A CRY FOR HELP
''Get me out of here!'' the middle-aged man shouted to his sister from his hospital bed. ''They're coming to get me.'' His eyes darted from side to side as if searching for someone who was after him. His arms and legs shook. She had never seen him like this. He looked terrified.
A TERRIBLE FALL
Three months earlier, the patient, a 55-year-old man who suffered from depression and alcoholism, was admitted to the same hospital after falling down the stairs in his home. He wasn't found for two, possibly three days. Because of his injuries and this delay, when he was discovered, he was close to death. His kidneys had stopped working, and his body chemistry was completely out of whack. On the way to the hospital, his heart stopped, and he had to be shocked back to life.
A SLOW RECOVERY
The patient remained in Waterbury Hospital in Connecticut for five weeks (where I was one of his doctors), three of them in intensive care. Even after these weeks of care, the toll of his injury was terrible: his kidneys were still not working, so he required hemodialysis three times a week; his arms and legs were so weak that he could not even lift them. He was unable to swallow and had to be fed through a tube. When his sister visited him there, she barely recognized him. His slender body was bloated. He had tubes everywhere. He could do little more than whisper. Still, she saw that he was slowly improving. He had started to smile and make jokes despite his many disabilities. After five weeks in the hospital, he was transferred to a short-term rehabilitation facility.
SEEING THINGS
After two weeks in rehab, something changed. He started talking to people no one else could see. He feared they wanted to harm him. When the hallucinations persisted for a second day, he was sent to the emergency room at Waterbury.
The patient told the E.R. psychiatrist that he was seeing people he knew couldn't be there. Despite the hallucinations, he was calm and clear. He told the doctor that he thought the visions began after he recently started taking a new sleeping pill. That made sense to the doctor. Delirium is an unusual but known side effect of that drug. He put the patient on a different sleep medication and returned him to rehab.
DELIRIUM
Two days later he was back. He was still seeing people who weren't there, but now he was also frantic and confused. He knew his name but little more. All he was certain of was that he was in danger. Because of his confusion, Dr. Brian Linde, the intern on call, couldn't rely on the patient to tell his own story. Instead the doctor had to depend on the patient's records to make sense of the situation in front of him: the hospital notes provided an outline of the patient's earlier admissions. The rehab-center records showed some details of his recovery from the serious injury. It also included a long list of the medications he was taking and reported that he had been confused for the past four days. On examination, the patient had a fever. His heart was racing, and his blood pressure was high. His arms and legs were weak and swollen. His legs were shaking, and his muscles were hyperreactive.
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