Updated: May 3
May 2, 2020
They laughed and cursed, viciously pushing me along, a brutish glee lighting their concealed plan. The moon was full and glaring, with a frightening red haze seeming to drip from the edge of the lunar planet. Strangely cloaked in the dense shadows behind me, two ghoulish visages hid from my terrified mind. A pungent, burning smell overwhelmed me, as a bitter wind howled through an invisible line of trees in the distance.
The propeller roared, scattering debris around me. The plane was small and rickety, the tiny door dented, with shards of missing paint, chipping away. The plastic window was torn and dangling, the craft shaking before me. Rudely, I was thrust into the rear of the craft, scattered objects cluttering the space, and that smell tormenting me so.
He was a tall black man in a small crowded space. Exceedingly thin and gray, he sat in silent apprehension, a layer of sweat shining on his dark face. He wore a grizzled afro, an unshaven stub of a beard lining his pathetic countenance. The jazz patch contrasted strangely, as the only manicured element on this anxious being. Thick black glasses adorned his tormented face, and he sobbed quietly.
Like the jazz patch, it was meticulous, a shiny black clarinet standing upright between his quivering knees. Soft, delicate hands seemed to caress the instrument, like a baby in a mother’s arms. A long black hand reached for the man and grabbed the clarinet, the shadowy villain now howling in derision, as he threw the object of love out of the plane. The jazzman was destroyed, his shoulder’s slumping with gasps of sorrow as if his last ray of hope was now gone.
The vacation, from my busy urologic practice, was needed. The time sped along, white sandy beaches and crystal blue surf, characterizing the week. My family and I indulged ourselves. Fun, food, and play rejuvenated our lives.
I suffered in silence upon my return, ill but practicing again. When I awoke with a shaking fever, I realized my mistake. I was intubated within hours of my emergency room visit. Resuscitative fluids and intravenous drips of pressors were infused in response to dangerous hypotension. Respiratory failure with hypoxemia overwhelmed me. A delirium laced six weeks of ICU torment began that day.
The plane roared down a bumpy rock-strewn runway as it repeatedly tried to leave the earth. Once aloft, the craft struggled to gain a feeble altitude. They were fighting now, screaming ridicule tossed between the two shadowy beings. The pilot spat as he shouted obscenities at his angry associate. A. darkened, sinuous hand, reached across the cockpit and viciously grabbed a greasy cloth-wrapped package.
The landing was violent, the two unschooled beings tossing back and forth as they tried to coach our vessel to safety. The plane’s nose was now rudely thrown down, myself and all occupants thrown forward in a heap.
The moon was back, dripping with the red blood cast. Deep shadows covered our path through a grassy weed invested field. Steaming, water-filled pools of muck, littered the way. The stench, that bitter burnt aroma sickened me.
“You, on your knees,” the co-pilot yelled. Out of his belt, he produced the greasy package, unwrapping a frightful possession, and tossing the cloth to the ground.
The jazz patch man began crying, whining a querulous exhortation. “But I am innocent,” he screamed.
“Your crime was silence, accepting it all.” The pilot wrestled the black handgun from his minion. The shot echoed a damning retort though the night’s air, blood, and bone cast across my tortured face.
I was to spend forty days and forty nights in an exceptional, and well-staffed, Kaiser Riverside ICU bed. When I awoke, I was terrified. Anxiety ruled, hysterical fears and a feeble lack of control, plagued me night and day. My hands were weak, unable to even depress a nursing call button. I felt trapped, imprisoned alone, in a foreign room.
The demon filled visions dreamed on. They were real to me, a horrible reminder of the ventilator-dependent days. While I considered little of this condition in the past, ICU psychosis in this setting was now a vivid reality.
Studies suggest that up to 87% of ICU patients suffer from this psychotic syndrome. The overwhelming lack of control, for even a brief visit, suggests to me that most patients have one sequela or another. Visions and hallucinatory dreams still plague me to this day, but anxiety, hopelessness, and depression are real conditions in the ICU patient.
It seems to me that the ultimate cause of this malady is the result of a devastating lack of control, witnessed by myself so long ago. Drug effects are powerful, side-effects myriad, and time stands still. Treatment is inherently painful, and sleep is fleeting.
Ultimately, ICU psychosis is inherent in the fragile state. Realize, however, that everyone has an irreplaceable role. From the compassionate attending physician, the noble, self-sacrificing nurse, to the altruistic hospital staff; awareness of this condition is vital. Dimmed lighting, quiet rooms, sleep intervals, and awareness of drug effects, therapeutically seem to me a bare minimum. A patient’s control of their environment requires a concerted team effort, and recognition of this critical syndrome is mandatory.
 Cavallazzi R., Saad M., Marik P. E., Delirium in the ICU: An Overview, Ann. Intensive Care, 2(49(, 2012.