PHILADELPHIA — Peter Goldstein has always been freaked out by needles and blood. When he was about 5, his mother, physician Susan Wiegers, had a small biopsy done. Goldstein and his brother asked to see the wound.
"It was a tiny line with two stitches," she recalled.
Goldstein's brother was fascinated. But Goldstein turned away. "I don't feel so good," he said.
Then he keeled over.
Since then, Goldstein has passed out, or come close to it, every time he has had a close encounter with a syringe or an intravenous line. At the sight of real blood, he has to quickly drop his head below his knees. He recently felt woozy listening to his mother describe someone in a cast. "I guess I was thinking about broken bones."
"It's not rational," said Goldstein, who is now 28 and works as a quantitative finance researcher in New York. "I can watch gory movies without a problem."
Goldstein warns anyone who comes near him with a needle that he has a tendency to lose consciousness. But he has even fainted while lying down.
"That's not easy to do," said his mother, a cardiologist at Temple University Hospital. "Some people just have that response ... Their brain overreacts."
It's fairly common for people to faint from needle phobia, although the problem is neither the needles nor the fear.
"Most people are anxious when they are faced with being stuck with needles," said Joshua Cooper, director of cardiac electrophysiology for Temple's Heart and Vascular Center. "It's not that some people are more afraid than others and that's why they faint. It's that they are wired such that they have a powerful vasovagal reflex."
The reflex, which can cause fainting, may be triggered by fear, pain or any of a number of other causes, including standing in church for a few hours, said Cooper. "Up to 20 percent of people have an inappropriate nerve reflex, where the brain inappropriately sends a very strong signal down the vagus nerve," Cooper said.
The vagus is the longest of the 12 cranial nerves. A main branch of the parasympathetic nervous system, the vagus starts in the brain, runs down the neck and branches through the body to the heart and blood vessels. When the brain sends a signal down the vagus, it slows the heart rate and lowers blood pressure by dilating or expanding blood vessels.
"Moment to moment, the brain is always using the vagus and sympathetic nerves to adjust heart rate and blood pressure to be appropriate to what you're doing," said Cooper.
When panic or fear triggers a surge of adrenaline, that causes the heart to race and the blood pressure to rise, Cooper said. In those prone to vasovagal syncope, "the brain gets the message that the heart is working too hard. The brain tries to counteract that, but overdoes it, dropping the heart rate and blood pressure."
So far, medical science has not come up with a good explanation of why so many people have this quirk in the functioning of their autonomic system.
"It is normal to be frightened of pain," said Cooper. "And the rush of adrenaline is a biologic preservation response. But the fainting reflex? We don't know why."
Some have hypothesized that there is an evolutionary advantage, he said. "If you're about to be attacked by a predator and you play dead, they may be less interested."
All bets are off, however, on how this applies to Sunday sermons.
When people stand in a warm place for extended periods of time, as on a crowded bus or in church, blood pools in their legs and they become dehydrated. Not enough fluid reaches the heart and brain, and next thing you know — “Let angels prostrate fall” — congregant down.
In most cases, these occasional fainting episodes are harmless, but if they happen regularly, it might indicate a problem with heart arrhythmias or other cardiac conditions.
The predicament is particularly inconvenient for health-care workers who cannot look at a needle coming their way without sending themselves into a head-spinning vortex.
“It is an interesting problem,” said Wiegers. “When you look at a group of doctors and find out why they didn’t get the flu shot in hospitals where there is strong pressure to get it, you find out that it is because most of them are afraid of shots or pass out.”
While Christopher Gonzalez has no problem watching other people get shots, he cannot even think about getting one himself without panicking. His heart races. He gets cold and clammy.
“It’s the worst,” said Gonzalez, a surgical coordinator for Pennsylvania Orthopaedic Foot and Ankle Surgeons. As part of hospital staff, Gonzalez, 24, has tried everything to buck himself up for the annual flu shot.
He has rolled up his own sleeve to trick himself into thinking he’s in control, aimed his focus fiercely on ceiling tiles to distract himself, and given himself upbeat pre-puncture talks.
So he asked, with all his persuasive power, for special dispensation.
Not happening, he was told. “I work here, so I have to get it. I try to be the last one to go,” he said. “The shot is never as bad as the anxiety that precedes it.”
“Then they give me a Band-Aid and call it a day.”