009: Months
June 2023
"Max? Come on, you're going to be late!" Kerry calls from the kitchen, her voice traveling down the hall, up the stairs, and hopefully to where Maxine is in her bedroom. She checks her watch impatiently. "Jesus, what is she doing up there?"
I look at the clock over the microwave; it's 7:45 a.m. and she has a ballet clinic at 8:30. It takes a half hour to drive into the city, where said ballet clinic is being held. We typically wouldn't care too much about when she managed to get herself up and out of the door—you know, if she's late it'd be her own fault and she'd theoretically learn a lesson—but ever since Henry arrived home from New York a couple weeks ago and Eli got his driving privileges back, we've been down to four cars and five licensed drives. Not a good number when every one of those drivers has places to be and people to see. On this particular day, Max has drawn the short straw and will be getting dropped off by Kerry before her shift at County.
"Good God…" Kerry slides her stool back from the kitchen counter, getting ready to march up the stairs in search of our eldest daughter.
I hold my hand up. "I'll go," I say, hoping to prevent any sparks from flying between the two this early in the morning.
Kerry relents easily. Though she's often stuck playing the role of the bad guy in our relationship, having to dole out punishments or keep the kids in line, I know she really only does it to save me from having to, and I try hard to take on some of the less pleasant duties myself.
I move up the stairs quickly and quietly in hopes that, if Kerry's shouts didn't wake up Henry or Gwen, my steps won't either. I take a left at the top and head to the end of the hall, coming upon the door that is left open only a crack. I raise my hand to knock but stop myself when I suddenly hear something.
Something…peculiar.
It's the distinct sound of labored breathing.
Labored breathing and the sound of footfalls against carpeted floor.
I knock quickly before pushing the door open all the way; I would normally be chastised for this, but I know in my gut something's not right, and I don't think she's going to be angry with me in the end.
"Max? Are you alright?" I ask, watching the pacing, distraught figure in front of me.
She looks up, acknowledging me as well as showing me the enlarged pupils within her terrified, watering eyes. Her chest is heaving as she draws short, fast breaths that aren't nearly deep enough to fill her lungs, and one of her hands is over her chest while the other is by her side, shaking uncontrollably as she paces back and forth. "I…I can't, I can't…I can't b—breathe…I'm losing it." She says, clearly in a deep state of panic.
I fly into psychiatrist mode.
"Max, sweetie, you're alright…" I take her very gently by the arm and lead her to her bed then sit her down on the floor against it. I squat down next to her. "I need to check your pulse, okay? Just take slow, deep breathes."
I clasp her wrist, finding her pulse with my index and middle finger and count the pounding against the second hand of my watch. After a minute I shake my head; her heart rate thinks she just finished a mile long sprint, it's beating so incredibly fast.
"Okay, sweetie, keep taking slow, deep breathes," I saw quietly as I rub her back, "you're going to be okay."
Pervasive thoughts of the mental, emotional, and even physical pain she's facing and the fear that she's experiencing find their way into my mind. I try my hardest to push them away so that I'm considering them only on a medical level, reminding myself that it's sometimes impossibly hard to be both a child's mother and doctor. Yet here I am, my hand still stroking her back in comfort while I run through the DSM-V-TR criteria of various mental disorders associated with panic attacks.
After a few minutes of deep breathing, she's no longer hyperventilating, and her shaking has reduced to a small quiver. "You're okay, just keep breathing. In through your nose, out through your mouth; nice and slow."
A few minutes later, I check her pulse once more. Better, though still not entirely normal.
I wipe a tear off her cheek with the pad of my thumb. "How are you feeling?"
"Less like I'm going to pass out…" she says, her voice shaking and breaking.
"Well that's a start…" I smile gently. "How were you feeling when you woke up this morning?"
A shrug. "Okay…"
"Did you have a stomachache or headache or anything like that?"
She shakes her head.
"What were you thinking about earlier?" I ask carefully, taking her hand in mine. I know this question could easily trigger another flood of intense fear and panic, but I need the answer to it in order to help her. It's a situation I face often with my patients who have anxiety and panic disorders, and there's unfortunately no subtle way to get around it.
She drops her gaze to her lap.
"Were you having scary thoughts? Or maybe you were worrying about something?" I prod a little further. She looks up at me, raising an eyebrow. I have another thought, "You know, I am wearing my doctor hat right now…you can tell me anything you want, and you don't have to worry about me telling anyone you don't want me to. And no matter what you say, I won't be angry. I'm Kimberly Legaspi, M.D. right now, here to serve."
