September 10, 2005

In a Panic


1539 story3 capY NAME IS NOT REALLY STEVE Neumann. I wouldn't mind telling you my name if you knew more about me and about my disease. The reason I want to tell my experience is simple. The thought that someone is now going through what I did, but alone and helpless, saddens me deeply. If possible, I want to help stop that suffering. We have no greater obligation to help others than in the same way we ourselves have been helped.

First Pain
I work for a Seventh-day Adventist institution. I have little formal medical training. At some point in the distant past I began having chest pain at night. My heart occasionally felt as though it was skipping beats.
I began to worry that I might have heart disease, but thought little of it, and told no one.

But the thought of heart disease gnawed at me. After all, my diet was not perfect. I was a bit overweight, and there was always more exercise I could do. But however much I sought to manage my health, very slowly over several years the secret little fear I had about my heart insidiously ate into my mind.

My nighttime hours became difficult. I would awaken with chest pain. I often experienced a strange sense of dread and foreboding. This dread became all mixed up with my relationship to God. I tried to put my worries into His strong hands. I tried to "trust" it all away, but the pain and dread persisted. I began taking my own blood pressure, but it was always normal.

A serious search for the cause of my chest pain began. My physician father tried to help me. At his suggestion I went to see a gastroenterologist. His diagnosis was a mild case of GERD, or gastroesophageal reflux disease, known as recurring heartburn. Acid from the stomach gets into the esophagus; the effects can be painful and can mimic a heart attack. I was thrilled to have a name for my pain. Treatment began. I faithfully took my acid-blocking medication.

"You're Going to Die!"
1539 story3Things only got worse. With greater frequency a voice would rise up inside me and say with great authority, "Tomorrow you are going to die!" The terrifying prediction seemed incontrovertible, destined. It was going to happen. The Bible says that God knows the day of our birth and the day of our death. Well, I knew when I was born. I guess I thought God was letting me in on the secret of my end as well. It gives me great comfort to realize that God doesn't ordinarily tell His people the day of their death. Such information is strictly on a need-to-know basis. How kind of Him to keep us in the dark about so many things! I wish I knew less than I do about many things.

When I didn't die the next day, I refused to be comforted. An even greater anxiety gathered power within me. I'm insane, I thought. I need to be in a padded room wearing a straitjacket.

My wife was a nurse who worked nights. Often when she was gone, I would lie in bed and meditate about the possibility of my insanity. A terrible prospect entered my mind: What if one of these nights I lose control of myself and harm my children? These thoughts would wash over me during the darkest hours of the night. I seriously considered tying myself down to my bed. I was becoming unhinged. My mind was failing me.

The Attack
One night I awakened once again with chest pain, except this time something was different. Intense fear, mingled with severe pain, began rising within me. My whole body flushed.

Deep in my soul I knew that the time for my death had arrived. My wife was at work, my children were sleeping peacefully, and I was dying all alone in the middle of the night. The most inexpressible horror swept over me. I cannot describe the awfulness of that "death" experience. Much later, in discussing this incident with my father, I learned that this "moment of death" is the most horrific aspect of a panic attack. Of course, persons suffering a panic attack do not experience death; however, they experience what may be worse--they experience what they imagine death to be.

The remainder of the night of my first panic attack was spent in a cardiac intensive care unit. I remember lying in that hospital bed for many hours with the most severe chest pain imaginable. The doctors gave me large doses of antacids, as well as morphine, but nothing touched the pain. The medical profession was trying to help me; they just didn't know what was wrong. The initial EKG and blood work done on my admission to the emergency room showed normal heart rhythms and normal blood chemistry. But I felt alone and abandoned.

More Testing
The next day saw the beginning of medical tests and examinations that would stretch on for some time. After the doctors performed a heart catheterization, for the first time I experienced the relief of knowing that I did not have heart disease. In fact, my heart was in great shape.

My father began suggesting to me that my troubles might be caused by a mental illness, specifically, severe anxiety panic disorder. This was hard to believe, since the pain I experienced was so incredibly physical. He continued talking with me over many days in kind and sympathetic tones, gently trying to get me to see something I just couldn't imagine.

I earnestly looked for other reasons to explain my pain. There had to be some explanation. A diseased gallbladder can cause chest pain. I had a gallbladder test; it came back negative.

Reluctantly, I began reading up on panic disorders. One book listed questions, the numeric answers to which, when totaled up, indicated the possibility of anxiety panic disease. My score on that simple test brought me face-to-face with a stark truth--I might have a mental illness. Finally I agreed to an examination by a psychiatrist.

