I’ve worked in this intensive care for 26 years and for the last 20 years of that we’ve been following patients up, looking at their experience of being critically ill, and the experience of the family, and also the impact that has on their recovery.
I look after level 3 and level 2 patients – so that’s patients needing organ support, and also to be able to treat [them] we have to use some sort of restraint… which means that we use sedation. And in our experience of interviewing patients after a critical illness we’ve found that a percentage of them have nightmares and hallucinations and then can go on to have acute post-traumatic stress disorder…
With follow-up we try to learn from patients’ experiences and then try to look at the front end of that, how we look after them now, and is there anything we can do to reduce, prevent, minimise, the effects or causes of sedation and related hallucination.
In our experience we find that if a patient is very young and suffers with sepsis, regardless of what that sepsis cause is, they tend to – their brain gets affected by being critically ill and being septic as well, and then on top of that what we then do is add sedation and analgesia, so that kind of makes it – increases the intensity and the incidence. So there are groups of patients that will be more susceptible. Often we find patients that use their executive function in their daily working life, so maybe managing directors, people that are maybe – controlling, for want of a better word, find it really very difficult to go through critical illness, so they’re challenged because of it and they tend to get quite bad hallucinations as well. They’re often really intense – so very vivid, and often very colourful, and we’re not talking insipid colours – they’re always really vibrant colours, so the colours that spring to mind are like the fluorescent turquoise, greens, oranges, those sort of colours. And they will often have persecutory hallucinations. And also they may well have Capgras hallucinations as well, where they may see aliens or they see human bodies with a horse head or something like that…
I’ll always say that patients we have here that are critically ill, you couldn’t be more – can’t be sicker and still alive, and I think there is a sense that your soul knows the closeness of the call. So often people in the past have definitely said that they’ve had you know walking down a tunnel they were in the dark and they saw the light at the end of the tunnel, and they were walking through mud, and one man said that he felt the grim reaper breathing down his neck and he kept saying ‘no no no, not yet not yet not yet’… so [with] patients, even though they look asleep to us, you can’t sedate the soul, you can’t sedate your mind; you can sedate physically but all that is still very active.
We’ve had some recently that was… it was in a game and they had to get the questions right – they were life and death, and they had to get the questions right to get to life and if they got the question wrong then they’d be going back to death – this woman was telling me; she was perspiring when she was telling me, and her heart was beating; you could see she was re-living it, and saying ‘I had one question to get my life… thankfully I got it right’. And she told me the question and said ‘ever since, I can’t remember the answer… I always have to google it to find out what the answer is, so why on earth I would have remembered that I never know’. But she said ‘that was the moment.’
She did have a near-death experience because she was very very very sick, and near to death at that point, so that correlated. And that was awful to hear, just awful.
So after we see them in clinic, we often invite them at the right time to come back and see the unit, and we go through their notes. For them that’s a revelation, because what has been happening to them is in here [in the mind]…so when they come back from their one-to-one, they’re learning it as it truly was, and it’s a complete shock for them – but it helps …them divide the real from the unreal; sometimes [when they come back to the unit] they can hear, and they can smell things, and see things that …they can then link to their hallucinations and see the reality of it …and learn coping strategies so they can think ‘actually that was a hallucination’ – but we never say it’s not real because it’s kind of imprinted on their hard drive, if you like, so it will always be there – that’s why they can recall them with such clarity, and such feeling really. That never ceases to amaze me – how somebody ten years ago can recall their hallucination and get just as teary today as they first re-told it ten years ago. They’re very powerful, very deep, very emotive.