When gruesome scenes in historical fiction started triggering a faint, inveterate swooner Gwendolyn Smith decided enough was enough. She went straight to a team of fainting experts, who armed her with helpful strategies.
It is late on a Friday night, on the bus home, when the wooziness sets in. Initially it descends gradually: my skin prickles with heat, my stomach churns, the light seems unpleasantly harsh. I wonder vaguely about sitting down rather than standing in the gangway. Then, all of a sudden, it’s urgent. My face is blaring with heat. My bowels are clenching in a manner that is not encouraging in a public space. I lurch towards the seats. And next … darkness.
When I come round, I’m flat on my back on the floor, with a clutch of concerned bystanders looming over me. “Too much to drink,” sniffs one of them disapprovingly. “Or drugs?” counters another. But the blackout isn’t down to Prosecco or pills. It’s the fault of my Philippa Gregory book.
That sounds positively unhinged, so allow me to explain. Ever keen to live up to the stereotype of the fragile millennial snowflake, I’ve fainted when feeling pain or seeing something gory since I was a child. Vasovagal syncope is the technical term for it, as my GP told me when I was in high school, patting my arm while I recovered from yet another injection-induced swoon.
Up until last year’s bus blackout, it had been relatively easy to manage. Lie down when you have a jab, leave the room if there’s a gruesome scene on TV, that sort of thing. But as I’ve got older, the triggers have become less predictable. I mean, the bus journey saw me floored by a childbirth scene in a historical novel. That’s not to mention an episode a few months earlier, when I found myself coming round on my scratchy office carpet after scrolling through an article about the contraceptive coil.
Sick of swooning
Shutting my eyes during horror films was one thing, but I wanted to be able to read about women’s health without a stranger being obliged to slap my face and yell at me. I was done with merely avoiding triggers. I wanted to get over the problem entirely.
But first I needed to know why I faint in the first place. I put this question to Dr Boon Lim, consultant cardiologist and clinical lead for the syncope unit at Imperial College London. Vasovagal syncope, he says, is “due to low blood pressure and/or a low heart rate – and, a third component: peripheral vascular resistance”. I’m going to need him to break that down a bit.
I found myself coming round on my scratchy office carpet after scrolling through an article about the contraceptive coil.
He directs me to an interactive diagram on his website, Stopfainting.com. “At all times your heart and brain should be filled with blood,” he says. “As the man in the diagram stands up, gravity pulls blood down into the lower limbs, emptying the brain and the heart in the process, right?” Right. “As it empties, the lower limb vessels start to expand, and when the heart empties in this way, it is sensed by very sensitive mechanoreceptors in your neck.”
This in turn activates the sympathetic nervous system, which governs fight or flight, he explains. Eventually, more and more blood pools in the legs until you’re unable to maintain a good enough blood pressure, the flow of blood to the brain is compromised ... and voilà! The faint sets in.
Fainting often affects people if they’ve been standing up for a long time, especially in hot weather. But that’s not true in my case – why is it happening when I’m just, well, freaked out? It’s all down to the autonomic nervous system, apparently – the primitive part of the brain controlled by the limbic system.
“Certain emotional and physical states can push the limbic system into taking a defensive mode to switch off, causing your blood pressure and heart rate to plummet,” says Dr Lim. “Not everyone’s brain is wired in the same way. You have a very sensitive response,” he adds, giving me extra snowflake points.
Ways to stay conscious
Nevertheless, now I understand the process behind it, I can try to avoid it. But how? “First off, ramp up the salt in your food and ramp up your fluid intake,” says Dr Diane Bruce, a consultant cardiologist and general physician with a specialist interest in the area. Dr Lim agrees, adding that reducing caffeine and alcohol is also wise.
I’m pretty sure I’m drinking enough water, but over the next few weeks I start being more generous with salt. Caffeine is trickier: I get through about six cups of tea a day. I try to cut this by half but, naturally, flout the rules during especially taxing periods (when I have to go to work hungover).
Dr Bruce is a proponent of eating more in general. “I always say to my patients, think of yourself as a little car. Unless you put enough fuel in the engine, it’s not going to go.”
Psychological tricks are also beneficial. Dr Lim recommends “a visualisation technique that takes you somewhere else, like lying down on a beach in Cuba”. Asking practitioners to distract you during blood tests also helps, while if you feel a faint coming on, fidgeting is the way to go, he goes on: “Clench your gluteals, your quads and your calves to try and physically squeeze blood back up from your lower limbs.”
So, now I have the coping mechanisms, all I need are the triggers. The universe obliges. I go to Franco Manca with a friend, who starts telling a story about getting her toe stuck in a door and the nail falling off. This is, objectively, disgusting – and also, as a side-note, conversation ill-suited to a pizza dinner.
Despite the unappetising chit-chat, I heed Dr Bruce’s advice and gobble down as much of my Margherita as possible. The friend yabbers on, peppering the narrative with words like “blood” and “skin”. Usually this would be prime faint territory, but the food seems to help. I endure the tale up until the point when she offers to show me the photograph her boyfriend took of the injury, when I shut her down for reasons of social propriety.
The next challenge comes when I’m visiting my parents for the weekend. After lunch one day, my mum launches into an anecdote about inadvertently chopping a hole in the family cat’s skin when trying to remove one of the mats in his fur. She points out the still-weeping wound. Yuck. I start clenching my glutes furiously but there’s a familiar swooping sensation in my stomach. I don’t faint, but it’s hard to feel as if I’m making strides when I’m overpowered by descriptions of feline grooming.
However, progress comes a few weeks later, when I go the GP for a blood test. I’ve come prepared: I’ve drunk plenty of water and eaten a substantial breakfast. I force the nurse to distract me by talking about the nearby park. There’s a scratch as the needle goes in, but soon she’s sticking cotton wool over it and chattering happily about her terrier fondness for the park’s pond. No darkness, no clammy nausea.
So, am I cured? Inevitably, it’s more complicated than that. According to Dr Lim, fainting is a kind of “Swiss-cheese effect where the holes on the cheese have to be lined up in a row”. Hydration, heat, emotional state, infection and menstruation are all factors – and if several occur at the same time, there’s a higher likelihood of fainting.
Nevertheless, eating more regularly and upping my salt intake has made me feel more robust, and knowing what to do when a faint comes on has bolstered my confidence. While I don’t want to cut down my caffeine and alcohol intake permanently, it’s easy to avoid them if I’ve got a medical appointment or something similar lined up. But if my mum launches into another grisly tale about the cat, I can’t pretend I won’t be glad to slip out of consciousness for a moment or two.
About the contributors
Thomas S G Farnetti
Thomas is a London-based photographer working for Wellcome. He thrives when collaborating on projects and visual stories. He hails from Italy via the North-east of England.