Dreams and visions

I’ve shared elsewhere in my blog how on 2nd September 2016 I collapsed with a previously undiagnosed “Triple A” – abdominal aortic aneurysm. You can read the story here
https://notanormalvicar.blogspot.com/2017/05/nhs-i-owe-you-my-life.html

But up to now I’ve not shared much about my experience on the ICU ward at Southmead hospital. What follows is an abridged version of a talk I gave to the annual general meeting of Willows Counselling Service covering my time in ICU and the impact it had on my mental health. It's purely based on my experience. And it may be that a little knowledge from the internet is a dangerous thing! But in researching the topic, it has helped me find some answers.

Willows AGM - Dreams & Visions

Following surgery at Southmead I was transferred to the Intensive Care Unit and placed in a medically induced coma. And by all accounts one of the challenges was that I was fighting the sedation, so I was on some powerful stuff!

Now I promise this isn’t meant to be a synopsis of an episode of Casualty. I am getting to the point of my talk this evening. “Young men will see visions; Old men will dream dreams”

That phrase comes from the Bible. From Acts of the Apostles chapter 2. It is a phrase spoken by Peter on the Day of Pentecost.

17 ‘“In the last days, God says,
I will pour out my Spirit on all people.
Your sons and daughters will prophesy,
your young men will see visions,
your old men will dream dreams.

And when I was asked for a title for my talk, that phrase “Young men will see visions, Old men will dream dreams” popped in to my head. Because what I want to share with you is a flavour of the “dreams and visions” I experienced during my time in ICU and what that meant for my own mental health. And I hope that by sharing it may give some of our counsellors some insights, or at least an understanding, of the trauma ICU patients can face.

ICU

As I say, I was heavily sedated for about 3 weeks. During that time, I had no real sense or recollection of what was going on or who was visiting.
But my brain was clearly very active because I experienced many dreams and hallucinations. Though these weren’t dreams and visions inspired by the Holy Spirit!

All of us dream, don’t we? Some of us remember our dreams. Some of us don’t. I remember most of my dreams normally. But the dreams I had in ICU were like nothing else. Some were dreamlike in that they were funny and pleasant. But others were scary and frightening nightmares. They were vivid, colourful and very lifelike. In fact, like nothing I’d experienced before or since.

They very fact that the dreams were so vivid and “real” caused problems later. For example, for some reason in one of my dreams a male nurse was black mailing me. But as I regained consciousness and this nurse treated me I was scared of him. Though I couldn’t express this as I had a tracheotomy.

And another dream which had real consequences – to me at least - involved me being booked on a flight to the USA on 21st September to go out to be treated by the top specialist in the world for my condition. All arranged by real American friends.

By this stage I was again semi-conscious, and I was trying to write notes for my wife to explain I was flying to America. She thought I was referring to a holiday we were supposed to be having at the end of September to coincide with our 30th wedding anniversary. Not being able to tell her about my “flight” to the USA was very frustrating.
There are many more dreams I can recall. As I say some very funny and some horrible. But I don’t need to go further. I’ll keep them for my novel!

I was transferred from ICU on 27th September – our wedding anniversary. I spent the next month on the vascular ward at Southmead and a further 3 weeks in Chippenham hospital. I was finally discharged from hospital in late November – after almost 3 months.

Dreams, hallucinations or psychosis?

As I said earlier, the reason for sharing this is to give you as counsellors and supporters of Willows an idea of the trauma faced by people who have undergone heavy sedation.
I’m not sure what the best term is to describe the trauma. The condition seems to be called Sedation hallucinations, delirium and ICU Psychosis. Please forgive me if I use several different terms. I suppose they may mean different things medically. But for a lay person like me, they seem synonymous.

If you Google sedation hallucinations, you will find a great deal of material and research on the subject. In fact, it seems clear that for as long as there have been anaesthetics, there have been sedation hallucinations.

One web site I’ve found informative is healthtalk.org. A British web site founded by two doctors and supported by the University of Oxford. There is a good section there on the condition, complete with video interviews of those who have experienced such hallucinations.

