What are the common symptoms of nausea. How can you distinguish between harmless and concerning causes of nausea. What are the most effective treatments and prevention methods for nausea.

Decoding Nausea: More Than Just an Upset Stomach

Nausea is a complex sensation that many of us have experienced at some point in our lives. It’s that unsettling feeling in your stomach, often accompanied by the urge to vomit. While nausea is commonly associated with vomiting, the two don’t always go hand in hand. Understanding nausea, its causes, and how to manage it can significantly improve your quality of life when faced with this uncomfortable condition.

The Science Behind Nausea

Nausea occurs when the brain receives signals from various parts of the body, including the stomach, intestines, and inner ear. These signals are processed in the chemoreceptor trigger zone (CTZ) and the vomiting center in the brain stem. When these areas are stimulated, they can trigger the sensation of nausea and, in some cases, lead to vomiting.

Recognizing the Signs: How to Tell If You’re Going to Throw Up

Identifying the signs that you might vomit can help you prepare and potentially find relief before it happens. Common indicators include:

• Increased salivation
• Sweating
• Pallor (pale skin)
• Rapid heartbeat
• Feeling hot or cold
• Dizziness
• A sensation of fullness in the throat or chest

Is it possible to prevent vomiting once you feel nauseous? While it’s not always possible to stop vomiting once nausea sets in, there are some techniques that may help:

1. Practice deep breathing exercises
2. Sit or lie down in a comfortable position
3. Apply a cool compress to your forehead
4. Sip clear fluids slowly
5. Try acupressure on your inner wrist

Unraveling the Causes: Why Does Nausea Occur?

Nausea can be triggered by a wide range of factors, from minor inconveniences to more serious medical conditions. Some common causes include:

• Motion sickness
• Viral infections (e.g., stomach flu)
• Food poisoning
• Pregnancy (morning sickness)
• Certain medications
• Migraines
• Anxiety or stress
• Acid reflux or GERD
• Inner ear disorders
• Chemotherapy

Can certain foods trigger nausea? Yes, some foods are more likely to cause nausea in certain individuals. These may include:

• Spicy or fatty foods
• Dairy products (especially for those with lactose intolerance)
• Alcohol
• Caffeine
• Foods with strong odors

It’s important to identify your personal triggers and avoid them when possible.

When Nausea Becomes a Concern: Red Flags to Watch For

While most cases of nausea are harmless and resolve on their own, there are instances where medical attention may be necessary. Be alert for the following warning signs:

• Blood in vomit (may appear red or like coffee grounds)
• Severe abdominal pain
• Signs of dehydration (excessive thirst, dry mouth, decreased urination)
• Vomiting lasting more than 24 hours
• High fever (above 101.5°F or 38.6°C)
• Confusion or decreased alertness
• Severe headache or stiff neck
• Projectile vomiting in infants

How can you differentiate between harmless nausea and a more serious condition? Pay attention to the duration and severity of your symptoms, as well as any accompanying signs. If you experience persistent nausea along with unexplained weight loss, chest pain, or severe abdominal discomfort, it’s crucial to consult a healthcare professional for a proper evaluation.

Effective Management: Strategies to Alleviate Nausea

While nausea can be uncomfortable, there are several approaches to manage and alleviate the symptoms:

1. Dietary Adjustments

Modifying your diet can significantly impact nausea. Consider the following tips:

• Eat small, frequent meals instead of large ones
• Opt for bland, easily digestible foods (e.g., toast, crackers, rice)
• Stay hydrated with clear fluids, taking small sips throughout the day
• Avoid strong odors and greasy or spicy foods
• Try ginger in various forms (tea, candies, or supplements)

2. Environmental Modifications

Your surroundings can influence nausea. Try these environmental adjustments:

• Ensure proper ventilation and fresh air
• Avoid strong smells
• Create a calm, relaxing atmosphere
• Use a fan or open a window to promote air circulation

3. Mind-Body Techniques

Mental strategies can help manage nausea:

• Practice deep breathing exercises
• Try progressive muscle relaxation
• Use distraction techniques (e.g., listening to music, watching a movie)
• Consider acupressure or acupuncture

4. Over-the-Counter Remedies

Several OTC options may provide relief:

• Antiemetic medications (e.g., Dramamine, Bonine)
• Bismuth subsalicylate (e.g., Pepto-Bismol)
• Ginger supplements
• Vitamin B6 supplements (particularly for pregnancy-related nausea)

Are there any natural remedies that effectively combat nausea? Yes, several natural options have shown promise in alleviating nausea:

• Peppermint tea or oil
• Lemon (inhaling the scent or adding to water)
• Chamomile tea
• Fennel seeds
• Aromatherapy with lavender or ginger essential oils

While these remedies can be helpful, it’s always best to consult with a healthcare provider before trying new treatments, especially if you have underlying health conditions or are pregnant.

