Recognizing You Are At Risk - The First-Person Experience of Suicidal Ideation
The first step in preventing physician suicide is recognizing a clear and present danger of suicide in an individual person - be that you or someone else.
This recognition comes in two parts.
You recognize when you are in danger, step back and get support.
You recognize someone else is - or may be - at risk and reach out to offer support.
- In this podcast we will explore the First-Person experience of suicidal ideation, so you can understand what happens on the inside when suicide risk is high.
- In Part 2 we will explore how to recognize suicide risk in a colleague and reach out to them to offer support.
Watch or listen as two of our coaches here at TheHappyMD.com
Pam Pappas MD and Penelope Hsu MD
... bravely share their personal experiences of suicidal ideation, so all of us can learn to recognize these symptoms and inner voices in ourselves.
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This is Episode #70 of our Physicians On Purpose [ POP ] Podcast - with 24,408 downloads to date.
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POP Podcast #70: The First-Person Experience of Suicidal Ideation
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- The connection between burnout and suicidal ideation
- Dr. Pam’s story: burnout, trauma, and the power of a listening ear
- Dr. Penny’s story: isolation, creative calling, and the road back to medicine
- Suicide statistics in medical students and physicians
- Book a Discovery Session with Dr. Hsu: https://www.thehappymd.com/physician-coach-penelope-hsu-md
- Website: https://drpenelopehsu.com/
- Linkedin: https://www.linkedin.com/in/penelope-hsu-3796395/
- Book a Discovery Session with Dr. Pappas: https://www.thehappymd.com/physician-coach-pam-pappas
- Website: https://drpampappas.com/
- Linkedin: https://www.linkedin.com/in/pampappasmd/
Physician’s On Purpose Podcast 70.
Pam Pappas MD and Penelope Hsu MD
Preventing Physician Suicide Part 1: Recognizing You Are At Risk - The First-Person Experience of Suicidal Ideation
Dike Drummond MD 00:35
Hello again, Dr. Dike Drummond here at the home of TheHappyMD.com in beautiful Seattle, Washington with the latest edition of the Physicians on Purpose Podcast.
Today is a real treat. It's part of a three-part series that we are going to do I say we because I have Dr. Penelope Hsu, one of our coaches here at TheHappyMD.com and Dr. Pam Pappas. Both of them are MD’s and ICF certified coaches that work to help the doctors that come in through TheHappyMD.com for help with overwhelm and burnout and optimizing their practice.
So what we're going to talk about here for these next three podcasts is suicide, specifically preventing physician suicide. And we're going to do a three-part series here today is going to be how you can recognize your own suicidal ideation, how you can recognize when you're at a place where this may be turning into something more significant, with larger implications than just being overstressed.
The next podcast we're going to talk about, if you as a friend of a doctor, how can you tell that they may be having suicidal ideation? And how do you respond to that.
And then the third one is going to be specifically for physician coaches, what happens when you're having a conversation with a coaching client, and all of a sudden, the conversation turns to something that is tapping into suspicious for or actually true about suicidal ideation. So today, we're going to talk about the first person experience.
And let me just set the stage a little bit Our Philosophy here. I believe that physicians are lightworkers, all of us stood at a fork in the road way back in the day when our choice was to go to medical school or do basically anything else, we decided to go to medical school, because there was actually a calling that marked us, as someone who needs to have meaning and purpose as a helper and a healer in our professional life. And it's when we aren't able to make the difference that we want to make that our heart breaks. Especially if all it is is EMR and other crap like that, that gets in the way of you making a difference with your patients. And that's when burnout leaks in around the edges.
Burnout is a combination of physical exhaustion, cynical and sarcastic, “what's the use”, and in itself, it is not a mental illness. It is a normal response to overwhelm in a lightworker.
However, there are complications of burnout that can go deeper into, for lack of a better word, what medicine is considered to be psychopathology, so depression, suicide, alcohol and drug addiction are all known complications of burnout. And what we want to talk about is how you can tell when you're tipping into the most significant of the depression, complications, which would be suicidal ideation and suicide. And then we're also going to have a little bit of discussion about it's not always a mental illness, it may actually be a spiritual piece of the spiritual journey. We're going to talk about that a little bit, too.
