Saturday, February 06, 2010

Panic in Hyde Park

"I'm here to see Dr. Glass. I have a 1:30 appointment."
"Have a seat, it'll be a few minutes. He's just finishing up with a patient."

"Patient? What the fuck does she mean by that? Jesus I'm sweating like a fuckin' pig and the AC is working fine. Why am I sweating? What the fuck is wrong with me? Who the fuck am I? What in the hell is going on in my head? Nice couch. Oh good, Popular Science. What's the point? He'll call me in as soon as I start reading it. What the fuck is wrong with me?"

"Hi Doctor, how are you?"

"Just fine Michael, why don't you have a seat?"


"This is Steve, he's one of my students. Would it be alright with you if he sits in for our first visit?"

"I guess. A student?"

"Yes. The initial diagnosis is very important, and I try to have one of my students sit in for each of them."

"So they can learn how to spot a real crazy person from an average loon right away...."

"I wouldn't put it that way Michael. I'm going to ask you a few questions, and then after you leave Steve and I discuss the various methods of diagnosis based on your symptoms."

"He wants to become a shrink too, and you want to make sure he's a good one."

"I guess you could say that."

"So you're the University of Chicago chief of shrinkology eh?"

"I am."

"Marge M gave me your name. She said you're the best."

"Why don't we get started...tell me what's going on with you."

"I'm going crazy. It happened at 6PM on July 15th."

(smirks at me)

"Yeah I know. It's nuts. I was sitting in my apartment feeling totally normal, and my wife calls from downtown. Wants to know if I feel like going to her brother's house for dinner and a few drinks. I said "sure", hung up the phone, and all of the sudden my mind started going a million miles an hour. Crazy fuckin' shit too. Am I going to die before she gets home? What am I going to wear? What if I start farting uncontrollably at dinner? And then I started sweating like a motherfucker. Like somebody turned on a faucet. Dripping with sweat. And I'm sitting there freaking out, my mind racing like a motherfucker, sweat pouring off my face, ....I had to go outside and breathe fresh air, and then as soon as I went outside, I felt like I had to go back inside because I didn't want to be outside.....see? Look. I'm sweating right now."

"I can see that."

"So my wife gets home, and I tell her I'm going crazy. She looks at me like I'm nuts or something, and I tell her I shouldn't be around people until I figure out what the hell is wrong with me. We canceled the dinner plans, and we just sat in our apartment talking. I'm telling her I think I'm cracking up, going schizo or some fucking thing, and she's trying to calm me down."

"Do you take drugs Mike?"

"No. Well I smoke pot, but that doesn't count."

"How much pot?"

"Every day, but that's not making me nuts. It calms me down."

"Try and go easy on that stuff for now."

"Okay. So anyway, we go to bed, and I can't sleep for shit. My stomach feels like there's a fire inside of it, I'm fuckin' shaking, my hands this....and I'm still fuckin' sweating my balls off, and I feel like I'm about to die, or something completely terrible is about to happen to me. So I get out of bed, and go pull out one of my wife's Psych textbooks. She was a Psych major in college. And I flip to the chapter on abnormal psychology, and I'm reading up on all of this shit, and it's 3 o'clock in the morning, and I'm shaking like a fuckin' leaf, just freakin' out man, freakin' out, and I get to the part about "Generalized Anxiety Disorder." Bingo! That's what I have. It all fits. I go back in the bedroom, and I'm shaking my wife to wake up, and she looks up at me "What?" and I tell her, "Honey, I think I have Generalized Anxiety Disorder."

(Dr. Glass smirks again, and looks at Steve the student, and he's smirking too.)

"You guys think this is funny?"

"You tell a good story Mike. And no it's not funny at all, although the part about waking your wife to tell her you have G.A.D is a bit humorous. You don't have Generalized Anxiety Disorder Mike."

"How do you know that?"

"It's not my first day. So then what did you do?"

"Am I fucking schizo? C'mon R, can I call you R?...tell me. I can take it."

