Wednesday, 3 December 2014

ITU Psychosis – A realistic account from David Aaronovitch

The Times




On Sunday, September 4, I woke up to find that I was no longer mad. It was 2pm, my two brothers were sitting on either side of my hospital bed, my wife between them, the sun was slanting in through the window behind me and the horror that had dominated my life for nearly a week had evaporated. But I will never forget those days and nights of terror and delusion, and will never think about madness in the same way again.
What had happened to me was unlucky. Three weeks earlier I had presented myself at a London hospital to have keyhole surgery to remove a pre-cancerous growth from my colon. The surgeon is one of the best-respected and most experienced colorectal specialists in the country, and I had quite happily signed the consent form, noting the small risk attached to the procedure. If things went as planned I’d be in hospital for three days, then out under what they call the enhanced recovery programme.
Later I was told that the following is what happened, because I remember just about none of it. That evening in the recovery room I was “sore” but fine. The next day I have some small recollection of being got up to walk down the corridors with Denise, the rather wonderful physiotherapist. We stopped by a window and I saw that it was raining outside. That was my last coherent memory. My phone shows that I texted my wife, Sarah, and asked her to bring some screen wipes in when she visited. It was Tuesday.
On Wednesday things were going wrong. I told Sarah, apparently, that I felt “like I am going to explode”. The nurses, though, assured her that all my “vital signs” – blood pressure, temperature, urine output (sorry, but most hospital tales are stories of blood and p***) – were fine. Sarah texted several times from home asking how I was. I sent back very short messages saying I was OK, which I wasn’t.
When Sarah came in on Thursday I was much worse. I kept stopping halfway through sentences and told her that I couldn’t breathe because of the pain. This was the moment at which Sarah – usually a stoic on her own and everyone else’s behalf – became alarmed. At her insistence the nurses ran a new series of checks, and just as they discovered that my temperature had indeed soared, my consultant dropped in on one of his tours of inspection. I was whipped upstairs for a scan. When he looked at the results, the surgeon told my wife, “I think I’d better go in again.” This time there was no keyhole, but a big cross incision that has left me with the most magnificent scar.
The original op, it turned out later, had perforated the bowel and my being fed shortly after surgery had therefore created all sorts of problems. There had been a risk and I had fallen foul of it. Someone had to. And then things really deteriorated. I spent Friday in the intensive care unit (ICU) “sedated” – in a coma. On Saturday night my vital signs took a dive. Somewhere along the line I had aspirated food and my lungs had been crushed. A tube was inserted to clear my air passages, but I was highly (and unconsciously) intolerant of this invasion. To get me to allow the tube in, the people in intensive care told my wife that they “used a few tricks” involving morphine and persuasion. I experienced this as a nightmare from which I couldn’t escape. Faces would appear, looking down at me – faces with the smooth colours and odd animation of computer game avatars – separated by, and at the four corners of, a bright, swirling, highly coloured paisley table top. I was desperate to surface from this appalling dream and couldn’t.
But I stabilised. Four days later, on the Wednesday, they brought me round in the intensive care unit and that’s when the madness began – gradually at first and then at the gallop. Maybe it was because my mind was almost the only part of me that could move. I had a rough awareness of tubes everywhere, up my nose, in my arms, into my gut and heavily threaded through my penis. Every few minutes the blood-pressure cuff would tighten automatically on my arm and someone would take my temperature or pass some liquid through me. Often I would be fitted with an oxygen mask or a nebuliser. My lower regions were essentially lost to me in a mass of catheters, anti-clot stockings, bandaged wounds and unspeakable bags; things I did not want to know about. At some point, I dimly recall catching sight of the great cross scar from my navel to my diaphragm, looking like something the Spanish Inquisition might have branded into the flesh of a recalcitrant heretic. In my mind I had lost most of my insides and I couldn’t see how I would survive. “There’s hardly anything of me left,” I told my wife.
In the early hours of consciousness (I don’t know when), someone – I think a visiting friend – must have given me a rough account of what had happened. What I thought I understood of it was that I had been very badly let down by the hospital and that it should never have occurred. But I couldn’t become involved in this thought, because I was preoccupied with trying somehow to persuade anyone who would listen, whoever they were, that the intubation experience had been so bad, I might prefer to die than go through it again. One or two of the nurses were surprised to discover that I recognised them from the morphine nightmare and I didn’t think that they quite believed me. This increased my anxiety.
