Transcript of 1st Session between Charles Balis, M.D. and Ms. Sarah Wright, Monday, September 9, 1996 at 2 pm.

Dr. Balis: Please, won't you come in? I'm Doctor Balis.
Ms. Wright: Hi, nice to meet you. I'm Sarah.
Dr. Balis: Have a seat, Sarah.
Ms. Wright: Thanks. I'm a little nervous, would you mind if I took off my shoes? I always take off my shoes when I'm nervous.
Dr. Balis: If that makes you comfortable go ahead. So, why did you came to see me today?
Ms. Wright: Well, it's kind of hard to explain. I went to my family doctor first and he suggested I see you.
Dr. Balis: What sort of symptoms are you having?
Ms. Wright: Well, I feel like I'm going to explode at any minute. Like I could jump out of my skin. I cry a lot. A lot! My stomach hurts all the time and I can't sleep more than an hour or two straight. And when I do sleep, I have the same dream over and over again. I keep dreaming of falling down a flight of steps. It's scary. Oh and I get words mangled up in my mind. I'll mean one thing, but say something else.
Dr. Balis: Can you give me an example of how you get words mangled up?
Ms. Wright: Okay. Like the first time it happened, I was talking to my girlfriend on the phone. Her name is Lisa. She and I have been friends for years. Actually, she should be the one sitting here, if you know what I mean. Talk about problems! Anyway, I told her I was going to run over to KMart and get some garlic.
Dr. Balis: I see. What did you mean to say?
Ms. Wright: I meant to say I was going to get some new sheets for our bed. Well, right away Lisa just starts laughing, and I say, "What the hell are you laughing at?" And she says, "Why are you going to KMart to get garlic. I have garlic if you want to borrow some." Well, that really scared me, you know? I told her someone was at the door and I had to hang up. I stayed in bed the rest of the day and cried. When my husband Jeff got home from work that day, that's the way he found me. Crying. Only I couldn't tell him what I was crying about.
Dr. Balis: Why couldn't you tell him why you were crying?
Ms. Wright: I don't know, I guess I just didn't want to burden him with any more problems. He'd been so supportive since my heart attack, I just didn't want to push him any further. Ever since I came home from the hospital, I just can't seem to get my shit together.
Dr. Balis: You had a heart attack? When was this?
Ms. Wright: About 3 months ago. It was mild, but I had to have that heart catheterization done. No big deal. The only thing is, I keep having the same kind of pain I had that day, so I go to the emergency room thinking I'm having another heart attack. The first couple of times the doctors were very sympathetic. You know, they'd check out my heart, say everything was fine, give me something to calm my nerves, then send me home.
Dr. Balis: Please go on.
Ms. Wright: Well, my husband and my girlfriend--the one I was telling you about?--they talked me into going to see my family doctor. He looked over everything in my records, sent me for more friggin' tests, and finally decided all my pains and complaints are...
Dr. Balis: Yes?
Ms. Wright: Okay, he thinks it's all in my head. He doesn't think there's anything wrong with me physically. I just think he doesn't want to try to find anything else. It's easier to just send me to a head shrinker! Sorry, I don't mean to offend you.
Dr. Balis: No offense taken. Tell me, what do they think caused the heart attack? Do you have a family history of heart problems?
Ms. Wright: Nope, no family history of anything! I guess they think stress had a lot to do with it.
Dr. Balis: Are you under a lot of stress, Sarah?
Ms. Wright: No more than anyone else, I guess. I got a husband, three kids, a house, a part time know, the regular stuff that goes along with that.
Dr. Balis: You seem awfully young to have had a heart attack.
Ms. Wright: Look, Doc. I've heard this story a hundred times and I'm sick of it! Yes, I'm too young to have had a heart attack, but I did!
Dr. Balis: Why are you so angry?
Ms. Wright: Why shouldn't I be! I'm feeling a lot of things. Anger, frustration, fear.
Dr. Balis: I can empathize with what you must be going through.
Ms. Wright: Oh I seriously doubt that! Did you have a heart attack at 33 years old? Did your life suddenly change over night? Did you have to face your husband, your kids, your family, and say, Look, I've fucked up, I'm sorry. My god, the guilt I've been living with, putting everyone through this bullshit. I just keep saying I'm sorry, I'm sorry. I can't even look at anyone without crying. No, I doubt you can understand.
Dr. Balis: It's true that I've never had a heart attack, but I have worked with other patients who have.
Ms. Wright: Okay, so maybe you can try to understand, but it's hard for me to even understand. I can't begin to understand why this has happened. I know that bad things happen to good people. I truly believe that the things that happen in your life, happen for a reason. You may not know what the reason is right away, but still, there's a reason. Maybe my heart attack was for someone else's benefit.