So I have Dr. Penelope Hsu and I have Dr. Pam Pappas with us. And I'm just going to toss this out here, where did the two of you want to begin?
Penny Hsu MD 04:01
Um, I mean, you know, if today is the personal aspect of things, I mean, I'm always I'm always happy to share and I this is sort of become part of my, my introduction when I meet groups of people. And even when I meet new clients of just sort of telling them and sharing my story, it's I don't know if Pam if you want to, if you want to go first. Or if you have anything else you want to start with.
Pam Pappas MD 04:24
I don't usually bring this right out with my clients immediately. My story of suicidal ideation and all of that. Certainly I talk with them about my burnout, experiences multiple and digging my way out of those and what I wish that I would have had available to me during those times. But because of the subject matter of this and my personal experience, I was willing to say a piece about that.
Dike Drummond MD 04:58
Well, and let me also say that one of the things that we teach here is we teach a lot of wellness leaders, people who lead wellness in their organization. One of the key principles is to tell your own story first, if you have a story of burnout, and you're a wellness leader, you have a story of suicidal ideation. And you're a wellness leader, the most powerful thing you can do inside your organization is actually tell your story, The Good, the Bad, and the ugly. And so what we decided to do, what Dr. Hsu and Dr. Pappas decided to do is to tell their stories, that would be now
Pam Pappas MD 05:33
Okay, I can I can start.
So the thing is, that I would really want to convey is that things are going on inside us all the time, that may look very different on the surface and how other people see us. And we know that physicians are extremely well versed in trying to look more together than they actually feel because of this mandate never show so called weakness. Do not have pain do not have needs, basically, and the code of silence around depression and suicidality is extremely strong in our culture at large. But I think even more so in physicians, because there's a lot of implications and so in so what I'll share is my own personal experience that is many years ago now.
And I was highly busy in working in a in a psychiatry department at a major medical school. And my marriage was going south. This This was very, very hard for me, it coalesced with a long time history of family trauma and alcoholism and domestic violence, which I had been exposed to as a kid.
And I think that my particular trajectory in becoming a physician lightworker like dike was you were just saying, had to do with wanting to heal my family, my quote, fucked up family and very deeply suffering family.
So when my marriage was starting to unravel, this became absolutely horrible for me. And the thing is that during this time, I was in twice a week psychotherapy with a psychiatrist, who had agreed to see I was a chief resident and an early faculty member by that point, and he was like a half hour away from our department. So the confidentiality was there. He was a good guy, and an excellent listener, and a therapist. And my then husband was upset with me for seeing him. Because he didn't understand that, that I was unraveling my lifetime trauma, and trying to deal with it, so that I can deal with this marriage, that's not going so well.
So the thing was, that I was so depressed, and so feeling unworthy, and feeling so ashamed of all of that, that I started saving up, trycyclic antidepressants from the medicine closet. This was in when we had to trycyclics. You know, those will definitely kill you. And so, of course, there were also some SSRIs, too, but, you know, if you get the nortriptyline and amitriptyline and you store enough of those and you and you take them, you will cause yourself an arrhythmia and die.
And I was collecting them for months with a plan.
And I did not tell my psychiatrists that this was going on.
Why did I not?
I was ashamed for not being able to make any further inroads into the marriage, not able to write papers that I needed to write for my faculty stuff, just feeling slammed on about every side. And I think that I was basically not trusting anybody.
At that time, even this well-meaning physician who was trying to help me and at home, the man I was married to, he just didn't want to hear it. I was telling him about what had happened to me growing up and what I was trying to equalize or trying to integrate, trying to come to terms with come to see some kind of peace with so that I wouldn't be so triggering and all those things that he didn't like.
And the problem was, for me, the way that I was seeing myself was a total failure. Even though on the outside, I was actually serving people, I was helping them through their suicidal stuff through their addiction stuff. And I had lots and lots of medical student and resident patients and some faculty member patients.
So what I was doing in my work, life was such a disconnect from how I felt in my personal life was really, really jarring. And I thought that the only way out that I had would be to off myself.
There was a particular night that I had a especially horrible interaction, finding my husband with another woman. And I was so devastated with that, that, that, I thought, okay, that's, that's going to be the night. So I'm driving away from the house, and a little voice comes inside me, go see your friends that are kind of on the way. It's a couple. One was a co faculty member in my department, and one was his wife. And I, I don't know how I did it. But I turned the car and I went to their house. And they answered the door, and they let me come in the house, and just talk to them about what was going on.
