She is tall and pale. Her face is dark with the shadow of barely concealed terror that looks as though it could jump out and devour her at any moment. Her eyes are wide and glassy, seeming too big for her face. Her jaw is clenched as tightly as though she were chewing glass. Her hands shake with terror, although you can see that she is trying to restrain them.

Still, you give no outward sign and invite her into your office, smiling in as friendly a manner as possible as you encourage her to put her bags down and take a seat in one of the cold hard chairs that line the wall by the door.

“Back for your blood test?” You ask, although you already know the answer.

“I guess so,” she mumbles, staring steadfastly at the floor.

“Well, we’ll do that as fast as we can so you can get out of here, but if you’ll have a seat on this table, I’d like to talk to you for a minute first.”

Her eyes seek your face, hunting for the reassurance she dares not beg for. She backs towards the examining table, eying it warily as though she thinks it might grow teeth and bite her.

She hoists herself up, narrowly missing tripping over the side of the table, her shoulders hunched in dread as she tries to arrange herself in something resembling a comfortable position without looking up. Leaving the stack of papers you had been carrying on your desk, you follow her over to the other side of the room and lean casually against the opposite wall, trying to look reassuring.

“I just want to talk to you for a second before we do anything. I have a note in my files from last year that you really don’t like this sort of thing. Want to tell me about that?” You ask gently.

To your surprise, she bursts into hysterical tears that have obviously been building for at least an hour. They dribble unchecked down her cheeks and fall from the end of her nose.

You calmly walk over and sit beside her. As you reach to touch her wrist soothingly, she flinches and a considerable shudder rips through her body.

“That bad, huh?” You ask.

She shudders again and nods, a new spate of tears erupting.

You sympathetically pat one of her cold hands and make quiet shushing noises for a few moments to allow her to calm down. “Can you tell me about it?” You ask.

“I feel so awful,” she admits. “I hate acting like an idiot like this, but I can’t help it. I have ridiculous nightmares about this.” She smiles a little. “You can tell me that it won’t hurt all you want, but I won’t believe it, I’m warning you now.”

You meet her eyes, trying to project honesty. “I wouldn’t lie to you about something like that. I know some doctors swear by it, but I’ve never done it. I can promise you, however, that even if it hurts, I’ll be right here, and I can try to help you get through it.”

She is still shaking, smaller trembles that ripple down her arms and across her torso. “Can you talk to me? Tell me what’s going on? I hate being so confused,” she manages to stutter.

“I’ll do my best,” you assure her. “I understand that this is hard for you, but we really do have to do it, I’m sure you’ve heard the reasons far too many times. Let’s see what we can do. Are you ready to try this?”

The girl looks rather like a small rabbit caught in an oversized bear trap or in the path of an advancing train. She nods slowly, still not looking up.

You move your hand from where it has been lying comfortingly on hers and stand up, only to take her by the wrist again. Nerves in high gear, she barely manages to keep from pulling away.

“I’m not doing anything yet,” you reassure her, holding up your empty hands. “I’m just going to touch your arm quickly so I can see how your veins are. You’ll barely feel it, I swear.”

She nods, holding her arm out rigidly, as though about to be tortured. “There,” you say, finishing as quickly as you can. “I want you to understand that you can believe what I tell you. If I promise you that something won’t hurt at all, it really won’t. You’ll be a lot more comfortable if you can bring yourself to believe that.”

The girl blushes and starts to stammer a teary apology.

“No, don’t worry about it,” you say reassuringly. “Think we can keep going?”

You wait for her nod before moving away again. Even turned away, you can hear her trying to control her harsh breathing and failing.

“Next, I’m going to clean your arm off with some alcohol. It’ll feel cold, but nothing else.”

The girl nods, squeezing her eyes tightly shut, then quickly opening them again, looking panicked. She is still crying, although more softly than before. As you take her arm, you can feel the shaking that she can’t quite control and the sudden stiffening of her arm as she tries not to pull away. You gently dab her arm with the damp cotton ball.

“Very good,” you say. “Now, fair warning, I’m afraid we’re up to the part you don’t like. We’re going to do this really slowly, ok? I promise, I won’t do anything without warning you first,” you reassure her.

“First, I’m going to get out the things I need and bring them over here. These are called butterfly needles, see, they’re sort of butterfly shaped, except I’m sure you find the real thing much friendlier.” You pick up a couple of small packets and bring them over, placing them on the other end of the examining table from your patient, who is growing paler by the minute.

“Now, here’s how this is going to work,” you say quietly, drawing her attention from the needle to you. “I’m going to get ready and let you know. Then, I’ll count to three and stick you. I want you to try to focus on me, not the needle. I’m going to keep talking to you, try to focus on my voice and my face, not what I’m doing. That way, you’ll see what’s going on without getting fixated. This should all be over in less than a minute, ok?”

She tries to smile and fails, hunching even smaller.

“I’m picking up the needle,” you warn. “Now, I’m going to support your wrist with my other hand, so don’t worry if you feel something.”

She steels herself visibly, but as soon as you touch her wrist, her tears, which had begun to ebb, turn back to noisy sobs. “I’m sorry. I can’t do it,” she wails.

“Yes you can. There’s nothing to be sorry about, crying is quite alright. Do you need me to stop until you get it together?”

The girl shakes her head, the movement turning to a convulsive tremble at the last minute. “Talk to me?” She pleads.

“You’re doing just fine so far,” you say. “I’m going to start counting now.” Surprisingly, she makes no move to pull away. “You’ll feel one sharp prick, but it won’t last long. Ready? One, two, three.” You count fairly fast, knowing how seconds can become eternities for nervous patients.

You insert the needle as gently as you can, talking softly as you do so. The girl is nearly hysterical, and you aren’t at all sure she can hear you.

“There, that’s the worst of it now,” you say after a moment. “You did fine, now we just have to wait a few minutes.” You hold her wrist tightly, allowing the vial to fill. You then disconnect it gently.

‘You’re all done now. I’m just going to take that needle out. You might feel a tug, but this shouldn’t hurt.”

The girl carefully loosens the death grip her other hand had held on the plastic covering of the table. After you’ve put everything away, you turn back to the girl, who is still sitting dazedly on the table, not moving.

“You can go now, if you feel ok,” you prompt her. “If you think you might faint, you can stay there for a few minutes.”

“Oh…no, I won’t faint. I never do,” she says, getting up and stumbling towards the door.

You watch carefully to see that she doesn’t suddenly pass out, but when she seems fine, you turn back to your work.