Hello RLR

First of all, may I say this forum and what you do is wonderful, and I imagine that your wife would be extremely proud of what you do.

My question stems around the vagus nerve and fainting. I have seen you mention in a couple of posts that extreme fear may cause an individual to faint.

I have had significant health anxiety for the past couple of years (I'm 22 and have been evaluated by a cardiologist with an ECHO, ECG and event monitor, all normal thankfully)

One of my concerns is that a panic attack would cause me to faint. I have never in my life fainted, so the anticipation of what it would be like plays a big role in my fear.

However, I work as a Midwife - (so I am rather ashamed to be illogical about health matters!) - and I am newly qualified. I have been in some emergencies and coped well, however I still can't stem the fear of being in a particularly frightening situation one day, and simply fainting from the fear.

When I panic, I do not usually feel dizzy, however I get a horrible sensation in my chest and that "impending doom" feeling.

I was just curious - are certain individuals more prone to vasovagal syncope from fear than others?? I suppose I'm trying to say, if I haven't fainted yet (and I have 'tested' my body by being in some stressful situations as you can imagine, but I always wonder in cases of having to do something extremely stressful like maternal CPR) do you think there is a chance I could? Or has my vagus nerve demonstrated it is pretty dynamic in coping?

Thankyou very much for your time

Natalie

Hi Natalie. I've read your posting and concern.

Syncope is quite common among persons in the healthcare industry and mostly befalls newcomers. It's certainly nothing to be afraid or ashamed of because it's a normal physiological response. Indeed, some people are more predisposed and it arises from a number of factors rather than vagal tone exclusively. If I had to count the number of medical students who fainted in my presence during a procedure, I'd have to find a comfortable chair for it may take some time.

Indeed, you sound as though you've surpassed the timeframe during which this most often occurs and I would encourage you to relish a sigh of relief. Syncope of this type is mostly driven by rigid focus upon the more traumatic or unpleasant features being observed or attended to and this is gradually replaced by the redirection to one's skills and training as a matter of routine care of the patient. What a person is exposed to initially with regard to medical procedures typically has no prior reference and can in some instances be quite dramatic as you well know. Once you have undergone some degree of exposure to such circumstances, the reaction becomes blunted.

It is also not uncommon for persons to become fearful of a demonstration of syncope in the presence of their peers and the patient, presumably raising questions regarding competency and composure to adequately perform their duties. This is an example of an irrational fear, the consequence of which characteristically grows exponentially in the mind of the individual by sharp contrast to the actual circumstances at hand.

Additionally and although rarely admitted, you should be aware that all healthcare professionals experience uncertainty at some point during their career and I was certainly no exception. For a period of time during the honeymoon phase, every physician experiences the apprehension of a case arriving in their presence for which they lack the ability to properly address, accompanied by a nagging sense that the level of bravado normally demonstrated will be stripped away in the presence of the nursing staff. It's quite common and fades with time and experience. Incidentally, nothing ever arrives that you can't handle. You simply apply your skills and training to the matter at hand based upon standards of practice.

In other words, when you act in accordance with your professional standards of practice, you're not acting alone but rather with the aid of the wisdom granted you by hundreds of thousands before you in the same or greater capacity. You're unavoidably acting on behalf of those before you whose shared wisdom comes to bear upon each and every case you encounter. Your allegiance to such standards is what compels you to take charge and act in the best interest of your patient and the demonstration of the collective wisdom granted you. We're all mere representatives of the same cause; excellence in the practice of medicine.

Therefore, you now know precisely where you stand as a young colleague and the manner to proceed in avoiding uncertainty is to remember that you're performing on the behalf of all of us, with your focus to the standards of excellence in practice and the demonstration of competency. The time to worry has passed and you have what it takes.

Enjoy your career, for you represent a select group who can attain your level of abilities.  

Best regards,

Rutheford Rane, MD (ret.)