She nods in response to my question, drawing in another deep, shaky breath, "I was fine when I woke up…" she begins, "and then I showered, but while I was in the shower I started thinking about dance, about this stupid class. And then I got really uncomfortable and felt—felt like I couldn't breathe and like I was going to—to pass out. I thought I was…" her breathing starts to pick up again and she never finishes her thought, though I'm pretty sure I know what she was going to say. I've heard it countless times before as patients of mine recall what they go through during panic attacks. 'I thought I was going to die…I thought I was going crazy…I thought I was losing it…' It's almost always the same, and it's always so disconcerting.
"It's okay, I understand…" I assure her, "just take some deep breaths."
She nods, inhaling and exhaling slowly.
We sit in silence for a while longer when suddenly Kerry's voice travels in through the bedroom door, "Maxine? Let's go! Now we're both going to be late!" She says.
The seventeen year old turns to me, her eyes wide and filled with terror once again.
"It's okay, sweetie…just keep breathing. I'm going to go talk to Mom, alright?"
"Don't make me go, please don't make me go…" she pleads in between breaths.
The desperation in her voice is heartbreaking.
Out in the hallway I nearly run head on into Kerry. "What the hell's taking so long?" She asks, trying to get around me.
I put my hands out to stop her. "She's coming down from a panic attack, Kerry." I tell her point-blank, my voice soft and quiet.
Kerry's eyes widen then narrow. "What? Are you sure it's nothing physiological? How's her heart rate? Wait, she is responsive, isn't she?"
One of my hands goes on her shoulder and the other drops to my side. "I'm positive it was a panic attack, it's coming down slowly, and she's still shaky…coherent, able to tell me what happened, but you walking up the stairs just about triggered her again."
Kerry's hand flutters over her lips. "What was it?"
I open my mouth to speak but stop myself, actually thinking about what Max told me for the first time. 'I started thinking about dance…' Dance. The activity that she's lived, breathed, and loved for the past eleven years. What's happening now? Is the pressure too much? Is she injured? Has she slowly and silently been developing a disdain for it? Or is this episode completely unrelated to dance and rather a manifestation of a panic disorder that is suddenly making itself known? I fear the thought that it's any of those, to be honest, but I can't imagine any alternatives.
"Dance."
I'm rereading the fifth paragraph of a fourth year resident's research proposal for what has to be the tenth time when Kerry slowly lowers herself onto the couch next to me. I can feel her grimacing. Even after a comparatively short, six hour shift she's clearly in pain, and it adds to my mounting worry surrounding my family.
I swallow down my questions and concerns; one battle at a time, Kim.
"Have you spoken with her?" She asks, speaking undoubtedly of Max.
My head falls back against the couch. "Around lunch. She seemed…better; she actually ate something, went for a run. She hasn't been open to talking much, though."
Kerry sighs, expressing the frustration and confusion we're both feeling, "So still no idea as to whether or not this, the anxiety, the panic, has been happening for a while? You know, under the cover of night?"
"I asked, she said dance. For all we know, she could have been going through this for the past three months." I admit, disgusted by the idea that our eldest daughter may have been struggling with this and neither myself nor Kerry knew.
"Six." A voice, Gwen's, suddenly interjects from behind the couch.
I turn around slowly, my eyes finding my lanky, almost-ten year old standing in the entryway that separates the kitchen from the living room. Her arms are crossed over her chest and she's leaning, a little too comfortably, against the doorframe. "Gwyneth, you know it's inappropriate to eavesdrop—how long have you been standing there?"
"Since Mom came in from the kitchen;" she looks at Kerry, "you're walking differently; are you okay?"
Kerry holds up her hand. "Don't deflect."
Gwen bites her lip. "Sorry."
Kerry nods her head once. "What does 'six' mean, Gwen? Six what?"
"Six months. She's been like this for six months." She's wringing her hands, her gaze trained on the floor.
"And you know this how?"
A silent shrug.
"Did she tell you this? It's okay to tell us, even if she asked you not to—we're trying to help Max feel better." Kerry says.
No response.
Kerry and I exchange a glance.
Suspicion is clear in her eyes, and I'm sure it's mirrored in my own.
"Gwen," I begin sternly, making sure she knows I'm not messing around, "if Maxine did not tell you how she was feeling, how do you know?"
She mumbles something undetectable.
"Gwyneth…"
She looks up at us slowly and repeats herself, her voice timid, "I…I read her journal…" she admits, practically flinching.
A thick hush falls over the living room, one I remember to be so dreadful when I was young. We let it sit for a while before Kerry speaks up, telling Gwen to come and sit on the coffee table across from us.
"You should not have read her journal, Gwen. That is a huge invasion of her privacy, and we will be talking about it later, and you can expect a punishment. We'll also be talking about your eavesdropping, because that is not appropriate." I explain. "But right now, we need to ask if you've noticed anything different about your sister's behavior…maybe something related to dance?" I ask carefully, hoping to stay clear of straight out asking her to tell us what was in Max's diary.
