He was still in the ICU -- an open ward of post-surgical cardiac patients, separated from each other just by curtains -- and although he should have been sent to the cardiac recovery floor within forty-eight hours, he was waiting for a bed to become available. He was wearing a full oxygen mask and was labouring to breathe, apparently because he had just been up for a short walk, and the sight was upsetting for Granny -- and as is her way, when she doesn't know what to say, she starts chattering about whatever, and as she was telling about how it had started to snow overnight, Grandpa, still breathing hard and looking a little panicked, started waving his hand and shouted, "I don't care." This wasn't like him.
Not long after, his lunch arrived and Grandpa took off the mask, and with some difficulty, started poking at the items on his tray. With frustration, he took the pulse monitor off his finger so he could pick up his spoon, and Granny jumped up and said, "You need to leave that on, Jim. They need to keep track of that." Grandpa didn't seem to react to her, but since taking off the monitor made the stats machine beep loudly, he turned to it and said, "Damn that cursed thing and its beeping." Not one to be ignored, Granny ran over and began trying to wrestle the monitor back onto his finger.
"You need to leave that on!"
"Get the hell away from me. Everybody out of the pool!"
I had no idea what my role was supposed to be, how I was supposed to intervene, so I asked, "Are we tiring you? Did you want us to leave?"
"No," said Grandpa, settling down. "No, that's fine."
The nurse came in and turned off the beeping, saying that it's okay for Grandpa to have the monitor off while he's eating. Granny sat back and started chattering again as if nothing had happened. She then asked, "Do you want me to open your milk for you?"
Grandpa answered, "No. Don't worry about it."
Granny started bawling. "You just won't ever let me help you with anything. Never. You just don't need me."
Grandpa sighed and said, "No. That's okay. It's okay."
I still didn't know what I was supposed to be doing. What a mess. Happily, when Granny next asked if she could feed Grandpa his pears, he agreed and that was accomplished. Suddenly, he asked us when he would be going to the hospital. Granny and I exchanged worried looks, but when she explained that he is in the hospital already, had already had his surgery, Grandpa looked confused and then calm and said, "Right. Of course." Then he leaned forward and said, "I just knew this was going to happen. Dr. McIntyre came in and looked at me and said, 'I told them not to put the vein in you because it's going to kill you'. I just knew it."
There is no Dr. McIntyre -- this conversation never happened -- and I told him that it must have been a bad dream. Grandpa agreed that he had been having some strange dreams : Every time he closed his eyes there were crowds of people dancing all around him.
At this point, and although we had been there for less than a half hour, Grandpa said he was worn out and we may as well leave.
We asked the nurse about the delusions and she said it's completely normal for patients to become disoriented when they spend too long in the ICU; it's noisy and there are no windows for the patients to keep track of the time of day or even the passing of days. She suggested they might give him some medication to help him sleep and confirmed that Granny had signed a consent form for restraints in case he became a danger to himself (!!). We left, concerned and hoping that Grandpa's bed would become available soon.
The next day is when things got really weird.
Grandpa had been moved to the CCU -- to a private room where he could remain until his permanent recovery bed became available -- and he had been able to spend the previous night there. As soon as we arrived, Grandpa leaned forward in his chair, a paranoid glint shining in his eye (and that is not hyperbole, at a glance he was not himself) and he said to Granny, "Something has to be done about those terrible, terrible people."
Now, I don't know if it's the Alzheimer's or just a lack of intuition, but Granny was not picking up the fear and paranoia. She laughed and said, "What people? Who's terrible?"
"The ones in the house."
I could immediately see that this was another delusion, but Granny laughed again. "What house?"
"The house. The one attached to the hospital. The one with those freaking terrible people. They have the people, all the people on tables. And there's paperwork. And there's dead people in there, too, on the tables. And you think it's the doctors who are in charge of the hospital, but it's not, it's these people. And they keep you on the tables and they want you to pay to get a hospital bed. But I didn't have any money."
Granny laughs. "You don't have any money here, but I've got some money on me."
"I didn't have any money so they kept pushing me to the back of the line. With the dead people."
This story came out really fast and I could see that Grandpa believed that this had happened to him exactly as he described it. I jumped in and said, "That was just an awful, awful dream."
He turned on me, "A dream? A bad dream? But it happened -- it was as real as you sitting here talking to me now."
