How to Have a Panic Attack, and Nine Other Things It's Taken Me 25 Years to Learn

‘Well in our country’, said Alice, still panting a little, ‘you’d generally get to somewhere else - if you ran very fast for a long time, as we’ve been doing.’- Lewis Carroll, Through the Looking Glass

1. How to have a panic attack

The most important thing is not to panic.

Some people will tell you that panic is essential. Do not believe them. Sure, you could have a panic attack in the fast lane on the 405 freeway and have to pull over onto the hard shoulder, while traffic goes whizzing past and the misty LA light starts to fade. You might stagger into a hospital, gasping and wild-eyed. There might be tears, flailing, falling. These things might happen: but it's just as likely to be slower, more subtle. Maybe you won't even notice. Maybe years will go by before you identify the feeling as something significant.

Lie in bed, on your side, facing the wall. Maybe you've taken some yoga classes, maybe someone once tried to teach you to meditate, and you think you can trick yourself into feeling calm. Feel dizzy anyway, maybe because all those times you were "meditating", you were really just napping in the presence of incense. Feel your heart racing. Wonder if this is what dying feels like. Keep wondering this. Tell yourself that you would know if you were dying, in the same way you know if you're about to vomit or when you're hungry or tired. But you don't know. Worry that you don't know: is it good or bad that you don't know? Is not knowing the same thing as knowing?

Wake up in the morning pleased and surprised. Go to bed the next evening not knowing if you'll survive the night. Repeat until something more interesting happens in your life: you get drunk for the first time, you get a C on a calculus exam and have a meeting with a stern teacher who expected more of you, you get into college anyway, you spend two hours after the prom making out with a boy you didn't even know you liked, you go to Europe for a month, you move across the country.

2. How to talk to doctors

Go running every day. When winter sets in and it's too cold to run along the river, start spending your evenings at the gym, which is in a humid basement with a sweat-stained carpet and flickering lights. Run fast, but never very far: your usual distance is four miles on the treadmill, and the funny thing about this is that even four miles later you're still standing in exactly the same spot. Play your music loudly and try not to look at the television screens flashing news at you. Lift weights sometimes, just the lightest ones, in an attempt to tone your arms, which is something you've read about in magazines. Lie on a purple mat and do a few sit-ups and wonder when you'll start to look like someone who goes to the gym.

Then, at some point, late one evening, begin to feel a pain.

"What sort of pain?" the nurse in the campus clinic will ask you, when you arrive for your appointment and tell her you think you're going to die.

Tell her you don't know what sort of pain. Pain, in your chest. That can't be good, can it? She'll take your blood pressure, say it's good. She'll say you're a healthy young woman. She'll want to know if you do any other exercises at the gym. Any weight-lifting? she'll say.

Tell her: a bit. Not very much though, can't you tell? You'll think this is funny, because you're still pretty scrawny, or at least your arms are. But she won't laugh; she'll just say, without missing a beat: well, you've probably just pulled something.

Tell her you don't think you've pulled something.

She'll ask if you have any other symptoms. You'll say, restlessness, inability to sleep, palpitations - only you won't know the word for palpitations, so you'll just say, my heart feels funny. You'll tell her about that time you went to the ER for something that turned out to be nothing and the attending doctor said he thought you had some sort of heart murmur, and that you should ask your family doctor about it, but you didn't have a family doctor because you were not from around here and your insurance didn't cover things like that, so you were asking her about it, now, months later.

She'll absorb all of this. She's in her fifties. Maybe she has daughters of her own, college-aged girls. Maybe she thinks you're crazy. Start to wonder if you're going to be late for your 3 o'clock class after all. Is this the sort of thing you can get a doctor's note for? Imagine visiting your professor during office hours, saying, I'm sorry I wasn't there to discuss Discipline and Punish, I was keeping an appointment to announce my impending death.

Finally the nurse will say, alright, fine, I can refer you to a cardiac specialist. He'll probably do an EKG, she'll say. But I still think you've probably just pulled something, she'll add. You have no idea what an EKG is but you're happy to be taken seriously.

Go home. Look up "EKG". Start to worry.

Tell your boyfriend that they're going to hook you up to a machine. A machine! But he'll be asleep, so you'll mostly be talking to yourself. A machine!

Arrive at the clinic wary but fully intending to go through with this thing, to find out once and for all what's wrong, or not wrong, with you. Sit in the grim waiting room. Take stock: note the 70s brown carpet, the dirty yellow walls, the hazy late winter light trying to push its way through greenish-tinted windows. Note that nothing seems very clean, even though nothing is obviously dirty. Keep thinking: oh my God, I need to get home and have a shower. Wonder if heart disease is contagious. Reach for your hand sanitizer; rub the gel between your palms. Wonder if the people working here really work here at all, if the other people in the waiting room - quiet, like shadows - really exist outside of this space. Wonder if you'll emerge as the same person, or if you'll emerge at all. When the doctor calls you in, don't tell him about the heart murmur or the palpitations (you still don't know the word, and you can't tell a doctor - a cardiac specialist, no less - that your heart feels funny), just that you'd had a bit of pain in the chest area. Play it down: say, my chest, maybe my shoulder. The nurse thinks it's just a pulled muscle. The doctor will do some poking and prodding and ask a few questions and in the end he'll say exactly what you want him to say: that he thinks the nurse is right, you probably pulled a muscle lifting weights at the gym. And because a doctor has said it - even a doctor with an incomplete picture of an incomplete problem, in a dubious clinic populated by ghosts and shadows - it's okay. Buy a new pair of running shoes on the way home to celebrate.

