Critical Care

By Max Mulgrew

An impossible place to wake –

sulphurous light, a devil in my throat,

a boiling sea of beds.

I was someone drifting, afloat

on steaming oil, past hawsers and bollards,

sepulchral docks, cranes and ships,

monitors, chest drains, arterial lines,

pacemaker wires, catheters, intravenous drips.

I heard a nurse shout 'oh God, no'

and the team flooded round

a drowning mermaid I would never see.

Scientific Statement

I awoke from an induced coma in a critical care unit following lengthy open-heart surgery to replace my faulty aortic heart valve. The ventilator tube was still in my throat, and I had multiple lines and tubes inserted into my body. My heart had been stopped during surgery, so I had been chilled and attached to a heart by-pass machine to protect my vital organs.

Patients who undergo open-heart surgery, particularly for valve replacement, frequently suffer post-operative delirium (POD).  While POD is most prevalent on the first day after surgery, it may start later and may last several days. It can affect the patient’s recovery, may lead to longer-term problems, and is associated with a higher rate of mortality.

While suffering delirium, I was in a huge gymnasium that seemed to go on forever, then at endless Liverpool docks (to which I have no connection), with doctors looking down at me under industrial lighting.  There were no windows, and I became obsessed about time so a big clock was hung by my bed to appease me, but I still did not know whether it was nine o’clock in the morning or nine o’clock at night.  The risks of suffering POD are increased by prolonged heart-lung by-pass during surgery, blood transfusion, induced hypothermia during surgery, and the conditions in the critical care unit, which can make it difficult for the patient to know whether it is day or night.

As I lay there, I heard a shocked nurse’s words as she realised the woman in the next bed had pulled vital tubes out of her body. It was an understandable reaction from a dedicated medic who was caring for critically ill patients. I learned later that the patient I never saw had died.

Bibliography

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Gibbison, B. (2019, June 18). Is it normal to have hallucinations after heart surgery? British Heart Foundation. https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/ask-the-experts/hallucinations-after-heart-surgery

Tehranineshat, B., Hosseinpour, N., Mani, A., & Rakhshan, M. (2021). The effect of multi-component interventions on the incidence rate, severity, and duration of post open heart surgery delirium among hospitalized patients. Journal of Cardiothoracic Surgery, 16, 32. https://doi.org/10.1186/s13019-021-01422-0

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