Delirium update: “I couldn’t talk I was lost in the forest, but now I am back”

I went to see Granny again on Saturday. The delirium is improving but she is clearly frail and unlikely to get better and she’s now comfortably receiving palliative care in a nice nursing home, complete with an anticipatory care plan with appropriate medications. The palliative care nurse specialist and GP have been out. After a week of frankly awful (but strangely enjoyable) nights as the Med Reg I booked myself onto the first flight to Gatwick. This time I took the train to Reigate and a short walk to her nursing home.

She looked much the same, still with oxygen, but in her own bed in a nursing home with a view of the garden. The oxygen concentration dominated the room and hummed away in a corner.

She recognized me ‘I’ve wanted to see you, I couldn’t talk last week, they had my teeth, I don’t know why they took my teeth’. My heart leapt — had the delrium resolved especially for me? ‘I went for a walk in the woods, I was silly, and I got lost’. No it hadn’t, she has been using a wheelchair for the last 8 years.

Granny you had delirium, it’s very common when you are ill, we’re doing some research into it at work, my boss has a grant to devise a new test….’

‘Anyway I wanted to see you,’ She apologized for something she said to me in my early 20s (something too personal to say publicly).

That was the lucid moment. Then she slipped back away from me. She held my hand, asked me not to leave her. She was better from the week before, she was speaking in sentences, and a few of them made sense. She asked when Jim (her late husband) was and then said ‘no, I know he’s dead’. Some days all she will say is that she wants to die. We managed to get her to eat some food, but then she coughed again.

I sat with her for hours, whilst I was with her she wouldn’t let go of my hand.She wouldn't let me read.

The matron of the nursing home was very pleasant, she showed me the risk assessment for the oxygen concentrator. I promised not to smoke. She said she thought my grandmother had a recurrent pneumonia, and she would ask the duty doctor to see her. I wasn’t entirely sure what that would achieve.

We are waiting now. She is not really here. Not the Granny we knew. Not the Granny who played scrabble and gossiped about the expected babies. My Aunt is visiting daily and looked exhausted. I want to stay. I want to take annual leave and spent every day there, holding her hand. But you can’t. You can’t take compassionate leave for a grandparent. That’s for parents, children, spouses. I have my own patients to care for. I have a PhD to write up. But I feel although I have been run over by a steamroller.

At work I am managing when I have patients to see, but struggling to write. If I am careful I can write badly at glacial pace.

This weekend I’m going to visit again. This visit was planned. It’s my uncles 70th birthday. We booked a party in Reigate so Granny could come. Her little sister (aged 96) is coming down to visit her. We expect she is holding on until then. Or maybe until my cousins wife had their baby.