"The nurses told us that bad dreams are totally normal after being in the ICU and you just had a bad dream," I said. (Granny laughing, "Boy, that is a doozy.")
"Just a dream?" Grandpa became calmer and pensive. "Every time I closed my eyes I was back in that room. The room with the people. With the dead people. And it was just a dream."
As frightening as his delusion had been to hear, I couldn't believe how easy it was to make him understand that it hadn't happened.
This visit lasted for hours and every now and then he would mutter, "Those freaking terrible people. Just a dream after all."
Yet he was still delusional, but aware of it. At one point he closed his eyes and said, "Right now, I see a post. Two posts with coats hanging on them. And there's a wee little man. And he's opening his coat and it's full of tiny hockey sticks. And he's waving at me. Hellooooo." Grandpa waved a toodle-oo and said, "He's a little Scottish man."
Granny laughed and said, "Is he wearing a kilt?"
"Certainly, he's wearing a kilt," Grandpa blustered.
Every time he mentioned one of these delusions, I'd remark, "Well, at least that sounds like a happier dream." I have no idea what the proper response would be to the hallucinating, but I thought it was important to keep reinforcing what is real and what is not.
I found this visit to be really upsetting, especially the very frightening room Grandpa had been trapped in, and I told him it would make a good horror movie (since he's a fan of old horror flicks). By the end of the visit, every time he thought of the room and the terrible people, he'd say he was going to write that screenplay one day.
This talk of screenplays may have inspired the following story: "I can remember the opening shot, of a long beachfront. There's a beach-house and that's where the jailers live, you see. There are all these candy houses (maybe he said shanty houses?) and that's where the prisoners live. They're divided into houses, with all the Cubans together and the African Americans (that's an unfamiliar phrase for him to use, I would have expected "Black people") and so on, and that's the way they live. And they work to get their stipend, which is five dollars a week, but that's okay. You better believe that every day they take out their boats and they get their quota of fish to get that money. And that's the way it was."
Granny asked at this point, "Was that that movie you were watching last month?"
And he answered, "Yes. That's Third Hand Luke."
Needless to say, when I looked it up later, there is no such movie as Third Hand Luke.
Like I said, I thought this whole visit was terribly sad and I felt so awful that my father-in-law had lived such a nightmare. But my mother-in-law was left with the impression that the whole thing had been hilarious. As she talked to different people on the phone that night, she comically told how Jim had asked if we could see the black dog with the red squares on it that was walking by. Lots of laughs, but although I could see that she had been rather missing the point, I also couldn't see the benefit of me telling her any different.
As I was telling Dave and his sister about the horrifying experience their Dad had had, I came to the following epiphany: The ICU is like the Chinese Water Torture (if that's considered insensitive these days it's not meant to be; just using the colloquialism) -- there is the nonstop beeping of machines, sleep deprivation, no sense of time, and people jumping out from the shadows to jab at you with sharp objects. The experience is pretty much designed to make a person delusional, and the nurses take it as normal. As I remarked to an American friend, this highlights the major difference between our health care systems: While Grandpa, and every other Canadian, can expect world class medical care that won't cost them a dime out of pocket after the fact, I have no doubt that a private hospital would have had the proper bed available when he needed it, preventing what I believe to have been a form of psychological torture.
That night, Grandpa was finally given a sleeping pill and moved to the proper floor, and although he did dream that he was on a train with eighty-thousand people, it wasn't upsetting and he was a bit more himself the next day. He was groggy from the lingering effects of the sedative, and he spent the day on the verge of sleep, and every now and then he'd open one eye and ask me if there was actually a cat on his bed, or if I could also hear the whispering voices, but overall he could tell the real from the not so much.
The next day he was even better and the next day, yesterday, he was rested and his mind was totally clear.
How much sooner would he be on his way home had he not been forced to lose his marbles; all for the want of a quiet bed?
*****
Update added September 24, 2015:
In today's paper, I read an article about how common (and unstudied) this phenomenon is, with many patients experiencing longterm PTSD after an ICU stay. I don't think that Grandpa is still suffering but it would have been useful to know about the possibility of delusions beforehand.
As an interesting aside, the woman featured in the article is the same Cheryl -- Kevin's older sister -- who was getting her PhD at Oxford and allowed us to stay at her flat some thirty years ago, which I wrote about here.
