Kim Victory was paralyzed on a bed and being burned alive.
Just in time, someone rescued her, but suddenly, she was turned into an ice sculpture on a fancy cruise ship buffet. Next, she was a subject of an experiment in a lab in Japan. Then she was being attacked by cats.
Nightmarish visions like these plagued Ms. Victory during her hospitalization this spring for severe respiratory failure caused by the coronavirus. They made her so agitated that one night, she pulled out her ventilator breathing tube; another time, she fell off a chair and landed on the floor of the intensive care unit.
“It was so real, and I was so scared,” said Ms. Victory, 31, now back home in Franklin, Tenn.
To a startling degree, many coronavirus patients are reporting similar experiences. Called hospital delirium, the phenomenon has previously been seen mostly in a subset of older patients, some of whom already had dementia, and in recent years, hospitals adopted measures to reduce it.
“All of that has been erased by Covid,” said Dr. E. Wesley Ely, co-director of the
Critical Illness, Brain Dysfunction and Survivorship Center at Vanderbilt University and the Nashville Veteran’s Administration Hospital, whose team developed
guidelines for hospitals to minimize delirium.
two-thirds to
three-quarters of coronavirus patients in I.C.U.’s have experienced it in various ways. Some have “hyperactive delirium,” paranoid hallucinations and agitation; some have “hypoactive delirium,” internalized visions and confusion that cause patients to become withdrawn and incommunicative; and some have both.
The experiences aren’t just terrifying and disorienting. Delirium can have
detrimental consequences long after it lifts, extending hospital stays, slowing recovery and increasing people’s risk of developing
depression or post-traumatic stress. Previously healthy older patients with delirium can develop dementia sooner than they otherwise would have and can die earlier,
researchers have found.
“There’s increased risk for temporary or even permanent
cognitive deficits,” said Dr. Lawrence Kaplan, director of consultation liaison psychiatry at the University of California, San Francisco Medical Center. “It is actually more devastating than people realize.”
The ingredients for delirium are pervasive during the pandemic. They include long stints on ventilators, heavy sedatives and poor sleep. Other factors: patients are mostly immobile, occasionally restrained to keep them from accidentally disconnecting tubes, and receive minimal social interaction because families can’t visit and medical providers wear face-obscuring protective gear and spend limited time in patients’ rooms.
“It’s like the perfect storm to generate delirium, it really, really is,” said Dr. Sharon Inouye, a leading delirium expert who founded the
Hospital Elder Life Program, guidelines that have helped to
significantly decrease delirium among older patients. Both her program and Dr. Ely’s have
devised recommendations for
reducing delirium during the pandemic.
The virus itself or the body’s response to it may also generate neurological effects, “flipping people into more of a delirium state,” said Dr. Sajan Patel, an assistant professor at University of California, San Francisco.
The oxygen depletion and inflammation that many seriously ill coronavirus patients experience can affect the brain and other organs besides the lungs. Kidney or liver failure can lead to buildup of delirium-promoting medications. Some patients develop small blood clots that don’t cause strokes but spur subtle circulation disruption that might trigger cognitive problems and delirium, Dr. Inouye said.
After the ventilator was disconnected, Mr. Rios, a normally gregarious man who hosts a radio show, only responded with one- or two-word answers, said Dr. Peggy Lai, who treated him.
“I saw people lying on the floor like they were dead in the I.C.U.,” he said. He imagined a vampire-like woman in his room. He was convinced people in the hall outside were armed with guns, threatening him.
“’Doctor, do you see that?’” he recalled saying. “’They want to kill me.”
He asked if the door was bulletproof and, to calm him, the doctor said yes.
Like many delirious patients, Mr. Rios warped typical hospital activities into paranoid imaginings. Watching a hospital employee hanging a piece of paper, he said, he thought he saw a noose and feared he would be hanged. His delusions were not helped by one of many seemingly small delirium-fueling factors: his eyeglasses had not yet been returned to him.
After 10 days of hospitalization, he spent two months in a rehabilitation center because of foot inflammation, recently returning to his East Boston apartment. In May, his father in Mexico died of Covid-19, Mr. Rios said. He reflected on another hallucination in the hospital.
“I saw the devil and I asked him, ‘Can you give me another chance?’ and he said, ‘Yes, but you know the price,’” Mr. Rios recalled. “Now I think I know the price was my father.”
‘Down a rabbit hole’
Two months after returning home from her three-week hospitalization, Ms. Victory said she’s been experiencing troubling emotional and psychological symptoms, including depression and insomnia. She has been noticing the smell of cigarettes or wood burning, a figment of her imagination.
“I feel like I’m going down a rabbit hole, and I don’t know when I will be back to myself,” she said.
Dr. Kevin Hageman, one of her physicians at Vanderbilt University Medical Center, said she “was pretty profoundly delirious.”
Ms. Victory, a Vietnamese immigrant and previously healthy community college student majoring in biochemistry, said she didn’t remember yanking out her breathing tube, which was reinserted. But she recalled visions blending horror with absurdity.
One moment, scientists in Japan were testing chemicals on her; the next she was telling them, “‘I am an American and I have a right to eat a cheeseburger and drink Coca-Cola,’” she recalled, adding: “I don’t even like cheeseburgers.”
Along with this agitated hyperactive delirium, she experienced internalized hypoactive delirium. In a recovery room after leaving the I.C.U., she’d stare for 10 to 20 seconds when asked basic questions, said Dr. Hageman, adding, “Nothing was quite processing.”
Ms. Victory managed to take a picture of herself with nasal oxygen tubes and a forehead scar, post it on Facebook and write “I’m alive” in Vietnamese so her parents in Vietnam would know she’d survived. But another day, she called her husband, Wess Victory, 15 or 20 times, repeatedly saying, “I give you two hours to come pick me up.”
“It was heartbreaking,” said Mr. Victory, who patiently told her she couldn’t be released yet. “For four or five days, she still couldn’t remember what year it was, who the president was.”
Finally, he said, “something clicked.”
Now, to help overcome the fallout from the experience, she’s started taking an antidepressant her doctor prescribed and recently saw a psychologist.
“People think when the patient got well and out of the hospital, it will be OK, it’s over,” Ms. Victory said. “I worry if the virus didn’t kill me back then, would that have affected my body enough to kill me now?”
Dabrali Jimenez contributed reporting,
Pam Belluck is a health and science writer whose honors include sharing a Pulitzer Prize and winning the Nellie Bly Award for Best Front Page Story. She is the author of Island Practice, a book about an unusual doctor.
@PamBelluck
She’s really planning to go to the beach and the worst part is that she has asthma too. I tried to warn her but this bozo is hardheaded.
a friend of mine text me sayin he planning a trip to Atlantic City in August
asking me if I wanna go
