Pieces of the Puzzle

The doctor walked toward her oak filing cabinets, hell-bent on a mission.  Then suddenly she paused and looked at her watch.  It was getting late and Carly faced an hour’s ride from her Century City, California office to her San Fernando Valley home in the hills of Encino.  All day she had been looking forward to going home, taking a nice relaxing tub bath and catching up on the latest issue of The Journal of Abnormal Psychology.  But that was before she received this invitation, she told herself.  She set the alarm on her wristwatch, determined to stay in the office only a little while longer. With a steadfast resolve her fingers quickly flew over each alphabetized name on the manila folders until she found the one for which she searched.  As Carly shuffled through the file, she thought about the first time she met Julia Baron.  It was a Wednesday.  No, she thought.  It was a Thursday and it was 5:00 p.m.  She remembered this because Mrs. Baron was the last patient scheduled for that day.  Her mind wandered back to that first meeting…

“Hello, I’m Dr. Carly Miller.”

The tall, slender doctor rose from her chair and walked around her antique desk toward her new client.  She offered her right hand and shook hands with her new referral, Julia Baron.  Dr. Miller sensed the pretty, red-haired woman was very nervous.  After the introductions were made, Carly urged the young woman to sit down and relax.

“Make yourself comfortable.  You can either sit in that chair to your right or lie down on the couch.  The choice is up to you.”  The doctor noted that the client chose to lie on the couch.

“Dr. Grossman sent me some preliminary information on your case, but I’ll want you to tell me your story in your own words.  I understand that you and your family have been going through some difficult times.  I am here to listen and to do everything I can to help you.”  The young woman understood and nodded her head accordingly.

“Before you start, at the beginning, I want you to explain how you feel when you experience a panic attack.”

Julia Baron reclined on the brown leather couch and tried to relax.  She placed her arms at her sides, took a deep breath and answered, “I feel apprehension, a feeling of impending doom, but I don’t know why.  The feelings seem to come upon me suddenly, unexpectedly.”

“Tell me about the very first one you had,” the doctor urged.

“Well, I first experienced feelings of anxiety when I arrived home on the night of the shooting and learned what happened to my husband.  I even fainted.  But everyone has told me that my reaction was rather normal in such a situation.”

“Okay, then tell me about the first one you experienced after that initial one.”

“It was a few days after the shooting.  I was driving alone in my car.  I was on the San Diego Freeway on my way to The Madera Market.  Suddenly, without warning, I was overcome with panic.  I felt that I was on the verge of hysteria.  My pulse raced and my heart pounded with a force so strong that I feared my heart would be propelled right out of my chest.  There seemed to be no rational reasons for such feelings.  Although I did try to remain calm, I could feel that I was losing control of myself.”        

“I see….”  Dr. Miller shifted her weight and adjusted her position in her chair.  She was very interested in Julia Baron’s account of the etiology related to her panic attacks.  With pen in hand she busily recorded her clinical notes.&