Confusion: held prisoner by Nazis? Or watching a Bollywood romantic comedy? Neither…exactly.

Jordon experienced a condition I had never heard of until conversing with him: ICU psychosis, a disorder in which patients in an intensive care unit (ICU) or a similar setting experience a cluster of serious psychiatric symptoms. Another term that may be used interchangeably for ICU psychosis is ICU syndrome.  Speculations about the cause of ICU psychosis include the patient’s inability to tell the time of day, since ICUs are often windowless; sleep deprivation as a result of the constant noise from the medical machinery and the incessant interruptions to take one’s temperature, draw blood, check blood pressure, or administer medication; or a feeling of helplessness that comes from being under the control of authoritative strangers, all busy poking, prodding, telling people what to do, and having incomprehensible conversations about one’s health. Fortunately, the condition seems to be transient.

In Jordon’s case, after being in a coma he awoke in an ICU and became convinced that, among other things, he was being held by Nazis in a WWII prisoner-of-war camp. Here is our conversation:

What caused your coma?

I had surgery to replace my pulmonary valve.  Overnight, I developed a large orange-sized blood clot that pressed against my organs and threatened my life.  They had to do a second surgery to remove the clot.  They kept me in a medical coma to give my body time to heal.  They also believe I may have had more than one stroke during that time and I probably had pneumonia.

How old were you at the time?

34 years old.

How old are you now? (If you don’t mind saying.)

40.

How long were you unconscious?

Eleven days.  It took more than another week to fully come back after they stopped the sedation.

If you remember, did you wake up all at once or  was it more like coming out of anesthesia, starting with semi-conscious, then groggy, and on to full awakening?

You don’t really wake up.  There are moments when you can see the room around you.  Maybe you can hear a voice.  Time is meaningless.  The clock, if you can see one, spins like in a cartoon.  There’s no window.  Lights come on and go off at any time of day.  Eventually, the amount of time you’re awake is long enough for people to talk to you.  Even then, you can’t remember one conversation to the next.  Then you start to be able to talk.  You won’t make any sense, though.  Eventually you sit up, see out a window, maybe even walk.  Time starts to matter, and then it becomes an oppressive jailer.  For twelve to fifteen hours a day, you’re completely alone.  Sleep doesn’t come in any regular manner.  So you sit in the dark, watching nurses pass by your door.  And then one day you’re more awake than asleep, you walk to the end of the hall, you eat a sandwich from your favorite deli, you get your ipod and watch TV (just sitcoms, dramas are too confusing), and a neurologist says, “Glad to have you back.”

Did your psychosis manifest itself as soon as you regained consciousness or did it come on gradually with your time in the ICU?

Lack of sleep, an inability to see night and day to create regular rhythms, and monotonous stimulation all work to disorient the mind.  It happens to people in ICUs, to prisoners in solitary, and to those guys in Gitmo who had earphones on and black bags over their head.  In experiments at universities, a student in a sensory deprivation chair could begin to hallucinate in as little as three hours.

You said your psychosis took the form, “among other things,” of thinking that you were a WWII POW being held by the Nazis. What were some of the other directions your psychosis took? What was the first?

Did you switch back and forth between delusions several times a day, or did each delusion last for some time, to be replaced by another?

Did the delusions repeat or were they one-time-only events?

My delusions were not consistent.  They rarely are in psychotics.  What was consistent was an overwhelming paranoia, and  visual and auditory hallucinations that were indistinguishable from reality.  So, I imagined that I watched an entire movie about an Indian con man who gets money from wealthy Indian families to bankroll movies that he is supposed to make, starring their relatives.  But he falls in love with the daughter of his latest marks.  So, he tries to actually make a real movie around her.  She finds out, big climax, and they end up together.  THIS IS NOT A REAL MOVIE.  I never saw it.  But I looked at an area where there was no television and imagined the whole thing.

