ICU Psychosis and a colorful episode
Another problem associated with critical care units according to the medical literature is what's been called ICU psychosis. In other words, the design of intensive care units actually causes a number of different psychological aberrations, such as psychotic paranoid delusions and hallucinations. Several theories are floating around, but the consensus is that this happens from a combination of the drugs, constant noise, and continuous bright lights. We also see this more often in patients who have had cardiac bypass surgery and those who survived after a cardiac arrest. Besides whatever effect the cardiac interruption seems to have, it is maddening to be stuck in bed, loaded with multiple drugs, exposed to constant bright lights, and surrounded by ventilator noise, electronic beeps, and loud talking nonstop around the clock. Most of my ICU patients have told me they felt like screaming after one day even if they were not psychotic.
The example that most stands out in my mind was a forty-eightyear-old printer I'll call Norman. He was a patient in the coronary care unit at Bellevue Hospital, where I was working about seventeen years ago. One day his heart gave out while I was standing at his bedside. We were all over him in a few seconds, and he survived. His heart stopped three more times, and we were able to revive him. After he stabilized, we took him off the ventilator and removed the tube from his throat. He was making considerable progress, getting stronger every day. The wife and the girlfriend became good friends, with each respecting the visiting rights of the other.
After twenty-five days of normal behavior, Norman started to become combative, and we had to restrain him. Although he still cooperated with me, he would grab my arm or shirt and plead, "Don't let that man get near me!" His face showed stark terror, and he was pointing to Dr. Fox, a world-renowned cardiologist and professor at NYU Medical School. This episode lasted about two weeks until Norman suddenly reverted to his usual self. When I asked him if he remembered anything, he replied, "I believed that I was Superman and that Dr. Fox was Lex Luthor and that he was conspiring to kill me by putting liquid kryptonite in my intravenous line."
"Did you see anything unusual?" I asked.
Norman smiled, hesitated for a moment, and replied, "Dr. Fox was hanging around outside my window."
"Didn't you wonder how he could do that? Your window is on the tenth floor, and there is no ledge or fire escape."
"He was wearing his antigravity belt."
While not all episodes are so colorful, they are disturbing to the patient and family. The best way to deal with this phenomenon, aside from remaining with the patient as much as possible, is to equip the patient with soothing music through a headset. If allowed, familiar items from home might also help, such as framed pictures, favorite souvenirs, keepsake items, religious objects, and so on. Additionally, a portable DVD player with headphones or a laptop computer might offer some pleasant distraction from the surrounding monotony.