…And my hellish journey back from post-op delirium

5 min read

The moment my brain lost its grip on reality is one I remember with alarming clarity. It was a sweltering New York day in August 2018, and I was at JFK airport preparing to fly home to London.

At the check-in desk, a young woman with a ponytail was taking deep breaths and repeating apologies to grumbling passengers for the late departure of the plane.

Writing about it now plunges me vividly back into that crowded room. The mood is ugly, and some of the passengers are expressing deeply unpleasant and racist views.

I start arguing with them about how Donald Trump’s America is becoming a hateful place and a betrayal of the values of liberty and inclusion upon which it was founded.

A pretty young woman who looks like a glamorous version of my ex-wife, Moira, puts her hand on my arm. She tells me I am a hero and agrees with every word I say. Her name is Lucy, she kisses me on both cheeks and says, ‘Look, I have to go now, but I promise I’ll come and see you in Europe. I love you, Eugene…’

Under attack

Only a handful of passengers are left, and some are still fuming from my rant. With hours to kill before my flight home, I traipse out of the airport and head towards the subway, where a gang loiter by the turnstiles, including a woman I recognise from the check-in desk.

She starts telling the others I’m a Trump hater and shouts at me: ‘Who the fuck do you think you are, coming over here to lecture us?’

Another young woman laughs and pulls out a handgun. ‘Maybe I should cap the fucker?’ she snarls.

I don’t believe she will really shoot me in front of all these witnesses, including two men in NYPD uniforms a few hundred yards away. But then she does shoot me, straight in the abdomen, and there’s a flash of light before everything grinds into slow motion. As I go down, the two cops start running towards me, but it’s too late. The darkness takes over. I am gone.

As anyone with a more than cursory knowledge of JFK and the New York City subway system will know, none of this really happened. What did, in fact, happen was that I had emergency heart surgery in London and experienced a phenomenon known as post-operative delirium.

It impacts anywhere from 8-87 per cent of patients, depending on factors such as operative stress, pre-existing dementia, and age, to name a few.

It can cause a patient to be aggressive and agitated, or sleepy and inactive - often both. It also increases the risk of longer hospitalisation and death. Luckily, I survived both the thing that put me in hospital in the first place and the delirium that followed. 

Early signs of trouble

It all began in early August 2018 whilst I was on holiday in the French Pyrenees. I had a week of severe pains in the armpits that turned me cold and clammy. When I got home, I took myself to my local hospital and investigations found I had been having a serious heart attack. 

I was in the grip of a STEMI – an ST segment elevation myocardial infarction – a type of heart attack that occurs when one or more (three, in my case) of the main arteries to the heart become blocked. I was blue-lighted to St Bartholomew’s Hospital.

My true memory – and not the weird alternate reality my brain made up in post-op delirium – fails around that point in the ambulance but I’m told medics tried unsuccessfully to insert stents to unblock the arteries and then a balloon pump, which also failed.

Sometime the following morning, I suffered a massive coronary when a fourth artery failed, and I was taken straight into the operating room for an emergency triple-bypass. They opened up my sternum with a circular saw and used a large vein from my leg to graft new arteries in three places, navigating around the blockages. It should have been a two-hour operation but took nearly five. 

During surgery, I also suffered a stroke from a clot on my brain. My lungs filled with fluid and there were further complications with my kidneys. My body shut down and I was put on life support with a ventilator breathing for me.  

As I began to come round after surgery, all I could see were gold stars against a deep-blue background, maybe for seconds or minutes or hours or days. Then, the vivid hallucinations from my post-operative delirium began…

After the shooting in New York, I delirium-travelled to Dublin with my 13-year-old daughter, Evie, where I was drugged and held prisoner in a stately home. Later, I went to Italy and my lovely new friend, Lucy from JFK Airport, visited. Next, I went to a wedding in Jaipur, Rajasthan, where I was mugged.

Intensive care

Back in reality, Moira and Evie visited me daily. I grew angry because they didn’t believe my story about the NY shooting. One afternoon, I heaved myself out of bed and I pushed myself to the nurses’ station in a wheelchair, where I picked up a phone and demanded to speak to the hospital’s press officer.  

I told her I was livid at her dirty tricks to discredit me. There was a pause, then she asked if I was in the intensive care unit. I failed to see what that had to do with anything.

