Christina’s World

Episodic, Paroxysmal Anxiety, Initial Encounter

In retrospect, I should have seen it coming. There were clear signs.

For one, it seemed to be getting more difficult to share my patient story. I wasn’t sure why. My psychiatrist friends insisted it should be the opposite. They viewed my onstage performance of trauma as a type of exposure therapy, desensitizing me over time, and allowing me to regain control. While it was true initially that reclaiming my story made me feel stronger and more resilient, something had shifted. It was as if some important part of me felt flattened and excluded by the version of the story I told. I felt it knocking from the inside. Trying to reinsert itself, as I stood once again, waiting to go on stage.

I pacified myself by imagining I could blow air back into my experience, reinflating it to scale until it became a giant parade balloon. Something about that 3D version left me certain it would carry me away. I felt the need to diffuse it, to make it manageable again. I imagined stomping on it, allowing the air to escape in a deafening whistle.

I was standing at the foot of the stairs, listening for my cue to begin my presentation. It wasn’t truly a stage, but an elevated platform sitting at one end of a vast convention hall. The CEO of the hospital introduced me from a bio that, while objectively true, still managed to sound synthetic. I’d been invited to speak to a Houston healthcare system, though the interior was so nondescript I could have been in any city, in any convention hall shaped like a rectangular black box with rigging overhead, loudly patterned carpet, and the complete absence of natural light.

It was 2018, and I was giving a lot of talks. Despite the searing Texas heat, it was almost inconceivably cold, which made me feel out of place in the calendar. At home we were in the early leafy days of autumn, with brisk temperatures and air so new it cleansed our lungs through the open windows. I tried to invoke that feeling as the CEO spoke about me. It felt important to remind myself there were places where the inside matched the outside, and that a fresh start was always possible.

With the sound of the audience’s cursory applause, I climbed the stairs up onto the black platform. The lengthy introduction of my accomplishments and awards made me uncomfortable. I had the urge to offer an objective failure or some intentionally humbling anecdote, like the time I nearly electrocuted my physics lab partner in college. But I was looking out at rows of disinterested men in suits, arms crossed, or scrolling their phones, so I allowed my academic introduction to stand. I needed them to see me as a credible authority, not just a small brown woman telling her patient story.

I projected an outsized image of our one-hundred-year-old hospital onto the screen behind me, the way a traveler returning from overseas might show a photograph of a distant temple. The picture was intended to allow the audience to better visualize the place I was speaking about, but it was such a pale substitute for the experience of being inside of those walls that it was difficult to believe they were even related to each other.

“I’d wanted to become a doctor since I was five years old, when our family’s pediatrician saved my infant brother’s life. My brother woke up drooling and leaning forward on one hand in his crib, something I later learned was called ‘tripoding.’ My mom carried him to the kitchen and called the doctor’s office. The doctor translated the signs and symptoms into a diagnosis of epiglottitis, which was enough for him to know what to do to make my brother better. Filtering a story through a lens of medical knowledge and knowing how to heal sounded like the best job description I could imagine. I was hooked. From that moment on, it was all I ever wanted to be.

“Ironically, on the day I finally achieved that goal, the very last day of my critical care fellowship, I became critically ill myself.”

I attempted to communicate the initial pain of the ruptured liver tumor to the audience, though in truth it still exceeds my capacity for language. I described how despite being a physician with what was clearly an acute surgical abdomen, I allowed myself to be wrongly triaged to Labor and Delivery by a hospital security guard. “It’s policy, everyone over twenty-four weeks goes to L&D.” I was terrified, knowing that I needed the Level 1 Trauma ED, but I quietly complied. “It still shocks me how quickly, as patients, we can lose a sense of our own agency, regardless of our other identities,” I said.

I described my physical experience of accelerating hemorrhagic shock, the strange heady effervescence of an oxygen-deprived brain. The insecure obstetrical resident who approached me with the ultrasound probe, unsure of himself or his place in the hospital or at my bedside. I described how when I said, “There’s no heartbeat,” he casually asked, “Can you show me where you see that?” Behind me was an ultrasound image of a fetal heart, like a four-chambered pool covered in slowly falling snow. The room settled into a more deferential stillness.

“I worried that if he couldn’t see me in that moment, he would be unable to do what it would take to keep me alive. By that time, I’d already heard my labs return, hemoglobin of three, platelets of fifteen, AST and ALT in the tens of thousands. I knew the level and frequency of care it would take to save a patient like me. The late-night calls to the blood bank, endless orders, scans, consults, and procedures. I knew how much easier it would be for him to just say, ‘She was very sick, and she died, I’m sorry.’ ”

I had rehearsed saying this until my voice did not waver and my pulse did not race. Practiced until I could reliably suppress my emotions, like a doctor delivering a heartbreaking diagnosis. I didn’t want the audience to feel responsible for me. I viewed my role as one of translation. I was to reduce something complicated and overwhelming into discrete and digestible bites. If the patient accepted the diagnosis, if the audience understood our culture, if my body could see itself as healed, then we could move forward. We could discuss the next steps. I wanted to get to a more comfortable place. I wanted us to agree on treatment.