"We'll get to that. What did you do next?"

"The next day I called a friend who's in charge of gastroenterology at Loyola. Marilyn M, you know her?"

"Sure do. She's a fine doctor. She took you right in?"

"Same day."

(Glass looks at Steve with raised eyebrows.)

"Really? She's a very busy woman Mike, you're lucky."

"She's a friend. Went to college with my mother-in-law. Anyway, Marilyn shoots me up with some liquid valium, and waits for about a minute, and nothing happens, and she tells me normally I should be out like a fuckin' light, but I'm sitting there with eyeballs like this 00 and I'm sweating and I'm freakin' out, and my stomach is cranking out acid like nobody's fuckin' business, so after waiting a little bit more for the valium to kick in, she snakes a fuckin' camera down my deep-throating a fuckin' baseball bat....she looks around, sees some old scar tissue from a duodenal ulcer I had a few years ago, but other than that she comes up with nothing. So I ask her what she thinks I should do."

"The scope showed nothing unusual in your stomach?"

"Right. And I can't figure out why I'm freakin' out, and she's looking at me kinda serious, and she says "Mike, you're Lenore's son-in-law, I have a hard enough time telling patients that I think maybe they should seek alternative treatments, because they might be bringing things like this on themselves, but have you considered..."

"And I figure I should let her off easy, so I finish her sentence for her and I say "A shrink?"

"And she laughs, and sort of shrugs, and then nods her head. So I called Marge, cuz I knew she'd had some issues, and asked her who her shrink you mind if I say shrink?...I mean no offense...."

"Not at all. Just relax."

"Relax? Are you fuckin' kidding me man? I'm freaking out! I'm the calmest guy you ever met normally. Totally in control of my emotions at all times. I like to think very very clearly. I've had teachers tell me that my test scores are up there. Way up there. And here I am feeling like I'm losing my fucking mind. So what's the fucking story? If I don't have Generalized Anxiety Disorder, what do I have?"

"Panic Disorder."

"Panic Disorder? No fuckin' way. I'm not a panicky guy."

"You have a high level of tension. It came on suddenly."

"July 15th, at 6PM."

"You're feeling a sense of impending doom. You're sleep has been disturbed. You're generating excessive stomach acid for unknown reasons. Your mind is racing with unwanted thoughts. Panic Disorder."

"You're the doctor, but I think you're nuts."


"So what do we do?"

"There are various opinions on treatment. I believe they're brought on by an over-production of norepinephrine and dopamine in the brain, triggering the fight or flight mechanism at inappropriate times."

"Freaking out for no reason."

(grins) "Right. Some doctors suggest cognitive behavioral therapy, but I'd like to suggest pharmacotherapy as well."

"You want me to take drugs, and lay on a couch."

"No couch. These chairs are okay aren't they?"

"Yeah, they're nice."

"I'm going to give you prescriptions for a tricyclic antidepressant, Imiprimine, and a benzodiazepine, Xanax. Now the Xanax is for right away. It'll calm you down. What we need to do is build up the level of Imiprimine in your system, and that takes a few weeks. Once you reach that level, I want to lower the level of Xanax until you don't need that. I want you to come back next week. Is Friday at 1:00 okay?"

"You're the doctor."

"Don't worry Michael. You're going to be fine. Try to relax, and go easy on the pot. We want to get all the toxins out of your system. And if you drink, go easy on that too. And try to exercise a little. Go for walks with your wife. Fresh air."

"Okay R. Can I call you R?"


"Thank you Doctor Glass."

That was August of 1988.

In the weeks and months that followed, I went for weekly visits with Dr. Glass, and we talked about everything from drugs, to sex, to thoughts of suicide, to tennis, to marriage, to skiing in Colorado. Everything in my head, and in his, we talked about it.