Nausea in Special Populations: Children and Pregnant Women

Nausea can affect people of all ages, but it presents unique challenges in certain groups:

Nausea in Children

Children may not always communicate feeling nauseous and might suddenly vomit without warning. Parents should be vigilant for signs such as:

• Decreased appetite
• Irritability
• Paleness
• Lethargy
• Complaints of stomach pain

How can parents manage nausea in children? Here are some tips:

• Encourage small, frequent sips of clear fluids to prevent dehydration
• Offer bland foods when the child feels ready to eat
• Provide plenty of rest
• Use distractions like quiet games or stories
• Consider over-the-counter remedies appropriate for children (consult a pediatrician first)

Nausea During Pregnancy

Morning sickness, which can occur at any time of day, affects many pregnant women. While usually harmless, severe cases (hyperemesis gravidarum) may require medical intervention. Management strategies include:

• Eating small, frequent meals
• Avoiding trigger foods and smells
• Consuming ginger in various forms
• Wearing acupressure wristbands
• Taking vitamin B6 supplements (under medical supervision)
• Getting plenty of rest

Can pregnancy-related nausea be a sign of a healthy pregnancy? While nausea can be uncomfortable, some studies suggest that it may be associated with a lower risk of miscarriage. However, the absence of nausea doesn’t necessarily indicate an unhealthy pregnancy. Every woman’s experience is unique, and it’s essential to discuss any concerns with a healthcare provider.

Prevention Strategies: Minimizing the Risk of Nausea

While it’s not always possible to prevent nausea, certain strategies can help reduce its occurrence:

• Maintain good hygiene to prevent infections
• Practice food safety to avoid foodborne illnesses
• Manage stress through relaxation techniques
• Stay hydrated and maintain a balanced diet
• Avoid known triggers (e.g., certain foods, strong odors)
• Take motion sickness precautions when traveling
• Follow medication instructions carefully

Are there any lifestyle changes that can help prevent chronic nausea? Yes, adopting certain habits may reduce the frequency of nausea episodes:

• Eating regular, balanced meals
• Avoiding excessive alcohol consumption
• Quitting smoking
• Exercising regularly (but not immediately after meals)
• Practicing good sleep hygiene
• Managing underlying health conditions effectively

Remember, persistent or recurrent nausea may indicate an underlying condition and should be evaluated by a healthcare professional.

The Role of Technology in Managing Nausea

Advancements in technology have introduced new tools for managing nausea:

1. Mobile Apps

Several apps are designed to help track symptoms, identify triggers, and provide management tips. For example, the Kinsa app allows users to log symptoms and receive personalized advice.

2. Wearable Devices

Some wearable devices claim to reduce nausea through electrical stimulation or acupressure techniques.

3. Virtual Reality

VR technology is being explored as a potential tool for managing nausea, particularly in clinical settings like chemotherapy-induced nausea.

4. Telemedicine

Remote consultations with healthcare providers can offer quick advice and treatment options for nausea management.

How effective are these technological solutions in managing nausea? While research is ongoing, many users report positive experiences with these tools. However, it’s important to remember that they should complement, not replace, professional medical advice. Always consult with a healthcare provider for persistent or severe nausea.

Understanding Bile Vomiting: A Cause for Concern

Bile vomiting, characterized by green or dark green vomit, is a concerning symptom that requires medical attention, especially in infants. It may indicate a blockage in the intestines or other serious conditions. If you or your child experiences bile vomiting, it’s crucial to seek immediate medical care.

How can you differentiate between bile vomiting and other types of vomit? Bile vomit is typically:

• Green or dark green in color
• May appear more greenish-yellow when mixed with stomach juices
• Often occurs on an empty stomach
• May be accompanied by abdominal pain or distension

In contrast, yellow vomit is usually stomach acid and is common when vomiting on an empty stomach or after prolonged nausea. While uncomfortable, yellow vomit is generally less concerning than green bile vomit.

