by Mara Altman
I have another friend who fainted during a meditation course. Not knowing exactly what brought it on, she was concerned she would go unconscious again, maybe this time while she was driving. She didn’t man a vehicle for months. She still gets panicky thinking about how her brain went black. Yet another woman I spoke to fainted while being screamed at by her abusive boyfriend. While he berated her, her body slackened and fell to the floor. Still not knowing why she fainted, she asked me recently, “Do you think my mind was trying to save me from experiencing that awfulness?”
I, like my friend, had also theorized why I lost consciousness—I thought the phlebotomist had taken out too much blood and so my body could no longer operate. Separately, I theorized that maybe my body went into shock and needed a time-out to recuperate. I’ve come back to revisit this moment, because it occurred to me I’d never done any research. Everything I believed about fainting, well, I’d totally made it all up.
When I looked at the situation with some distance, I saw how crazy it is: We are all walking around with a spontaneous off button hidden somewhere inside and yet have no idea what triggers it. Maybe if I figured that out, I could finally regain my confidence, go back, and start enjoying one of my favorite pastimes.
* * *
Over the next week, I was able to speak with two fainting specialists. One was Dr. Nicholas Tullo, a cardiac electrophysiologist who runs the New Jersey Center for Fainting. The other was Raffaello Furlan, a cardiologist from Milan, who coedited a book on the phenomenon.
Fainting, formally, is known as syncope (sin-kuh-pee). Upon first hearing the term, I felt misled. It sounded like a quaint fishing town in Alaska rather than what it is: falling onto your face after a loss of consciousness.
But by talking to both researchers, I would learn that syncope is not always evil and is in fact quite common. Half of all Americans faint at least once during their lifetimes. Fainting is also simpler yet simultaneously more complex than I’d expected.
“It’s really due to one thing,” Tullo said.
He explained that while there are many different triggers—emotional as well as physical—that can cause fainting, each results in the same condition: a lack of blood flow to the brain. “Without blood, your brain cells just shut down. It only takes four to ten seconds to completely lose consciousness.”
Without blood in my head, it made a lot of sense that I couldn’t eat cookies. The surprising part was to hear that I could actually survive those moments without going brain dead.
“There is no danger,” Tullo assured me. He went on to say that while fainting is the result of a problem—the lack of blood to the brain—it also results in the cure. When we become horizontal by falling to the floor, our brains fill back up with blood, because the fluid no longer has to fight against gravity to get there. (Of course, this is the case only if you’re not driving at the time or near the edge of a steep cliff.)
“You recover almost immediately,” Tullo said. “Crazy enough, a lot of people even wake up feeling refreshed.”
I know nothing of refreshment; those who feel good after slamming to the ground must be of the same breed that cheer with stupefaction each time their airplane touches down.
But syncope became much more complicated when Tullo began to explain what causes that lack of blood to the brain in the first place—the impetus for the off button to be pushed, so to speak. It turns out that researchers still don’t completely understand why it happens.
Furlan, the other expert, told me that the answer is elusive. “It’s like trying to hold tiny grains of sand in your hands.” And he’s been studying syncope since Jimmy Carter was president.
What researchers do know is that our brains control many involuntary reflexes, such as breathing, digesting, temperature regulation, and blood pressure. Reflex syncope (which also goes by the name vasovagal syncope), the most common type of fainting, occurs when the brain sends out a wonky signal to lower the blood pressure and/or heartbeat. When the blood pressure drops dramatically, blood can no longer make it all the way up to our brains—hence the loss of consciousness.
“But why these reflexes go wrong,” Tullo said, “we really don’t know yet.”
So after donating blood, it wasn’t that I didn’t have enough blood left in my body or that I was in shock, it was that the blood I did have wasn’t distributed properly. Something, though it’s hard to say what, exactly, had triggered my blood pressure to rapidly drop.
“What do you think happened?” I asked Tullo after detailing my experience.
“A lot can predispose someone to a faint,” he said tentatively. He listed off a few of the many possible triggers—dehydration, standing too long, a hot day, or a claustrophobic environment.
It turns out that there are so many things, both emotional and physical, that can cause a faint. There is even something called defecation syncope, which is the term for fainting if it happens while taking a crap—in this case, the brain, misreading a message sent from your colon, triggers this precarious blood-pressure drop.
“But you know, often it has to be a perfect storm,” Tullo said, “like that old song goes, ‘When the moon is in the seventh house and Jupiter aligns with Mars.’”
“Fainting is like Aquarius?” I said, surprised that any musical, let alone Hair, would figure into this.
“Yeah,” he said. “See, you’re dehydrated and you’re standing up and it’s hot and someone gives you some bad news or you have some emotional stress—everything lines up, and that’s when you’ll faint.”
He told me that doing the same activity on a different day or under different circumstances would rarely lead to the same outcome. “You can go ahead and give blood another time and it won’t happen,” he said.