Most of my delusions were not nearly so pleasant.  I thought I had died and that I was in hell.  I thought that my nurse was mad at me because I had “gone corporate” by selling my play Wicked to Broadway producers.

And, I believed I was being held by the Nazis and that the entire hospital thing was a ruse to get me to reveal secrets about the Allied plans.  In fact, I attempted to confess and spilled a great number of details about the Manhattan project before I was sedated.

Were you able to see and recognize friends and family members during this time? Who did you think they were?

I recognized everyone.  It’s just that I couldn’t interpret anything correctly.  I thought they were trying to kill me.  I thought my sister was a Nazi spy.  I spent an entire day refusing to have my mother in the room.  I tried to attack and strangle my pregnant wife (which would have been frightening if I were strong enough to even sit up in bed.  She thwarted my attack by sliding her chair a little farther away.)

What have they told you about how they experienced this time in your life?

They didn’t enjoy it.

How did the medical staff react at first to your delusions?

You know, this is one of my biggest complaints.  The doctors care about one thing only – whether you’re alive.  If you are alive and you have no immediate plans to die, they lose interest.  The nurses really care only if you’re taking up their time.  If you’re not in pain and can feed and toilet yourself, they leave you alone.

The few things that could have helped me – keeping me near a window and opening the shades during the day, keeping me company, talking to me as much as possible, making sure I was hydrated – were not done.

Instead, I was medicated when I made too much of a scene.  At one early point, after I pulled my IVs, feeding tubes, and Foley catheter out, I was put in restraints.  It was necessary for my safety.  But more could have been done.

What sort of medical treatment were  you given for your psychosis? Was it all pharmaceutical or did they also take you out of the ICU to show you that the “real world” was still there?

Drugs.  Time and drugs were my only treatment.

Do you ever worry that your psychosis might return?

The last time I went in for a procedure, I wrote myself a long note that everything was fine and I should trust my doctors.  I woke up the same day, though, so I never got to test it.  I’m sure if it happened again, I wouldn’t be able to understand or appreciate the note at all.

In another context, you have mentioned that you are originally of Jewish heritage. Do you think that influenced your particular delusion of being in the custody of Nazis?

When I was in eighth grade, my English teacher told us a story from either a book or a movie, I don’t remember which.  An American aviator was shot down in World War II and woke up to find himself in a stateside hospital, having been in a coma for some number of years.  The officer was assured the war was over and that everything had turned out well.  He was asked offhand questions about his mission and his memories of the military.  However, he noticed a scratch on his face from when he had cut himself shaving before his flight.  He realized it was all a Nazi trick to get information out of him.

If this sounds familiar, it was basically stolen for the Star Trek: the Next Generation episode “Future Imperfect.”

In any case, this story was most certainly the source of my delusion.  During my psychosis, I remembered the story and it was how I “figured out” that I was really being held by the Nazis.  The words “figured out” can be replaced with “invented out of nothing.”

Many people have described experiences like yours as “life-changing.” Do you see it that way, and if so, how?

I’ll put it this way.  I was in the hospital a total of 23 days.  And those 23 days represent about one out of every five of my memories.  There isn’t a day that I don’t think about it.

More about ICU psychosis:

When a Stay in Intensive Care Unhinges the Mind

Does “ICU Psychosis” Really Exist?

**Information is gathered with the subject’s knowledge and consent.**

**The subject has the opportunity to review and correct the interview prior to publication.** (more…)

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Published in: on May 11, 2011 at 1:50 am  Leave a Comment  
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Still under construction

Still searching for the right story for my first post here – anyone who has suggestions about interesting articles, please feel free to post a comment.

Published in: Uncategorized on July 5, 2010 at 6:05 pm  Leave a Comment  

Pardon me, may I ask…

I see lots of people who interest me, and I want to know their stories. With this blog, I am going to start asking them for those stories and posting them here. If you have someone you have always wanted to ask about, leave a comment and let me know. I’ll do my best to find out for you.