Entombed, I lay rigidly infixed in coils of bubble-wrap, ice-cold.  A frollick of strange lights darted in bullets of pink and blue above me, until they all blurred into one infinite line, fogs of white splaying out.  I was strapped into the hold of a Boeing 777.  They had given me a special mask to breathe comfortably inside the pressurised cabin.  In one hand they had strapped green masking tape to my fingers, making me promise not to let go, or else the cabin’s oxygen supply would fail.  For all of us.  I let go.

Next moment, I was spewed out onto a dry, gravely runway.  I can remember the concrete felt hot, sun-baked and clay-grey. But I couldn’t get up.  My body felt like a jelly, melted into the road, the corners of my jaw yanked into a form of a quadrilateral, terrifically displaced.  To the sides of my peripheries, I could make out the skeleton of a fatally crumpled wreck, crinkled metal no more than scrunched up boulders of paper, chaotically littered, lightly fizzling.  The oxygen tank had burst, causing the entire plane to explode during transit, and now I lay misshapen and disintegrated on a distant airport runway.  It was all my fault.    

They were all filming it.  International journalists were there, it was all over the media.  I was told that everybody knew, that everybody had been informed.  But I was convinced it was a skiing accident that had thrown me onto the tarmac.  I had lost control of the two mere planks of wood beneath my feet, collided with an oncoming car, and been snapped into more than a dozen pieces.  The driver didn’t make it, and I can still very much recall and visualise his car disappearing into a big black hole, slow-motion.  The driver’s daughter cradled me, crying her eyes out, but promising that we’d stay in touch – that this bittersweet day would tie new bonds.  Meanwhile, I had to be cut up even more, to be pulled free from this overwhelming wreckage, but I was already trying to pull everything off of me, out of me.  My jaw was popped back in, back to front, my legs were also back to front and swapped right to left, left to right.  They took out my brain, my stomach and my spleen, of which all were now being controlled by a top laboratory in Geneva.  I was told that the neurosurgeon keeping my brain safe was a cunning but incredibly intelligent doctor, consumed by immense power and paranoia.  Once he got hold of someone, he’d never let it go.  He had complete and utter power over me and there was simply no way out of it.  I was now a scientific experiment and these events would unfold over and over, and over again, until I did what I was told.

The police guards stood solemnly as they draped plasticky sheets over me, but they didn’t say a word.  They just stared through me, glumly.  The plastic sheets soon turned hot and sweaty, as a warm soup of faeces filled the air-mattress-like tube I now poised waiting in.  From my mouth, a huge, extraordinarily rigid metal pole emerged, connecting a pipework of other metal poles to my nostrils, jaw-line and then the ceiling.  It meant I couldn’t even move my head.  They pierced in agony.  And then I was lifted up, and into the box.  From here, I was wheeled into a big trailer, but it was musty and dim.  The trailer was full of lots of other bodies – some corpses, some patients, or just about.  We were all naked, piled upon one another, silently moaning, but the woman next to me held my hand tight, and so did another, in my other hand.  I squeezed onto their thumbs so tightly that they had turned clammy and cold.  If I let go of them I would slip into another dimension and be lost forever.  I wondered what they were in for, how they had fallen sick, but whatever it was I needed to get out soon, and I was taking them with me.  I was leaning against the wooden berth within this trailer, now a cathedral, yet, on the other side of the thin panel I lay painfully pressed against, the choral choir sang at the top of their voices, the organ playing so piercingly that it rang in my forehead.  It was excruciating and I wanted them to stop.  But it was far too loud to even try asking them.  I kept calling out, pleading to know how long it would be until it was my turn to be seen.

Eventually, I was moved, but I had to undergo a series of tests, tasks, before I was accepted into the next stage of my admission.  I would be wheeled into these small boxes, each with their own little task in them.  If I failed that task, I would remain stuck in that box, and moved back, having to do that task again, and again, until I completed it satisfactorily.  Which I couldn’t.  The lights shone purple and I was ushered into a nightclub – what sort of task was this?  I had to organise my Mother’s hen party…at the age of 50?  But very soon into the party arrangements I somehow stood heavily on a wine-glass, shattering the contents into a stinging dust of sharp fragments as my foot soaked in silky crimson blood.  They spent the next few hours picking the individual shards out of my skin and bathing my feet.  I was then returned to the first box again, before they drew the garage door down on me behind them.  Silence.  I was left alone once more. 

