(Note: This is the latest installment of an ongoing column. Click here to the index for previous installments.)
So I’m sitting in my car outside the emergency room, windows down, smoking a cigarette. Signs every ten feet or so declare this property smoke free, but for the amount these swine charge me for a visit here, they can lick my sphincter if they think I’m going to haul ass across the street to choke down a square. To be honest, I don’t even know why I’m sitting here. I just got out, after more than two hours. Two long hours. And nothing accomplished.
It’s a few minutes before ten in the morning. I woke up at ten ’til seven, anticipating my alarm, and felt strange: lightheaded, hollow-boned my heart racing. I bolted up and checked my pulse. 130 bpm. How the fuck do you wake up with a heart rate that goddam high? Sweet Jesus, I’m fucked. This is how I die, like my father—a fucking heart attack.
Fear twisted my head in a vice. Tension behind my eyeballs threatened to jettison them from my skull. Every muscle in my body tensed. No, “tensed” isn’t the right word; they seized. And every nerve in my body, every axon in my brain, seemed to fray then scorch.I’m having a heart attack. Oh fuck me I’m having a heart attack. I put on my socks and changed into my work clothes and descended the steps and wandered into the kitchen. I had to work. I couldn’t miss work. I pressed my fingers against my throat, below my jawline, and felt my pulse. Boom boom boom boom boom. No pause. No gaps between pulses. I counted thirty-five beats in fifteen seconds. Multiplying that by four produced a grim reading: 140 bpm. Fuck me.
Without thinking, I lit a cigarette—stupid, I know, but it was mechanical, non-conscious—and paced the kitchen. Oh god oh god oh god. Fuck fuck fuck me. This is it. Today I’ll die. Images flashed in my mind: my corpse on a gurney; my wife and kids at a funeral home, pale and stunned; so many dreams and thoughts and ambitions extinguished, destroyed.
Oh god oh fuck oh god oh fuck.
I chose to blow off work and fired a text to my manager: “I’m going to the ER.” No details, no context, nothing. Panic and anxiety and a pounding heart prevented me from elaborating. Those shaky hands wouldn’t have allowed me to author an extended text, so those five words would suffice. At least for the short term.
Everyone in the house slept. I unlocked the back door and stepped outside. Then I paused. I’ve got to tell my wife. But I dreaded climbing the stairs to tell her. Would that final ascension to the second story bedroom apply too much stress to an already spasmodic heart?
Fuck. What do I do?
If I’m going to die now, I thought, I’d prefer to die in my wife’s arms. So I scaled the stairs. She and our one-year-old slept. I kneeled beside my wife and tapped her hip.
Huh? she said, eyes closed.
Hey, I said. I’m going to the ER.
Her eyes flung open.
What’s wrong? Why?
My heart’s racing. I’m lightheaded. I feel like I’m going to puke.
Do you want me to go with you?
No. Stay here. Sleep.
Are you sure?
Go back to sleep, love.
Okay, she said. Let me know what’s going on.
I will. Absolutely.
Back downstairs, through the kitchen, out the back door, lock the back door, down the steps and through the yard and into the driveway and into my car—these actions passed in an instant as I focused on my pulse: index and middle fingers mashed into my neck with so much force I half expected to fuse atoms.
I lit a cigarette and rolled down both front windows and turned off the radio, turned it on then off again. My fear and anxiety violated the law of non-contradiction. I both wanted and didn’t want distraction.
Fuck it. No peace before death.
I turned the radio to the CD setting and blared Nine Inch Nails as I raced to the hospital, a mile away, give or take. Thinking about it now, I realize I wasn’t conscious of the speed limit or of potential cop cars. We lived near the police station and we frequently saw cops in that area. But they weren’t on my mind. In that moment, as far as I was concerned, they didn’t exist. I mean, really, who gives a shit? If the fuckers did race to catch up with me, lights spinning, I wouldn’t have stopped. When I arrived at the ER and explained I was on the verge of a heart attack, they’d understand. Right? Or would they assume I was hopped up on opioids and taze me? You can’t exclude the possibility in this day and age.
Fortunately, however, I didn’t encounter a cop. In fact, my pounding heart lassoed my attention: I don’t remember encountering a single car or stop sign or traffic light on my way to the hospital.
I circled the parking lot and found a spot about a hundred yards from the emergency room. After hotboxing my cigarette, I strolled to the entrance, careful not to run for fear of producing too much adrenaline.