He told me that, statistically speaking, I also shouldn’t be too concerned about fainting again. After a fainting episode, one has a 40 percent chance that she will faint again in the next year, but if she doesn’t faint, then her chances drop to 17 percent for the year after that. This is because, he said, fainting often occurs in “clusters,” but as to why that is, we still don’t know. “Some people never faint again, but some do so several times a month,” he explained. “It’s one of those imponderables.” Considering that as of the time of this writing it’s been about 2,555 days since my one and only faint, this news was heartening.
Before I was satisfied, though, I had another question. If fainting was so common, I wondered if it had any benefits. I thought about my friend, the one who’d fainted while in a fight with an ex-boyfriend. She’d suspected that her body shut down to save her mind from having to undergo and catalogue that experience.
“So does fainting protect us in some way?” I asked. After all, reflex syncope is not considered a disease, but something that actually falls within the bounds of normal human behavior.
Tullo told me that theoretically one could say fainting is protective, but they would be using poetic license, because no benefits have been proven. “In my opinion, the brain is not trying to save anything.” He explained that fainting occurs because the brain is screwing up. “By signaling the blood pressure to drop, it’s responding inappropriately,” he said.
Furlan, who has looked at the phenomenon from a more teleological standpoint, had a different take, but even he was hesitant to attribute too much purpose to a fainting episode. “It’s not protective in this era,” Furlan said, “but maybe it was to our very old ancestors.”
He explained that when some animals are frightened, they freeze. “Rabbits in the desert respond to a rattlesnake by playing dead,” Furlan said. “A snake doesn’t like to eat dead meat, so maybe the rabbit will survive its predator.”
When an animal “plays dead,” it is actually experiencing an involuntary rapid downshift in heartbeat and blood pressure. It’s possible, Furlan said, that when a person faints because of emotional triggers—fear, shock, disgust, phobias, and gruesome images—they are actually experiencing a relic of the playing-dead response
found in our fellow vertebrates.
How helpful fainting may have been for our ancestors would have depended on the kind of predators they ran across. “Am I going to respect you because you are lying down and not dangerous, or will I take the opportunity to finish you and cut off your head?” Furlan said, positing the decision to be made by a potential predator. Ultimately, he said, figuring out if there were benefits when a person fainted in the Paleolithic period is impossible. “Who can know?”
In essence, it’s unlikely that my friend’s brain was trying to save her from experiencing the quarrel, but it is possible that she felt threatened enough that some ancient mechanism was trying to save her from being eaten.
All I knew for sure at that moment was that I felt like a jerk. I didn’t realize how standard it was for people to faint because of emotions. I’d always suspected that people who fainted at the sight of needles or upon hearing shocking information had a low threshold for suffering. More or less, I considered them weaklings.
“So those people aren’t just extra wussy?” I asked Tullo.
“No, it’s not their fault,” he said.
I still didn’t believe him. “But it sounds really precious, you know?”
“But it’s not,” he reiterated.
Apparently, fainting from emotional stimuli is often genetic. Some people can’t stop fainting at the sight of a needle any more than someone with allergies can stop from sneezing during a hay storm. I’m going to try to have more compassion next time I see a movie where the ingénue faints at the sight of a sharp-toothed and slimy alien.
Before Tullo and I finished up, I asked him one more thing.
“So how do you trust your body again?”
He was quiet for a moment. “I know it’s scary,” he said, “it’s always scary to lose control of your body, but know that you’ll always wake up again.” He went on to say that though the triggers are still somewhat mysterious, there are actions to take, which can make fainting less likely. The best preventatives are drinking lots of water and eating salt. While staying hydrated helps increase blood volume, salt helps to retain the fluid, making a drop in blood pressure less likely. “People think salt is bad,” said Tullo, “but it’s only bad if you have high blood pressure.”
Regular exercise is also important, as is listening to your body. “If you start to feel the prodrome,” he said, of the sensations like dizziness, blurred vision, muffled sound, sweating, and nausea that tend to precede fainting, “lie down immediately and put your feet up.”
Just because you feel faint, it does not mean fainting is inevitable.
If I had known that before, instead of wasting time by raising my hand to ask a question, I would have hit the ground intentionally.
“Again, all you need to do is get blood back to your brain,” he said.
Furlan was also supportive of my return to the donation chair: “Go give blood. It won’t happen again, I assure you.”
But he had slightly different advice, which was not to think about passing out. “When you’re there, just look out the window and say to yourself, ‘Isn’t it so pretty outside of my window?’”
* * *
A week later, I booked an afternoon appointment at a bloodmobile.
The hardest part of the appointment was picking out my outfit. I believed those fainting fellas, but I wanted something comfortable that would—just in case they were wrong—also work well with urine. After trying on various ensembles, I went with an ankle-length black skirt and a white T-shirt long enough to cover my groin.
When I arrived at the bloodmobile, Donna, a petite middle-aged woman in a blue nursing uniform, brought me into a small room for the vetting process. Even though it was so cold that my arm hairs stood up like a million tiny pins, my armpits had managed to produce sweat stains the size of dinner plates.
