For two years after a traumatic birth and NICU stay, setting foot in a doctor’s office with my newborn was enough to trigger a panic attack.
On one September morning, I took my 1-year-old daughter to the hospital for a renal ultrasound to determine the progression or resolution of a mild kidney condition detected at birth. As we pulled into the parking garage, my mind and body were already in “fight” mode, and everything was a threat. The clock threatened to run out before we could complete this appointment and get to the next one. The parking garage threatened to trap me in its loops of full or off-limits spaces. The corridors and hospital staff threatened to repeat the frustrations we’d been through in the last year — forgotten appointments, lost records, miscommunication. I was managing my child’s complex medical appointment amid a tangle of panic attack symptoms — sweating, dizziness, feeling faint, confusion, and trembling.
The strangest sensation was feeling lost in my panic and disconnected from anything going on around me. The baby was happy, only needed a little attention. Being a mom with panic disorder can feel like parenting on auto-pilot. I bounced a stuffed animal in front of her stroller, like an automaton. In fact, all of my actions were automatic and produced with the greatest effort to simply fill social obligations.
My mind said, “That person is speaking to you. Respond now. Smile. Say something about the parking. Say thank you. You are moving through space. Be aware of other objects or people around you.“
Otherwise the morning was like having my head wrapped tightly in bandages that no one else could see. I couldn’t perceive or connect to anyone, just pretending to tell the difference between the ghosts of trauma and the reality around us.
I found myself triggered by going to the hospital, seeing other NICU newborns, and anticipating a devastating diagnosis at every appointment.
The procedure was conducted in the second sub-level of the hospital. That’s two floors below ground, in the basement’s basement. In the waiting room, I watched Kelly Ripa and Ryan Seacrest talk about their celebrity friends, but I could no longer exchange panicked texts with my husband.
We were so deep in the earth, my signals could not escape. I was so deep in myself, no signals could get in. Couldn’t take deep breaths, couldn’t see, hear, sense anything more than an inch outside my body. All other activity occurred as if on the TV screen with Kelly and Ryan, but I was obliged to awkwardly interact with these remote, artificial characters. Reality had been reduced to my fear response.
I was experiencing dissociation, or feeling disconnected from myself and my surroundings.
When weekly (or more) medical appointments for my daughter started to trigger panic attacks, I had no choice but to find a way to cope. After Lizzie spent her first two weeks in the Neonatal Intensive Care Unit, she spent her first two years in endless followups with specialists and therapists. I also experienced PTSD after her birth, so I found myself triggered by going to the hospital, seeing other NICU newborns, and anticipating a devastating diagnosis at every appointment.
The panic attacks continued, sometimes the day before an appointment, sometimes on the way to the appointment, sometimes in the middle of an examination. When they happened, I did my best to put every ounce of attention and energy into caring for the baby and absorbing information from her doctors, nurses, and therapists. When I could think of nothing else, I knew breathing was the first step to calming down.
Panic Coping Strategy #1: Breathing
My therapist Sally Bennett taught me how breathing calms the nervous system. There are countless breathing exercises to calm anxiety, but the trick that works best for me is to inhale deeply and exhale slowly through my mouth.
“Exhaling through your mouth signals your parasympathetic nervous system to respond,” Bennett says. “The parasympathetic branch of the autonomic nervous system is responsible for relaxation response. The sympathetic nervous system (the other branch) is responsible for fight/flight (which is activated when people are anxious or panicky) so exhaling through your mouth is a way to deactivate the sympathetic and activate the parasympathetic.”
Bennett is a licensed clinical social worker who specializes in cognitive behavioral therapy, mindfulness-based approaches, and eye movement desensitization and reprocessing. She very patiently explains brain science things to me, and I lap it up. I began working with her after Lizzie was born, as I dealt with the crushing anxiety and trauma of not knowing when or if my child would be “OK”. (Spoiler: Lizzie is definitely fine. A horde of specialists have one-by-one dismissed the most frightening and complicated possible diagnoses she faced in the NICU.)
