My (New?) Experience with Vasovagal Syncope

Two weeks ago, I collapsed without warning in a crowded restaurant, and the experience shook me. I'm writing to begin processing what happened, and to calm myself as I set out in search for answers...

Photo by Sigmund on Unsplash

I returned a few days ago from hosting my first Write to Heal Retreat in sunny Carefree, Arizona, and though I’m hardly surprised that I’ve spent much of today exhausted (in a good way!) and resting my body and brain, I’ve been struck by the powerful, tearful emotions swirling just below the surface, aching to get out. And so, I’m turning to the page and letting my unfiltered feelings flow. It’ll be interesting to see where this goes…

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The Write to Heal Retreat was held at a gorgeous resort in Arizona, May 9th-13th.

In addition to my full-time job as a writing coach, I’d been working overtime for the past year preparing for this 5-day, 4-night event.

My efforts included building a website and a support team, creating presentations and promotional materials and waivers and registration materials, networking, navigating contracts and budgets, and answering tons of questions from prospective attendees. Thankfully, I’ve had an incredible network of support around me, and though I regularly worked around the clock, I felt that my stress was pretty much under control.

I was fully aware that, since this was the first retreat I’d hosted of this scope and scale, I’d have a steep learning curve. I also knew that preparations would likely take twice as long since I was learning my way around a project this big. I knew I’d taken on a LOT, but I seriously thought I was handling things as well as could be expected. I never felt overwhelmed to the point of questioning what I was doing. My intentions were crystal clear: I wanted to bring 10 women together for a transformative experience in writing and wellness. Knowing this, I soldiered on with relative confidence, even when several recent curveballs flew at me.

For instance, though I grew worried when the spots didn’t immediately fill after I opened registration, I designed a creative way to attract attendees. When one of my facilitators came down with Covid two weeks before the event, I focused on her recovery rather than her potential absence. And, when I had to pick up the slack for another team member managing a family crisis, I reminded myself that, no matter how things went, I’d be that much more prepared as the event host. I tried to keep my focus on the positive, and as such, things seemed to be falling into place.

On April 29th, the weekend before the retreat, I was feeling so good about everything that, when Eric and I went to a local Mexican restaurant before catching an evening show, I physically felt my body relax for the first time in ages.

As we sat at the bar eating our dinner and chit-chatting with some of the patrons around us, the space around us quickly filled with an upbeat, Saturday night crowd. It felt so good to be out of my house and focused on things other than spreadsheets and contracts and all the little details of the retreat. As I turned to Eric, I smiled, and I literally felt my blood pressure drop.

Suddenly, though, I was no longer hungry, so I pushed my plate away. I noticed my belly feeling as though it were a balloon filling with hot air, and I tried to adjust my position on my barstool to get more comfortable. I twisted my body around and tried to stretch my abdomen this way and that, thinking that maybe I had some air trapped inside my belly, but nothing seemed to help.

Weird, I thought. My belly and legs feel so heavy…

And then, all at once, waves of nausea and rising panic hit me. It occurred to me that I might actually be sick right there in the restaurant, and I didn’t dare look around at all the people. Instead, I remember taking Eric’s hand and saying something to the effect of “We should get the check.”

I’m sure I was speaking too softly in that loud space for him to hear, because my words didn’t seem to initially register. It was hard to see his face, especially since the restaurant seemed to be getting darker and darker by the second. When the walls felt like they were closing in, I debated my options: Stand up and get to the restroom quickly (and risk getting sick in front of an entire restaurant) or hold completely still and wait for this feeling to pass. I didn’t realize at the time that I was having both a fleeing AND a freezing response to my circumstances.

Without turning my head, I reached into my purse, fished out my wallet, pulled out my credit card, and tapped it on the bar.

“I think I’m about to be sick,” I said, feeling sweat running down my back and dread washing over me.

“Want to go to the restroom?” he asked, taking my hand, clearly concerned. “I’ll handle the check.”

“I’m afraid to go by myself,” I said. I wasn’t just worried I’d get sick in front of others; something felt terribly wrong. I just didn’t know what it was.

