When anyone, anywhere, is threatened, we are all threatened


Published Tuesday, January 28, 2014, Circleville Herald


By Brad Cotton


Jim (names changed) was clearly hyperventilating. His hands were spasmed like bird claws. His eyes moved from nurse to tech, to registration staff, searching each face for help.


“Mr. Brooks, Doctor Cotton, like no polyester, no rayon. You look pretty panicked. I know it’s easy for me to say, but if you can slow your breathing down, we’ll help you do that, you’ll feel better, really.”


“Doc, I can’t breathe! I’m gonna’ die! I can’t move!” Jim was breathing 32 times a minute.


We see this a lot, at least once every day. Panic disorder is real. It is the body’s alarm system malfunctioning. Just like some hospitals’ fire alarm. The alarms go off, lights flash, sounds like the old WWII submarine movie, “Run Silent, Run Deep” — you expect to hear orders to “Dive! Dive!” and hear depth charge explosions going off. This is what the patient feels like.


It is not weak character. Jim doesn’t need to just “Buck up!” The alarm system malfunctions — they breathe too fast, carbon dioxide levels go down, more alarms, more panic. I’ve never been there, but it doesn’t look like fun. Sometimes there is a stressful event, bad news, etc., that sets it off; often not.


Often patient coaxing to slow breathing down works, or breathing in a paper bag. With Jim, we eventually had to give him some relaxation medicine.


Thirty minutes later: “Mr. Brooks, doing better?” Now is time to look for any problem we may have missed underlying the panic disorder. No gain in missing a blood clot in the lung, a collapsed lung or heart attack by too quickly assuming panic only. The EKG and heart blood tests look OK.


“My grandfather died, he was the only one accepted me.  I’m gay, I married my boyfriend. My parents disowned me, my brothers and sisters also. Only my grandfather talked to me. Now I have to go to California for his funeral, have to be on a plane in four hours. I have to see all my family who won’t talk to me. I love them. Why can’t they love me?”


“I’ll talk to you. That sounds tough. Hopefully you can learn the first warning signs of these attacks, slow your breathing and you can nip it in the bud, so to speak, before it gets out of control. I’ll write you a very small prescription, six or eight pills. I don’t want to teach that pharmacology is the answer. Sometimes the med works best just sitting in the drawer, just knowing it is there as a back-up helps you learn you can control this on your own. What do you do?”


Jim is some well-paid account something or other. Thirty-five years in the ER, I’ve never been in the “account something or other” world. I am sure it is a job needs done. I often tell patients thinking of harming themselves that I personally need them, I need them to be the best they can be, pay a lot of Social Security so I can retire. Many depressed folks will smile and make eye contact for the first time at this.


“I’m sorry your family is like that, Jim. What this means is that in fact you are the bigger and stronger person. They are limited, or were harmed in some way. Everyone has been harmed in some way and we are kind to those who have been harmed, even if they cannot be kind back. I am sure this is hard for you. I’ve not been in your shoes. I’m right-handed, born that way; you’re gay. Sometimes people draw a circle that closes us out, we have to draw a bigger circle that brings them in.”


Lots of discussion in the Herald recently about amiable disagreement and listening to the other side. Sometimes the other side is just plain wrong. It is then wrong to not to oppose the other side with all the non-violent courage, character and strength we can muster. We can never close them out of the circle, but we have to marginalize their harmful-to-other-persons views.


Gay, civil and human rights are not up for debate or subject to the will of the majority. When folks suffer without health insurance, we must speak up. When someone is making a fast buck at the cost of harm to another disempowered person, we must speak up. Jesus did. When the dignity or rights of one person anywhere are threatened, then we are all threatened.