It took me years to realize that people can’t see panic attacks.
Illustration: Lia Kantrowitz
On Edge is a series about stress in 2017.
The first time I had a panic attack I was on a boat. A ferry at night on Vancouver Harbor. The cabin, an open window-ringed space filled by rows of waiting room seating, was nearly empty and very quiet. The water was smooth. My chest tightened from the inside and I couldn’t breath―or I couldn’t catch my breath. I knew this was the end and I felt nothing but terror. Imagine the desperate, doomed fish flopping about the bottom of the fishing boat.
The panic of a panic attack feels like a real physical thing that is inside my skull. It’s a hand pulling backward on the surface of my brain, like a magician pulling away a cloth napkin to reveal nothing underneath, except the napkin won’t budge and the magician is left to pull and pull. I might gasp as it happens, but no one notices. For years, no one notices.
The panic of a panic attack feels like a real physical thing
The intense fear burning underneath a panic attack usually, for me, has no clear spark. It just happens. It happens when I’m falling asleep, or when I’m by myself watching a movie. It happens at work. It happens when I’m eating. It happens during sex. At the grocery store, I leave a basket of unpaid-for items by the door as I stagger outside, gasping for air as the hand pulls back my brain and fear metastasizes. I feel my neck for a heartbeat.
The physical symptoms mostly connect to hyperventilation. I breathe too fast, which removes more carbon dioxide from my blood than is being produced by my body. Carbon dioxide is a waste product, but it’s also part of a balance existing in blood between acids and bases that keeps blood just slightly more basic (between pH 7.35 and 7.45) than neutral (pH 7). CO2 is acidic when mixed with water—as in blood—so an abnormal decrease in CO2 leaves the blood more basic (or alkaline) than normal, a scenario with immediate physiological effects.
There are pins and needles at first, in my hands and arms. A warm, heavy ball forms inside my chest. It feels like a tightening fist. The pins and needles congeal as they saturate skin and then muscle. The change in pH lowers the number of calcium ions in my blood, which results in an increase in nerve and muscle excitability. Next, the muscles in my hands and lower arms start to seize up, contracting and becoming difficult to move. My hands are like claws, twitching and trembling.
My head contracts in its own way. My focus narrows to tunnels. I’m breathing too much, but can’t catch my breath, so I breathe harder. Everything is just fear and clawing and breathing. This is the point that some people pass out. Their bodies, now freed from the doom-loop of panic, are able to restore chemical order quickly. I’ve never passed out during a panic attack. Sometimes I drank them away, and-or I took a bunch of Benadryl. Xanax helped, but often not enough. Sometimes, I think they stopped just because my brain was completely exhausted.
Everything is just fear and clawing and breathing.
It took me years to realize that people can’t see panic attacks. On the ferry and afterward, no one saw my shaking. No one saw it quieten later at a bar, or saw that the color had returned to my face. Or that I could speak more than a word at a time.
When this started in 2004, I worked at a reasonably fancy, hip hotel. I carried luggage, flagged taxies, and made small talk in elevators. If you had any idea that your bellperson was mentally convulsing, you didn’t let on. I offered to get ice and gave you restaurant tips. Only once or twice did I have to excuse myself to a nearby stairwell to breathe into the sleeve of my purple corduroy suit. Later, as the attacks got more frequent and more intense, I would have to leave in the middle of busy shifts. This was an issue. Later, as a newspaper editor, I could suffer alone in an office, under my desk.
A couple of years after that first panic attack, I found a doctor who could tell that I was having a one in her office almost as quickly as I could. She walked me to an empty waiting room and turned out the light. She sat in the seat next to me and I told her about it.
In the bad years I would wind up at the emergency room every couple of months before finding the right medication. The bare facts of the situation wouldn’t be enough. I felt out of control, and then I just felt the terror. I remember sitting in the back of a cab in Baltimore clutching a vinyl door handle thinking I couldn’t make it. I wouldn’t make it. It would finally happen, this thing that was just over the edge of the panic attack. And then I would be dead. (Baltimore emergency rooms: not great places to have panic attacks.) I told a girlfriend that I loved her for the first in an emergency room because I thought I would never have another chance. They gave me Ativan in a little paper cup.
It would be years before my particular suite of mental illnesses was “well managed,” in large part to my own resistance to taking medication, but that bit of understanding in a dark waiting room was a really big thing. I get kind of choked up now when I think about it.
I felt out of control, and then I just felt the terror.
Panic attacks will never not be a part of my life. I haven’t had one in years. I take a medication called Effexor and it helps a lot. I have panic attacks a few times a year, but they’re short. My last ER-worthy panic attack was in Cortez, Colorado in 2013. My prescription ran out and I and couldn’t afford the refill. Three pills of Effexor wound up costing me about a thousand dollars. The next January I was able to get health insurance coverage through Medicaid expansion, which covered my prescriptions. I’ll take Effexor for the rest of my life.
I keep a small reserve of Xanax in my apartment in case of emergencies. There are feelings I’d like never to feel again. I haven’t needed to take one in years.
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