By now, my heart was racing. And, I could now hear an odd sound, somewhat in the distance yet right there in my ear, almost like a whistling kettle or an approaching train’s horn. My hands shook as I kept tapping my credit card on the bar, and my eyes darted back and forth, searching for a bartender who could help us close out our tab. Where is she? I wanted desperately to get out of that space.

I turned to Eric. “Maybe I’m having a panic attack?” I said, wide-eyed, trying not to speak too loudly. “I think I might be having a panic attack.”

He looked into my eyes, held my hands, and said in earnest, “You’re okay. I’ve got you.”

I nodded and believed him, yet the room was now bobbing as if on rolling ocean waves.

“Hey,” I heard him say, his voice far away even though our noses were almost touching. “Look at me,” he continued.

I didn’t realize I’d been looking down. My head… it felt so heavy.

“Hey. Hey. I’m your anchor,” he continued, nodding and smiling calmly. “You’re okay. I’ve got you.”

In that moment, I’d never felt so safe and so vulnerable.

And then, I completely lost consciousness.

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After the Collapse

I wake up on the floor, looking up at the ceiling of the restaurant. Several faces, including Eric’s, are looking down at mine. I am drenched in sweat. I feel his hands smoothing my forehead and his fingers in running through my hair. Where am I and what just happened?

Someone is holding my right hand, and voices float in from every direction. I keep hearing myself repeat I’m sorry. I’m sorry. I’m sorry.

“Does she normally have low blood pressure?”
"Oh, good, her color’s finally coming back…”
"Does she have diabetes?”
"Does she have a heart condition?”

I’m later told that, when I stood up from my bar stool, I collapsed directly into Eric’s arms, and that’s when he laid me down on the floor. To this day, I have no memory of doing this. Apparently, I was only unconscious for a minute or two.

Before the collapse, I’d had half a margarita, some queso fundido, and a few bites of our shared salad. I’d been feeling 100% calm and happy in the moments before any of this occurred. The only thing that seemed “off” was the odd, belly-filling sensation. Only then did the waves of nausea, sweating, racing heart, tunnel vision, and sound disturbances begin.

What’s happening? I think, lying on my back on the floor. How did I get down here on the floor? Did I fall? What’s happening?

I’m acutely aware of the cold floor against the back of my head and my legs. Someone’s touching the tops of my feet, rubbing them.

When the EMTs arrive, I’m helped to my feet. The gathered crowd parts as I walk out of the restaurant with the paramedics. One woman gets close to my face and says, “Hope you feel better. I just love your shoes.”

What is going on?

The EMTs guide me to a stretcher, then load me into the ambulance. I’m asked if I’d hit my head (I don’t think so?); if I remember what happened (No); if I’m a diabetic (No); if I have a heart condition (No); if I’ve taken any new meds (Just finished an antibiotic for an eye infection).

I’m completely confused by all of this, and ask if it’s really necessary to go to the hospital.

One EMT responds. “You just collapsed for no apparent reason. We recommend you figure out why.”

I nod, then look at Eric who’s standing in the street, holding my bag. I’m sorry, I mouth silently. I feel terrible that we’re going to miss the show he was so excited to see. He puts a hand up, then rests a finger on his lips. Shhhhhh.

“Do you know what today’s date is?” one EMT asks. He’s likely assessing me for a head injury or a stroke. I’m trying not to freak out. What’s happening? I answer all his questions. I’m completely aware of the date, the time, the city, the president. What I’m not clear on is why I can’t remember how I got from my chair to the floor. That gap in time scares the hell out of me, and I keep replaying what I DO remember on a loop.

I remember eating…feeling uncomfortable…sick to my stomach…hot…wanting to leave…scared…

“Has this ever happened to you before?” I’m asked.

“No,” I insist.

It won’t be until the next day that I realize this kind of thing may have actually happened several times before, just not to this extent.

But for now, in this ambulance, on the way to the hospital, I keep hearing how low my blood pressure is.

And, I try to joke with the EMTs: “I’ve always known Eric has a calming effect on me, but this is ridiculous.”

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At the hospital, I’m hooked up to all the things, including an IV for fluids in case I’m dehydrated (I’m not); heart monitors (though everything’s fine); a blood pressure cuff (also normal); a pulse oxygen meter (which shows nothing concerning).