Suddenly and strangely, she perks up. Her head and all of her hair begin to nod vigorously, "Yeah, and that's why I read her journal—at the end of school, like in May, I was at Ellie's house after lacrosse practice. But it rained so Ellie's mom brought me home because you were working but you knew that Max was going to be home. So she dropped me off and I went upstairs and I found her in her room crying really hard." She shook her head, "It was really sad and I didn't know what to do, but I just sat there until she felt a little bit better. And then I asked her what was wrong, but she just wouldn't tell me, and she got so angry and she yelled at me and told me to get out." Gwen explained, "I really wanted to know what was wrong, because she's always so sad, so…I did what I did…" The story finished with a deep, sad sigh from the redhead.
I pat her on the knee. At least she has good intentions.
I excuse her, sending her to her room and assuring her that we'll be having a discussion about her habits tomorrow.
She nods and shuffles away silently.
When she's cleared the top of the stairs, I let out a long, loud sigh.
"So now we've not only got a seventeen year old who's suddenly lost the composure she's so famous for, but also a nearly-ten year old who's decided this is a great time to jump on into her eavesdropping and snooping stage?" Kerry thinks aloud, clearly as exasperated as myself.
"At least it's after we've pulled our other seventeen year old out of his rebellious, experimental stage and sent out nineteen year old off to college." I add a weak smile to the end of that one.
She shakes her head. "Where do we start, Kim?"
I take her hand and squeeze it. "I'll give it one more shot with Max, you go take some Advil and take a bath; Gwen's right."
She swats at me as I walk past.
Upstairs, I find Max lounging on her bed on her back, her cell phone to her left, an unopened book to her right, and her eyes staring blankly at the white ceiling. When I knocked lightly, she turns her head and glances at me when I knock on the door. "Hi."
"You're awake." I smile, stepping into her room and sitting on the edge of her bed. It's only eight, but after the day she's had her body and mind has every right to be taxed.
"Hardly."
My smile saddens. "I'm sorry, I know it's rough…the fight or flight response, what your body is going through, it takes a lot out of you."
She nods.
A short silence.
"What's wrong with me, Mom?"
I feel my eyebrows knit together.
Deep breath.
"What happened this morning, what I think you were experiencing, is called a panic attack. It's this strange thing that happens inside your whole body, and it really feels like that, doesn't it? Your heart may pound, you may feel sick, or dizzy, or really confused, and you may even feel like you're going to go crazy, or like you're just going to lose control of yourself…" I explain, observing a subtle understanding appear across her facial features. "Now, one of the stranger things about these attacks is that they don't always need a trigger. Some people just develop panic attacks for no apparent reason. On the other hand, some people's panic attacks are triggered by something. For a lot of people, this is something that they're worried about…a lot of teenagers who have panic attacks are triggered by stress with school, family problems, their social life, and even problems with extracurricular activities." I say, watching as her eyes squeeze shut.
Bingo, Dr. Legaspi strikes a chord.
"Do you think that's what happened to you, Max? Do you think your panic attack was triggered by something that you might be worried about, rather than it being random?" I go a little further.
The deep breath she draws is shaky.
An affirming nod.
"Maybe ballet?" I hold my own breath.
She looks up at me now, her eyes moist with tears. "I hate it, Mom."
Any suspicions I had about what it was about ballet that was bothering her have gone out the window.
She doesn't want to do it.
She continues tearfully, "I used to love it so much but now it's become…it's such a burden. I used to wake up in the morning, excited to go to school so I could go to the studio and dance until my feet were torn and bleeding. I lived for that. Then it was like…like, after Christmas last year I just couldn't do it anymore. Every day I was more tired and I missed my friends, and Owen, and—and you guys…" she chokes back a sob, shaking her head, "But it's who I've always been and what I've done for a really long time and I f—feel like…like I'm nothing now. So I kept going. But I h—hate myself for it."
"And that's why you didn't tell Mom or I about it?" I ask quietly, feeling like my stomach and my heart and every other vital organ inside my body has dropped to the floor.
She nods, opening the flood gates and breaking my heart.
I draw the rest of the conclusions and open my arms for her to lean into.
Kerry's in bed with her eyes shut but glasses and bedside light still on when I finally retire to our room. She stirs when I climb in next to her.
"The boys are home, Gwen's tucked in, and Max is asleep." I say all before she can open her mouth.
She nods against her pillow. "Any progress?"
"She's been developing this…this disdain for dance, and it all kind of exploded." I roll over onto my side so my head is even with Kerry's. "She was afraid to tell us, Ker…she said—she said that she hates herself because of how she feels."
Kerry runs her hand through my hair. "We didn't do this to her, Kim."
I'm not aware of my quiet sobbing until I speak.
"But we didn't realize it was happening."
She holds me as I cry.