The Impact of Nausea on Daily Life and Mental Health

Chronic or recurrent nausea can significantly affect a person’s quality of life and mental well-being. It may lead to:

• Decreased productivity at work or school
• Social isolation
• Anxiety or depression
• Nutritional deficiencies
• Sleep disturbances
• Strained relationships

How can individuals cope with the psychological impact of chronic nausea? Consider these strategies:

• Seek support from friends, family, or support groups
• Practice stress-reduction techniques like meditation or yoga
• Consult a mental health professional if needed
• Set realistic expectations and prioritize self-care
• Explore cognitive-behavioral therapy to manage anxiety related to nausea

Remember, addressing both the physical and emotional aspects of nausea is crucial for overall well-being.

The Future of Nausea Treatment: Emerging Research and Therapies

The field of nausea management is continuously evolving, with researchers exploring new approaches to understand and treat this common symptom. Some promising areas of research include:

1. Targeted Drug Therapies

Scientists are developing medications that specifically target the neurochemical pathways involved in nausea and vomiting, potentially offering more effective relief with fewer side effects.

2. Gut Microbiome Research

Studies are investigating the role of gut bacteria in nausea and how modifying the microbiome might help alleviate symptoms.

3. Neurostimulation Techniques

Non-invasive brain stimulation methods, such as transcranial magnetic stimulation (TMS), are being explored as potential treatments for chronic nausea.

4. Personalized Medicine Approaches

Researchers are working on developing individualized treatment plans based on genetic factors and personal health histories to optimize nausea management.

What potential breakthroughs in nausea treatment can we expect in the near future? While it’s difficult to predict with certainty, some promising areas include:

• Novel antiemetic drugs with improved efficacy and fewer side effects
• Advanced wearable devices that can predict and preemptively treat nausea
• Gut-brain axis therapies that target both the digestive system and the brain
• Improved understanding and management of chemotherapy-induced nausea and vomiting

As research progresses, we can hope for more effective and personalized approaches to managing this common yet challenging symptom.

Nausea and/or Vomiting

Nauseous? Queasy? The impending doom that you may throw up soon? As someone who regularly gets carsick, I feel your pain. That feeling of nausea is miserable, and I’m convinced that vomiting (also called emesis) is the most uncomfortable thing on the planet.

Nausea and vomiting don’t always go together, especially in our kiddos. They rarely communicate nausea and instead seem to just throw up out of nowhere. If you’re lucky, you might get a “my belly hurts” as a warning. Overeating is a common reason… and then they immediately feel better and continue running around like maniacs! As adults, we typically do feel nauseous before throwing up (and thus, we’re better at making it to the toilet).

Most of the time, nausea and/or vomiting is short-lived. They can be symptoms of so many things, from motion sickness to a virus to something more serious, such as vertigo (dizziness) or head trauma.

When should I be concerned about nausea and/or vomiting?

It’s time to be concerned if you witness:

• Blood in the vomit (also described as looking like coffee grounds, “coffee ground emesis”)
• Vomiting after trauma to the head
• Projectile vomiting in babies
• Confusion or decreased alertness
• Lethargy, dizziness, or lightheadedness
• Signs of dehydration
• Suspicion that you or your kiddo ingested a poisonous substance
• Severe abdominal pain or a swollen, tender abdomen
• Chest pain
• High fever and stiff neck
• Unexplained weight loss along with your nausea and vomiting
• Vomiting lasting more than 24 hours

If you or your kiddo aren’t having the above symptoms, it’s okay to wait this out at home.

What can be done to control or relieve nausea and vomiting?

• Stay hydrated with small sips throughout the day. Ginger ale, tea, or water will help.
• Either hold off on food for a while or stick to bland foods, such as toast or crackers. Avoid spicy foods and dairy products.
• Avoid strong odors.
• Rest! Don’t shake up that belly with increased activity.
• Get some fresh air.
• Smell peppermint oil.
• Take slow, deep breaths.
  ‍

What to do if you feel nausea after eating?

Stay upright for 30-60 minutes after your meal. You may be experiencing acid reflux (or heartburn), where the stomach acid creeps back up the esophagus. Feeling nauseous after eating could also indicate food poisoning or a stomach ulcer. Call your doctor if you suspect an ulcer!

What causes bile vomiting and what to do about it?

Bile is green or dark green, can be more greenish-yellow when mixed with stomach juices. This is a concerning finding, especially in infants. Call the doctor to see what’s going on.