However, when Lizzie was referred for evaluation for physical, occupational, and speech therapy at 18 months, my panic became unmanageable.
I sat in a very small room with my playful toddler and six adult women, each one evaluating, testing, writing, and questioning — me or one another — about how my daughter measured up to expectations. I stopped breathing. I couldn’t pick out a voice to follow in the buzz of action around me.
“Wait, I’m overwhelmed,” I said to the crowd of therapists. “Can we slow down?”
I think they were confused by my interjection.
“First you said she doesn’t need physical therapy, then she needs it once a month, and now she needs it twice a week. And you think she needs occupational therapy twice a week, and speech therapy twice a week. And how long will this go on? Will we live here?”
The questions were spiraling out of me, but the answers bounced off my armor of dissociation. I nodded and said “OK” at least a dozen times as I gathered the baby and headed for the door.
I found that staying aware of tangible things around me left less mental space for catastrophizing.
Once that episode was over, we still faced driving to the office for therapy several times a week. During the half-hour drive, I checked out, could not face the fear and worry brought up at each appointment.
Panic Coping Strategy #2: Grounding
To stay safe and aware on those drives, I practiced grounding, a sort of antidote to dissociation. I would tick through my senses, describing things around me to the toddler in the back seat.
I am driving the car down the highway. It’s a cold morning. My seat heater feels warm. We are listening to Radiohead. That car is red. I can smell Starbucks. It’s Tuesday morning, and we are on our way to physical therapy where Lizzie will play. Lizzie will play and Mommy will relax, and in one hour we’ll go home.
I found that staying aware of tangible things around me left less mental space for catastrophizing. Over the next few months, Lizzie made progress in all of her therapies, and I even started to look forward to appointments. Sally reminded me that before every appointment, I could make the decision to go or not. The freedom to choose gave me the strength to go again and again.
Panic Coping Strategy #3: Exposure
What turns a formerly dreaded activity in a tolerable one? According to cognitive behavioral therapists, it’s exposure. Exposure therapy can be conducted in a number of systematic ways under the care of a therapist. But I went through a sort of forced in vivo exposure by committing to follow through with Lizzie’s treatment.
As repeated exposure blunted my fear response, I was building positive associations with every appointment that ended well. Over the next few months, positive associations began to replace my preoccupation with worries that Lizzie would be sentenced to a lifetime of interventions.
Panic Coping Strategy #4: Identify Common Thinking Errors
Therapy helped me identify what thinking errors made me so afraid of taking Lizzie to the doctor.
Because of all-or-nothing thinking, I believed, “Unless the doctor says Lizzie is definitely fine, she is definitely not fine.” There was no room for uncertainty. Thanks to overgeneralization, I applied a few bad medial experiences to every single appointment thereafter. Due to emotional reasoning, I thought my feelings of anger, frustration, and fear were proof that Lizzie was unwell.
These common thinking errors are illogical... once you learn to recognize and correct them. To a tired and anxious mind, they sound true enough to prop up a shaky structure of fearful beliefs.
As Lizzie grows up, she gets stronger, and the frequency of medical follow-ups has dropped. As Lizzie grows up, I get stronger, and I’ve learned to manage my anxiety at her appointments. I will even celebrate getting through one without a panic attack, but they still happen sometimes. I panicked at the hospital during an x-ray; I panicked at the pediatrician’s office when she suggested further testing; I panicked at the ENT office before a hearing test.
But I don't panic at speech therapy appointments anymore. I let Lizzie go play with her therapist while I enjoy the break.
If you or someone you know is experiencing antenatal or postpartum depression or anxiety, contact the Postpartum Health Alliance warmline at (888) 724-7240, or Postpartum Support International at (800) 944-4773. If you are thinking of harming yourself or your baby, get help right away by calling the National Suicide Prevention Lifeline at 1-800-273-8255, or dialing 911. For more resources, you can visit Postpartum Support International.