After passing the interview and hemoglobin test, I warned Donna about what had happened the last time I donated. She didn’t seem fazed. “Some people, when they black out, can even have a bowel movement,” she said.
I guess that’s life; people are always trying to one-up you.
Instead of hightailing it out of there, I thought back to something a bit odd yet comforting that Furlan had told me. He suspected that those who were crucified back in the day actually died from fainting—without being able to move their legs, blood would pool into the lower half of their bodies, triggering syncope, but because they were pinned to a cross, it made it impossible for them to fall and get blood back to their brains again. I think it was his quirky way of making me feel better: Unless the phlebotomist crucified me afterward, which was unlikely, I would survive even the worst fainting episode.
Donna decided to take some extra precautions. She had me lie down and put cold wet towels around my neck. In order to keep me conscious, she exploited part of my thermoregulatory mechanisms—when a cold compress is used on the body, blood vessels will constrict in that area of the skin. Making my neck cold, she explained, would free up more blood to circulate in necessary areas like the brain.
From there, the experience was predictable. Phlebotomists, though it had been almost a decade since I last donated, were still complimenting people’s veins. “You’ve got a nice big one right here,” the woman working on me said.
She pressed the needle inward. I looked out the window. A few plastic bags were being swept upward by the wind, but I followed directions anyway: “Isn’t it so pretty outside of my window?” I said to silent and skeptical stares.
After ten minutes, the phlebotomist extracted the needle. She’d successfully obtained one pint, which I soon learned accounted for more than a tenth of my blood. That seemed a bit excessive, but when I later contacted the American Red Cross, Ross Herron, a divisional chief medical officer, explained that the standard donation is one pint, or more specifically 525 milliliters (15 percent of the blood volume of a person who meets the minimum weight requirement of 110 pounds to donate blood), because that is how much blood a person can lose without having too many physiological changes. “In other words,” he said, “it is a safe level of blood loss.” Once someone loses more than 20 percent of her blood volume, all hell begins to break loose—the heart rate increases as the heart pumps harder and still will not be able to distribute blood to all the necessary tissues. “This is when a blood transfusion becomes essential for trauma patients,” he explained.
My takeaway: Make a concerted effort not to get run over by a car after donating blood. Your buffer has already been depleted (though don’t worry too much; blood volume does quickly increase with rehydration).
After resting for a few minutes, I stood up, wondering if my vasovagal reflex had been triggered. I was still standing after a minute, so that seemed positive.
The phlebotomists still didn’t trust that I had it together, so one followed me when I told her I had to go to the restroom. She wouldn’t let me lock the door. “If I hear a thud, I’m coming in!” she said. You would think that having someone follow me to the toilet would feel invasive, but I actually liked it; I felt special yet also in danger, like a high-value target. It made me think I wouldn’t mind being the president.
I stood up. I wiped. I flushed the toilet. When I washed my hands, I was still standing upright! Donna, at that point, felt that I was in the clear. Before going home, I walked to the front of the bloodmobile and did what I’d aimed to do so many years before: sat down and indulged in three bags of mini Oreos.
The cookies were good, but I’ve got to be honest: After all that buildup, staying conscious and not soiling myself felt incredibly anticlimactic. When I got home, even Dave was slightly disappointed. I never realized how much I’d been terrified by the incident, but also oddly cherished the memory. After all, showing up at Dave’s door in that state had been an essential step in our love story. It was a yarn we’d shared multiple times with close friends and family. All I can say is I guess sometimes the moments in life that feel the worst in real time can make for some of th
e best ones when they are assembled in the highlight reel.
Within an hour, I got over the fact that I’d had a very routine and unexceptional experience. I was also pleased that I didn’t have to do laundry.
Over the next several weeks, I busied myself with work. Thoughts of blood donation didn’t come up, at least not until yesterday, when I received an email from the blood bank: “Your blood donation was sent to Gadsden Regional Medical Center in Gadsden, AL to help a patient in need.”
I thought of a woman lying in a bed with a needle in her arm, exactly how I had been lying in a bed with a needle in mine, but instead of blood shooting upward through the translucent tube, that very same liquid—liquid she needed to live—would flow downward and into her body.
It was for her that I’d be going back again.
14
Bloody Hell
A couple of months ago, Dave and I were standing in the kitchen, deciding what to make for dinner. As we discussed baking salmon, our discussion somehow took a sharp turn.
“Why haven’t you gotten your driver’s license yet?” I said.
Dave is forty-two years old. Driving is not that hard.
We moved on and began to consider making a stir-fry, until I was like, “And you still don’t put the toilet seat down!”
At that point, we decided it was probably best to order take-out. Dave pulled out his laptop and began scrolling through the possibilities, but I cut in while we were debating the type of cuisine.
“Why haven’t you gone to the gym lately?” I asked. “You’re going to give yourself a heart attack.”
I’m a chubby-chaser, and because of that, I live in a perpetual catch-22: My preferred body type could also cause harm and shorten the life span of its owner. I experience a near constant and conflicting mix of wanting to feed my husband a tub of lard and wanting him to go run a marathon.