I couldn’t tell you when the boxes started opening up, or disappearing altogether, but what I do know is that the hospital seemed to be undergoing reconstruction whilst I lay there, waiting still.  I had been transported back and forth between the first and seventh floor, but I much preferred it in the latter.  The hospital ceiling was made entirely of glass you see.  During the day, streaks of hazy sunlight soared through, heating my face up.  For once it felt like normality, and it was so calming.  But soon they began taking all the doors down, one by one, the walls made up of polystyrene, foam, the sorts you get in your parcels when receiving fragile gifts in the post.  Consequently, they came to me and there was nothing they could do – the construction company had ordered them to pull down all the walls and doors, including the ones that were holding me up in bed.  I spent the next five days hanging off the edge of the hospital building, and I was terrified.  I clung, dangling, gripping onto the bedsheets as I tried so desperately hard not to fall further down the side.  I begged the nurses to pull me back up, which, occasionally they did, rallying together to pull me upwards and over the cliff, but there was only so much that they could do.  I always stuck up for myself, and I wasn’t going to let this define me, be the end of me, crumpled in a heap seven floors down at the bottom of the building.  So I complained.  But the nurse I told them about got fired.  She was not ever allowed to set foot back into the hospital premises again.  And it was all because of me.  Shouting, screaming and arguments roared on for days, to the point that I had to be moved somewhere safer, somewhere where I could be protected from the accusations I had made on other staff.  How could I possibly have done that, as a medical student myself, to another fellow colleague?  I felt sick with guilt

The place of safety, respite, was on the top floor of a Turkish palace.  There were three middle-aged ladies, laden by age and wisdom, constantly waiting upon me, doting on my every need.  They cooled me down with the most extravagant, large-breasted fans, jewels of pearl and sapphire dripping from their foreheads, swathed in rich Arabic blankets.  The room was seeping with thick-dusted rugs, embroidered in so many hexagonal patterns that they grew a kaleidoscope of illusions to the eyes.  It was beautiful, but also very disorientating.  I just wanted to go home.  But they wouldn’t let me.  I couldn’t understand – how had they let me walk down to the beach that very same morning and now they weren’t even letting me out of the bed?  How delightful that warm, breezy beach walk was.  I can clearly remember the still soapy tide of the Mediterranean sea brushing back and forth over the tops of my feet.  It was so soothing that I fell asleep at the harbour-side.  They drew out my hospital bed and we slept, watching the light from the stars intensify into the night, listening to the waves softly crunch and crash into the sodden shore. 

But I wanted to go inside now – the heat of the day had become too much.  Yet, they insisted I was already inside.  In fact, they insisted that I had never been outside in the first place.  What utter nonsense, the beach was right there – I was so sure of it!  The bedsheets burnt my skin, everything itching me madly as though I had thousands of tiny insects crawling around underneath the surface of my skin.  It stung.  I lay naked to the world, skin so untouched for weeks that it had grown smooth, like that of a new-born baby.  But the cramps that rippled over my body were crucifying me.  I wriggled and retched as I shuffled into weird contortions, limbs seizing up, violently shaking.  I couldn’t shut my mouth, perhaps because they still hadn’t rectified the botched surgery of putting together the jigsaw of my jaw.  It meant that I continuously drooled rivers of saliva, as a strange man came by every minute or two, packing my face up with soggy towels and suctioning pipes.  That heat of the day lasted very little time.  Soon, the bed turned a frosty cold, the bed and lights all around me turning a deathly clinical white.  I had suddenly become frozen within an incubator of some sort, as though I had just been reborn.  But it was far from that.  Instead, I was dying.  My liver and kidney numbers plummeted and my blood pressure was the metaphorical equivalent to the sinking Titanic.  I had lost all ounce of energy to lift my own ribcage to inhale and exhale, and with each sap of energy being drained out of me with every shallowing breath, the room turned whiter, and whiter, and whiterWhiter.  Everything around me became so white that it was nothing but astoundingly bright.  Heavenly bright.  I could hear a chorus of sobs in the far distance, followed by the choking of two words:  “She’s gone”.  But I had no power to do anything, no power to tell them that I was still here, that there was still some time to reverse things, to save me.  My poor Mum and Dad.  All I could think about, was them.  This was it.  This was really it.  I was at my own funeral

