Here's a picture of my Mom. She's been in the hospital now for 30 days, 18 of those spent in ICU. She's still in ICU, but word from the nurse is that she will get sprung tomorrow to a regular room. Physically, she is doing well. She has been able to come off the ventilator, her breathing is good, her innerds are all working and she seems to be rallying. Her mind left her, though, some time back. I know exactly when it happened. I have been at the hospital no less than twice a day, and for many days, all day, since she enrolled there. She was initially always responsive to me. Always. Then one day, she wasn't. It happened a week ago last Saturday. It was a marked change. She no longer squeezed my hand, she didn't open her eyes much, and when she did it was with a very unfocused, fleeting gaze. I was a bit worried that she'd had a stroke or something. I kept asking the nurses if she was responding to them. She wasn't. She seemed to sleep more.
So, as she began to show physical signs of improvement, she was less aware, less engaged, less responsive to any stimulation. Then, finally this past Saturday, she was successfully extubated (off the vent) and breathing on her own. The diprivan she had been getting for the past 17 days to keep her comfortable and sedated, was discontinued to make sure she was awake enough to breathe and respond. When I walked in the room a few hours later during visiting time, she brightened up and said, "You wouldn't believe what these people have done to me!" and that was the last coherent thing I heard from her. I tried to explain, as had the nurse, that she was in the ICU and had been there for quite awhile and that it was now December. She was unable to sustain attention to the shortest of explanations. She was gone baby gone. So, things got worse. She became agitated, tried to break the finger of a nurse, pinched another nurse (it WAS a cute male nurse), and spent much of her time moaning and writhing in the bed. Only restraints on her arms kept her from doing more damage. She required more sedation. This morning, when I called from work, the day nurse said that they had called in a neurologist to assess her to see if she'd had a stroke. I was pretty doggone sure it wasn't a stroke. This was ICU-crazy, dementia, delirium.
So the neurologist, a handsome laid back kind of guy, ordered an EEG and CT scan today. When I went in this evening, he told me that she had not had a stroke, and this was stress. I told him I agreed with his diagnosis. They had given her Haldol at my urging earlier today, and she had become a bit more lucid, but developed restlessness. She was actually much better with me today. She was able to pay attention but she said very little. Her speech is all run together, quiet, and sounds like she's had a stroke or a hearing loss. She nodded her head most of the time when I asked her a question. She rolled her eyes, made good eye contact, and attempted a couple of smiles at my lame jokes. I closed the sliding door to block out some of the ICU noise, closed the curtains to some of the stimulation, and talked quietly to her about everyday things, grandchildren, weather, meals I cooked over the weekend. I think it helped. The EPS was the most bothersome thing. Just before I left, the nurse gave her some paid meds and she settled down. I had unstrapped one of her hands, and I left it unstrapped. She was able to lie on her side, and at least that gave her some control where she hasn't had any at all over her body for the past month.
So, the good news, is she gets to go to a regular hospital room tomorrow. I'm going to take off from work and spend the day with her, and the night too, if she needs it, and see if I can't get a little more normalcy in her life.
This ICU delirium occurs in up to 80% of intubated ICU patients. Most of the time it's a quiet, withdrawn type of delirium but sometimes it's this more agitated or mixed state. It usually goes away when the patient gets out of ICU and most return to normal functioning. It's under-recognized and not always preventable when it's a choice between saving a life or having a crazy person emerge. Hopefully, we are coming to the end of this saga.
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