ICU psychosis might be one of the more comic aspects of my job. Mostly because I'm slightly mean and it is actually hilarious to encounter these folks in their delirium.
Consider Mr. You-Better-Take-Me-Seriously. He, in his altered state, ardently believed that he deserved a cocktail and deserved it now. It probably was close to 5 o'clock but how would he have known that?....Anyways, he's screaming at every person who walks by that he "need a martini! On the rocks!"
ICU psychosis is a condition that some people develop as a result of constantly being woken up for procedures, having the lights on at all hours of the day, and soon losing track of whether it was 1 am or pm. Because we draw labs at midnight, tend to do baths at 3 am, and re-assessments at 4 am, you can imagine how much restful sleep one gets.
So we indulge Mr. You-Better-Take-Me-Seriously and give him an empty cup, telling him it's his martini just like he wanted. (And the funnier part is that going along with it often puts them at ease). He started sipping his empty glass, saying it "hits the spot". He was content and only then began to tell us tales that seemed to be a compilation of Vietnam war stories and vignettes about his house full of cats. It ended up being a fusion of war-ready felines and it was hilarious.
Usually we put patients on a sleep-wake cycle, which generally means that you aren't supposed to wake the patient up from 11 pm to 5 am to do baths etc. This is usually feasible, except when the patient is on the neurosurgery service and has to be woken up every hour for a neuro check. A neuro check consists of asking them simple questions like their name, where we are right now, and what's the year or who's the president. It takes one minute but you can probably guess that patients are ecstatic when you wake them up to ask them if they know their own name.
Little Miss Precious-Old-Lady was just that. Precious. And 79 years old. She was delightfully confused black woman who had ICU psychosis and waved to everyone walking by. She was restrained so it ended up looking like she was having a spastic hand cramp under the sheet because she couldn't lift her arm off the bed. But she wasn't phased by this. She looked at everyone who came up like she had known them for years and was so pleasantly surprised by their visit! One time I simply looked at her with a big smile and she said "I love you too dear!" We don't get that kind of affirmation from our patients often so I laughed out loud and told her I loved her too. Precious.
She wised up to the fact that we were asking her where she was every hour...and that she couldn't remember.
"Miss Precious, do you know where we are right now?"
"Yes"
"Where are we?"
"Here"
"Where's here?"
"This building"
"What kind of place is this?"
"A business"
This went on for a while as she cleverly tried to maneuver her way around her own dementia. You've got to give her points for trying.
All in all, you have to wonder what you would say if you were in the same spot. Would you tell your biggest secrets or talk about your family? Would you be pleasant or onery?
I think I would tell everyone I love them... just like I do when I have one too many. But I would be pleasant and I hope people would indugle me.
I think Little Miss Precious and I could be good friends. You've got to the love the old people in your life. Because even if they are confused, they have lots of love to give. So give it back, because one day we will all find ourselves in the same spot...probably asking for a cocktail.
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