My voice trembled as I spoke to the woman at the check-in desk. I spoke sotto voce and repeated myself two or three times. My shaking hands prevented me from writing with anything approximating elegance. Filling out the obligatory paperwork produced abstract sketches some might construe as words.
In the waiting room time stopped. I fidgeted and bounced as I waited. A woman called me back and led me to a room, and I waited. Silence. My heart pounded, pounded, pounded. A nurse sidled into the room and attached herself to a computer a few feet away from me. She talked to me while she stared at the screen, only moving her eyes to glance at the clock on the wall.
You have bipolar disorder and generalized anxiety disorder.
Do you smoke?
About a pack a day.
Do you drink?
Do you take street drugs?
I don’t know. A lot.
Yes. Sometimes twice a day.
That’s not good.
That much caffeine can make your anxiety worse.
I know. I’m an idiot.
She laughed. But she still didn’t look at me.
Are you still taking Lamictal, Klonopin, and Trazadone?
No. I’m not on anything. Can’t afford it. I was going to the free clinic and they prescribed me Xanax, but then they said they couldn’t keep prescribing it long term, so they weaned me off it.
Yeah. I heard they made those policy changes. More than a few places have.
It’s fucking ridiculous.
She shrugged, actually shrugged.
My heart pounded, pounded, pounded.
When were you diagnosed?
Bipolar disorder and GAD?
—pounded, pounded, pounded.
Excuse me, I’m sorry. I feel like I’m going to puke. My heart, I swear to Christ, is getting faster.
Pounded, pounded, pounded.
She wrapped the cuff around my bicep to measure my blood pressure and snapped a white clip over my left index finger to measure my pulse—I assumed. The cuff squeezed until my right arm tingled, then it sighed and deflated in measured hiccups.
The monitor, to my right, displayed my vitals. Oxygen: 98%; BP: 108/83; pulse: 107.
What the fuck was that? 107? Bullshit.
My chest felt like a washing machine after someone had chucked a cinder block into it. The machine was clearly broken. My heart beat was manic, intense, an amorphous mammal hopped up on crank. I wanted to demand a recount.
The doctor will be in shortly, the nurse said. But between you and me, I think it’s most likely an anxiety attack.
She perverted her face in what someone might construe as a smile and ambled out of the room. The urge to throw something at her, a chair maybe, assaulted me, but I resisted. No reason to get worked up. Too much adrenaline might kill me.
Still, fuck her. An anxiety attack. My ass.
I knew anxiety attacks, and this wasn’t one. They ignited every nerve in my body, altered my perception—everything was gray and doomed—and sent me on edge. Sometimes I chattered my teeth. Sometimes I felt like running in circles or leaping out a goddamned window. Sometimes I wanted to run and abandon everything or drive into traffic. When anxiety grabbed me by the throat, tension wound its way around me and I felt like a tautened coil on the verge of popping.
This wasn’t a fucking anxiety attack.
It was my heart.
I glanced at the monitor. My pulse read 138. Where’s the nurse? How much time had passed? A minute? An hour? I was going to die in that fucking room because no one was around.
A controller tethered to the wall lay on the pillow beside my head. It operated the television, served as its speaker, and doubled as an intercom to communicate with the nursing staff or to alert them to an emergency. I wrapped my fingers around it, near the red “alert” button. Just in case.
I worked two low-paying jobs, between seventy to eighty hours a week, seven days a week. I had a great job until a few years ago, when it was automated. Now I struggled to make ends meet. Hell, sometimes I couldn’t make rent, despite the amount of time I spent away from home, squandering my hours for a few dozen quarters.
My father died four years earlier. That event served as a climax to a pattern of depression, mania, and chaos, and I wound up in the behavioral medicine ward on suicide watch, where they’d diagnosed me with bipolar disorder and generalized anxiety disorder.
In the weeks and months and years following my diagnosis, my doctor had tried a variety of combinations of medications—various anti-seizure meds for bipolar, benzodiazepines for anxiety, and anti-depressants as sleep aids, despite the fact that anti-depressants, for some reason, assume the properties of crank when it punches its way through my neurophysiology. Anti-depressants and bipolar disorder don’t gel, yet every doctor I’d seen prescribed it to me, and the results didn’t change: I’d stay all up night in fits of hysteria.
