Imagine you’re in a grocery store — your local, familiar spot with a list and plenty of time. You’re picking through the green beans when the floor drops, the earth ceases to turn, or maybe picks up speed. Your heart races, your throat tightens, a chill creeps quickly from your feet to your face. Sounds change — the common chorus of a food-shopping crowd becomes a tinny, clanging jumble, jarring and garbled. Light and movement is suddenly visual overload. You feel that you must run, but perhaps it’s safer to sink, in case you fall. What if this dizzy madness causes a blackout and you pass out, again? Right there, by the beans, for everyone to see.
Most of us take consciousness for granted, like breathing. We breathe, in and out, all day and hardly give it a thought, just as we wake each morning and count on the seemingly simple fact of consciousness. We don’t will it or work on it, we expect it and are never really in fear of losing it. Like the rising sun, day in and day out. But what if you can’t count on it, or don’t feel as if you can? What does life look like then?
Back to the beans. You assemble your face and limbs into what you imagine mimics any other shopper and find a relatively quiet corner by the organic juice, a niche where you can sit on the floor (not exactly mimicking any other shopper, but it’s the best you’ve got) and hopefully gather your wits. You sit and breathe, smiling weakly at the concerned and confused faces that loom over you. When you feel stable enough, you lean on a grocery cart and leave the building as fast as you can, beans a forgotten goal. You feel, as you collapse in your car, that you have been through the wars, known true terror. Right there, in the grocery store, by the beans.
This is my life now and it makes no sense at all. I don’t drive much anymore, my husband does most store shopping, and I won’t be meeting you at the bar. After a half-century of performing normal (it’s all performative, admit it), I’m a nervous wreck — largely because I might pass out. It’s ugly and I don’t want to subject any of us to it. So I navigate the world in a protective bubble. I’m very functional within a small radius and in small, human-sized establishments. Put me in a crowd, in a large public space, give me too much stimuli, and I might be going down.
Vasovagal syncope is the medical term for the fainting that plagues me — vasovagal referring to the vagus nerve and syncope referring to fainting. It’s very common. An ER doctor called me the poster child for vasovagal syncope.
The physiology of fainting includes a drop in blood pressure and heart rate, accompanied by an assortment of alarming things — sweating, pallor, dizziness, visual disturbances, nausea, stuttering, tinnitus, etc. — any or all of the above, followed very quickly by the hallmark loss of consciousness. The list of causes is a mile long and includes such banal things as swallowing, stress, and hunger.
Life, in other words.
Those of us afflicted — mostly women, it seems — may simply be felled by life, regularly and unpredictably. It is therefore understandable that we may develop issues with anxiety, for lack of a better word. When a subtle change in temperature or slight dehydration could send me crashing to the ground, I worry. It happens rarely, but the episodes live in my memory and are so mysterious to me that I feel as if I have no control over the very common human ability to stay on my feet. I don’t trust my own consciousness— my tenuous relationship with it makes me wary and skittish. If an environment makes me feel nervous at all, for any reason — bright lights, layers of sound, too much visual stimulation — I am immediately reminded of the last time it all went quiet, as if someone rapidly turned the volume knob of life all the way to zero.
What would that look like here? Here by the beans? With these specific individuals around me? In this outfit?
It’s crazy, I know, and the humor isn’t lost on me in the good, strong moments. Don’t mind me, just leaning on the fish case for a moment so I don’t fall down and piss myself. It has been used (perhaps overused) for comic effect in film — think Jim Carrey buckling at the knees at the sight of chicken decapitation in Yes Man. But the experience itself is absolutely not funny, trust me.
Consciousness is a right, we think, given at birth and used until we lose it permanently, at death. We tend not to think of sleep as unconsciousness, as it restores us and we live it through dreams. I can say from experience that unconsciousness is not restorative — quite the opposite, it is completely draining, almost deadening. It has taken me time — hours, days, most recently years — to fully recover. The state of unconsciousness, for me, has been varied; a black hole, at times, an unspooling of a film-like dream at others. Once, I believe I viewed my own body on the floor, from a vantage off to the side and slightly elevated, like the frequently heard description of the out-of-body experience. And once, to my everlasting embarrassment, I woke to the sounds of manic shouting, only to realize very quickly that it was me — shouting at my poor frightened mother who was trying to help. This was my most recent experience and the reason I don’t shop for the beans anymore.