The geography of the ICU ward was to become intensely important to me. I had no idea what was behind me, just that there was a hinterland into which some of my tubes passed. To my left were lime green stiff paper pleated curtains that were always closed and which would be extended in front of my bed when various inspections and washings were carried out. On my right was a wall, with a television set on a bracket and a notice about visiting hours. Then there was a wide doorway giving on to a much bigger room where nurses would rest and occasionally sit at a computer, its screensaver seemingly a Vogue model, all lips and cheekbones. Opposite were two glassed-off rooms with one bed in each.
Every time I closed my eyes, the inside of my eyelids would display a kaleidoscope of red, black and yellow violent cartoon images. So for four days and nights I didn’t sleep and for much of that time didn’t know if it was day or night. After a while I noticed the clock on the wall of the room opposite, so now I could see the time, but I didn’t know which 12-hour cycle I was in – whether it was 7am or 7pm, lunchtime or four hours before dawn. All I did know was that the nurses came and went in shifts, handing over to each other every 12 hours in a rather cacophonous atmosphere of greetings, innuendo and consultations over the patients’ notes, and that this handover was going on up and down the passageway.
I found, to my surprise, that my inability to move was being compensated for by a heightened acuity in hearing. It was possible for me to hear almost every word of what was being whispered or muttered between the staff. (Of course, this wasn’t true, but to me it was.) Much of what I heard surprised and rather shocked me. There were quite a lot of “ooer, missus” double entendres exchanged between the staff (most were young women, but there were some young men and older women) and quite a lot of complaining about each other and about the doctors. One young Scottish nurse embarked on a description of how all her compatriots had gone back to Edinburgh for Hogmanay revels, leaving London hospitals understaffed.
From first waking up, certain things became very important to me. I didn’t quite understand that I was on a ward, imagining instead that I was in some kind of room with a passage at the end, and it became upsetting if people passed by my bed without acknowledging me. Being completely helpless I worried if there was no nurse in my eye line for more than a few minutes. When nurses or doctors did come to see me I’d ask their names, request that they shook or held my hand for a moment and gently demand to know what they were putting in my intravenous drips.
The day shift was replaced by the night shift. My effervescent black British nurse handed over to a diminutive Filipina. A noisy male South American nurse with long hair and a big smile progressed down the corridor and into the nurse’s station. “Idiot,” muttered my nurse, under her breath, inaudible to all but me. The place subsided into a never-ending pattern of beeps, occasional conversations, groans, blood-taking and the administration of potions. I was now becoming mildly alarmed by two things: the odd and sometimes hostile relationships between the nurses, and the very callous attitudes towards the patients that some of them were exhibiting, or that I thought they were.
In the room opposite my bed was a man whose room during the day had been full of dark-skinned women sitting or standing beside his bed, tending to him or seeming to mourn. Now I could see the panel behind his bed that tracked his heart rate and other vital signs, and the coloured lines had changed from regular waves to lines. There was a commotion, and I heard the South American male nurse, Ruiz, exalting somewhere away to my right that, for anybody who hadn’t seen it before, there was a flatliner.
The man opposite survived. No body was wheeled out with its face covered and now I was preoccupied with my own battle to keep the tube in my throat intact, despite my increasingly desperate desire to cough it up. And again I heard Ruiz laughing that he had never seen a man keep a line down. As I fought back the dangerous urges to lose the line, Ruiz triumphantly (but out of vision) counted each near miss. My other enemies that unending night were thirst and sickness. Being “nil by mouth”, my tongue was furred, the area behind my teeth arid, my lips cracking. From somewhere by my bed ice lollies made of water would emerge and were placed lightly on my lips or in my mouth. If I felt sick, an anti-emetic was fed into my drip and the need to retch would dissipate.