Throwing up stomach juices and acid, which is yellow, is very common if you haven’t eaten in many hours or if you’ve already thrown up enough times to empty your stomach. If either of those are what you are experiencing, that is normal and there is no need to be concerned. Beyond the general concern of When will this misery stop? of course. Truly sorry you’re dealing with this, it isn’t fun at all.

If the nausea and vomiting are part of a virus, you may also experience headaches, stomach ache, diarrhea, fever. List some of your other symptoms in your Kinsa app so you can get more detailed information!

As you or your kiddo battle this illness, wash those hands – everyone in the family! You can’t wash too much. And grab some disinfectant to get those germs out of the house so you can move on before the next thing strikes. Wipe down surfaces and doorknobs – this is one of those things we don’t want to share. If you have gloves handy, wear those during vomit clean-up duty! Hopefully whatever is making you queasy is more short lived than my lifelong nemesis, motion sickness. Fingers crossed that you’ll be feeling better by tomorrow!

Feeling sick (nausea) – NHS

Feeling sick (nausea) is common and usually goes away on its own. There are some things you can try that might help.

Things that may help you stop feeling sick

Do

• get plenty of fresh air

• distract yourself – for example, listen to music or watch a film

• take regular sips of a cold drink

• drink ginger or peppermint tea

• eat foods containing ginger – such as ginger biscuits

• eat smaller, more frequent meals

Don’t

• do not eat or cook strong-smelling food

• do not eat hot, fried or greasy food

• do not eat too quickly

• do not have a large drink with meals

• do not lie down soon after eating

• do not wear clothes that are tight around your waist or tummy

Important:
If you’re being sick

If you’re also being sick (vomiting), you could become dehydrated.

Find out what to do if you’re vomiting

Non-urgent advice: See a GP if you:

• are feeling sick and do not feel better in a few days
• often feel sick (it keeps coming back)

The GP can look for the cause and suggest treatments.

They may prescribe anti-sickness medicine if needed.

Call 111 for advice if you cannot see a GP.

Immediate action required: Call 999 if:

You suddenly feel sick and have:

• chest pain that feels tight or heavy
• pain that spreads to your arms, back, neck or jaw
• shortness of breath

This could be a heart attack.

Common causes of feeling sick

Lots of things can make you feel sick.

Any other symptoms you have may give you an idea of the cause. But do not self-diagnose – see a GP if you’re worried.

Other reasons for feeling sick include:

• pregnancy (morning sickness)
• motion sickness
• anxiety
• alcohol
• medicines
• recent surgery

Information:

Do not worry if you’re not sure what’s causing you to feel sick. Try the things that may stop you feeling sick and see a GP if you do not feel better in a few days.

Page last reviewed: 12 May 2021
Next review due: 12 May 2024

Acupressure for nausea and vomiting

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This information explains how to use acupressure (AK-yoo-PREH-sher) to help with nausea and prevent vomiting. Nausea is the sensation of vomit. Vomiting is the eruption of vomit.

Acupressure is a type of massage. It is based on the traditional Chinese medicine practice of acupuncture (AK-yoo-PUNK-cher). With acupressure, pressure is applied to certain points of the body. Such points are called acupuncture points (AK-yoo-points).

Pressing these points allows the muscles to relax and improves blood circulation. It also helps relieve many of the side effects of chemotherapy, such as nausea and vomiting.

You can do acupressure at home by applying pressure to various acupuncture points with your fingers. To learn how to do acupressure, watch this video or follow the steps below.

This video will show you how to perform acupressure to help relieve nausea and vomiting.

Details on video

The P-6 massage point is also known as nay-gwann. It is located on the back of the hand next to the wrist. Massaging this point helps relieve nausea and prevent vomiting.

Massage of this point is not recommended in the following cases:

• The skin at or near the point is flaky or blistered.
• An open wound at or near a point.
• Rash at or near this point.
• Redness, swelling, fever, or pus at or near the point.

How to find a massage point P-6

To find the P-6 massage point:

1. Position your hand so that your fingers are pointing up and your palm is facing you.
2. Place the first 3 fingers of your other hand on your wrist (see picture 1). Your fingers should be just below the crook of your wrist.
3. Place your thumb just below your index finger. Remove 3 fingers from your wrist, but leave your thumb in place (see Figure 2). Press on this place with your thumb. Under the thumb, you should feel 2 large tendons (tissue that connects muscles to bones). This spot between the two tendons is the P-6 massage point.
   • Once you have found the massage point, you can relax your hand and keep it in a comfortable position.

