Delirium, Reality, and the Contours of the Mind: reflections on my post-operative experiences in intensive care
Following heart surgery in January this year, I found myself convalescing in a comfortable nursing-care home in one of the glens of the Hillfoots near Stirling. It was a lovely experience, the staff were very kind, and the sun shone gloriously through the windows — even though I was regularly frustrated by the bars on my bed that prevented me from going anywhere. Soon after, however, I drove down to Manchester, and from there onto Ireland where I worked with Olivia Colman in a new drama for the BBC. And then I was lucky enough to take up an offer to travel to southern Italy, for a quasi-academic experience of convalescence after my operation.
All of these things happened. I have very clear memories of them. However, what I didn’t realise until later was that during all this time I had been in the Royal Infirmary of Edinburgh, in the high dependency unit next to where I had undergone extensive surgery on an aortic dissection. My body was being carefully controlled by drugs, I underwent substantial blood transfusions, and I was in a medically induced coma. I was going nowhere, except in my mind.
What was happening was post-operative delirium, a very common patient reaction to major medical intervention. Apparently, it is particularly associated with heart-bypass surgery and its aftermath. Indeed, it often goes by the name of ‘intensive care syndrome’.
I was in hospital in Edinburgh for two weeks and I remember none of it. Even though my experiences took me far and wide, it was all delirium: my mind was crafting a number of bizarre experiences of what was happening around me on the ward.
Such delirium is also associated with age. At 54, I am on the younger end of the spectrum for this, and so I wasn’t necessarily taken to be slipping over from delirium into dementia (which is usually distinct). I was, however, prone to the ‘sundown syndrome’ — that is, the delirium became more intense in the evening and night-time. In fact, most of my memories are of quite surreal things happening at those after-sunset times.
As I have subsequently been going through the long process of recovering from this surgery, I have tried to learn more about what medical experts have to say about delirium. It is generally presented in the literature as a less than positive experience — and I think it definitely is so for close relatives, who have already been through their own traumas of seeing their loved ones undergo life-threatening surgery.
The human mind is a very powerful thing, with the capacity to create images and experiences of great fear, pain, or joy. For example, the researchers Duppils and Wikblad describe a patient’s experience of delirium in which the ward became a prison camp, with the medical staff as sadistic jailers. Although some of my delirium was very dramatic, I still have a sense of that time as positive and internally healing.
In short, my sense is that, for me, such delirium was not a negative experience. It was very real: I had experiences that were very visceral and which come back to me, even now, with an intensity as though they actually happened. And as I think back to what I was going through, I do not think it would have been any better for me to be ‘really’ conscious, lying in a hosptial bed, wired and tubed up to a range of life-supporting machines. My delirium was not medically necessary — if anything it was a side-product of the medical interventions on my body — but it did help me with the experience of an extremely traumatic medical breakdown that had nearly cost me my life.
What is most strange for me is that the day after I became more conscious of my surrounds, I had a further episode of delirium. I had been transferred from Edinburgh to Perth Infirmary, close to my home. And it is around this time that I began to find mental clarity. So much of arriving in Perth feels more like the reality I know, rather that the reality that I had constructed during the delirium. Despite that, for the first night the ward television was showing a rugby match, and this coincided with the arrival of several new patients in my room. I was convinced for several days that they were related to the game on TV, and two of them were famous figures from the Welsh rugby team of my childhood — in particular JPR Williams and Gareth Edwards. I am assured they were not, although one of them looked uncannily like JPR today (I googled him to check).
However, it was the following night that my mind wandered most during this post-delirium time. I don’t know how much this experience was based on any ‘real’ events, but I became involved that night in an interesting discussion on the ward about the development of a new medical research project — to develop ways of using delirium to help patients recover from the trauma of surgery. The project was based at a medical school in Hawai’i, and there was a lot of excitement among some of the staff that they would need to be flown out there to participate.
Although I was not fit to travel at this point, of course I liked the idea too — not only of being involved in research in Hawai’i, but also that such delirium was not simply an aberation, but actually something that could be harnessed — as a way of putting the mind to work in healing the damaged body. It took me several days to realise that neither of these things were going to happen. I had had delirium about the delirium. One positive for me that night, however, was my cathetar was finally removed (however, I also remember the pain of that being done).
There were thin boundaries between the reality that I went through, involving hospital wards, intensive care, and extensive heart surgery, and the other reality that filled my mind for that time. It has left me with an uneasiness about what reality actually is, and how much I can ‘trust’ my mind about any of the real things that I experienced. In this sense, the boundaries with dementia are quite clear (and quite close). All realities are mediated to us through our minds and then our memories — what is ‘out there’ is only real inasmuch as it is ‘in here’, inside the mind.
In many respects, the days I spent travelling around Europe during my delirium are some of the most real things I have done this year. However, whenever I look at the healing scar cutting down my chest, I remember that other reality that also went on inside me — the surgery and the internal healing that my body has been doing to put myself back together.
And it feels to me that the experiences of delirium were (and perhaps still are) a part of that healing process.
Malory Nye normally writes about religion, race, and culture, particularly on his Religion Bites blog. In the past few years he has held short term and precarious posts at the Universities of Glasgow and Stirling, but he is currently in recovery mode — without any position or salary.
Malory Nye is also the author of the books Religion the Basics (2008) and There Shall be an Independent Scotland (2015). He is currently working on a new edition of the Religion the Basics book, together with a new book on Race and Religion, which will be published by Bloomsbury Academic.