A researcher becomes a patient experiencing delirium

Contributed by Namrata Patil, M.D., M.P.H., Faculty at Brigham & Women’s Hospital and Harvard Medical School, Boston

April 2020

I pulled my blanket tighter as I started sipping on my warm tea. All of a sudden, I saw a couple of big ants crawling on the floor. I pulled my legs up before the ants could get to me. I watched as they multiplied and proceeded to cover the whole carpet on the floor. I wanted to scream but I could not. A chill went down my spine. I couldn’t think further. My mind was so tired. I cuddled in my blanket, wrapping it around me like a shield. I attempted to close my eyes, shake my head… and that’s the last of that episode I remember. I do not know how long it was before I ‘woke’ up again. My daughter had come to check on me. As she made sure that I was still breathing, I asked her if she saw the ants. Yet, even as I asked her that question, I somehow knew that there weren’t actually any ants.

This is one of the episodes of delirium I experienced during my prolonged illness with Covid that I am still recovering from. It feels as though the worst of this illness has wiped away five weeks from my memory. I have not slept in seven weeks now. There has been no nap longer than an hour once or twice a day at best, sometimes even not that. When I was struggling to breathe, perspiring from fevers, shaking with chills and experiencing extreme physical fatigue, my mind was experiencing complete exhaustion. The sense of day, night, time was completely lost and even more so due to the quarantine. How did I lose five precious weeks of my life? How come I do not remember most of the things?

I remember that for the longest period, I did not tell anyone that I had lost my taste because I was not sure it was real. When the nurse got worried on the phone and asked me if I was keeping myself hydrated, I spontaneously answered, “I can’t drink anything, even water…it feels as if..uhh.. how do I say this? It doesn’t taste like water.. I can’t eat or drink because I just don’t taste anything!” Surprisingly, I remember, the nurse completing my sentence, “You lost your sense of taste! Do you smell anything?” “I don’t know,” I answered. There was so much that I did not know what was real or unreal. I have been dizzy, disoriented, unsteady. I experienced mental fatigue to the extent I did not know existed. I have tried to rationalize every situation in my mind. I do not know which one was a dream, or a nightmare, real or hallucination. My body is tense, my subconscious mind is anxious, and constantly worrying about being ‘under the fog’ has consumed me.

As a researcher, delirium has always intrigued me. Experiencing delirium myself, though, has taken my understanding of delirium to another level. As I hear from other cases of COVID-19 of the delirious state they experienced while managing their illness at home, I find familiarity in their stories.. I remember how scared I was when I somehow knew that the ants I was seeing were not there. That feeling of helplessness and the fear were real. That spell probably broke because my daughter came in to check on me and to reassure me. As I gain more normalcy back in my recovery now, I hope that I won’t remember any of those scary hallucinations.

August 2020

I wrote this piece three months ago. In the last three months I have returned to full time work, and I have been managing same intense patient load. I am glad to report that for the most part I have recovered completely. In the last month and a half, the sleep that had eluded me so long has come back naturally. I am glad to say that I am very relieved.

With COVID-19 mandating strict isolation and quarantine, with caregivers behind masks and gowns, and no family members around in-person, a huge proportion of the hospitalized patient population has experienced delirium. As we know from literature, many of them will not remember anything. Does COVID-19 itself affect your brain to alter your state of mind? I do not fall in the high-risk category for developing delirium. I had no other risk factors other than having this serious viral illness that basically took away my capacity to breathe properly for weeks. I was not under any chemical sedation or any other mind-altering medications. I was in quarantine and was, as I call it, “under the fog.”

Now I am more interested in knowing why and how this virus affects our sensorium. We need to study delirium in COVID-19 patients carefully to figure out how it affects mental status. It is most likely very different in hospitalized patients versus moderate to severely sick patients managed at home. The characteristics of COVID-19 related delirium should be studied in-depth and documented as we move forward.

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