Hallucinatory Radio: An Analysis
Narrative strategies in ‘The Delirium Wards’, a Radio 4 documentary
The narrative strategies employed by the masterful writer and veteran radio presenter David Aaronovitch for ‘The Delirium Wards’ [link below] are complex and powerful.
He sets a reflective tone from the start with a soft, insistent piano note in D flat minor, a brooding, intensely melancholy key. And then, his familiar voice: David Aaronovitch begins to speak, and immediately we know this documentary springs from a deeply personal experience: ‘Ten years ago, at this same time of the year, I woke up in hospital and I realised I wasn’t mad anymore.’
It’s just 0:11 seconds into the program and I’m gripped. With this Kafkaesque awakening, we are there, and from this shocking tale of experience, a near-death experience, he then weaves his story into an exciting and unpredictable documentary with a larger dimension, using many voices of his interviewees to create a sense of a mounting storm, an argument that calls into question whether powerful sedatives designed to induce longer-term comas in patients were overrused in emergency health care.
The structure of the documentary, which is just under 30 minutes, is dynamic and efficient — an interconnecting, whirring machine, combining personal memoir with interviews, expert opinion, a crisis in emergency health care during Covid, with a sense of resolution at the end. What binds it all together is David A’s calm and steady voice, familiar to Radio 4 listeners from ‘The Briefing Room’, a low-key, thoughtful current affairs show. ‘The Delirium Wards’ makes a dramatic departure from this Socratic, rational arena as the listener is transported to the very surreal and frightening setting of the ICU ward and the profoundly interior psychic landscape of the hallucinatory brain.
As a counterpoint, the show flits between these nightmarish settings to the comforting domestic settings of both home and garden. We swing between all three settings, as in A Christmas Carol, peering through the world of insanity and sanity, both equally real.
The hallucinations are vividly described and not restricted to visual description; they are subtly dramatized with a delicate undercurrent of sound effects and even a sense of touch becomes important. Furriness comes up a couple of times. The sound effects are very delicate. Mimesis using sound would be too strong, because at times the sound effects are playful and interpretative. For example, one former patient called Zara describes ‘whispering voices’ urging her to live as she recovers consciousness.
Sound effects fade in and mimic the whispering sounds she describes, but in some ways, it’s pure invention, an interpretion by the highly imaginative sound designer Eloise Whitmore of what Zara might have heard in her head. And there’s a hint of movement — she describes standing on a dock, and then on the edge of a feather — and you hear rippling water and the wind. The story and the sounds work together, and most definitely transport you, the listener, along with her back to the conscious world. There is a strong sense of movement created by these sound effects, however subtle, and her story feels all the more dramatic and real. The movement is psychic, which is slightly different from imaginary, because the premise of the show is how real hallucinations actually feel. The listener experiences what it’s like to travel from a deep state of comatose delirium to waking consciousness and back to life.
There is just one sound effect that made me laugh. One patient, an 83-year-old explorer called Robin, describes his delirium in vivid detail, describing how he remembers stroking a jaguar by his hospital bed. When David A asks what that felt like, he answers with delight, because no-one had ever asked him this question before, and with such understanding. Robin’s answer — that it felt soft and furry — is met with a wonderfully warm, purring sound effect that the listener assumes is the jaguar. The listener is experiencing what Robin experienced, and so is part of the story.
There is tremendous compassion and sympathy throughout the show. It is a journey of discovery, full of inquiry, and David A takes the listener by the hand, like Marley’s ghost. Each interviewee becomes a character in the play. We care about them. I found the nurse, called Crystal, especially tender and compassionate. The former patients each have a very distinct accent, which saves time reintroducing them, and helps to form a distinct portrait of each of them. The star patient is surely Robin, the 83-year-old explorer with a double-barreled last name, rational, lucid, precise, worldly, with a crisp English accent reminiscent of David Cornwell aka John Le Carre. In other words, someone with great credibility — who tells David A of the most surreal experiences. Part of the challenge David A faces is to persuade the listener this not only happened, but was a kind of reality, akin to madness, that even he, a rational human being, and Robin were susceptible to. David A reports seeing red-eyed cartoony creatures and attacking his nurses; and Robin, the explorer, tells of a jaguar and bats ‘with furry ears’ climbing up the saline drip and snakes crossing his bed. These are not mad people, but rational people who all went over the same precipice, and lived to tell the tale.
The former patients, together with the nurse’s witness account of ICU during the height of Covid, and the expert opinions of the doctor, all create a heightened sense of a larger crisis, beyond the personal. The factual research underpinning the program helps to ground the story. At its heart is the intubation and induced coma strategy used by ICUs to battle Covid — and the fact that the number of patients who suffered delirium in ICU shot up from 50 per cent to 90 per cent during the epidemic. The use of intubation and ventilators decreased over time as this drastic measure was seen as less effective and too traumatic for patients in the long term. The climax of the story comes as the listener understands this is not one man’s isolated story, but a larger story of emergency health care and questions the use of ketamine, for example, to induce comas. Also at one time, comas were thought to be empty, peaceful mental states but are now understood to be far more nightmarish and distressing, more akin to sleeplessness than a deep sleep.