In hindsight, I can see she asked me that because post-op delirium is quite common - the most common complication for older adults after surgery, usually brought on by the surgery itself, side effects of drugs (usually opioids), an electrolyte imbalance or immobilisation. Sometimes it’s a medley of one or more of those things.

Coming back

After 10 days on a ventilator, I drifted in and out of delirium, mixing up the real-life medical staff caring for me, with the kaleidoscopic of faces from my hallucinations.

I remember feeling scared and confused, unable to distinguish reality from hallucination. One day, I told Moira I’d had a vivid dream where I’d brandished a metal stool at a nurse, threatening to ‘smash her fucking head in.’

Moira looked at me with an expression of both pity and concern, and said, ‘Euge, that wasn’t a dream. That really happened.’

I collapsed back against my pillows in defeat, tears coursing down my cheeks, while she patiently helped me piece together how my traumatised brain might have interpreted scraps of semi-conscious events.

Her doppelgänger Lucy connecting with me in JFK? That likely stemmed from Moira visiting me daily while I was on life support. The Jaipur mugging? A fantasy constructed from the constant stream of Indian music playing next to me from an ICU neighbour.

Delusions about having throat cancer? Brought on by 10 days-worth of hoarseness from the tube in my throat.

Why does it happen?

Medical experts still do not understand exactly what causes post-operative delirium, but it is most common in intensive care patients who are heavily sedated or on ventilators after major surgery — particularly heart surgery — or those who are over 65.

The American Delirium Society estimates it affects as many as seven million hospitalised patients in the U.S. every year, and costs as much as $150 billion in extended hospital stays and health complications.

Dr Valerie Page is an intensive care consultant at Watford General Hospital, Hertfordshire, and an expert on post-operative delirium. It is the physical trauma of major surgery, rather than the effect of anaesthetics or sedatives, that triggers delirium, she explains.

‘Opening someone up, fumbling around inside, taking some bits out, putting some bits in and then closing them up again — it’s a massively traumatic event for a body,’ she tells me.

Travel, escape, and death are all common delirium experiences. Most imaginings are simply the traumatised mind’s misinterpretation of the patient’s environment, which, in all the confusion and trauma, form into complex delusions in an attempt to make sense of every that’s happened to the body.

Dr Page believes there is a physiological explanation for delusions, and that they have no relationship to psychological well-being: ‘These are simply physical neurological manifestations of the brain malfunctioning due to transmitters, blood flow, and inflammation.

‘People talk about seeing a white light, but that’s because as your optic nerve loses blood, a white light is what you see.’ 

Some patients exhibit agitated delirium like I did, but tend to recover more quickly; others have more withdrawn delirium that presents like depression, which is harder to diagnose.

Researchers are exploring how to minimise delirium by reducing the use of certain tranquillisers, encouraging patients back into healthy sleep cycles, coming off ventilators sooner and getting patients out of bed.

The future

Dr Page explains my mind may not feel as sharp as before but suggests having a previously busy and intellectual mind may aid my recovery.

She says: ‘You’re educated, so you have what we term cognitive reserve. Because your brain has been active, the theory is that you can use other bits of your brain to take over the jobs that the affected part used to do. So, an active brain and education give you cognitive reserve to be resilient.’

In the beginning, I struggled to find words, wasn’t very mobile, and suffered mood swings. However, nearly two years later, I’m recovering well. I’ve lost weight by working out at a gym and last year I completed a four-week drive from the U.K. to Mali in West Africa to raise money for the British Heart Foundation and a couple of journalists’ charities that supported me whilst I recovered. 

Some experts say survivors of these major health events — including the delirium — can experience a form of post-traumatic stress disorder. In my case, my trauma is as mitigated as it could be. I am as well as can be expected, better, in fact, and for that I am grateful. And of course, I am here to tell the tale.

*Eugene Costello is a freelance journalist based in Valencia. Find out more about his work here

Do you have a health story to share? We’d love to hear from you. 

Like this article? Please help us commission more like it by donating the cost of a cuppa on Ko-fi. Sharing this article on your social media, and following us on Instagram, Facebook, and Twitter are also a great way to support our independent, self-funded platform.

We encourage debate, but trolls are not welcome. Please read our comments policy before contributing.