Even then, I didn't tell them I had been thinking about killing myself. Just this horrible thing that had happened and how outraged and how wounded and how ashamed and all the stuff that I was in.
It was not until several years later that I called up my friend and said, You know what, I remember that night.” And he says, Yeah. I said, well, you know what, you your wife saved my life. You probably didn't know it. He says, Well, yeah, I knew you were pretty down. But I didn't know it was that far down. And I said, you know, I really owe you for being willing to hear me, even if I was talking in ways that you couldn't relate to or didn't understand, or I wasn't explaining myself very well. But I was really freaked out. And I just want to thank you for doing that.
And I am convinced that had they not been home, y'all might not be seeing me now. But that little voice inside me was really, really, really important. We all have one. And I think one of our best things is to try to help people learn to hear that and to hear that. Thank you.
Dike Drummond MD 13:05
Thank you for telling your story. And I think yes, I pick up the magic bubble, right, the magic bubble. Of course, they were there that night.
Pam Pappas MD 13:17
I was lucky,
Dike Drummond MD 13:18
probably watching reruns of Seinfeld, or something they felt okay about turning off just to talk to you. That was marvelous. And I want to just put in a little public service announcement because we know when if you are hearing stories like this, and they resonate with your experience, dear listener, we don't want you to be left in the lurch here.
So I'm going to just let you know that if you're recognizing yourself in this story and would like to do something about it, the physician support line staffed 24/7 With psychiatrists, volunteer free, is 888-409-0141.
So what we're doing here today, is sharing stories of our own struggles, so that you can understand that you're not alone. And Pam went first because she's super brave. And Dr. Hsu is super brave, too. And now it's her turn.
Penny Hsu MD 14:19
All right, so my story is also many years ago, it actually started in medical school.
For those of you who don't know me, I am a coach. I'm also a physician and I'm also an actor, and I had gotten into an Acting Program and medical school at the same time. I had applied to both and After what felt like you know, World War Three in my house, I went to medical school.
And as soon as I got there, like day, one of convocation or whatever the white coat all of that everybody's like, giddy with excitement, and I was like, oh, no, what have I done? And I was miserable. So I knew that first day that I had made the wrong choice. But I was there, you know, what am I going to do. And obviously, it's always an honor to get into medical school. And, you know, I was like, Alright, let me just see how this all goes, I can probably tough it through. But, um, I was quite miserable.
And so after my first year of med school, I decided to run off to LA, and crashed on all my friends couches, who are out there already, you know, pursuing an acting career. And so I did that for the summer, I just kind of got my hands on whatever I could do, like student projects, and low budget films and music videos, and all this kind of stuff. And it was great. And it really kind of, like rejuvenated me and made me kind of feel whole again. And I was like, Okay, I feel like if I can kind of keep this balance, maybe I can get through medical school.
So I went back for a second year. And when I got back, everyone started, like, sort of tiptoeing around me and sort of like, talking to me, like I, you know, had, I don't know, like, like, I belonged in a padded room, basically, you know, they're like, how are you feeling? Are you okay? Oh, you're back this year. And I was like, What in the world is happening? And I was like, yeah, it just went away for the summer, like, what is this, and nobody would tell me what was going on.
And I finally got somebody in my class to tell me what was going on. And basically, what had happened was the rumor going around that I had actually had a psychotic break at the end of our first year. And that in my psychosis, I thought I was an actor. And I had flown out to LA and I had this wild and crazy, you know, psychotic episode thinking I was an actor. And I somehow made it back to school. But was I still psychotic? Did I spend some time in a padded room like what was going on with with Penny, and obviously, I was mortified.
And I like to stopped speaking to most of my class. And I had very few friends after that. But that was my first sort of introduction, or what I interpreted as my introduction into the way medicine was going to react to sort of taking a path less traveled or not traveled, right, like anything outside of, you know, lab research, bench research, volunteering a lot at all, anything in the world of creativity, was a sign of psychosis.
