Panic Attacks

The Medical Student Scared of Wards

Libby Smith

5th Year Medical Student, University of Nottingham

I can’t tell you how many times I’ve opened a blank word document that I’d pre-emptively saved as “panic attacks blog”, only to close it after the enormity of the task dawned on me once more. How am I supposed to put in words the most tortuous time of my life, with the intention of sharing it with the internet? But that’s exactly why I feel compelled to. A reluctance to talk about mental health, be it due to fear, shame or denial, feeds into the already damaging narrative of secrecy that perpetuates the stigma seen at medical school and beyond. So here it is. Here’s the story of how someone with no prior mental health problems went from fully functioning CP1 student to a ball of anxiety too terrified to enter a ward.

The start of CP1 involves 2 weeks of pretty intense lectures and skills practice, in the comfort of seminar rooms and lecture halls, and I won’t lie, I loved it; I’d been waiting two and a half years to finally get out of LT1 and into the front line. Pre-clinical hospital visits gave me a joy de vivre that told me I was exactly where I needed to be. In the third week, I’d been inducted into Southwell, a respiratory ward in city hospital that would be my home for 9 weeks. That Wednesday, I had a doctor’s appointment at Cripps to have a review of my migraines, and it felt like it was the first time I’d stopped in weeks. As I walked up Cripps Hill, it started. My throat felt like it was closing up, and I thought I was having a delayed anaphylactic reaction to something I’d eaten. My tongue felt too big for my mouth, which seemed to be instantly devoid of any saliva and my hands and toes went numb. A rush of heat started from my stomach and swept over me, leaving me faint and sweaty, and my heart was beating so fast I feared it would burst out of my ever-constricting throat. I went into panic mode, as I think anyone who thought they were dying would, and after what was only probably a minute but felt like at least 10, I managed to control my breathing and start walking again. It was only then that I realised that there were tears streaming down my face. I never told my doctor what happened just minutes before. I’m so ashamed to say it now, but I was afraid he’d think me weak. I was afraid he’d think me unable to manage what seemed like every other CP1 student was managing just fine with. In fact I told no-one that day, and went to bed with an anxiety that had crept into every corner of my mind, and an inescapable fear of the day’s events repeating themselves.

Fear is defined as an unpleasant often strong emotion caused by anticipation or awareness of danger.

It is what grabs hold of those suffering with panic disorder and squeezes harder and harder, leaving them terrified of anything that could bring on a panic attack, manipulating any place or scenario that coincided with a panic attack and turns them into triggers, leaving fewer and fewer fear free places or situations. I got my second on the way to a ward, and from then on hospitals presented a very real danger to me. I remember walking up 3 flights of stairs to get to an AMU (lifts were a big fat no due to me now being scared of confined spaces, or a lack of immediate exit), getting to the door of the ward, and feeling that rush of terror crash over me. I ran down those stairs 3 at a time, fumbling for my phone, and ran out of south block hyperventilating and crying, desperately calling members of my family for reassurance. I called my mum, no answer. Called my sister, brothers, no answer. I wouldn’t normally disturb my dad in work for something as trivial as being too scared to walk onto a ward, but you have to understand that in that moment walking onto that ward was the worst thing I could possibly do; it was terror inducing. He answered, thank god, and spent 10 minutes talking me down from dropping out of medicine. At that moment I thought I had well and truly gone mad.

The anguish of forcing yourself into panic inducing scenarios day in day out took its toll on me, and I started getting near constant migraines, which in my current state was almost a relief. Alas, a physical health complaint I can use to excuse myself from a ward. How much easier it is to say “I’m sorry I can’t come in I have a migraine” than “I’m sorry but the prospect of walking onto your ward makes me want to simultaneously cry, vomit, faint and run away, and I have absolutely no idea why”. Of course, I couldn’t spend the whole 18 weeks avoiding wards, and so I finally mustered up the courage to talk to a teaching fellow and I decided to reach out to one from the induction weeks who seemed particularly approachable. As I sat in his office and spoke aloud for the first time about what I was going through, I finally snapped. Migraines were now the least of my worries, as the hopelessness of having panic encroach on more and more aspects of my life made me depressed. Imagine feeling like you had absolutely no control over your body, how it reacted to harmless scenarios and how that would make you feel. I doubted my future vocation daily – surely no successful doctor has ever been too terrified to enter a ward?

Confiding in someone was my turning point.

The teaching fellow submitted a support form to the university on my behalf, and as a reply I was told to make appointments with the welfare team, a clinical sub-dean and university counselling service. I will say, to any of the powers who’ve gotten lost and found themselves reading this blog – one meeting with a counsellor is useless, as is the fact that I had to take even more time off placement to go to these meeting which were all at QMC or university park. I was told time and time again that distraction techniques would fix me, which is total bullshit, and when they didn’t work made me feel even more broken than I already did. One good did come of it, as I was told after my 1 counselling session that I could self-refer for CBT online. I did it that night, and poured my heart out on that application form, which is probably why I was offered an appointment 3 days later. That first appointment involved me crying non-stop for about an hour, but after the second, the panic seemed to melt away. What caused this miraculous recovery? Education. My therapist explained the cycle of emotions, thoughts, physical reactions and behaviours, and suddenly there was a reason why I was reacting so irrationally. We spent the next few sessions challenging thoughts, inducing panic attacks in a safe environment, graded exposure and discouraging safety behaviours. I got given homework to do, and she gave me resources that helped to educate me about the condition. I also came out with a diagnosis of social anxiety, but that’s a story for another time.

Recovery was by no means overnight, and I still have some residual anxiety, but I can now subdue feelings of panic before they become full blown panic attacks, and I’m infinitely happier. I owe my happiness, my still being on this course and my sanity to my therapist. I ended up having 8 sessions, but I’ve been thinking recently about re-referring myself for help with my social anxiety. I’m now onto CP3, I loved GP, obs and gynae and paeds more than I ever thought possible, and I’m forever grateful that I’m still training to do my dream job. I’m also on sertraline to keep my anxiety and mood at a more manageable baseline, which I’m no longer ashamed of.

My name’s Libby: I have panic disorder; I have social anxiety and generalised anxiety disorder; I take sertraline and propranolol. Reaching out for help was terrifying but I’m forever grateful to my past self for doing it when I did, and for being brave enough to go to therapy. Because it is brave.

Admitting you need help is courageous. Asking for help is heroic. Getting help is revolutionary. And you deserve it.

As always, if you want to share any of your experiences at medical school with us, email us at welfarehub.nottsmed@gmail.com or fill out the form below. If you’re struggling with any other issues, have a look at our website to find some resources that may help you including our CRISIS page.