returned inside, I found out that I would be among the first to rotate through the simulations. While walking over to the simulation center with the other students, I felt like an observer in my own body. Not quite myself and not quite a third-party. In some ways, I imagine this feeling similar to a postictal state after a seizure. Exhausted and not entirely returned.
Luckily, my simulation group was culled from my coaching group. A preceptor that has served as my coach and fellow students that I have interacted closely with since the first days of medical school. I told them that I had “something like a panic attack over lunch,” and that I wasn’t really present. They allowed me my dignity in accepting the information. Then, they suggested that I take care of myself do and whatever I needed to do.
I left campus and went home to lay down with Honey. I spent the afternoon stretching and self-massaging my tight muscles and wound up soft tissues. I walked Honey and enjoyed the warm, almost Summer Solstice weather. I felt like myself, for the first time in weeks.
Reflecting on the experience, I feel the need to be transparent about my panic attack. I think I will surprise others with my honesty. Some might think I’m immune to any insult of mental health, that I’ve somehow transcended the muck of daily living. I have not and I am just as susceptible to rage, Shame, and anxiety. And I am so glad to be here in the realm of the living, with you all.
I can identify one previous panic attack from a few years ago. I believe that I am only prone to them when I am experiencing considerable stress and exhaustion. My long sprint is over: from that final week of surgery night shift to the end of Prologue and the true start of Fourth year.
I can build up instead of draining the battery over and over again.
I can pour my love into baby.
I can breathe.
These breakdowns in my strength, in my resolve, are important to me. They connect me with friends and patients. They provide a framework to relate the pain and suffering of others to myself. I’d be suspicious of any bachelor providing advice on how to parent. Similarly, I will have more compassion and patience with the depression/anxiety case that rolls through the inpatient wards.
I have not walked in their shoes, but I know how the shoe fits.
Long Form Sundays
- On frustrating starts (or the beginning of Fourth Year)
- On four clerkships (or Third Year: a post-mortem)
- On summer nights (or Surgery: a post-mortem)