I remember deciding, I'm shutting all of this down, I'm shutting down acting, I'm shutting down performing, I'm never going to do it again, let alone talk about it. And certainly never with anyone within the medical institution. And I'm also going to remove myself from all these people who now think I'm a wackadoo. And I don't want to talk to them. So I just kind of like isolated myself for the rest of medical school. I mean, I still had friends, but like a very small knit group of friends. And that was it. I just didn't want to deal or talk to or interact with anyone.
And then you go to residency. And obviously, it's even worse, right? Like, the hours are longer and whatever. And as much as I had sort of tried to suppress everything, and be like, okay, that life is over. I'm not doing that anymore. I just kept dreaming about LA and like, pilot season, and I would like secretly be looking for auditions. And like, what could I sneak out to and again, not not tell anybody.
But it got harder and harder to kind of like compartmentalize and shove it down. Because the worse I felt in residency, just like the exhaustion and the mental toll of you know, watching children die, and all this kind of stuff, the worse I felt there, the more I would dream about acting, and then the more I tried to shut that down, and it just sort of became this vicious cycle of like, never been happy. And that the little things that would make me happy, I immediately had to shut down. And again, I didn't dare say a word to anyone, you know, forget my co residents forget my program director, you know, nobody, not my parents, no one.
Penny Hsu MD 18:53
Pam, like you just like, what do you do with all that, you know, and I was like, whatever, 26 at the time, or something, you know, like, who can handle all of that and without any sort of avenue to work it out with anyone?
You just kind of start to think it's you, you know, like, I really did start to think like, maybe they were right in medical school. Maybe I am like literally crazy, you know, maybe I don't have what it takes. Maybe I am like schizophrenic or multiple personality, you know, like, maybe that is me, because nobody around me has these issues. Or at least I thought right again, to your point like the wall of silence, you know, so I didn't see anybody else struggling beyond just the physical exhaustion of residency. I didn't see anybody struggling with the sort of like, who am I? Is this the road for me kind of questions.
And so I didn't know what to do with it. And it just got worse and worse than again, there's always that fateful night right? Like, I remember it was December in New York and I was in the ER and so when you're on the ER rotation, you know, you get 12 hours on and 12 hours off. 12 hours on 12 hours off for like weeks on end. And I remember during that time, you know, it's December, so it gets dark at like four o'clock. You know, December's always super busy for pediatrics, I would like get home at whatever it was like midnight or one o'clock in the morning.
And I remember many nights like not even making it and I lived in the studio, I couldn't even make it to my bed, I would just kind of collapse the living room floor in my scrubs and just cry myself to sleep. And then I would wake up like eight hours later, take off the scrub shower, put on a new set of scrubs and go right back to the hospital and rinse and repeat for days and days and days. And like, like literally my bed was untouched. And I was just I could not even make it 200 feet from my floor without krumping in a pile of tears.
And one night, I was like driving home and I was like, fuck it, I don't want to do this anymore. And so I instead of going home this way, I went this way, which was the the Throgs Neck Bridge, which is a bridge near my house where I was living. And I was like, I think this is the best idea like this is this is going to make me feel better. If I just don't have to go home and cry and get up tomorrow, then everything will be better, right? I will feel better, you know, the residency will be fine. And they'll have another resident take my place who will be 100% dedicated, and all will be well.
And I remember staring at the water, you know, as it was going by under the bridge, in my weird state of mind trying to figure out how fast the water was going right? So that I could figure out like, How far would I float by morning? And like if I took off all my clothes, like how long would it take for hypothermia to kick in, given my weight and the temperature of the water, like I was doing all this math, essentially, to make sure that I would drift away so that my parents would never find me and you know, and like no one would ever and I was like, Okay, take off the ID and you know, take off all your clothes. So there's no identifying information, like I had the whole thing planned ready to go.
And so I got back in my car. And I'm like, you know, taking off the idea. And I'm doing all of this. And then very similar to your story pant, like I heard a tiny little voice, but it wasn't inside of me it was like, outside of the car. And it was just this very soft voice at first. And I'm just like ignoring it. And I'm like, alright, you know, put my shoes over there done it up. And the voice is getting louder and louder. And I finally kind of pay attention to it. And I recognize it as the voice of my grandmother who had passed on during medical school.
