"I'm so scared to die." She lays in bed and barely looks at me.
"So, what's most scary to you?" I ask.
"I'm scared that I'll look dead, and they'll think I'm dead but I really won't be. Then they'll take me away and bury me alive. That's what I'm really scared of---being buried alive."
I take a deep breath.
"Well, first of all, I'm going to tell you something. One day, when you die---and we all die---they will make absolutely sure that you're dead. I promise. Now, what do you think they'll do when they take you to the funeral home?"
"They'll make me up and and comb my hair and dress me in the clothes my daughters give them."
"Well, yes, but I'm gonna take a risk here and tell you something that someone else wouldn't tell you. The only reason I'm doing this is because we know each other so well and we trust each other, right?" (She's my former patient and I've been sent to see her as a nurse consultant to assess her increasing anxiety.)
"Oh, yeah. I trust you more than Dr. __________. You can tell me anything." She sits up in bed a little, a sure sign that I have her attention.
"Well," I continue matter-of-factly. "The first thing they do in the funeral home is look over the death certificate and make sure that it's you on the table. Then they check over your body and make sure that you are absolutely dead." (I'm stretching the truth here a little, perhaps.) "Then they remove all of your blood and fill your veins with embalming fluid. Believe me, they would only do that when you're dead." (And no one could wake up after that, I think to myself.)
"So, they won't bury me alive?" she asks plaintively.
"No, I'm absolutely sure. Now that we have that settled, what's going on with this anxiety?"
"I don't know, I don't know. I just wake up in the night and I can't breathe, my chest hurts, I'm sweating, and only my daughter can calm me down and distract me. I call her on the phone---even in the middle of the night---and she talks to me. Or my youngest daughter who lives with me tries to get me to play some stupid game. It doesn't always work. I just feel like I'm gonna die."
"Do you have bad thoughts, or want to hurt yourself, or feel like someone's out to get you?"
"No, nothing like that. I just get so scared---sometimes even during the day, just like that!" She snaps her fingers in front of her face. "I've always been afraid of dying. Always."
"Are you afraid of the pain of dying? What scares you?"
"It's just that I'm scared. I can't explain it. I hope I'll go up there," she gestures towards the ceiling with her eyes, "but I'm not so sure."
"Oh, I can tell you for sure---you've raised all of these wonderful children and grandchildren for all these years. You're goin' to Heaven, my dear, no doubt about that. You can quote me on that one."
We review some simple breathing techniques and talk about psychotherapy. She's housebound, agoraphobic, morbidly obese. Finding a therapist to come to the house is almost impossible these days. Her family is frustrated, and she's just afraid of dying. Period. Well, we could take into consideration childhood trauma and the like, but who's counting. She has a panic disorder, plain and simple.
"You try those breathing techniques I taught you, and I'll make sure Dr. __________ thinks about giving you something that you can take when the attacks are really bad. OK?"
"OK. Thanks. I hope you can come over again some time, but I know you're not my nurse anymore."
"Yeah, you know I don't work there full-time anymore, but I'm coming in to help every week or so. If you need to see me again, I'll come by, OK?"
"OK. See you soon."
And with that, the visit is over. She may die today, tomorrow, or in fifteen years. The only thing I'm sure of is that she won't be buried alive and she'll go to a Heaven made just for her. The rest is up for grabs.