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I walked slowly up to a door that eerily resembled a two-way mirror.  In a split second I wondered if the people inside, people like me who needed help, saw the same person my reflection showed me walking through the door.  Who were they looking at?  Who was I looking at?

There were two water fountains mounted on the wall in perfect symmetry.  They must have been custom made for the office.  Between lay a long reception desk with a thin glass barrier separating the office receptionist from the rest of us.  As I approached the desk I had hoped to be able to speak to her, tell her I desperately needed someone to talk to.  I made my appointment like everyone else and had showed up promptly.  The glass shield remained still as she pointed a pale boney finger to a clipboard resting on the small ledge provided for my comfort.  I snatched the pen and scribbled my name on to the roster.

I took a seat with the rest of them and tried to imagine whose name would be called next, surely not mine.  Like those nervous neurotics clutching lottery tickets, hopelessly waiting for their number to be called, we sat.  Fidgets from all sides of the room made me uncomfortable. 

A door suddenly swung open and a middle-aged woman shrieked “Shawn Brewer.”  My name! I couldn’t believe it.  I had just walked in five minutes before.  Why were all these people still waiting?  Had they no appointments?  Or were they staged to intimidate me, get me thinking before I saw the doctor.  I was severely confused.

“Right this way Mr. Brewer.”  The shriek in her voice had quieted to a dull scratch.  I was led down a narrow hallway and through a dark mahogany colored door and in to a room that looked as though it were designed to provide comfort in a place where there was little to be found.  I plopped down on to a couch and was told that the doctor would be in shortly.

Shortly turned out to be about ten minutes.  He looked distracted as he blitzed through the door, not even glancing up from a strange laptop-like device, as though he could navigate the office blindfolded.  He sat, still fixed on his device.  Without looking up he said, “Tell me everything.” 

“Tell you everything?” I replied, as though I were the one with the answers.  “If I knew everything I wouldn’t be here.”  He finally glanced up.  His eyes seemed to indicate a feeling of irritability, as though I had rudely interrupted a very important thought he was in pursuit of. 

“You’re chart indicates you’ve made an appointment based upon the claim that you’ve been suffering from panic attacks.  Why don’t you tell me about that.”  His voice was calm and suggested an inner sureness of purpose and intent.  I decided to play his game.

“The feeling of anxiety,” I began, “has always been apparent to me in any social situation or really every situation that involves my reputation as a human being.  In the past I became aware of my heartbeat and felt as though I had just finished jogging or running when the anxious feelings were present.  I used to believe that these increased feelings of adrenaline like symptoms were beneficial in the sense that they made me more alert and capable of dealing with intense and stressful situations.

He didn’t budge, still staring at his device.  I continued.

“About two years ago I had my first encounter with what many people and much research defines as a ‘panic attack.’  My heart began racing and I became very aware of the idea that I may be having a heart attack.  As soon as that notion popped in to my mind I started to loose my peripheral vision and eventually “blacked out.”  The first time I experienced these feelings I was driving and was so taken by surprise and overwhelmed that I lost consciousness at the wheel for almost 10 seconds and woke up driving in the median of a rather deserted road (luckily).”

His fixed position unnerved me a bit.  I guessed that I would be the one doing the talking. 

“After the first ‘attack,’ I didn’t experience the feelings for at least another year.  The second time I remember feeling this way I became very aware of my heartbeat seeming irregular and the same notion of “heart-attack” came in to my mind.  However, I maintained consciousness and practiced a deep breathing exercise until the adrenaline-like rushes and out-of-my-control feelings subsided.  For the next two or three attacks the breathing exercises worked much in the same way.  However, it took a lot of mental strength and the ability to tell myself that I was fine and it was all in my mind to overcome these panicked feelings.  It is important to note that three of these initial attacks were random and had no identifiable cause, at least as far as I was concerned. 

Recently the attack-like symptoms have been becoming more frequent and far more pronounced.  When I feel something that I assume is the pre-cursor to a potential attack, I become even more nervous, frightened and worried about my physical safety.  The worst part is that sometimes the situations I assume are the cause of the attacks provoke these feelings and other times they do not.  The most recent set of attacks all happened in the same situation and in the same way.  I would be sitting in the board room among my colleagues, allowing my thoughts about a specific discussion to brew in my mind so that I may ultimately have something significant to contribute to the notions beings presented and addressed.  As the thoughts become less abstract and more practical I feel a slight increase in heartbeat, and as I come closer to sharing my thoughts the heartbeat begins to race and blood pressure increase to the extent that I can actually see my heartbeat moving my shirt. 

After I become aware of this racing and pounding heartbeat I try and tell myself to calm down and begin to take deep breaths and try to put myself somewhere other than the boardroom.  This has worked a few times, however the majority of these attacks force me to remove myself from the room for fear of my heart exploding or someone noticing that I am obviously extremely uncomfortable.  After leaving the boardroom the sweating starts and I have to remove myself from contact with anyone, even those I know and trust, even if they are trying to help calm me down.  I must close my eyes and focus on anything other than the physical symptoms I am experiencing and take very deep and focused breaths.  Usually these types of exercises only help in shortening the length of an attack and do little to prevent or treat the symptoms so that I don’t have to remove myself entirely from a situation. 

The attacks have become a nuisance in the sense that I cannot physically or mentally control them and have been missing out on crucial discussions through which my opinion should be heard.   What’s more is that I have been finding myself maintaining residual feelings of anxiety even when attack symptoms are nowhere to be felt.  Also, I find myself fearful of experiencing future attacks, and tend to avoid certain situations (going out to bars with friends, meeting new people, spending time with unfamiliar people, etc.)  The problem here is that I can’t avoid the very situations that have recently been contributing to these attacks, namely my work environment.  The general fearful feelings are also making it difficult for me to contribute to important discussions at work for fear of being forced to leave in the middle of them.  I feel like anxiety is holding me back from expressing my ideas, ideas that may hold great significance for the context from which they derived.  This is a huge problem.”

“Sound like it,” he interjected, again without looking up.  I felt neglected.  I went on.

“As I am very aware of the abuse and dependence dangers associated with many prescription medications available to treat anxiety related disorders (i.e. alprazolam, diazepam etc.) I have tried to avoid the notion that I may need their assistance in dealing with this…”

He interrupted, “Who told you these drugs had any danger of dependence?” 

“I have done my own share of research in to the effects of these and other benzodiazepines, and I know with prolonged use they can leave the user essentially hooked,” I snapped.

He immediately scribbled what appeared to be notes. “Here,” he said as he handed me a square blue piece of paper, “I don’t know where you did your research, but you are mistaken.”

“What is” I began. 

“Take one in the morning to start with, and up to two a day as you find necessary.  You may call my office if you have any issues or unwanted side effects.  The pharmacist will explain the rest.” 

The sound of his getting up was clear before he could even finish the sentence, and before I could look up he was out the door as surely as he had entered.  I looked down at the prescription he had written, the only note he’d taken throughout my entire explanation.  In sloppy short hand classic doctor style writing it read: “Alprazolam 1MG, Qty. 40.”

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