All of my previous fainting spells were preceded by something that could be called a trigger — usually blood, wounds, or illness — and a woozy, dizzy feeling. This one, however, was a stealthy shot from the blue. The ER doctor said that urination could have been the trigger — common among the vaso-vagally challenged, apparently. I had gone to pee in the wee hours — staggered from my bed feeling fuzzy-headed and wobbly and, according to my visiting mother, I went down like a tree at the foot of her bed.
Down like a tree, for no apparent reason.
Rational thought provided me with a stew of potential causes after the fact — after the ambulance, and the second faint while the crew fished for a vein, and the exhausted, helpless hours in an ER bed. After coming home and sitting in the backyard with tea, there were some things that presented themselves. My husband was out of town on business and we were not speaking — a first in a long, strong marriage. I skipped dinner the night before, choosing instead a pomegranate martini — very unusual behavior for me. My visiting mother had been weepy and needy for days (hence the martini) as we discussed my very damaged and life-challenged sister. I was knee-deep in the all-encompassing, 24/7, task of raising four children (because when is parenting not 24/7?). It was 2008 (economic crisis, anyone?) and I was spending my nights catering for a friend to stanch the financial bleeding that ensued when my husband’s pay was cut. I was, in hindsight, exhausted and stressed — like so many others — and, as luck would have it, knocking on the door of menopause, that lovely chapter in a woman’s life when she should be handed a drink and a good book and sent to smell the roses for a few years.
The horror of the thing, following virtually no warning, has made me skittish, prone to constant self-analysis.
What if I drop now, staring at the lacquered eyes of the check-out clerk? Or now, foot on the gas, 60 mph, with a string of distracted commuters behind me?
I don’t worry at home — a dizzy spell sends me to the couch, like a silent movie star, to dissect the depressing fact of my fallibility. But a hint of dizzy at a red light can send me into full-fledged panic, a mad rant of what-ifs chattering inside my odd, busy brain. I soldiered on for months after my last episode, even though the bean incident was only a week later. I drove kids around and staggered through errands before finally giving in.
With a diagnosis of whiplash and post-concussion syndrome (after the tree thing), hypothyroid, vitamin D deficiency, and peri-menopause, I retired, as it were. I drive when and where I can, I don’t shop much and I say no a lot. I’ve been to doctors and chiropractors, acupuncturists and massage therapists. My blood has been over-analyzed and supplemented. I take Chinese herbs and thyroid medication, while refusing the acronyms (SSRIs, EMDR, CBT). I do yoga and I try to meditate.
I’d like to count on consciousness again, the current that ran through my days before this new reality. You don’t know it’s there, really, until you lose it.
I want to believe this is a direct result of the hormonal storm raging inside my middle-aged female body and that it will subside, gracefully and thoroughly, like the bleeding. I’m afraid, though, that the link to consciousness is more complicated and that my fear of losing it has as much to do with my brain, my history, and my neuroses as my hormones. How many modern Americans say yes to the SSRIs and their cousins, legal and otherwise, to quell their own special brand of anxiety and depression, the twin monsters of our epoch? I’ve been shocked to learn, through my own drama, that many, if not most, of my middle-aged friends are medicated in some way, white-knuckling it through the day. One friend rescued from the shoulder of a major freeway in the midst of a crashing panic, another forced to give up her pursuit of higher education because of crippling anxiety. Menopause forums are jammed with nervous ladies seeking assurances that their anxieties aren’t unusual. Most women I know (and some men) have their own dramatic fainting stories.
I’m not the only one, it seems, who breathes much easier in a field of beans than in the produce section.
Others have it worse, of course. My niece, through her teens, would faint randomly and frequently. I met a lovely teen girl, a friend of my daughter, who faints several times a week. Down she goes, everywhere, anywhere, with no warning. Neither girl has ever been definitively diagnosed. My niece has largely grown out of it but the local teen continues to drop. She is bright and accomplished, but her world is becoming smaller because of fear — hers and her parents’. Doctors can’t figure it out — the brain is, to a large extent, an unknown wild.
So it goes that my world has gotten smaller and I’ve become more tentative with regard to the way I move in it. The farther I get from the last episode, the more firmly planted in consciousness I feel. This has always been the case, but it’s getting harder to rely on. Curling around the corners of my consciousness is the fear of the other side. I’ve fainted about 10 times in 5 decades. I haven’t in over 5 years now — if I take care, maybe I’ll never faint again. But I think daily about consciousness in a way that I never have before — it’s tenuous. It’s not necessarily mine and can be swept away at any moment. Who wouldn’t be affected by that?