And then they came back.  They looked at me, and I looked back at them.  For a very, very long time.  Who were they?  I couldn’t speak.  Nor think.  I had been swooped over by dysphonia.  I could no longer recognise anyone, no longer put face to name, name to face.  My Mum was unrecognisable and my Dad was a complete stranger.  Yet, when they tried to explain to me their day’s event – the pizza restaurant they had quickly stopped by at, the wild plants that grew in the hospital courtyard, their faces began turning a ghastly shade – he turned into the face of a pizza, his eyes puppet-like and pepperoni.  Then his hair turned green with spikes, weeping out like weedy leaves streaming from the ears, before growing a beard, which quickly turned grey like Grandad.  That’s when I knew.  He had visited me every single day.  He stood close at my bedside and smiled quietly, composed and polite, warm and handsome.  This had to be the love of my life, surely

But I soon forgot him.  The guards came back, with guns and plastic sheets.  I saw the same police officer that had picked me up from the tarmac a few weeks before.  He kissed me on the forehead, saying sorry that he couldn’t do anything more.  Who knew if I truly had a sister, and why would I know my own birthday?  It was the year 2024 and I had been so tired the night before that I had slept through ten years of medical school and foundation training.  I would never make it to qualifying as a doctor after all.  Had I slept on this sticky tarmac all this time?  And that fear, humiliation, hit me like the swing of a concrete boulder, a wrecking ball.  I shrieked.  I was so petrified that my voice bellowed into the vacuum that surrounded me.  But it was high-pitched and shrill-like.  I had turned into the voice of the sheep that flocked the sweet-green fields back home in Wales.  I was no longer human

It’s perhaps worth mentioning at this point then that none of this above in fact happened.  Instead, this was all just part of the horrific delirium I suffered in one of my worst admissions to Intensive Care yet.  This was my 10th ICU admission out of 13 – intubated and ventilated for a fortnight, in the unit for three weeks, transported between two hospitals, and ravaged by respiratory failure, pneumonia and sepsis.  All whilst being in a foreign country.  I still have daily flashbacks from all these hallucinations and delirious events, and I wake up frequently having to remind myself that none of this was real, none of this really happened.  But perhaps what scares me most, is not the series of delirious events themselves, but not knowing what did actually happen, what was real, whilst I was going through this.  And, as a result, my next 3 admissions, bringing my latest admission being only a month ago, were only built upon more by the delirious experiences I encountered in my 10th.  I screamed to them not to take me back to Italy, (where my 10th admission was), I bit my parents’ fingers and tried to pull all my lines and tubes out.  At one point, after being extubated, I was so confused that my gaze was undoubtedly fixed – I couldn’t shut my eyes, ironically due to the extreme tiredness.  I thus witnessed a nurse slapping a porter in the middle of the night, and the trolley tables rising up into the air, turning green and rotating.  Again, none of this really happened. 