The conclusion of the show rests on the resolution, introducing a new approach in emergency health care: a new culture of drug use and intubation and sedation only as a last resort, and a will to avoid prolonged comas to avoid the lasting psychological distress and depression.
The rapport between David A and Robin, the 83-year-old explorer is very effective, because as he establishes relationships with his interviewees the listener feels privy to an intimate conversation. Robin transformed with his Covid delirium in ICU from valiant mountain-climber to a Zimmer frame, his indomitable mind to a fragile one. As he recovered at home, his wife recalls his having intensely private Zoom calls with strangers who had experienced the same delirium, until David A asked to interview him, and Robin went public with his story for the first time. We are accustomed to journalists speaking publicly, but as a listener I never take for granted what it costs the interviewee to share publicly a very private and traumatic experience. In Robin’s case, the palpable relief with which he speaks is extremely touching and quite the opposite of the celebrity interview, for example, when the interviewee seems weary before the interview even gets started. You feel as the listener he’s saying things he’s never spoken out loud before, and that only a fellow delirium victim could have extracted his answers. David A is not just the narrator, but a player — his experience is what ignites the conversations, not merely his line of questioning. It would not be an overstatement to say this is a life-changing radio show.
The loneliness of the sufferer is evident and even the loneliness of the radio listener. There is a sense of communion between all the interviewees, patients, nurse and doctor, but also with the listener. It’s a secret club, one you enter when you listen in. Whatever your trauma, you are not alone; and in this sense it is a very powerful show, because it is deeply reassuring not only to the interviewees, but for the mature listener, too.
Robin, who is very wise and has an inquiring mind, would privately go over and over in his mind the details of his traumatic hallucinations, trying to understand them — he describes ‘lying in bed’, ‘re-enacting them’, something I thought only I did after witnessing my mother’s death in ICU and willing myself to relive the experience over and over to gain some understanding of her psychological state as she died. As Robin says, you never do understand. But you never stop trying. This is exactly what is described by all of the patients who to this day turn over in their minds what they saw, and even what glimpses of the afterlife, or ‘the spirit world’, as Robin calls it, and whether we make choices to die or to return to consciousness, and how their traumatic experiences might offer a glimmer of what comes next. David A does not shy away from speculation and neither does the highly rational doctor, who says: ‘That’s what our brains do, they pick up on stimuli and try to create a narrative that makes sense to ourselves.’
An alternative editorial approach might have been far more straightforward, a reading aloud of a good script, but David A’s own reliving of a personal trauma, combined with the experiences voiced by others, and a nurse and doctor offering their expert accounts, all give a far deeper and more textured account, with much more potential for the imagination of the listener to join in with the speculation.
There are strategic pauses within the show, usually a whoosh sound which arrests suddenly when David A returns to consciousness, or birdsong to let us know all is well, and the patient is in an instant returning to life, away from the hospital bed and ICU and to their home and garden where birds sing and a dog barks. There is something glorious about these sounds, especially after the sound effects of beeps and alarms in ICU. Having spent six weeks in Toronto in January 2020, day and night, on rotation with my siblings, sitting with my mother in ICU, I am familiar with these sounds. And I remember loving the rain and the snow on my face, and listening to the splash of puddles as buses roared by, because in the rarified atmosphere of the ICU with sealed windows, there are no natural sounds. The soundtrack of this show mimics this unnatural world and suffuses it with anxiety, and so when there is birdsong, your heart sings, too.
In some ways, this documentary took David A ten years to make, because for him it’s been a spiritual journey to be able to talk to others about his experience. By the end of the program, you feel you have shared this journey with him, from his hospital bed and the verge of death, back to his full life as a functioning, intelligent journalist. It is moving in the real sense of movement — a sense of awakening and of maturing, which great books and theatre and travel can bring. It’s one of the reasons I love radio.
There is one final, unifying, joyful sound that links through from David A’s traumatic delirium in intensive care, back to the present, and that is a snippet of Dick Van Dyck’s ‘Jolly Holiday’, from Mary Poppins, which plays at the middle and the end. It enters the story as David A says his hallucinations were not all frightening. One was of Dick Van Dyck singing ‘Jolly Holiday’ by his bed. And that’s how he finishes the show — recounting how ‘the madness was gone’, but still, the very last note is Dick Van Dyck’s song, as if to say, ah, yes, but it never really goes away.
BBC Radio 4 — Seriously…, The Delirium Wards
[Available for 21 days]