Healthtalk says this about the condition of sedation hallucinations:

Although some people had no dreams or hallucinations, for others these were an important part of their whole experience. Sometimes dreams and hallucinations caused anxiety, confusion or disorientation and some people found it difficult to distinguish between dreams, nightmares and hallucinations, particularly when they first came around.

That was very much my experience.

Other research pointed me to an American web site medicinenet.com

MedicineNet refers to what I experienced as ICU Psychosis.

(The NHS web site states that Psychosis is a mental health problem that causes people to perceive or interpret things differently from those around them. This might involve hallucinations or delusions.)

ICU psychosis facts

• ICU psychosis is a temporary condition and can be treated.
• ICU psychosis may last 24 hours or even up to two weeks with various symptoms occurring at different times.
• Many factors can be involved in causing ICU psychosis.

What causes ICU psychosis? ICU psychosis is said to be caused by Environmental and Medical causes.

Environmental Causes

• Sensory deprivation: A patient being put in a room that often has no windows, and is away from family, friends, and all that is familiar and comforting.
• Sleep disturbance and deprivation: The constant disturbance and noise with the hospital staff coming at all hours to check vital signs, give medications, etc.
• Continuous light levels: Continuous disruption of the normal biorhythms with lights on continually (no reference to day or night).
• Stress: Patients in an ICU frequently feel the almost total loss of control over their life.
• Lack of orientation: A patient's loss of time and date.
• Medical monitoring: The continuous monitoring of the patient's vital signs, and the noise monitoring devices produce can be disturbing and create sensory overload.

Looking back, I experienced all of these.

Medical Causes include:

• Pain which may not be adequately controlled in an ICU
• Medication (drug) reaction or side effects: The administration of medications typically given to the patient in the hospital setting that they have not taken before.
• Infection creating fever and toxins in the body.
• Metabolic disturbances: electrolyte imbalance, hypoxia (low blood oxygen levels), and elevated liver enzymes.
• Cumulative analgesia (the inability to feel pain while still conscious)
• Dehydration

Medically there were some factors with me – I certainly developed an infection and was briefly on dialysis to reduce the toxins.

The cluster of psychiatric symptoms of ICU psychosis include:
• extreme excitement,
• anxiety,
• restlessness,
• hearing voices,
• clouding of consciousness,
• hallucinations,
• nightmares,
• paranoia,
• disorientation,
• agitation,
• delusions,
• abnormal behaviour,
• fluctuating level of consciousness which include aggressive or passive behaviour.

I now realise that I experienced most of these.

MedicineNet says: “In short, patients become temporarily psychotic. The symptoms vary greatly from patient to patient. The onset of ICU psychosis is usually rapid, and is upsetting and frightening to the patient and family members.”

This is interesting, as my family didn’t realise what I had been experiencing and, as mentioned, I couldn’t tell them. And apart from one nurse who thought I was becoming depressed, so arranged for me to be moved to a room with a view, the medical staff seemed unaware of what was going on.

MedicineNet goes on to explain how ICU psychosis is treated.

The treatment of ICU psychosis clearly depends on the cause(s).

Many times, the actual cause of the psychosis involves many factors, and many issues will need to be addressed to relieve the symptoms.

In my case the psychosis, if that is what it was, wasn’t treated per se. I was just gradually taken off the heavy sedation and the infection cleared up. And the dreams and hallucinations ended. Being moved to the room with a view was the only “treatment” I had for the condition.
But I’m not complaining. I agree with MedicineNet

“It should be understood that in saving a life in the critical environment, ICU psychosis sometimes may be a small price to pay for cutting edge, precise medical life-saving measures.”

My online research identified a paper called Sedation in the intensive care unit by Rowe and Fletcher Oxford 2008. This refers to what I experienced as delirium. The paper states:

The recognition and management of delirium is important; it occurs in up to 80% of ICU patients during their admission.

As I said, although I don’t blame Southmead, I am surprised they didn’t check me for ICU psychosis / delirium / sedation hallucinations as it is so common.

Coming to terms with what happened

After coming home from hospital, with more time to think and reflect, I realised that the ICU psychosis (I’ll stick with that phrase) had left a mark on me. But what was I to do?