I described the moment in the operating room where I briefly hovered above my own body, near death and no longer burdened by the crushing pain. The sacred, nearly indescribable peace of those delicate, invisible minutes. Oddly noiseless, despite vigorous screams all around me, “We’re losing her! She’s circling the drain!” How small, light, and buoyant I felt, and yet expansive too, as if I were somehow connected to everyone and everything all at once. I knew those invisible bonds meant that I was already far enough away to leave. “She was very sick and she died, I’m sorry.” I knew I could just let go. That I would have to make a deliberate choice to return to my broken body and all the pain and suffering trapped within it. I still don’t remember choosing.

“I awoke days later, to the voice of my childhood priest who was making the sign of the cross on my body.” I moved my own hand from my forehead to my heart and then across my chest. “I remember thinking, if my priest is here, I must be dying. I moved my hand as if I were holding a pen, indicating that I wanted to write,” I said, squiggling the air with my right hand, just as I had that day. The bodily movement, the precise repetition of the physical gestures while visualizing the people who had surrounded me, took me back to the ICU room packed full of people, grief, and life-support machines.

For the briefest moment, I felt caught in an inhalation, as if a ventilator breath was pushing against me, not allowing me to exhale. I paused briefly to regroup, which I doubt seemed out of the ordinary, given the content of my presentation.

“I only wanted to write that question: ‘Am I dying?’ But they wouldn’t give me a pen because they were afraid that I would ask about the baby that had died and they had decided it wasn’t the right time to tell me,” I said. Because I was in Texas and women’s bodily rights were actively being dismantled, I explicitly stated what was normally just implied. That the people caring for me, who withheld information, and made decisions about my body, what aspects of pregnancy I could handle emotionally and what I could not, were men. I understood from their treatment of me that my body was not my own, and that information about my body also didn’t belong to me.

I described hearing the voice of the surgical ICU resident presenting my case to the team in the hallway.

“I heard him say, ‘She’s post-op day four, status-post fetal demise with intraoperative observation of a large, subcapsular hematoma. She’s received twenty-six units of packed red blood cells with additional cryo, platelets, and FFP. She’s up forty pounds from the resuscitation. Anuric, hypothermic, and acidotic.’ Listening to them, I almost felt as if I was back on the medical team. I was formulating a plan for what would be necessary for me to come off the ventilator and I was making a work list in my mind that included dialysis when I heard the resident add, ‘She’s been trying to die on me.’ It was stated as fact; I had apparently set an intention to ruin his night. We were not on the same team anymore. We were adversaries.”

The physicians in the audience sat upright, or shifted in their seats, unsure of whether it was safe to align with me. They were preparing themselves to be confronted with more of their own words. I lessened the tension by admitting that I had used similar phrases, we all had. We were products of our collective culture. Their shoulders dropped as they visibly softened. They knew.

“A nurse visited my ICU room and told me that she’d been there the night of the delivery, and I thought she had the wrong room because nothing about my experience felt like a delivery. And then I realized, she was referencing her own experience of the night, someone had handed her a baby that could not be resuscitated, and she had come to help me find closure. She wanted me to hold the dead baby. And when I declined, not believing it was in my best interest at that moment, she offered a series of escalating judgments.”

Well, I think that’s really sad.

Every baby deserves to be held by its mother at least once.

After a few days in the morgue, their skin starts to break down and you won’t be able to, even if you change your mind.

The sadness and shock I saw on the faces in the audience was such a stark contrast to my own lack of emotion, I felt momentarily destabilized. Even the seemingly unmovable suited men in the front row appeared heartbroken for me, and I felt … what?

Was it nothing?

Was I just suppressing my emotions, as I thought I should for the purpose of the talk, or had I effectively lost access to them?

With that question, my body seized upon the opportunity to remind me of what it was carrying. I became momentarily dysfluent and uncoordinated. I swallowed my breath awkwardly and emitted a series of half coughs to release the bubble of air lodged in my throat.

I was struck by my own detachment. I couldn’t imagine how such a tender and vulnerable story had become locked and static, more like a time capsule than a living, breathing thing. I was increasingly aware of the confines of my rib cage and my own breath, shallow and stacked. I was starting to sweat.

“Sorry, I’m just … um … I’m sorry,” I said and took a drink of water from the small bottle on the podium and cleared my throat. I would get it together. I dug my fingernails into the meat of my palms and, in doing so, accidentally advanced the slides.

I turned toward the screen to see what image was being projected. It was the small ivory remembrance box, given to us, the grieving parents, by the hospital. Contained inside were small inky footprints, a black-and-white photo, and an impossibly small bear. A representation of a shattering moment, the loss of something wanted that had once been real. Now just a box.


Copyright © 2026 by Rana Awdish