And now this is where I'm gonna cry. She was always so proud of me because she was allowed to go to the third grade in terms of education in her family. And at that time, she was the most educated woman in her entire line of women, right? She got to go to the third grade. So the fact that I went to high school, and then I went to college, and then I went to medical school, like she was so proud of me, I think they like celebrated when I got it when I got into medical school like they, they did like the firecrackers in her village. Like it was a really big deal. And she was always like, you know, this is why I came to this country, right like so that you could do all of this.
And so it was her voice, of course, who was basically just saying over and over again, not like this, and not today, not like this and not today. And it was just over and over louder and louder. And I'm just like trying to ignore it. And finally, I got so mad. And I was like, well, if it's not, it doesn't it's not to do them. Is it? Grandma, and I just sat there and that's when I finally just like bawled my eyes out, you know, and then I was like, Okay, I actually don't want to do this, you know, I don't want to jump off of a bridge in the middle of December in New York. And I just I just kept asking my grandmother, like, what am I supposed to do? You know, if it's not like this, and it's not today. And I don't want to bring your whole family shame. And I really, genuinely don't want to do this, and what am I supposed to do.
And somehow and all of that, it just came to me that like I was either gonna have to quit my life. Or I was gonna have to quit medicine. And as much as I tried to hold it together and ignore acting and all that. Like clearly that path was only going to lead me one way which was going to be to jump off the bridge. So I was like, Alright, I tried it. The good girl way, right? The good little Asian student way. And it's gonna kill me it's legitimately going to kill me.
And so the next day, I went to my residency director and I said I quit. And I don't think he was that surprised. And he was like, well just finish out the year. And then you know, at least you'll have your first year and you can moonlight or whatever. And then you'll always have a spot and a lot of metadata and I never told him about the bridge. I never told anybody about the bridge until I started doing these types of talks. Honestly, I had actually forgot gotten about the bridge until I was prepping my first speaking engagement. And it was for a bunch of college students. And I was like, oh, you know, like, well, how can I relate to these young kids who are so idealistic and like, their life is about to blow up. And then it all kind of like came back to me.
But I blocked it out for like over a decade. But yeah, so I quit, I quit my residency. And then, you know, the rest is history. I took I took, I quit thinking, I would never come back to medicine. And I'd like did acting full time, and I, you know, dedicated myself to it. But weirdly, about nine months after that I actually was temping somewhere. And as tempting as it I can't remember something. But anyway, my boss at the time was every morning, she'd be like, This is life and death, people. This is life and death, we got to get those numbers done and edited it out. And we gotta get this report done by 2pm life and death, like every day. And at some point, I was like, actually, no.
Dike Drummond MD 26:03
I've been there, done that. And this is not it.
Penny Hsu MD 26:06
Oh, actually, I know what life and death is. And out of this whole pot of people are probably the only one equipped to actually know how to do something if it was a life and death situation. And maybe that's actually special. You know, maybe that's actually a good thing that I'm not just, you know, an office rat, I'm not quote unquote, just an actor, like maybe it's okay that I have this special set of skills, and maybe I shouldn't, quote unquote, be wasting it, doing PowerPoint, and auditioning for student films, you know, like, maybe I should actually go back to what God, you know, has gifted me that not everybody gets that gift.
And so it was a weird thing, where and I had to leave medicine to actually find my way back to it. And that was a very long story. And I apologize.
Dike Drummond MD 27:00
Thank you. Thank you. Thank you. Thank you. You're both so brave. Oh, my gosh, thank you so much. Yeah, I'm reminded of the hero's journey, right. Your Own Private Star Wars? Well, and, Pam, you were saying you were saying that there are actually some statistics about how common this experience is, Can you can you please repeat those for
Pam Pappas MD 27:24
We know there's different research studies that have been done. But you know, the, of course, we know that that burnout itself is at least 63% of physicians will check all those those three qualifiers that Maslach talked about, but in terms of, quote, mental illness, depending on where you are in your training, I've seen statistics, looking at third year medical students with suicidal ideation prevalence of 50%. I've seen some of those, I've seen interns, you know that they are even higher, not that they immediately you're going to do something that they're going to go jump off the bridge, or that they are going to take an overdose of medications, but having at least passing thoughts, or the think, you know, if I have to do this, any longer, I am going to this is so horrible, I can't see any way out, I just want to reduce the suffering in some way.
And the other piece is, having lost hope that there is any possibility of it feeling any better, ever. So so I'm not going to give you a bunch of numbers, because they're all across the board. And those papers are available.
