Transcript of 2nd Session between Charles Balis, M.D. and Ms. Christina Herald, Thursday, March 13, 1997 at 12 pm.

Ms. Herald: Hi, Doctor. Listen, I'm sorry about last week. I'm very embarrassed about the phone call, and the state I was in.
Dr. Balis: It's all right, Chris. I don't understand why you'd do something like that to yourself. Nice shirt, by the way.
Ms. Herald: Thanks. But I guess I forgot about the midterms, and when I remembered, I got all tense and worried and just generally freaked out. I don't dare slack off in Carmichael's class, because the old goat has had it in for me from the beginning of my college career. He was my Intro to Fiction teacher as well, and decided he didn't like me when I corrected his translation of Shakespearian English. Big mistake there. It was just out of my mouth before I could help it, like so many other things. But as far as the thing with the caffeine, I paid for it. And I might just have learned my lesson.
Dr. Balis: What happened? Did you have a panic attack?
Ms. Herald: Um, yeah, you might say that. The funny thing is I was fine, actually coming down a little bit with no ill effects. I was probably going to make it okay. I had a bottle of water by my side like you said and was working that down. Then in walks Kevin.
Dr. Balis: Kevin?
Ms. Herald: Remember last time I told you that I dumped the guy I'd been seeing? Kevin's the guy.
Dr. Balis: I see. What happened?
Ms. Herald: Well, I tried to look inconspicuous, but it's hard to do when you're coming down off a pretty optimal rush of caffeine and literature. He spotted me right off and comes trotting over like a puppy. I wish I thought more highly of him, because he's a nice guy. But he just really has no ambition: he's majoring in something different every week. He's gorgeous--all tall and blond and well-cut muscles, and he's good in bed--but there's just no intellectual challenge. It's like trying to have a discussion with a side of beef. But he came over, "Just to say hi," he says, but eventually he starts asking me why I dumped him and backing me into a corner both emotionally and physically, and I freaked. I was ready to say anything to get out of there, even that I'd call him and we'd talk later. I could hardly breathe, he was right there with his hands on either side of me, close to tears and .... ugh. I feel so awful about the whole thing now, but there was really nothing I could do. It would never have worked.
Dr. Balis: Did you feel physically threatened? Could that have been what set you off?
Ms. Herald: I don't think I'd call it feeling threatened. I know Kevin would never hurt me. But...crowded.
Dr. Balis: I see. And you had a panic attack.
Ms. Herald: A six-foot three emotionally distraught ex and a small lake of lukewarm espresso in my belly are not exactly circumstances leading to emotional ease, Doc.
Dr. Balis: True. What happened next?
Ms. Herald: I went and sat in my car until I felt capable of driving, then I went home. Sat with my cat for awhile, that took the edge off a little bit. That's about the whole story as far as that episode is concerned.
Dr. Balis: Okay. How was the rest of the week as far as the panic attacks were concerned?
Ms. Herald: You'd be proud of me. I wrote all of the days and times and possible triggers down in my notebook. Being a good patient because I was a really bad patient last week when I called. Impressed yet?
Dr. Balis: Very.
Ms. Herald: Good, because this bespeaks a level of organization that I normally just don't have. Okay. Monday March Third. Happy Birthday to Me. Ten-fifty-five p.m. After a rather strained evening out with my family I arrive back at my apartment to find that Kevin has left a rather odd present before my front door. To be more specific, a kitten. This is, incidentally, the cat I mentioned earlier, Doctor. Well, I couldn't very well let the little thing freeze, so I brought him in and named him Lancelot, in honor of an old friend who I nicknamed Lancelot a long time ago. This isn't the point . The point is I had a panic attack earlier in the evening while having an argument through gritted teeth with my father over whether or not my kid brother should be allowed to do what the hell he wants with his life regardless of whether or not Dad is paying for his college.
Dr. Balis: Your father doesn't think so?