Dr. Balis: I'm not sure what you mean.
Ms. Wright: Okay, when I was in the emergency room, there was a high school girl there for career day. They asked me if it was okay if she stayed in the room, and I said sure. Her name was Abby and we talked a lot, but when she found out I was having a heart attack, she nearly freaked out. She had to leave the room. I'm like, "Hey girl, I'm the one with the chest pain. Why are YOU leaving?"
Dr. Balis: I still don't understand. What could that girl have to do with your heart attack?
Ms. Wright: See, this is the funny part. I found out later that she had thought she wanted to be a doctor but, when she freaked out, she realized the medical profession was not her thing, you know? So, if I hadn't come into the emergency room that very day Abby was there, she might have spent years in med school to find out she wasn't cut out for it. If you think about it, I saved that girl and her family a hell of a lot of money!
Dr. Balis: That's quite a stretch, don't you think?
Ms. Wright: I'm not saying I believe that's why I had the heart attack, I'm just saying it could be something like that. I was suppose to see my mother-in-law the day I had the heart attack. What better way to get out that situation?
Dr. Balis: You don't get along well with your mother-in-law?
Ms. Wright: Oh please, let's not waste time talking about her. She's the least of my problems.
Dr. Balis: Do you have other problems that you'd like to talk about?
Ms. Wright: I don't think people should dwell on their problems, you know? Right now my biggest problem seems to be why they can't find any good reason why I keep having chest pains. I'm sure if I could just get this all straightened out, I'd feel a lot better. It's just so frustrating!
Dr. Balis: Did you have any history of heart problems before the heart attack?
Ms. Wright: No.
Dr. Balis: Did the doctors say that your heart was badly damaged as a result of the attack?
Ms. Wright: No, they told me I was fortunate in getting to the hospital quickly. And they told me that the heart wasn't badly damaged.
Dr. Balis: I presume they put you on nitroglycerin or amyl nitrite?
Ms. Wright: Yeah, nitroglycerin pills. I carry them in my purse.
Dr. Balis: You said you have a part time job?
Ms. Wright: Yeah, I work part time as an office manager for a dental office. Actually, I was working for two dental offices at the time of the attack, but I've given one up.
Dr. Balis: And your husband? What does he do?
Ms. Wright: Oh, he's a computer nerd. His title is Systems Process Control Engineer, which basically means that he's boring at cocktail parties.
Dr. Balis: I see also that your doctor has you on Ativan. I guess you're taking that for anxiety? How is that working for you?
Ms. Wright: Not very well, I don't think. I take it because they give it to me, but I really don't notice any less anxiety. I still cry all the time. Just the smallest things upset me. What really bothers me is that I'm scared of what this is all doing to my husband and kids. Everyone walks around on egg shells. My husband never knows what kind of mood I'll be in, and my kids are afraid to come home from school to find me sitting on the kitchen floor crying. Honestly, I'm afraid the men in the white jackets will come and carry me away. I feel like I've lost control of my life and I can't seem to get it back.
Dr. Balis: It sounds like you're not just talking about losing control after your heart attack.
Ms. Wright: Yeah, that's true. For a long time I'd just been going along with life, like floating down a stream. But then one day it was like I just woke up and said, "This is bullshit." Since then, I started taking a more active role in the decision making in my life.
Dr. Balis: Who had been making the decision before that time?
Ms. Wright: Everyone else in my life. My husband, my parents, my boss--especially my husband and my boss.
Dr. Balis: Why did your boss have so much control over your life?
Ms. Wright: Oh jeez, I was hoping we wouldn't have to get into all that right now.
Dr. Balis: That's fine, we can talk about something else.
Ms. Wright: Good, cause I'm just not ready to deal with that yet.
Dr. Balis: That's okay. I'll be talking to your doctor, but since the Ativan hasn't been working for you, I would recommend switching you to another drug called Xanax. I've had some good results with it for panic disorders, which might help with your chest pain. I'll write you a prescription for the generic alprazolam. Let's see how that works for you.
Ms. Wright: That's fine. At this point I'm willing to try anything.
Dr. Balis: Good. Why don't we make an another appointment for next week?
Ms. Wright: Okay, sounds good to me. Can I ask you something before I go?
Dr. Balis: Sure, what is it?
Ms. Wright: Do you think I'm loony?
Dr. Balis: No, Sarah, I don't think you're loony.
Ms. Wright: Good, that makes me feel better already.
Dr. Balis: I'm glad. I'll see you next week then.
Ms. Wright: I'll be here!
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Button to Dr. Balis' Notes Doctor Balis' Notes on this Session

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