A few years later, realize that you can Google all your symptoms. Learn the word "palpitations". Feel immediately better: as soon as you find a word for something, some evidence of it existing, being a thing, it becomes easier to deal with. Visit your doctor. Try to tell him what you think is wrong without actually describing anything: say that you want to do something about the physical manifestations of your anxiety. He'll think you mean diarrhea, so it will come as a big relief to both of you when you can laugh and say, no, no, heart palpitations, things like that. Things like what? he'll say. Do you have any other symptoms? You'll say, Not really. Well, dizziness at night. Sometimes nausea. Shivering, uncontrollable shivering.

Any shortness of breath? he'll say.

No, you'll lie.

Fill the prescription. Forget, for years, that you even have this problem. Let it become something that's past: and forget about that Faulkner quote you once read, the one that says, "the past is not dead. In fact, it's not even past." Forget what any of it feels like, so that it can seem new each time it resurfaces.

3. How to fool yourself into thinking you look like a grown up

Get a job, preferably one that you hate, though you could settle for one that you just find boring. Commute. Start to become one of those people who shouts at pedestrians when they walk in front of your bike and realize you're not angry because someone could get hurt: you're angry because you're in a hurry, and you were going at a good clip, and they've fucked with your momentum.

Make photocopies and send emails. Become one of those people who distributes agendas before pointless meetings and uses the word "pipeline" regularly. On your lunch break, take a walk and wonder why everyone else looks so much happier than you feel. Catch a glimpse of yourself in the darkened window of a recently-shut shop. Think that you look pretty happy, actually, and that your expensive new haircut certainly looks expensive, or at least it looks expensive if you know how much it cost, which you do, because you paid for it.

Pay your rent. Pay your phone bill. Pay your other phone bill, even though you haven't used a landline in about ten years. Pay your gas bill. Pay your electricity bill. Pay your credit card bill. Pay for your gym membership. Pay for your groceries to be delivered to your house in the evenings because you just don't have the time during the day anymore. Go to the bank on a Saturday because you just don't have the time during the week anymore. Discover that you're not going to have enough money to pay your rent and your phone bill and your other phone bill and your gas bill and your electricity bill and your credit card bill next month, even though you have a job that you hate (or at least a job that you find boring). Start to dream about work: compose emails in your sleep, look for solutions under your wilted pillow. Wonder if you're doing it right. See: 1. How to Have a Panic Attack.

4. How to actually be a grown up

Don't.

5. How to not feel jealous of people who are fitter, happier, funnier, prettier, smarter, more accomplished, and more interesting than you

You could try telling yourself that they're not fitter, happier, funnier, prettier, smarter, more accomplished or more interesting than you, but you probably won't believe it, even if it comes from your own trustworthy mouth. Start to resent yourself for trying to deceive you: you don't deserve to be deceived, even if everyone else is fitter, happier, funnier, prettier, smarter, more accomplished, and more interesting than you. How dare you do this to you! How dare you!

Go to the pub. Sit in the corner. Have a drink and scowl at everyone. Feel marginally better, in an "I feel worse" sort of way. Go home. Go to sleep. Dream about something boring, like buying groceries. Wake up. Think about how everyone else probably has better dreams than you do. Slide into what's commonly known as a funk, but know there's nothing common about it: you're the Queen of Funks, and this is the Funk to End all Funks, and if nothing else - if nothing else! - you can be a superlative failure.

6. How to get out of bed in the morning, even when you don't want to

Find someone you love who loves you back and will make you a bacon sandwich but refuse to bring it upstairs, even when you say that there is no point in getting out of bed and you'd rather starve because frankly starving would be more interesting than not starving at this point. Wait a few minutes for the smell of bacon to climb the staircase and enter the bedroom. Decide that you're still not happy with things, that you're resolutely unhappy, in fact, but that you may as well go downstairs and have the bacon sandwich, as it's there, because no one else is going to eat it, and it would be a shame to waste a bacon sandwich.

7. How to feel more productive

Stop reading things you don't want to read. Even that. And yes, if it helps, even this. Also, add things you've already done to your to-do list. I know it's cheating but it still feels good and it will always feel good, no matter what they say.

8. How to feel smug

Don't own a television. Don't own a car. Don't tell people that it's mostly because you can't afford these things.

9. How to avoid awkward conversations

Don't talk to anyone. Ever.

10. How to avoid feeling lonely

Talk to people. Often.

n.b. This originally appeared in GENE 01 last year. Some of it's fiction. Some of it isn't. Its alternative title, in my head, is, "It Would be a Shame to Waste a Bacon Sandwich".