ntensive care is no place for the faint-hearted. Improvements in medical technology, particularly the development of the modern positive pressure ventilator, have transformed our efforts at the boundary between life and death. A few decades ago, many of the people in that ward next door would already be dead.
But progress comes at a cost. The noise of life-support machines and vital-sign monitors is a constant background. Phones ring, bin lids bang, staff call for help and doctors are constantly being paged to the next emergency. The racket frequently exceeds World Health Organisation (WHO) guidelines for safe noise levels. In The Guardian in 2016, Helen Taylor, an intensive care survivor, described a ‘constant, frightening’ noise from which there was little respite at night. It’s one reason why a recent article likened the modern ICU to ‘a branch of hell’.
The chaotic atmosphere was less of a problem 10 years ago. If I had stepped next door then, there would have been few patients awake to disturb. The standard approach, while life-saving procedures were being administered, was heavy sedation. While the machine was being fixed, the patient was put into a coma.
That changed with the recognition that, inside those ravaged, intubated bodies, minds were still working. And those minds were not at ease. The British journalist David Aaronovitch had a stint in intensive care after routine keyhole surgery went disastrously wrong. He heard people behind a curtain railing violently against him. As his disorientation deepened, he started to believe that the sinister officers of the night shift were preparing his body for human consumption. They were feeding him oxygen in order to make his flesh sweeter. He was going to be eaten.
This kind of break with reality used to be known as ICU psychosis. Nowadays, the term ‘delirium’ has superseded it, particularly when there is an apparent biological cause such as medication, inflammation or sepsis. In delirium, the patient’s attention is disrupted and vivid hallucinations and delusions sweep in. The British artist Victoria Hume, who made a piece based on conversations with ICU survivors, told me she heard stories of ‘persecution, conspiracy and terror – of bombs under the bed, or being left at the bottom of a lift shaft for eternity, or trapped on a spaceship, unable to return home’. In patients who are heavily sedated and on ventilators, rates of ICU delirium are as high as 80 per cent.