After a couple of hours, I’m diagnosed with vasovagal syncope, then discharged with instructions to follow up with my doctor.

According to the Mayo Clinic website,

Vasovagal syncope (vay-zoh-VAY-gul SING-kuh-pee) occurs when you faint because your body overreacts to certain triggers, such as the sight of blood or extreme emotional distress. It may also be called neurocardiogenic syncope.

The vasovagal syncope trigger causes your heart rate and blood pressure to drop suddenly. That leads to reduced blood flow to your brain, causing you to briefly lose consciousness.

Vasovagal syncope is usually harmless and requires no treatment. But it's possible that you may injure yourself during a vasovagal syncope episode. Your doctor may recommend tests to rule out more-serious causes of fainting, such as heart disorders.

Symptoms can include:

• Pale skin

• Lightheadedness

• Tunnel vision — your field of vision narrows so that you see only what's in front of you

• Nausea

• Feeling warm

• A cold, clammy sweat

• Blurred vision

During a vasovagal syncope episode, bystanders may notice:

• Jerky, abnormal movements

• A slow, weak pulse

• Dilated pupils

Recovery after a vasovagal episode generally begins in less than a minute. However, if you stand up too soon after fainting — within about 15 to 30 minutes — you're at risk of fainting again.

I’d had nearly every one of those symptoms.

The discharge instructions leave me confused. Is this serious? What set this off? Am I permitted to drive? What if this happens again? What kind of follow-up do I need? I’m scheduled to leave for my retreat in just 4 days, but will I be clear to attend?

I barely sleep that night.

The next morning, at breakfast, the cycle begins again as I’m sitting on a stool at the kitchen island eating. This time, though, when I feel the dizziness coming on, I immediately lay down on the floor so the blood will rush back to my head, and I feel better right away. I’m relieved that I now know what to do when an episode comes on, but what the hell is happening to my body?

I message my primary doctor. She insists there’s no need to worry, that this is a common occurrence. Still, she suggests I schedule a follow-up visit with her.

I also message my neurologist, just to be safe. He suggests I follow up with a cardiologist and an autonomic neurology specialist. I have no idea yet how to find a good autonomic neurology specialist, let alone what that individual does. On one hand, I want to trust the nonchalance that seems to ooze from the E.R. doc and my primary doc; on the other hand, if this kind of thing can happen so suddenly when I’m feeling completely relaxed, what else can happen?

Clearly, I’ve just had an upsetting, emotionally disturbing experience. Collapsing in the middle of a crowded restaurant without warning is the stuff of my nightmares…and yet I know my experience could have been far worse. I could have fallen and injured myself, but instead, Eric safely caught me and laid me down. And, I was fortunate in that the gentleman seated next to us at the restaurant was (I’m told) a physician who recognized what was likely happening.

I’ve come to realize, though, that this wasn’t the only time an episode like this has occurred. I’ve had similar episodes that I’ve always chalked up to “other things”.

**In the 1990s, I nearly passed out as I boarded a crowded airplane, drenched in sweat, dizzy, woozy, and nauseous. I never collapsed, but I was certain I was about to. Thankfully, I sat down just before losing consciousness and drank a glass of orange juice. I chalked the episode up to having a blood sugar issue (low blood sugar? hypoglycemia? or perhaps a sign that my maternal grandmother’s diabetes might also run in my blood?). I didn’t know, and I didn’t have a Google rabbit hole to disappear into, either. It happened, it was over, and I didn’t think about it again.

**Fast forward 13 or so years to a night out with girlfriends. I blacked out in the ladies’ room of a restaurant. I’d had 2-3 glasses of wine. I was mortified. Had I had too much? My friends put me in a cab and helped put me to bed. Was I a lightweight? Had I been overserved and didn’t realize it? Should I have eaten more before going out? Was I dehydrated? Shame on me, I thought. What an idiot. What an immature idiot.

**Something similar happened over 2018’s 4th of July weekend. One minute I was talking with friends at an intimate gathering, and the next thing I knew, I was blacked out, slurring my words, needing help getting into a car to go home. I’d had one, maybe one and a half drinks. Again, I was confused and embarrassed by my unexpected lapse in consciousness (even my friends said it was bizarre that one second I was talking and the next I was “out of it”). Despite clear evidence to the contrary, I immediately and unquestionably decided that I’d drank too much.

