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TW: Stigma, panic attacks, discrimination based on mental health, phobias, vomit phobia, nausea, suicidal thoughts
Hello everyone, and welcome to The Oh Shit Kit! Today is mostly about Maddie and Leora’s recent experience in the emergency room. AKA the whole episode is one big shit show. So, Maddie is sharing a positive thing instead of her “oh shit” moment. After posting about her health issues, several people who Maddie was not expecting to reach out actually did, and sent helpful recommendations and support. This is just one more example of the power of talking about mental health! This is why this podcast exists!
Big disclaimer for this one, guys. We are talking about our experiences getting help in a particular instance. Leora will also be providing some diagnostic criteria for panic attacks. It’s especially important to remember during this episode that our podcast is not a substitute for professional support and/or advice.
As you all know, Maddie has been struggling with her health for a few weeks now. This episode is about Maddie’s most recent visit to the emergency room. After struggling with not being able to eat much and having unusual symptoms such as abdominal distress and lightheadedness for several weeks, Maddie had an incident where she nearly threw up and then fainted while at work. Maddie’s boss drove her to the emergency room, and Maddie called Leora to come and support her while she was there. When Leora and Maddie were explaining what had been going on with Maddie, they mentioned the possibility that some of her symptoms could be mental health related.
Leora and Maddie decided to mention the possibility of Maddie’s symptoms being related to mental health because they had broken out the good ol’ DSM (Diagnostic and Statistical Manual for mental health disorders, AKA the only book Leora actually reads) a couple days prior to the ER visit. They discovered that Maddie’s symptoms were actually consistent with panic attacks, even though they were nothing like the panic attacks that Maddie had in the past. It’s important to know that if someone has four or more of the following symptoms, they may be having a panic attack. This can occur from a calm state or an anxious state. Here are the symptoms, taken directly from the DSM (cited below):
Palpitations, pounding heart, or accelerated heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath or smothering
Feelings of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, lightheaded, or faint
Chills or heat sensations
Paresthesias (numbness or tingling)
Derealization (feelings of unreality) or depersonalization (being detached from oneself)
Fear of losing control or “going crazy”
Fear of dying
An important lesson that we learned from this is that your symptoms can be different at different times in your life. Maddie didn’t think that she was having panic attacks, but medical tests ruled out medical causes for her symptoms, and anxiety medication has been working to lessen her symptoms. These were NOTHING like the panic attacks Maddie has had in the past, but she did have seven of the thirteen symptoms.
So, the point of this episode isn’t just to provide information about panic attacks to you all. It’s also to discuss the experiences that we had at the ER, and how these motivated us even more to stand up to mental health stigma. Maddie mentioned directly to the staff at the hospital that sometimes when mental health is brought up, people are treated differently at the ER. Maddie was assured that this would not happen, but, unfortunately, that was not true.
One of the issues that occurred was a lack of understanding about Maddie’s vomit phobia. Maddie began feeling nauseous while in the ER, and Leora and Maddie asked the hospital staff for something to help with the nausea, reminding them that Maddie has a vomit phobia. It took about fifteen minutes to get any medication for the nausea, and by then, Maddie was having a full blown panic attack because she was afraid of vomiting. Leora then asked for some medication for panic attacks for Maddie. It took forty-five minutes for that medication to be administered. At first, the doctor prescribed something for which a side effect was nausea...not helpful when your panic attacks are related to vomit phobia. A couple of additional things happened while waiting for medication that were demonstrations of mental health stigma. Maddie was told “I need you to help me help you, and breathe”. She was also told “I have a patient in another room who is really sick, so you’re going to have to wait”. Le sigh. We have a lot of work to do, people!
The most shocking part of the whole ordeal was when Maddie’s medical tests came back clear, and a doctor came in and told her he was ready to discharge her because he could not find anything medically wrong with her. Leora and Maddie did not want to go home without some type of help, because Maddie could not eat or drink without feeling sick. Leora and Maddie asked for additional tests, and the doctor said no. He stated that he didn’t even want to do some of the tests that they did, but he decided to give the test anyway. At that point, Leora asked if Maddie could see a psychiatrist, and the doctor stated Maddie could not see a psychiatrist unless she was suicidal. Maddie tried to explain that if her panic and nausea continued, she could become suicidal. The doctor did not wish to take any action based on this. He became visibly angry and began saying things like “this is an ER and you’re not dying, you’re not going to starve, and other people need beds”. Leora and Maddie explained that he was coming across as dismissive and that a little compassion would go a long way, but the doctor did not change his answers or start treating Maddie in a more respectful way. The only thing that the doctor would agree to do was allow Maddie and Leora to talk to a social worker. Apparently, (at least in Wisconsin), if you ask for a social worker in the ER they have to allow you to talk to one. Upon leaving the room, the doctor slammed the door.
Leora and Maddie were finally treated respectfully by the social worker. The social worker spent time with Maddie and thoroughly went over what had been going on with her. The social worker called an on-call psychiatrist, and medication was prescribed to help Maddie with her panic and anxiety. The social worker was also able to speak to the doctor Maddie had seen previously and get a medication for nausea prescribed.
This is where we talk about what comes next. Mental health is treated differently from physical health in the medical profession. The truth is, mental and physical health are interconnected. They cannot be separated. A panic attack is a perfect example- it is a mental health issue, but it causes physical changes. Your heartbeat quickens, you may feel sick or faint, your body temperature changes...this is no less real than any other physical symptom caused by an illness. But, because this is related to mental health, the ER does not view it as an emergency. This is why we do this podcast! Remember, if you have an experience like this, you are not alone. We are all part of a community that has each others’ backs, and we are ready to start a movement to change the way the medical profession looks at mental health.
TOOLS
Having had a panic attack can be a trigger for panic attacks (because of the fear of having one), so it’s important to seek help if you’ve had a panic attack so you can prevent them in the future.
If you’re going to the ER while in mental health crisis, bring a trusted person with you if you can so that they can help you relay information. If you’re the person helping, always ask permission and don’t talk over the person who is in crisis.
If you are told to leave the ER without any help or answers, ask to speak to a social worker.
Tele-psychiatry can be a way to talk to a psychiatrist more quickly than you can get an in-person appointment. You can ask a social worker to schedule one of these appointments for you if you are in the ER for a mental health issue.
If you have a negative experience with the healthcare profession related to mental health, remember that you are not alone. Reach out to others, whether that be friends, family, a therapist, or an online support group.
CITATIONS
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596