Figure 1. How to place 3 fingers on the wrist to locate the thumb

Figure 2. How to press the thumb to the point under the index finger

1. Press this point with your thumb. While pressing, make circular movements with your thumb. You can move it clockwise (right) or counterclockwise (left). Do this for 2-3 minutes.
   • Some people may find it difficult to use their thumb. Instead, you can use your index finger.
   • Press hard enough, but not so hard that it hurts. You may feel some discomfort or tenderness, but it should not be pain. If you feel pain, then you are pressing too hard.
2. Repeat steps 1 to 4 on the other wrist.

You can massage this point several times a day until symptoms improve.

Acupressure is an additional treatment. Complementary therapies are treatments that can be used alongside primary cancer therapy. They can help relieve symptoms.

For more information about complementary treatments, call MSK’s Integrative Medicine Service at 646-449-1010 or visit www.mskcc.org/integrativemedicine.

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Date last updated

Thursday, June 23, 2022

No. Just not this. No way How to get rid of the fear of nausea. Excerpt from The Age of Anxiety – Meduza

Simone Golob / Corbis / Vida Press

The Alpina Non-Fiction Publishing House published a documentary book by American journalist Scott Stossel, The Age of Anxiety. Fears, hopes, neuroses and the search for peace of mind. The book says that a quarter of US residents are subject to various neurotic disorders. Meduza publishes an excerpt from the book in which the hero tries to recover from emetophobia – the fear of nausea. As Stossel himself notes, and we are forced to agree, “if you also suffer from emetophobia (or are simply squeamish), it is better to skip this text.”

Having found out, as my other psychotherapists before and after Dr. M. found out, that my other fears are rooted in the fear of vomiting (for example, I am afraid of flying because of the fear that I will feel sick), Dr. M. suggested with this phobia and start.

“Reasonable,” I agreed.

— Only this method of treatment, — said the doctor. – You need to face your fear openly, experience what scares you the most.

Oh ho.

– You need to make you vomit.

No. Just not this. Never.

Dr. M. said that her colleague recently managed to cure a patient of emetophobia with the help of an emetic – syrup of ipecac. A patient in a responsible position, having specially arrived for treatment from New York, went for a week to sessions at the Center for the Study of Anxiety. Every day she took a nurse’s vomit, she vomited, then she worked through her feelings with a therapist – in cognitive-behavioral therapy, this is called “decatastrophization.” A week later, she flew back to New York, having completely got rid of her phobia, according to Dr. M..

I was not convinced. Then Dr. M. showed me an article in a scientific journal describing a case of curing clinical emetophobia.

“This is an isolated case,” I remarked. — 1979.

– There were others. “The doctor once again reminded me of her colleague’s patient.

– No, I can’t.

“If you don’t want to, then don’t,” said Dr. M. “I won’t force you to do anything.” But the only way to deal with this phobia is to face the source of the fear. And the only way to meet him is to induce vomiting.

This dialogue was repeated in various variations for several months. Despite the senselessness of the methods of influence invented by Dr. M., I trusted her (she was kind, sweet and smart). Therefore, one fine autumn day, I surprised her with a statement that I was ready to consider this option. She gently and reassuringly explained how everything would go. A laboratory room upstairs will be reserved for me, where Dr. M. herself and the staff nurse will be constantly next to me. I’ll eat something, take an emetic, throw up what I’ve eaten (and stay alive, the doctor promised). And then we’ll do a “cognitive restructuring” of my relationship to vomiting. I will learn that there is nothing to be afraid of, and I will get rid of the phobia.

Dr. M. took me upstairs to meet the nurse. Sister R. showed me around the office and explained that vomiting is a standard procedure in exposure therapy, she personally participated in more than one session for former (cured!) emetophobes.

“Just last week, we had a guy here,” she recalled. — I was very nervous, but everything went fine.

Scott Stossel

Photo: Howard County Library System / Flickr (CC BY-NC-ND 2.0)

We went back to Dr. M’s office.

“Okay,” I said. – Let’s. Probably…

Over the next few weeks, we scheduled an exhibition session over and over again, I came on the appointed day – and backed off, admitting that I could not. What was Dr. M’s astonishment when, on an unseasonably warm December Thursday, I suddenly, having come to a regular session, said: “That’s it. I’m ready”.

