Those were the first words my father said to me in a 4.00 a.m. phone call during late September of 2011, two days after he underwent a massive heart bypass operation.
He went on to tell me that the walls of his ward were changing shape and that a "ragged clown" was sneering at him from the shadows. Dad was terribly afraid and upset and he begged me to rescue him.
At this stage I should mention that my Dad, who was 75 years old at the time he was felled by the heart attack, had never shown the slightest sign of dementia. He wasn't a drinker and certainly never took drugs. He had been alert and lucid during the week leading up to the bypass operation.
Hearing him spout paranoid nonsense over the phone at 4.00 a.m., I could only assume that something had gone terribly wrong with the surgery and that my Dad was now, suddenly, insane.
Welcome to the world of postoperative delirium, a.k.a. "hospital delirium", "ICU delirium", "ICU psychosis" or just "midnight madness", which I was fortunate to be able to identify via frantic Google searches after reassuring Dad of who and where he really was. "Fortunate", because our family was given absolutely no warning nor information about this syndrome, which afflicts a very large proportion of elderly people who survive serious surgery and spend time in intensive care units.
Post-op delirium is caused by a whole raft of factors in combination; sleep interruption/deprivation, the inflammatory effects of illness, the cocktail of heavy anesthetic and analgesic drugs used to manage physical pain, day/night disorientation, the stressful environment of an intensive care unit, etc.
One of the most extraordinary things about post-op delirium is the dismissive attitude towards it that has seemingly built up in "medical culture". Prior to about 2000 it was hardly studied, being simply taken for granted as an unpleasant but transient and "normal" side-effect of ICU care for people aged in their 70s and older. Astoundingly, it's only over the past few years that medical professionals have started to take it seriously and consider ways to prevent or at least reduce it.
It's sometimes spoken of in soothing terms as "a period of confusion". Don't believe that for one second. A "period of confusion" sounds like a gentle thing, like not being able to keep track of what time it is, or not being able to complete a crossword puzzle. Post-op delirium sufferers often experience terrifying hallucinations and delusions such as kidnapping by aliens, deadly conspiracies among the nurses, bugs and spiders crawling on their beds, being turned into zombies or stalked by monsters. They may become violent or attempt to remove their catheters and IV tubes. The hallucinations are typically worst at night, can continue for up to a week or more after the surgery, and have been known to trigger PTSD flashbacks up to a year after the surgery.
Sadly, post-op delirium is also linked to permanent declines in cognitive function and to drastically decreased quality of life via depression, etc. Some people make full recoveries over time; others, like my Dad, do not.
On the chance that any medical professionals read this;
* If you're not already familiar with post-op delirium, educate yourself.
* Before the surgery and stay in ICU, inform a level-headed member of your patients' family about the realistic likelihood of their elderly relative being afflicted by this syndrome and what they may be able to do to help.
* Please, do whatever you can to ease your patients' psychological suffering in intensive care.