Journalist Matthew D'Ancona experienced delirium after a burst ulcer left him hospitalised
You might have expected something emotional, even, at a pinch, portentous, at such a moment.
My father and elder son were visiting me in the high dependency unit (HDU) at University Hospital Lewisham, South-East London, for the first time since I had fallen seriously ill.
I was awake and talking, croakily, but talking all the same.
I beckoned my dad, who was clad in the regulation plastic apron for visitors, eager to exchange words with his eldest son for the first time since he had fretfully watched me being taken away by ambulance on a gloomy September evening.
Back from the almost dead, what did I have to say? What greeting would do justice to this moment of reunion?
‘Dad,’ I said. ‘For God’s sake, get on the phone to my agent.’
It says a lot for my father, and his phlegmatic, limitlessly compassionate approach to the business of lifelong parenting (I was, after all, 48 at the time) that he took this ridiculous remark in his stride.
A lesser man would have faltered. But he nodded and said: ‘Absolutely’.
I suppose, to put the exchange in context, he was relieved that I was saying anything at all.
In July 2016, on a press trip to the Bavarian town of Bayreuth to cover Wagner’s Ring Cycle for Sky Arts, I had started to experience severe, stabbing stomach pains.
After Götterdämmerung — doing my best to conceal my discomfort from my neighbour, Stephen Fry — I had crawled back to London via Munich.
Like an idiot, I did not go straight to A&E to admit that, nevertheless, I felt like I was dying. Instead, I saw a doctor who prescribed antibiotics, anti-nausea meds and paracetamol, and told me — you guessed it — to drink plenty of fluids.
But when the pain returned at full blast in September, I was all out of evasive options: this time I fainted whenever I tried to stand up. Up, crash. Up, crash. The paramedics came and whisked me straight off to the emergency room.
A CT scan and gastroscopy — camera down the gullet, no fun at all — suggested a perforated ulcer. I would be out of action for a few days after surgery.
I remember grumbling, in the way that men of my age do when they want it to be known that they have important stuff on their plate that cannot be postponed.
But by then, I just wanted the pain to stop.
A jolly anaesthetist, with superbly colourful tattoos all over his forearms, invited me to count down from ten. I got to seven before slipping into welcome oblivion.
I have dim recollections of some odd dreams: a trip to China, a BBC workshop, a close-to-the-bone conversation in a plush library about the alleged harvesting of organs for sale in America. Definitely dreams. And then, no less abruptly, I was awake.
‘You’ve done very well, Matt,’ a nurse said. ‘And you’re much, much better.’ Beat. ‘But you’ve been asleep longer than we expected.’ Beat. ‘Asleep for ten days, actually.’
So glad was I not to be in pain that this astonishing disclosure did not astonish me all that much.
I noticed that I had a pretty nifty track of staples down the centre of my stomach, suggesting a more invasive surgical procedure than I had expected.
But the missing ten days? Well, these things happen. Can’t be helped.
I have dim recollections of some odd dreams: a trip to China, a BBC workshop, a close-to-the-bone conversation in a plush library about the alleged harvesting of organs for sale in America. Definitely dreams. And then, no less abruptly, I was awake, writes MATTHEW D'ANCONA
As it turned out the agonising ulcer had saved my life. I had, in fact, been in the full grip of abdominal sepsis, a form of infection that has a 75 per cent fatality rate. I got lucky, to say the least.
The pain had forced them to open me up — and to discover the extent of the poison in my system.
And then, doubly lucky, my brilliant surgeon, Adrian Steger, and his team had saved my life and spared me from the loss of limb that is such a miserably common price of septic shock.
Post-surgery, I was put into an induced coma to allow the cocktail of industrial-strength antibiotics and other drugs to do their cleansing. It worked.
Every day now feels like a spectacular bonus. Is it good to see you? Hell, to quote Keith Richards, it’s good to see anyone.
Back in the HDU, three years ago, with all this mortality-narrowly-evaded stuff going on, you might have thought that I would have been lying in bed, contemplating the mysteries of life and the caprice of the Grim Reaper.
But I had only business on my mind. Showbusiness to be precise. From this most unlikely position, in a hospital cubicle in autumnal South London, I was planning my next step to Hollywood stardom.
Well, my first step, really. My illness and incapacity, I was absolutely convinced, were an irritating diversion from my preparations for a new HBO spy series — for which I was both finishing the screenplays and in which I would co-star. Hence my initial request to my dad to get on to my agent.
Entitled The Collaborators, the series was set in a proto-fascist world in which my character — a seasoned MI6 agent — would team up with a Russian counterpart to fight the bad guys, both criminal and governmental.
In the early episodes the Russian FSB operative and I would be traditional enemies.
But, by the end of season one, he and I would be close allies, a maverick duo bonded by professional respect and a growing fear of the authoritarian politicians who were our ultimate masters.
Crucially, I managed to persuade myself that the pulse oximeter — the clip they put on a patient’s finger to check blood oxygenation — was in fact a sophisticated alphanumeric device, enabling me to send emails and WhatsApp messages to the showrunners and location scouts around the world.
I also held regular bedside meetings with script editors, fight choreographers and — looking ahead — the merchandising team.
If all this sounds like total, unmitigated nonsense, that’s because it was.
But — and it’s hard to exaggerate this point — it was real for me in every possible detail. This was not dreaming or psychedelia. This was hallucination.
The distinction is very important.
In his Principles Of Psychology (1890), William James makes the point clearly: ‘An hallucination is a strictly sensational form of consciousness, as good and true a sensation as if there were a real object there. The object happens to be not there, that is all.’