A Diagnosis
Psychiatrists are interesting physicians. I've heard it said that if a physician will just listen, patients will often diagnose themselves. Well, this was my psychiatrist's technique. I talked, and she listened, asked a few questions, and scribbled some notes. At the end of my hour, there it was--the answer. I did have panic disorder. This wonderful woman put me on two medications, and told me to come back every week until we had the doses right. My symptoms were stopped dead in their tracks.

I didn't know it at the time, but I had just been saved from many years of unnecessary pain and suffering. Undiagnosed and untreated, panic disorder can destroy a person's life. Panic disorder has many "official" symptoms: palpitations, pounding heart, racing heart, sweating, tremor, smothering sensation, shortness of breath, choking sensation, chest pain, nausea, dizziness, derealization, fear of going crazy, fear of dying, paresthesia (tingling skin), or hot flashes. Many other symptoms may exist for any particular person. An important "unofficial" symptom is just feeling really, really rotten.

Pursuing Pain

A Few Brief Facts

PANIC DISORDER is very common, but until recent years it has been nearly invisible. It is estimated that one in 75 persons has the disease. Studies suggest that a significant percentage of emergency room and doctor visits are panic-related. If you or anyone you know seeks medical help for mysterious symptoms and no cause is discovered, do not dismiss the symptoms. Pursue the pain and the symptoms.

Panic disorder is not the same as simple worry and anxiety. Many people become anxious about the normal events of life and may even have a "panic attack." But true panic disorder is a disabling condition that must be accurately diagnosed and treated by a health professional well acquainted with the vagaries of the disease. Panic disorder can have serious health consequences if treated improperly. Sufferers have been subjected to unnecessary surgical procedures and inappropriate medications without experiencing relief of symptoms.

My father, an old-timey doctor, now retired, has talked with me extensively about his early days in medicine. He was taught, and always made it his practice, never to stop searching for the cause of a patient's pain, or leave a patient in pain. A person with panic disorder must find a physician who will resolutely pursue the case. It is best to search for a doctor who treats many patients with panic disorder. An accurate diagnosis of panic disorder may take years and multiple visits to many different doctors.

The cruel reality of this disease is the separation it creates between the sufferer and other people. After all, the person with panic is perfectly aware of the stigma attached to some of the psychological symptoms, and so these symptoms are suppressed. And when no cause is found for the physical symptoms, what can a person with panic do, except become more anxious?

Getting Proper Treatment
Untreated, panic disorder can lead to terrible consequences: alcohol abuse, severe depression, family dysfunction, and phobias, particularly agoraphobia. Agoraphobia is the fear of going outside or going among people or crowds. Individuals with panic disorder have been known to go home, and stay there--for years, trapped by a disease they do not understand.

Since my wife is a nurse and my father a physician, I did not experience the isolation that often accompanies panic. Both my wife and my father offered me steady consolation, and good advice. I cannot emphasize enough how unusual my experience has been in finding proper treatment so quickly. I was pain-free in a matter of weeks after a correct diagnosis.

Panic disorder is so insidious and debilitating that even a proper diagnosis will sometimes fail to satisfy a person's desire to comprehend. After all, what is the physical evidence for the disease? Persons may engage in a lifetime of search for the real cause of their symptoms.

My experience has made me much more sympathetic to the sufferings of others. Panic disorder has taught me that I cannot know the true nature of suffering in others. I cannot be quick to diagnose why people feel bad, why they suffer. All I know is that I was saved from suffering by the kind attentions of others. Another important lesson is buried in the heart of this disease: all of life is one long experience with a certain kind of panic. When we become Christians, we're taking on an obligation to follow the pain in our fellow sufferers.

Panic disorder has led me to a deeper dependence upon God. I know that I can still suffer all sorts of ailments in the future, both physical and spiritual, but I know that when I cry out for His help, He is listening. Even though I may walk through the shadow of the valley of death, I will fear no evil, for He is with me. This promise describes a different kind of death experience than I had in my panic attack. Yes, the living know that they shall die, but they need to let go of their imaginings about death. I know that my health and salvation are in His hands, no matter what fears my mind may present.

The power of panic disorder comes from within the sufferer. That is the bizarre characteristic that makes panic disorder a vicious invention of the devil. He wants us isolated from each other, and the church body. I was saved by loved ones. Now whom can we save?

Steve Neumann is a pseudonym.