I'd sit there looking out the 3rd floor window at the U of C students playing football on the Midway, the 59th Street Commons, and talk. There were visits when all I wanted to talk about was him. I told him one week that I just didn't even want to think about panic attacks for fear of triggering one, and for 50 minutes I asked him the questions. What's it like being chief of Psychiatry at a prestigious hospital? What was med school like? His family. His leisure activities. His students. It was great fun, and he answered every one of them too. Not a bad way to make $200 an hour, eh Rich?

Without even realizing it really, in the course of about 6 months, I went from non-stop terror, to occasional uneasiness and mild anxiety. I got off the Xanax, because the good doc felt that Xanax simply masked symptoms and was also subject to abuse. I kept a bottle of the .5s in my medicine chest just in case because as Glass told me, "The goal is to get you med free, and symptom free, but we'll take symptom free for starters."....and, as it turned out, Rich was right. Xanax became one of the most widely abused prescription drug through the 90s, so I'm glad I got off of those little orange friends. It's a very nice, mellow buzz.

Have a tough day? Pop an X and everything's OK, ...but it only seems that way.

By the end of a couple of years, I had practically no symptoms at all. I desperately wanted the whole thing to be in my rear-view mirror. Told Rich that I wanted to take myself off the tricyclic antidepressants and see what happened.

He said "that's fine, but let's keep an eye on you a little closer. If you start to feel a return of those symptoms, I want you to start taking them again, and I want you to call me and set up an appointment right away." (By that point we were down to once every six weeks. He seemed pleased with my progress.)

A couple more visits, and everything was fine. My little dance with insanity was apparently over, and at our last session I told Dr.Glass something I've repeated many times since. To fully appreciate sanity, one must taste insanity. You can't fully appreciate how good "normal" feels, until you've felt abnormal. After you've been through full blown panic attacks, waking up and feeling normal feels more like euphoria. (Glass preferred the word "natural" to "normal.")

I told him that he had become one of the best friends I'd ever had in my life, and that in a way, I felt like he'd saved my life. No telling where I'd have wound up if it weren't for that guy. And then I told him, that if he didn't mind, I never wanted to see his face again.

He smiled, and shook my hand. And that was 20 years ago this coming June. Haven't had an attack since, and I never needed to go back on the meds. I would have if I'd had to, because the goal is to be med free and symptom free, but we'll take symptom free.

He was a very smart man, and still is I'm sure.

So I hope you're still playing tennis my friend, and thanks again Dr.Glass wherever you are.


Anonymous said...

Twenty + years can drop in an instant - with deep residue...

thanks for the recap, Schmutz

- - Robert

Keifus said...

Wish I knew what's just normal life rocking a little higher than usual on the chassis, and what's real anxiety. Sometimes it seems impossible to stay desensitized enough for sanity, and I'm familiar with this business of the turbulent guts. Had stress- (and fat-) related stomach problems a few years ago, which were (in the what the hell is wrong with me sense) delightfully self-propagating.

Schmutzie said...

Robert- 20 years, and I can still remember that July 15th like it was last week. Thanks for reading my friend. Hope all is well in CA.

K-That's one real problem for people who suffer from anxiety disorders, the "delightfully self-propagating" nature of the beast. The first tingling of anxiety breeds in the mind a sense of extreme dread..."Oh fuck, here comes another one"

There is nothing on earth that can compare to a "full blown" panic attack, and the most frustrating part for me was the total lack of attachment to something that brought it on. There were times when I expected to have one, ...bouncing around in an airplane that I was sure was about to crash into a mountain....and not a hint of a panic attack. And then, I'd be driving down a Wisconsin highway on the way to camping with the wife, and WHAM! Right out of the blue, and for no apparent reason. The abdominal distress was astounding, as was the hammering heartbeat. Doctors say that most Panic Disorder patients start off thinking they're having a heart attack.

Keifus said...

Yeah, wouldn't've guessed, btw. And glad it's under control for now.

My thoughts weren't entirely out there--there seem to be some anxiety issues in some parts of the family, and it's helpful. Not that you'd catch any of us talking about things like that (when we're sober).


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