I was desperate, though, to smell things. During the night my nurse, whose name I had decided was Valli, came back from her break with a cup of coffee. I asked her if I could smell it. But Valli’s English was as poor as her medical knowledge. Instead of holding the cup to my nose, she put its contents into a large syringe and injected it directly into my dripline. (Think about it: of course she didn’t.) Immediately, I felt sick and began to heave loudly. The neighbouring nurse called for the duty doctor, who came and remonstrated with Valli, who in turn flounced off and didn’t return for an hour. Some antidote was found, and I began to recover.
Eventually, it was day. I was assured that the man opposite had not “flatlined” during the night. When my wife, who had become a woman called Frances, arrived at visiting time, I told her of my plan to sue the hospital and everyone associated with it. I’d get £1 million, I told her. Hadn’t they nearly killed a leading journalist on one of Britain’s top newspapers? We’d also reach a settlement in which the millionaire consultants were forced to give me their 2012 Olympic tickets. The kids would be able to use them, I said, because I doubted whether I would be around. “Frances” said she thought I would. But what else could she say? Nurses said it too. “You’re not going to die. We’ll make sure of that.”
It was night again. I lay sleepless on my bed, which moved as I moved. The night shift returned, together with the thirst and the sickness. It was then that I first heard the voices next door – low at first, then increasingly strident. It seemed that the adjoining room, behind the green paper curtain, contained two people – and they were both furiously angry with me.
All night they railed against me, against blacks, against Jews, lefties and homosexuals. Their language became more and more violent. Every time my nurse came to sit with me, they invented a spiteful pretext to take her into their room on some task or other. Plenty of the nurses were on my side. Being black, some of them found the racism just too much. They told the appalling couple that I was an eminent writer for a major newspaper. I had met all the leaders. I was someone.
But the pair persisted. Why didn’t I just die? Wouldn’t the world be better off without me? For a few hours we traded insults. I swore that my children would revenge me and I tried to tear letters out of the Times sports pages to make a message, but just wasn’t strong enough. Somehow I lived through the pre-dawn hours and became the man who would not die. By breathing carefully I survived, though precariously. I was David O’Ronovitch, a columnist of Irish origin. Dick Van Dyke appeared on the wall and sang, “It’s a jolly holiday with Mary,” and I sang along.
Morning was approaching and with it visiting hours, when I’d be able to tell Frances what the pair had been up to. But the couple knew my game and, although frightened, also had their own methods. With threats of sacking and promises of riches they suborned several nurses. One, Mexican I thought, parked herself near my bed. Her intention was to tear out my lines when no one else was looking. Only by becoming very agitated could I persuade one of the incoming male day nurses to get her to move away. She went off to the nurse’s station, sat by the computer and would shoot me the occasional baleful look.
At this point the tanned consultant who was head of the ICU made a visit. When he asked how I was, I told him that I was being denied my human rights. He smiled benignly and said he thought not. I told him to f*** off. He became offended. I apologised, then “Frances” arrived. Relief suffused me as surely as the intravenous anti-emetic.
That day the authorities tried to persuade me that all was well. They fed me for the first time on yoghurt and ice cream, lifted me out of bed in a big blue hoist that somehow squeezed my balls, and sat me in a chair, where I wilted. I had visitors. Frances came back in the afternoon, but this time as Sarah, the South Africans were silenced and – for a while – I thought I would get through it.
I was wrong. That night, Thursday, they turned me into a zombie. After my friend Steve had departed, I imagined that the night nurses wheeled my bed down the passage to a different part of the hospital. I was getting special treatment from an English nurse, a woman with nannyish diction, a belief in New Age remedies and a disbelief in anything I told her. Eventually, she decided to convince me by pulling aside the green curtain. Behind a long, chaotic, deserted ward with empty, obsolete beds, three of her colleagues, very angry with me because of my complaints about Valli, were unloading supplies from cupboards.
They were all New Age, none believed in doctors and conventional medicine, and when I started to feel sick again, none would come when I called. As my terror increased, I decided the only way I could survive was to get out of bed and somehow get to another part of the hospital where more rational nurses were working. This was a catastrophic decision. As I pushed myself towards the end of my bed, my lines all came out. “That was a very stupid thing to do,” one of the nurses told me. I managed to look back at the electronic chart above my head. All the lines were beginning to flatten, and were showing the estimated time left before vital functions ceased. Even now I am not sure whether this actually happened or not.
Account written by David Aaronovitch | The Times

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