The White-Coat Syndrome

Every two years, I make the same trip: I fly to ABQ, drive to Santa Fe, see my friendly AME (Aeromedical Examiner), and sit around his lobby trying to get my blood pressure and heart rate down, so he can issue my new medical certificate, then rush back home. Worrying about this process takes a toll on me for a solid month leading up to the trip. However, I always come through with more or less flying colors, but only after a bunch of biofeedback, a little self-hypnosis and more than a few mental gymnastics. Life just shouldn't be this complicated.

This whole thing is because of a frustrating lack of body control that most call "white-coat syndrome." It's a form of phobia that causes our blood pressure and heart rate to skyrocket just because we're in the presence of a white coat that's holding a stethoscope to our arm while pumping a rubber bulb. I don't know if "normal" people have this problem, but I know for a fact that a good percentage of pilots do. For us, the cuff-and-bulb thing is a make-or-break moment. It could ground us or, more likely, lead to months of incredibly frustrating FAA-style hoop jumping.

This didn't used to be a big deal for me. In fact, for most of my life, the nurse would put the cuff on me, and I'd laugh and say, "118 over 72, guaranteed." My BP and heart rate were remarkably stable. Even on the day my brother died, everything stayed right there. Then, about 15 years ago, I had a really crazy week (I mean off-the-charts stressful) when I was doing a really complex catalog job for an advertising client while I was breaking in a big new computer system. The catalog was a serious heart-attack project in terms of deadline and complexity. The computer system was giving me heartburn while I tried like crazy to get all of the software to settle down. Then, the cable company somehow managed to fry a hard drive while doing an install, and I was going absolutely nuts. Close-to-putting-my-CPU-out-of-its-misery-with-a-Louisville-Slugger nuts. And I'm not kidding!

At one point, I started feeling bad, so I went to see the doctor, and my BP was so high it scared the hell out of me---the doctor, too. They started talking about cardiologists and serious heart stuff. To make things a thousand times worse, I had a flight physical coming up in a couple of months. I was scared! However, the computer got sorted out, the catalog finished, and the hard drive came back online. In the meantime, I had bought a blood pressure monitor and was pleased to see that the numbers had come back down to normal. But then, I had to go for my flight physical, and the trouble began.

That was the first time I experienced what has become a biennial problem for me: As I'm getting out of the car at the doctor's office, I can feel my pulse rate and BP going up (sound familiar?). That one incident showed I wasn't immortal after all, and I actually could have something go wrong physically. It shook me up enough that it now haunts me every two years.

I can mentally manage the numbers to a certain extent, and can generally get the pulse rate and systolic numbers down to non-catastrophic levels fairly quickly, but I have to work like crazy to get the diastole down. Incidentally, just to make matters clear, it never gets above 85 and never gets even close to the FAA's do-not-pass-go number of 95. But, my ability to control it is often a hit-or-miss thing. I never know if I'm going to be able to make it to work in the office or not. What if I can't?

My worrying about it going up makes it go up. So, it takes a very patient, friendly AME to sit around and let me try to calm myself down enough that he sees numbers he knows the FAA will buy off on. Hence the trip to Santa Fe, where an ex-student is an AME. He doesn't let me get away with anything, but is willing to hold my hand until the numbers go down. He's a friendly white coat---but, still a white coat.

This is all terribly frustrating. At home, with my magic (and carefully calibrated) BP machine hooked up, I can talk my body into relaxing and get my resting pulse rate down to the high 50s and BP down to 115/70, and keep it there. Even a normal reading, where I just plunk down in a chair and throw the cuff on, never runs higher than 120/74 with a 68 pulse rate. But, give me an official reason to take an official reading with someone official watching, and I can't even come close to controlling it. While I'm in the process of talking to myself, I swear I can actually hear my heart rate accelerating in my ears, and I'm just short of hyperventilating.

Don't you just hate it when your body is listening to some part of your brain over which you have zero control?