Recently, we’d had a baby, and as I raced toward forty, the years I’d squandered in my twenty and thirties weighed on me. I obsessed over them. Then I grew to hate my hometown. I hated Indiana and I wanted out. For reasons I didn’t want to think about, several reasons in fact, I’d settled on Las Vegas as a destination. And I obsessed over it.
I wanted out. I wanted out of my shitty jobs, Michigan City, Indiana could suck shit my from a dirty asshole, and I wanted to honor my father, whose dreams of moving to Vegas were derailed in the late 80s—derailed by me; long story—and I wanted to somehow provided a better life for my wife and kids, and I wanted to score a decent job so I could work less and live, and write, more, and I wanted to somehow alter my brain so my mania and depression and anxiety didn’t control me and toss me around and dictate my movements and behavior as if they were strings attached to my marionette body, and I wanted, and I wanted, and I wanted … And I wanted everything. I wanted to live. I fucking wasn’t living; I was existing; and what was the point in doing that?
And Jesus Christ I wanted to leap out of that hospital bed and sprint to the nurse’s station and tell them to fuck off and call them apathetic buffoons who weren’t taking my heart condition seriously, and I wanted to run, run, run to the nearest store and buy a fifth of the most potent alcohol they carried and chug it, and and and …
And so I knew anxiety. I understood it. I lived with it as if it were some sort of neural exoskeleton grafted onto my flesh, wired into my brain, and this wasn’t anxiety. This was a potentially fatal heart condition. I knew it. I felt it. My father died of a heart condition. In fact, most men in his family perished from same, and these fuckers should’ve taken me seriously.
This wasn’t anxiety.
The combination of my newborn and financial situation, the weight of my father’s death, especially since the birth of my son, the misery of working so frequently, and my overwhelming desire to flee the state and somehow raise money to move my family across the country had created a toxic mixture, and explosions of doom and gloom mushroomed throughout my days, everyday. I knew anxiety. I’d experienced it on a more or less minute by minute basis. It had enshrouded me, crushed and suffocated me.
And this wasn’t anxiety, goddamn it. It was my heart, my heart, my heart. And what the fuck were the doctors and nurses doing? Why weren’t they taking this seriously? Couldn’t they understand I was poor with no insurance and so I’d probably allowed an almost certainly fatal heart defect to go undetected? And … Why weren’t they taking this seriously?
I clenched my eyelids and tried to sleep, but the situation kept me awake. When my eyelids truncated the light, sending me into a gray state, my pulse sounded louder, more pronounced. But instead of ignoring my heart, instead of trying to distract myself, I focused on it. Boom boom boom. Boom boom boom. It pushed me into something like a zen state where only my consciousness and the sound of my heart existed.
Time stopped, sped up, stopped again. The nurse slipped in, muttered something about an EKG. She disappeared. I closed my eyes and focused on my heart and emptied my mind. Boom boom boom. Boom boom boom. Time vanished again.
Another nurse whisked into the room and told me to take off my shirt. She attached adhesive pads to my chest and stomach, arms and ankles. Then she skipped out. I closed my eyes. Boom boom boom. Time. Boom boom boom. Vanished.
Then an image popped into my head: a few years earlier I’d admitted myself into the psych ward on suicide watch. While there, I witnessed a man cut himself off from the population. He refused to leave his room, refused to talk. The nurses and staff tried to coax him out with rewards, but he ignored them. Then they threatened to punish him by banning him from the day room, where everyone convened for TV, games, et cetera. But he remained silent, so they threatened him with sedatives.
That situation, as absurd as something out of a Bunuel film, summed up mental health care in this country: the system threatens you with what you want if you deny them the gratification of offering it to you as a gift. Or it ignores you altogether, which is how the staff resolved the issue of the man who refused to leave his room.
A nurse wheeled a machine into the room. It resembled an old laser printer repurposed for a low budget science fiction film. She uncoiled wires from it and attached them to the pads on my chest, stomach, and ankles. Without saying a word, she left.
I considered the television, but I hated TV. A waste of time. I fired off a text to my wife, told her about the EKG. After waiting for her response, a simple request to keep her up-to-date, I closed my eyes and listened to my heart, softer now: boom, boom, boom.