We were unlucky from the very beginning. Sister R. ran out of vomit, so she had to run to the pharmacy, and I had to sit an extra hour in Dr. M’s office. Then it turned out that the upper laboratory was busy, so I would have to carry out the procedure in a small shared toilet in the basement. At every step I wanted to refuse the session, but did not refuse – probably only because no one took away this opportunity from me.

What follows is an edited excerpt from a report as dispassionate as possible, which I wrote after the procedure on Dr. M’s recommendation. (Writing down your experiences in an emotionally neutral way is a standard recipe for preventing post-traumatic stress after a traumatic experience in such cases.) If you too suffer from emetophobia (or are simply squeamish), it is better to skip this piece.

We met Sister R. in the basement toilet. After a short exchange of remarks, I took an emetic.

After passing the point of no return, I felt a sharp increase in anxiety. I started to tremble a little. But I hoped that nausea would come immediately, I would quickly vomit and I realized that I had been afraid for nothing all my life.

Dr. M. attached a pulse and blood oxygen monitor to my finger. While we waited for nausea, the doctor asked me to rate my anxiety on a scale of 1 to 10. “About nine,” I replied.

By that time, I was already a little sick. Feeling a sudden urge, I turned to the toilet. The throat constricted twice, but the vomit did not go. I waited, kneeling on the floor, still hoping for a quick end. The sensor on my finger interfered, so I unhooked it.

Some time later I felt the next urge and diaphragm spasm. Sister R. explained that “dry” urges come first. Now I desperately wish it was all behind me.

Nausea came in waves, twisting, then releasing. Each time it seemed that now I was going to vomit, I burped loudly, but nothing came out. Several times I felt my stomach shrink, turned inside out – and again to no avail.

Further on, the sense of time is somewhat blurred. At every urge, I am thrown into sweat, and when the wave passes, the sweat pours from me in streams. At some point, I start to pass out and I’m afraid, having collapsed into a faint, choke on my vomit and die. In response to my statement that my head is ringing, Sister R. says that my complexion is normal. But I think she and Dr. M. are a little worried. This also increases my anxiety: if they are worried, then it’s definitely time for me to panic. (At the same time, somewhere in the depths of my soul I really want to switch off, even with a fatal outcome.)

About 40 minutes later, after all these unsuccessful urges, Dr. M. and Sister R. suggest taking more vomit. But I was afraid that the second dose would make me suffer from nausea even longer: suddenly these “dry” urges would stretch for several hours or days. At some point, the hope for a quick vomiting and a quick end to the torture was replaced by thoughts that, perhaps, it would be more correct to resist the action of the emetic and just wait until the nausea passes. I was exhausted, nauseous, and utterly miserable. Between calls, I lay on the floor, trembling all over.

A lot of time has passed. Sister R. and Dr. M. urged me to take more vomit, but now I wanted to do without vomiting. There was no urge for a long time, and suddenly a strong wave of nausea caught me by surprise. Feeling my stomach turn inside out, I thought that now it was for sure. What is there … I choked on several secondary waves, and then the nausea noticeably weakened. Here I had a hope that the torture would still end without vomiting.

Sister R. began to get angry: “Wow, how unbreakable.” (At some point, she asked with annoyance if I was resisting because I wanted to prolong the treatment with Dr. M. Dr. M. objected: of course not, because I took emetic.) Finally, a few hours after taking an emetic, Sister R. left, saying that this was the first time she had seen ipecac syrup fail.

Some time later, after Dr. M’s futile persuasion to try to “complete the exposure session”, we decided to “stop trying”. I was still sick, but less so. We talked in the office, and I left.

On the way home, I was very afraid that I would start throwing up while driving and cause an accident. At traffic lights, I was dying of horror. When I got home, I went to bed and slept for several hours. When I woke up, I felt better, the nausea was gone. However, at night I had nightmares about vomiting in the basement toilet.

The next morning, I managed to drive to work to attend the meeting, but I panicked and had to return home. For the next few days, I was afraid to leave the house.

Dr. M called the next day to see if I was all right. She was clearly ashamed of the execution inflicted on me. And although this incident greatly traumatized me, I felt sorry for the doctor, she was so palpably worried. In the last paragraphs of my report, which until then had been conducted with objective accuracy, I slightly softened my true feelings (the session failed miserably, and Sister R. is a full-blown fool). “Given my history, I am well done for deciding to take an emetic.