**Then, in April of 2022, while walking through a crowded train station, that same familiar feeling came on…lightheaded, nauseous, dizzy, sweaty, tunnel vision, buzzing in the ears, and shaking. I sat down and got a piece of pizza in me and regained my composure. No alcohol was involved. Though I never passed out, I could feel myself losing awareness of my surroundings. Sitting down helped, and I assumed that I’d just needed something to eat. What I realized later was that I HAD eaten just before heading to the station. I just couldn’t (or wouldn’t?) let myself believe it could be anything else.

**A few months later, while at an outdoor music venue, I was having a blast dancing and singing. Suddenly and without warning, I blacked out and found myself sitting in a lawn chair, sick to my stomach. It was disconcerting and enormously embarrassing, and yet I chalked that episode up to having had alcohol after just finishing antibiotics for an ear infection. I focused less on blacking out and more on my friends helping me clean myself up.

**Then, earlier this year, after having been at a local indoor music venue, I got up in the middle of the night to head down to the kitchen for some water. As I walked back to the stairs, I caught myself as my body felt almost pulled to the floor; I was very aware that my body was making movements that I wasn’t entirely in control of. As I sat on the bottom step of my stairs, my body was drenched in sweat and my heart was racing. I wondered again if I’d had too much to drink. I knew I hadn’t had a lot, but then again, I don’t drink that often. Was it too much for me? With my head spinning, I convinced myself that I’d overdone it … and tried to let it go.

And then, the day after my recent collapse in the restaurant, I started sifting through the archives of my mind, putting all these “little” “similar” episodes together. Are they even related? Am I even drawing the right conclusions here? When asked if my recent lapse in consciousness had ever happened before, was I wrong to say no?

I wish I could say there’s been a single common element involved in every one of those experiences, but there isn’t. Most involved large crowds. Most involved standing for long periods of time. Most involved some amount of alcohol. And yet, each scenario (and each response) was slightly different.

The one thing I think of now is that I’d likely been relaxed during those events, and that they’d perhaps all followed somewhat stressful times. Does my body shut down or misfire when it switches from tense to calm situations? Is this an autonomic issue? An anomaly with the way my body handles stress?

I’m only beginning to learn what the vagus nerve is, and how it might be related to all of these episodes.

It’s times like this when I need a medical professional to sit down and spend more than 8 minutes with me to go over my history and help me figure out what the hell is going on.

Right now, the uncertainty is scary. I live alone, and I’m not sure if and when this will happen again. Should I avoid large crowds? That’s rough. Should I avoid alcohol altogether? I’d have no problem with that. Should I get my blood sugars tested? Should I get my heart tested? Should I lay on a tilt table and have someone monitor my blood pressure changes?

I have so many questions right now. Could some of this be related to my long Covid diagnosis, even if things were happening (on a less dramatic scale) back in my 20s?

In this moment, I can only remind myself that I’ve sent messages to my medical team requesting referrals, and I’m doing the best I can to avoid stress.

In this moment, I’m happily basking in the glow of a successful Write to Heal Retreat, resting back home, easing back into post-retreat life. I’d given my team a head’s up about what happened, just in case I had an episode during the retreat. Thankfully, I didn’t. However, there were a few VERY stressful moments during the retreat, and that’s getting me to think: does my body have a delayed response to stress? If so, it’s fair to say I’m due to drop sometime soon.

What’s hard is that my body feels like it’s once again betraying me. What’s hard is that I don’t know how to avoid this happening again. What’s hard is that I don’t want to have to manage a medical condition, if that’s even what this is. What’s hard is that I don’t know what to really believe. Was this just a fluky, one-off episode unrelated to all the other “little” “similar” episodes? Or is this something I can be actively managing?

Answers will come. I know I’m tenacious, and I know I’ll get some clarity. What I need right now is patience and trust in my instincts.

Thankfully, I’m able to put all these jumbled feelings down on the page. And, by doing so, I hope to get a solid night’s sleep before facing all the questions again soon.

Stay tuned.