No one in hospital had mentioned the condition to me. No one had asked me whether I was suffering from it or asked about symptoms.

During my time in hospital one Methodist minister who supported me and my family was Paul. (Not his real name.) Paul has done a great deal of work in hospital chaplaincy, therefore he is very knowledgeable on many medical matters. When I described to him – in broad terms – my hallucinations, he firstly affirmed that this was a very common occurrence for someone who had been heavily sedated. And he suggested that when I was ready, I should speak to a counsellor.

I learned later, that Paul knew of another Methodist minister who had experienced a very similar thing to me. And he drew on his experience of dealing with that colleague when speaking to me. That colleague had received counselling and it had been very beneficial.

Also, about 10 days after coming out of hospital, I took a Skype call from a friend who lives in the USA. 4 years ago, my friend had a massive heart attack. He ended up with a quadruple by pass. He’d called to encourage me. And almost as an aside he said, “Did you have weird dreams when you were in ICU?” He had had the same experience as me which was reassuring.

After being out of hospital for a couple of months I arranged to see a counsellor. With the counsellor I felt able to speak of all the hallucinations I’d had. This wasn’t easy as the hallucinations that had been the scariest, were often very violent and sexual (think of a Quentin Tarantino movie on steroids!) I’d been too embarrassed to talk about these to someone else. (My research has found this such hallucinations are not uncommon – which is something of a relief!)

I was also able to share with the counsellor something that had been of a great concern for me. And that was a missing month of my life. This loss of time and date is one of the environmental causes of ICU psychosis.

It is hard to explain, but during my time in hospital and during the first few months at home, it felt strange that there was pretty much a whole month of my life that I have no recollection about. Between arriving at Southmead around 5pm on 2nd September and my leaving ICU on 27th September I have virtually no recollection. I just abut recall some things about my last week on ICU but that is sketchy.

For a long time, this missing month was a worry for me. The counsellor helped me talk about this. And to a large extent helped me cope with it. But it took me many months to realise I’d not missed anything! Strangely enough, as I prepared this talk, I Googled events of September 2016 just to confirm I’d not missed anything. I don’t think I have!

Conclusion

It is only in the last 3 or 4 months I think that I really feel as if I have finally moved on. Although I’ve never had flash backs as such, I’d been able to recall the hallucinations. And until recently my mind did often seem to go back to them. Though it felt detached, like I was looking at a film. They didn’t seem connected to me any longer.

Some of you here this evening who are counsellors may have had clients with similar issues to me and if so, I’m sure you’ve helped them by allowing them to talk about them. But some of you may not have encountered this before – and may never encounter it – but I hope by sharing what I have experienced, you may have some greater knowledge to take back with you.

Most people connected with Willows – though not all – are Christians. If you’re not a Christian, my closing comments won’t mean much. But for Christians I think it is important for me to share one other thing.

Not long after being home, a clergy colleague came to visit. We had a good long chat and then he said, “So how are things between you and God?” I don’t know what he was expecting me to say. Perhaps he assumed I’d be angry at God. But I was able to say to him “Things are fine with me and God.”

From that moment of peace in the ambulance travelling to Southmead, throughout my time in hospital and during my recovery, I’ve felt closer to God than ever before. I don’t know what caused my aorta to fail but it wasn’t God. God didn’t wish what happened to me to happen. It just did.

For many years, a verse of scripture that has meant a lot to me is Jeremiah 29:11

11 For I know the plans I have for you,’ declares the LORD, ‘plans to prosper you and not to harm you, plans to give you hope and a future.

I’ve clung on to these words of hope. I don’t know what is next for me. I’m up for whatever God has in mind. Though I’d rather it didn’t involve ambulances, doctors, nurses and machines that go “ping”!

Sources

https://www.medicinenet.com/icu_psychosis/article.htm#how_is_icu_psychosis_treated
http://www.healthtalk.org/peoples-experiences/intensive-care/intensive-care-patients-experiences/sleep-dreams-and-hallucinations-icu
https://academic.oup.com/bjaed/article/8/2/50/338650