But the sense of loss of hope is what I really want to drive home here. And the feeling that you were talking about penny of of isolating yourself and knowing that what you deeply wanted what was really important to you seemed to be incomprehensible by the people that were around you. And that's something that I experienced as well. If you were to try to utter to some of these people what it was that you really wanted that they would think that you were psychotic, when actually you're God your gift it is the darn truth. And a lot of those people that were your classmates or your residents or whatever, they have creativity inside them to maybe differently showing up than being an actor or actress. But creativity is absolutely essential in medicine as well. And so I'm not surprised that they would shut you down because they don't want to have this rumbling around inside themselves. as either, you know, yeah, but and another
Dike Drummond MD 30:03
pattern that I recognize in my coaching clients is that oftentimes, all the time there is there are things going on at the same time that have nothing to do with their medical practice or their medical education. There's family of origin issues, there's, you're having a similar sensation to something that happened previously in your life that was negative. There's other things going on.
I'm also impressed that each of you were nudged, nudged back by a friend, or a past friend, a friend or a grandma, the voice of an internalized voice of a grandma. So one of the things that the programming of your medical education, and the process of being doctor will do is isolate you.
What if they find out,
never show weakness?
That's some of the prime programming. And I want, everybody is listening to know what we've just listened to our stories of great doctors who are willing to tell their stories here for us, because this is an incredibly common experience that many of us go through. So I would encourage you to tell your story. If you're listening to us right now, that hotline if you'd like some support, and again, I'm giving it to you. So you can do something right now, if you feel that you need to the physician support hotline is 888 409 0141.
And what we're going to do in the next piece of this mini-series, part two, is talk about how to be an ally in this situation. Meaning, what do you do if one of your friends knocks on your door late at night says they want to talk? Or if you're having a casual conversation and you get the hair stand up on the back of your neck? What might you do to reach out to your colleague who may be feeling just like Dr. Pappas and Dr. Hsu were when they were in the midst of these struggles.
And now let's go ahead and put a bow on this. What would each of you like to say? Or do or ask to be complete for today?
Pam Pappas MD 32:18
Well, I just want to say thank you for being willing to hear my story. And I am honored to listen to Penny's and that's a story I had never heard her tell before. So I'm very grateful that I had a chance to listen.
Penny Hsu MD 32:36
Thank you. And likewise, I don't think I've ever heard your story before, either. Pam, I think I just want to say that, like, it's so common, I think it is far more common than we think. I think the isolation is the thing that keeps us from acknowledging it within ourselves of getting support of sharing of leaning on anyone.
And so I think, you know, my hope would be that people can hear our stories and realize, like, you know, it doesn't mean you're weak, it doesn't mean you're broken, it doesn't mean, you know, you're incapable of doing this job, it doesn't mean any of that, right? It means like, we all say, life is hard. Being a physician, especially in this day, and age is incredibly hard. And it just means you're human. And, you know, I think we should start looking at it that way versus like a sign of psychopathology, necessarily. I mean, it is, but it is also a very normal human experience. And so, you know, I just hope that more people can see it that way and see the stories, not like what you know, but more like, Yep, there's another one, you know, and can we just sort of normalize it and talk about it more and, and lean on each other and not isolate from each other?
Dike Drummond MD 33:51
Yeah. And always have a friend or two where you can tell the truth. And maybe they predate your medical, your, your dive into the medical education universe, right? Well, and I have not heard either of your stories beginning to end like this. So thank you very much for allowing me to be a witness.
Thank you, Dr. Pam Pappas. Thank you, Dr. Penelope Hsu. And we're going to wrap this up and watch for part two, our podcasts come out every week. But if you're looking at the library that you can listen to part two right now will be all about how to be an ally in this situation, to a friend who may be feeling this way. And you're getting a little hint that that's what's going on.
So Dike Drummond tear at the home of TheHappyMD.com in beautiful Seattle, Washington with the latest edition of the Physicians on Purpose Podcast. Until all three of us see you again on the next episode, keep breathing and have a great rest of your day. Aloha mahalo
PLEASE LEAVE A COMMENT:
If you have experienced these thoughts and feelings before, what would you add to Dr. Pappas' and Dr. Hsu's descriptions of this experience?
What else did YOU notice?