Ms. Herald: What, Frank Herald give up control of any particular thing he feels his time or money has a stake in? Not in a million, baby. He's the original control freak. He wants Jonny, my brother, to go into business or law or something where he can be some sort of a big wheel in the whatever. I don't know. It's a businessman thing I guess. But Jonny wants to be a veterinarian and just live up in Oregon tending cows and horses and generally being happily useless to the corporate world at large. So Dad starts lecturing him on this and that and all those stupid business proverbs, "If you're not the lead dog the view never changes," and all that shit. And for the first time in recorded history, Jonny stood up for himself. Right there in Fillio's in front of the snooty waiters with their little mustaches and phony Italian accents. So I backed him up, and Dad gave me his patented "Herald the Horrible" look--his nickname around the office when he's not there, you might have overheard it or not, I don't know. Then he started in on me. And my stepmother is giving me this really disgusted look, and her daughter is just sitting there batting her eyes at the stud puppy in tight black slacks who's bussing the next table. My family has the total yours, mine, and ours thing going on. I'm Dad's from his first marriage to my mother, my stepsister Monica is Joanne's daughter from her first marriage, and Jonathan is Joanne and Dad's kid together. Neither Joanne nor Monica have brains beneath their perfect blond chignons, either. So we got into it, finally ending with Dad calling me an ungrateful little brat and me countering with the witty observation that he may have money and position but he has about as much soul as a rock. So the evening ended on a bad note. I got home and fell apart. But Lancelot actually kind of helped. It's nice to have another living thing in the apartment besides the plants. Anyway, I was just so upset I called Mommy in London, where she's working right now, and she made me feel a little bit better. She said that the panic attacks get milder as she gets older. Do you think that's true?
Dr. Balis: It might be. Your family life sounds pretty stressful.
Ms. Herald: That's why I avoid it whenever possible, at least Dad and Joanne's unholy alliance. Mom is okay when she's in town. But Aunt Sara's the best. She lives down in San Diego, and I go see her on weekends sometimes. She's Mom's sister, and is probably more like me than anyone else in the family. But I digress. We're talking about panic attacks here.
Dr. Balis: Chris, you don't have to worry about it. You can talk about other things besides your panic attacks. It actually helps when you do, because it gives me some insight into your circumstances and personality. So just go ahead.
Ms. Herald: Oh. Okay, cool.
Dr. Balis: But while we're at a lull in the conversation there are a few things I'd like to mention to you.
Ms. Herald: Okay, shoot.
Dr. Balis: First of all, I did a little research on the link between panic attacks and family members. It does have a higher rate of occurrence between monozygotic twins--
Ms. Herald: Monowhatsits?
Dr. Balis: Doctor-speak for identical.
Ms. Herald: Okay, freshman year, Principles of Biology 101. I remember now. Go ahead.
Dr. Balis: Okay, the rate for both identical twins getting panic attacks is something like a 45% rate. It's 15% for fraternal twins.
Ms. Herald: Hold on. Since fraternal twins are basically just brothers or sisters or brothers and sisters who happen to be in the uterus at the same time rather than naturally-occurring clones, wouldn't the 15% rate be the same for regular siblings?
Dr. Balis: Yes, but what I'm getting at is that there is scientific basis to think that this could be a hereditary condition.
Ms. Herald: Oh, okay. Sorry.
Dr. Balis: It's a good question. Another thing I wanted to discuss with you is seeing another doctor--not a psychiatrist but a good internist--to rule out the possibility of any illness that might mimic the symptoms of panic disorder. Here's the business card of a colleague of mine who's on your father's health insurance. He should be able to help you.
Ms. Herald: Douglas Halsey, M.D. Okay, I'll make an appointment asap.
Dr. Balis: Good. One more thing I wanted to mention before I let you go for the day is whether you'd consider pharmacological options for treating your condition.
Ms. Herald: Like drugs? Depends. What sort of drugs are we talking about?
Dr. Balis: Well, I've had good results in the past using anti-depressants to treat panic disorder. But you look doubtful.
Ms. Herald: I don't know. I'm not terribly comfortable with the idea of drugs. Between caffeine and nicotine, I usually have enough of them in my system, you know?
Dr. Balis: Well, these might be a little more useful than those. But think about it. If you're really uncomfortable with the idea, then we'll work without them. I'm just letting you know it's an option.
Ms. Herald: Yeah, I'll think about it. It was nice talking to you, Doctor, and once again I'm sorry about last week. Like the tie, by the way.
Dr. Balis: Oh, well thank you. I got it at the amber exhibit at the California Academy of Sciences. I was hoping the bugs wouldn't put off my patients. And don't worry about last week. Just try to be a little more careful with the espresso, okay?
Ms. Herald: I will. Promise. Bye, Doctor.
Dr. Balis: Goodbye, Christina.
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