Madeleine Robins

Since my teens (possibly even before that, but the facts get lost in the gauze of time) I have occasionally fallen over. Often publicly. The first time I remember was in gym class, where I turned to a classmate, said, “I feel like I’m gonna–” and did, coming to a minute later to see the faces of all three of the school’s gym teachers very close to mine, and to hear the “what happened?” of 40 15-year-old girls echoing like the cries of maddened seagulls in my ears. Since then, my public swoons have been the stuff of anecdote, like the time I fell at the top of the up escalator at a department store, and awoke to find that I was being prodded with a cane by an elderly woman who thought I was staging a protest (it was the ’70s).

I never really worried about it too much. When I was young, it seemed to be mostly associated with heroically bad cramps (or the occasional stomach bug), which was embarrassing but seemed on the outer edge of what was considered normal for us frail female sorts. I figured: if I felt rotten, best thing to do was to get down low on the ground until I passed out or the feeling went away. And I will say, your fellow citizens are generally very kindly to women who swoon. I have been in the back offices or living-rooms of strangers who decided I could not be left to lie strewn about the hallway or pavement. High embarrassment, lots of thank yous, and I’d go on with my life.

Until finally it was pointed out to me that I should really get this looked into. Here’s what happened.

One morning, when my younger daughter was still in diapers, I was getting her changed and dressed, when I had a stab of sciatica followed almost immediately by lightheadedness. I called my husband in to take over, and went off to the bathroom (the only place where Mama could get a moment to herself) to sit down for a moment until it passed. Somewhere in the sixty seconds after I sat down on the side of the tub I realized that I was really, really dizzy. I remember thinking “I’d better get down on the floor” just before the ringing gray tide swelled up around me (really, that’s the best description I can give). When I awoke I thought, for a moment, that I was in bed. I’d been having a vivid dream. Then I realized that I was on the bathroom floor. Lying in front of the door (which had stopped Danny from being able to come in and see if I required assistance). I picked myself up and realized 1) that I was bloodied (I’d bitten my lip spectacularly) and 2) broken (one of my front teeth had broken off at the gum line).

First things first: I called my dentist and got an appointment for an emergency root canal late that afternoon. Then I called my doctor, a calm sort, and explained what had happened. “Go down to the ER; my partner’s on duty. You need to have your lip sewn up.” So I followed instructions, not reckoning on the fact that few things get ER docs more excited than LOC (loss of consciousness). I kept protesting that I just needed a stitch or two, while they spoke of CAT scans and MRIs… until I said, “Well, my daughter has a diagnosis of vaso-vagal syncope….” At which point they did the ER doc equivalent of pouting, as if I had misrepresented my swoon as something interesting, sewed up my lip, and suggested that I might wanna get this checked out at some point.

Vaso-vagal syncope, as it was explained to me, is a relatively benign tendency to faint. It is often found in robustly healthy people whose systems are so finely tuned that said system mis-reads a cue, thinks that there’s a medical emergency, and cuts down blood flow to everything except the core systems–of which, it appears, the brain is not one. It is the world’s fastest episode of shock. Then, after a minute Silly Body says “Oops! My bad,” blood flow is restored, and the faint passes off, leaving the patient to deal with the embarrassment of swooning.

My doctor and I agreed that finding out what was happening was probably a good thing (and why hadn’t I ever mentioned this before? Because it mostly had seemed tangled up with gynecological issues, and…). So I was sent for a tilt table test. In a tilt table test you are strapped, Bride-of-Frankenstein-style, to a table which is then raised so that you are almost standing–thus the “tilt table” appellation. I imagine there are different protocols, but for me, they put into IVs each arm. For the first phase of the test, they piped something something into my left arm that slowed my heart rate to a crawl. Whatever it was (I remember it as adenine, but it was a long time ago and I can no longer state what it was with authority) it metabolized very quickly–after about two minutes the effects were gone. But that was a horrible two minutes. I didn’t faint, but I felt… rotten. No pain, no queasiness, just awful in a way that defies description. And then it was gone.

For the second part of the test they ran a second chemical into my right arm, something that sped my heart rate waaaaay up. And that part of the test was supposed to last for about 25 minutes. “What happens if I don’t faint?” “Then you’ve passed the test, and whatever it is that’s making you faint is sinister and must be further investigated.” “Oh.” Sinister? And here I’d been ignoring it for 30 years? Fortunately, 22 minutes into the test I said “I feel like I might–” and did. At which point they lowered the table and told me I’d flunked the test and indeed, I have vaso-vagal syncope.

And there was much rejoicing. At least by me, who now had a name for what it was, and the assurance of the neurology department at NYU that I didn’t have anything really really scary to deal with.

And the recommendation on how to deal with it? If I were fainting several times a day, they could medicate me. But given that it’s only once, maybe twice a year, they didn’t want to do that. “So what do I do?” I asked.

“If you feel faint, get down on the ground.” Hell, I coulda told me that.

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*I suspect the 10 degrees of tilt, or whatever it is, is so that if you faint you don’t overbalance the table and fall forward.