I don’t know why the image of the man in the psych ward had assaulted me. For some reason, it triggered another memory, again, a commentary on mental health care in America. After I was released from the psych ward, I scheduled an appointment with a doctor. He was, the hospital assured me, well versed in mental health issues. But I never saw him, never even glimpsed his face; instead, I met with his nurse practitioner.
She prefaced our first meeting by owning up to a lack of expertise in the area. But, she assured me, she’d run everything by my Wizard of Oz-style doctor. She adhered to the hospital’s recommendation for anxiety meds but decided to experiment with a certain anti-seizure med for my bipolar disorder. Without consulting anyone.
I remember sitting in the car after that appointment, prescriptions in hand, feeling less like a human and more like an experiment—or a machine head on a guitar, one the NP was twisting and turning as she learned the basics of tuning her instrument. Was I human to her? Or an opportunity, a guinea pig on which to experiment? Did I even matter?
A different nurse sauntered into the room. She smiled and said hello and unhooked the wires from me.
The doctor will be in shortly, she said. She dropped them into a cavity behind the EKG machine.
Then she left.
No one took my condition seriously, or at least with urgency. It calmed me. If I were having heart issues, I’d have assumed they wouldn’t have strolled in and out with leisure, with long gaps between visits. Fuck. Was this an anxiety attack?
A few years earlier I’d visited an NP with concerns for my heart—this was before my father died, before the psych ward—and wound up wearing a halter monitor for twenty four hours. It was the size and shape of an iPod, worn in a sleeve around my neck, attached via wires to pads on my chest. The results didn’t inspire concern, but my NP didn’t raise the specter of anxiety. I wasn’t diagnosed until my visit to the psych ward.
The attending doctor flew in, and what followed felt like a fever dream. She leaned against the counter, arms crossed, stethoscope around her neck, and fired off a series of questions.
Why aren’t you on your meds?
How long have you been off them?
Have you tried to see someone else?
Yeah. Unfortunately, because it’s a controlled substance, some organizations have changed their policies. It’s frustrating that they won’t prescribe them long term, but …
How much caffeine do you consume each day?
Why so much?
Do you know what I do when I’m tired? Ice water. It works. Brain freeze wakes you up.
So your heart looks good. I think we’re going to write this up as anxiety. I know. I can write you a prescription for Xanax but you’re going to have to get in to see someone who can prescribe it regularly. This is a short term supply only. I wish I could do more to help but policies are policies.
She spoke softly, imbuing passion in her tone. I liked her. A few minutes later I was out the door, prescription in hand. Now I’m sitting in my car, finishing my cigarette, debating whether or not to fill the script, and here’s why: they get me high—and I like it. And that worries me. It’s easy to imagine myself a full blown addict. It also helps with my anxiety to such a degree that I feed on the normalcy, on not feeling tense and anxious, on not viewing the world through gloom and doom.
While I was lying in the ER, something warned me my experience might be rooted in anxiety. A fleeting sensation of excitement filled me. Anxiety meant pills. Pills meant a high I couldn’t otherwise attain. But I pushed those thoughts away; I was convinced, for a time, that my heart was ready to burst.
But it’s not just about getting stoned. It’s about feeling something like normal. From the time I wake up until the time I go to bed, tension and anxiety dominates me. I feel it in my muscles—I’m never relaxed—and in my thoughts, in how I perceive the moment, the world. Pills do help. Enormously. When anxiety controls you, freedom is addictive.
I’m not a junky. I’ve never abused pills. But I’m always miserable with anxiety, and I like feeling relaxed, but it does come at a cost: they make me tired, lazy, unmotivated. A conformist. Anxiety and mania fuel my creativity, and when I’m on pills my creativity vanishes..
I flick my cigarette out the window. It lands beside a signpost. The sign informs me that this is a smoke free campus. A woman crossing the lot to her car glances at me. I pretend not to see her as I put my car into reverse. As I leave the parking lot, a debate emerges: should I go to work, home, or to the pharmacy? I sit at a stop sign, eyeing the prescription, my car idling.
What to do? What to do? What to do?
Daulton Dickey is a novelist, poet, and content creator currently living in Indiana with his wife and kids. He’s the author of A Peculiar Arrangement of Atoms: Stories, Still Life with Chattering Teeth and People-Shaped Things, and other stories, Elegiac Machinations: an experimental novella, and Bastard Virtues, a novel. Rooster Republic Press will publish his latest novel, Flesh Made World, later this year. Contact him at lostitfunhouse [at] gmail [dot] com