I had absolutely no intuition that this was all a fabrication of my upended imagination.
On one occasion, Chelsea Clinton even popped in, on her way to meet her parents at a party by the Thames.
As I perked up a little, and became more talkative with my family, I shared more of my fictional world with them: surprisingly lucid, they recall.
They nodded generously, wondering with some anxiety how long this was going to go on. I will always hate the fact that they had to go through that.
I wasn’t merely confined to my ward either. My bed was able to travel all over the world: to a home in Malaysia for a delicious meal; a New York hotel off Times Square; a Monaco-themed bistro in Chelsea.
The only potential glitch in these travels was that, one evening, I was kidnapped by Class War, the Left-wing anarchist group, who spirited me off to one of their safe houses, fed me beans on toast and, after an interesting ideological discussion about the internal contradictions of capitalism, drove me back.
Charming people. Badly misrepresented in the media, I concluded.
More worrying, given how much scriptwriting I had on my plate, was a visit to a secret facility, where shadowy scientists were using my body to engineer an alien-human hybrid species. ‘I’ve got work to do, you know,’ I told them.
I was — though I did not know it at the time — suffering from a very common condition that afflicts intensive care patients: ICU delirium.
There is broad agreement that a cocktail of factors is involved: the combination of powerful drugs, mechanical ventilation, physiological weakness, insomnia, and the underlying psychological stress of being seriously ill.
But the sheer power of the delusions has not been explained, and there is little consensus on treatment protocols (in my case, a short course of sleeping pills and rehydration did the trick).
Many never truly recover, and suffer from something like PTSD for the rest of their days.
Fortunately, my encounter with ICU delirium was, for the most part, free of fear and suffering.
There was one incident — a second gastroscopy — that involved being restrained as the tube was plunged down my throat.
I was convinced that this was the filming of an ‘enhanced interrogation’ scene for the TV series that had gone wrong – and I was inconsolably furious afterwards at such amateurism on my set.
For the most part, though, the medical staff — hideously overstretched at the best of times — left me to it.
In a high dependency unit, full of patients on the border between life and death, I have nothing but praise for the doctors and nurses who treated me.
I later discovered that work often features in these hallucinations, which struck a chord when I tried to make sense of mine.
It was true that, after I left the editorship of The Spectator in 2009, I had worked for a few months as a scriptwriter with David Milch, who was the creator of NYPD Blue and Deadwood and had a big development deal with HBO.
My off-the-wall TV series must have included echoes of our collaboration.
It’s true, too, that I have watched an awful lot of B-movie thrillers and C-division Netflix in my time.
When, in my final week in hospital, I gradually realised that the whole thing was imaginary.
During a family visit soon after, I finally experienced the full weight of reason come crashing back through the membrane of delusion.
No series, no HBO, no campaign for that elusive first Emmy.
‘Oh, f***,’ I said to myself.
Not that ICU delirium is a subject to make light of: it isn’t. As more of us live longer and recover more frequently from serious illnesses, this particular pathology will become a public health issue. It is especially hard on families.
My frequently-comic monologues were, I realised afterwards, difficult for my loved ones to hear, day in, day out.
And many relatives have to deal with a lot worse.
After three weeks — a shorter period than initially expected — I was home, convalescing, walking with a cane, eventually doing very low-key Pilates to get my body used to normality again.
The lasting impact, if I am honest, has been philosophical. I am a liberal rationalist, an enemy of superstition and New Age hokum.
So my brief exile from that intellectual homeland was much more unnerving in retrospect than at the time.
It is alarming to discover that the border separating the rational from the irrational is so porous, that the guard-rails keeping delusions, visions and unwanted apparitions at bay can be smashed through so easily.
I still laugh, remembering the preposterousness of it all. But such moments of recollection give me pause, too.
These days, I have a healthier respect than I did for the power of unreason, and its ceaseless pounding at the door of our lives. I now know that the door is always ajar; and I wonder, more than ever what dreams may come.
A longer version of this article was first published on Tortoise. © Tortoise 2019. To read more slow journalism, become a member for £50 instead of £250 at tortoisemedia.com/friend and use the discount code ‘Mail50’.
So what causes hospital delirium
By Thea Jordan
Post-operative or ICU delirium is most common among the over 60s who already have some kind of cognitive impairment, but it can affect younger people as well.
‘It happens more often than people think,’ says Dawne Garrett, professional lead for older people and dementia care at the Royal College of Nursing. ‘It is marked by usually reversible memory disturbances, confusion and hallucinations.’
Some people may become incoherent, others paranoid. The symptoms tend to develop in the days immediately following an operation and may fluctuate in severity depending on the time of day, often deteriorating at night.
People with existing lung or heart conditions may be at greater risk as they may have less oxygen flow to the brain and the type of surgery also makes a difference.
‘Those undergoing major surgery — particularly cardiac surgery — are at higher risk,’ says Dr William Harrop-Griffiths, chair of the clinical quality and research board at the Royal College of Anaesthetists. Why is unclear, but may relate to the anaesthetic.
A study in the U.S. by researchers at Johns Hopkins Hospital found post-operative delirium was far more common among those who had a general anaesthetic than those who had a local.
One theory is that a general anaesthetic leads to more surgery-induced stress inside brain cells.
Post-op delirium is associated with longer hospitalisation, loss of function and higher mortality, according to a study in the Journal of the American Geriatric Society.
‘Almost everyone who suffers from postoperative delirium will get better, but it can take days or weeks,’ says Dr Harrop-Griffiths. ‘There is no specific treatment.’