It’s interesting though, how, what happens around the critically ill patient and how these happenings influence and build up the delirious picture that they may or not experience as a result.  My hallucinations of the car accident and the deceased driver being sucked into a black hole slow-motion may’ve been caused by a story my parents had told me – their own ordeal, whilst I was still sedated.  Having been called out to Italy from their home in the UK, to see me in hospital, they drove over a bridge in Genoa, which, only a few hours later, crumbled, taking the lives of 43 innocent people.  That still makes me shudder.  My ability to see every single invasive procedure in my own reflection, the heart surgery, the removal of my brain, may’ve well been all due to the fact that I’m a medical student myself, perhaps knowing a bit more than I had liked about what was truly happening to me during my critical illness.  And the garage doors and aeroplanes – being transported in a land ambulance for 2 hours, between the first hospital I was admitted to, in Lavagna, to the second hospital, in Milan, all whilst being on a ventilator in between, were probably the cause for thinking I was trapped in a box, or in the hold of a Boeing 777.  What I sadly can’t justify is the gentleman I met during my hospital stay.  I was so convinced that I had fallen madly in love with an Italian gentleman that, upon returning home, and eventually being able to navigate social media again after a few weeks, I trawled through my contacts desperately trying to find Ricardo’s number…he sadly did not exist.  It was indeed all part of the delirium.

I was so oblivious and unaware to what delirium was and how it affected patients before experiencing it personally myself.  Since the worst of my delirium, I have suffered ongoing problems with a lack of sleep, short-term memory loss, flashbacks and nightmares, lack of concentration and, to some degree, a heightened sense of fear for death and dying, which is particularly frustrating for a medical student who very much hopes to specialise in the field of Palliative Medicine someday.  But, now I know how traumatic and debilitating delirium can be for patients, I am so passionate and concerned for raising awareness and broadening research around the subject of delirium for the better future of patients.   

The lack of sleep and the complete mess up in the patient’s body-clock is one substantial factor that can contribute to delirium, for starters.  Using sun-lamps during the day and eye-shades at night could thus help normalise and regulate the circadian rhythms and sleep patterns in patients whilst they are in the ICU, whether they are intubated or not.  Disposable ear-plugs are just another aid staff can give patients, to help trick their bodies into when it is necessary to sleep and ‘switch off’.  It also helps cut out distressing noises that could heighten or trigger aspects of delirium, such as machines and beeps, but also including the use of traumatic words during ward-rounds, such as “died”, “life support”, “fatal”, and so on.  I certainly know from my latest admissions that the slightest sounds from the monitors stressed me out greatly, the loud-closing bins startled me, and hearing the words of death and dying continuously around me during ward-rounds made me feel sick, lost and hopeless. 

All I was desperate for was exposure to reality, normality.  Without being near to any windows, and only seeing artificial light, I never knew what day or week we were on, let alone time of day, or night.  Being stuck indoors meant I hadn’t breathed ‘fresh air’ in for so long that I felt suffocated and institutionalised.  And, when I was discharged onto a general ward and eventually granted day-leave when I was a little better to go home for a few hours, I burst into tears, just from hearing the radio in the car for the first time in a very long while.  Because the radio, to me, meant normality, an outside world, people going about and discussing their normal, everyday lives.  So play the radio, play the music, to your patients.  And, communicating – this is the utmost important thing one could can do when trying to calm and reassure a delirious patient in the hospital environment.  Whist I thought people were hurting me, imprisoning me, doing unnecessary scientific experiments on me, it was because nobody ever introduced themselves to me, or told me what they were doing.  This was admittedly perhaps due to a language barrier, during my ICU admission out in Italy, but if you tell your patient that you are washing their hair, or putting some nice, warm socks on their feet, then use the softest, most positive language and they are less likely to assume, imagine and thus hallucinate that you are packing them up in boxes, tying them to the bed, threading metal poles up their noses, and so forth.  And, especially whilst patients’ senses are extremely heightened, both by their critical illness physiologically, and the concoction of drugs they are pumped with, simple noises will appear far louder, simple movements or transits within the bed, will appear more violent, more animated.  Go gently and explain everything in the process.  

I can only hope that by sharing just a snippet of my recent encounters with delirium can help others get a snapshot for what delirium really is and what it really means for patients.  It is terrifying, traumatising and in most cases, long-lived, but also very much so in those who witness patients suffering delirium real-time – the patients’ relatives and friends.  Raising awareness and improving research in order to find an answer for management and prevention is thus key.  Let’s come together this World Delirium Awareness Day 2019 and do just that.  We can only start doing this by sharing these stories and having the delirious experiences of patients personally heard. 

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