Delirium

Delirium

Photo by Etienne Girardet on Unsplash

Dad has been in hospital for 15 days.

It took me that long to write the first few paragraphs of this experience. And another 6 weeks to finish it. Forgive me, as I flip through past and present. It has been a journey. But then, as I’ve said before, cancer is cyclical. It’s about the roads less – and often – travelled.

This latest setback began with his last treatment – immunotherapy with a hefty side serving of steroids – a medication which has historically had dreadful effects on his behaviour.

The steroids kickstarted a blood sugar spike which peaked at 34 (normal readings are 4–7). So straight from the chemotherapy suite, we headed off to A&E where he needed to be “put through the system” in order to hospitalise him.

That made it our third rodeo. But one thing I do like about A&E is it isn’t limited to cancer patients. It doesn’t make you feel as if this wretched, unforgiving disease has permeated every atom of life form. Instead, you’re reminded hospitals also cater for the banal; flesh wounds, broken bones, dizzy spells. The stuff that doesn’t usually end in death.

Dad seemed not to notice his fellow patients, instead sharing a running commentary of what felt like his life story. From his childhood in the 40s – bell ringing at St Agnes church, home made jam and marmalade – through to the unfailingly disappointing service provided by McDonalds via Uber Eats.

By 2am, 9 hours in, I was ready to rip my ears off as my Dad became an open (vocal) book. Actually, tome. Think War and Peace.

He simply did stop talking. Or twitching, fidgeting, pulling at the cannula in his hand, reminding me he wanted to go home, that everyone there would be wondering where he was (much later, I was told this phenomenon of rambling is quite unremarkable in patients experiencing high blood sugar, infection and dehydration – all of which afflicted my Dad in that moment.)

But all of that was the literal calm before the storm, as delirium began to take hold.

My Dad had suffered periods of delirium during his only round of chemo. It generally involved brief personality changes, like an actor switching in and out of character. It rarely involved good humour, either. Cantankerous and curmudgeonly resistance to every interaction and a (misguided) superhuman perception of his own ability. As if shrugging off cancer and old age like an ill-fitting garment.

But this time he had a cocktail of hypoglycaemia, UTI, fatigue and a visceral aversion to hospitals thrown into the mix.

There came a point he decided he was going home. And nothing and no one was going to stop him. He ripped his cannula out of his hand, from a which a small fountain of blood erupted. He looked at it, surprised, and then tried to bend down and swab the floor with a tissue, ever the gentleman even in the throes of mania. He then lost control of his bladder, perhaps the final indignation.

Marching to the nurses station he announced he was leaving and (without his walking aid) almost swaggered to the door in defiance of their pleas to wait for the doctor. I watched from a plastic chair, stunned by the change in him, by his utter incivility, like a raving madman. “I’m going home” he growled as one, two, three and then four nurses attempted to sedate him.

I’ll never forget the image of him standing there, flailing in protest, angry, unforgiving and backing down not one jot. Someone placed a wheelchair behind him and he was eased into the seat, legs and arms still kicking. A fifth nurse administered a sedative after which he was wheeled to a bed where they tried to change him into a hospital gown.

At the top his voice he yelled “help me!” at least three times. The dwindling crowd of patients watched me curiously, as if wondering what I’d do.

But I did nothing. I mostly felt embarrassment that he had been so rude, which feels absurd now. I apologised to the nurses, assured them he was a great guy, usually. I wanted to advocate on his behalf, speak to his kindness and good humour rather than have him remembered as this person.

I was angry at him too. Angry that he didn’t just have cancer but was capable of becoming someone entirely different. His identity smothered, dying embers of a fire.

The sedative diminished his vocal aggression reducing him to a childlike state. But his feet and hands constantly cycled, like muscle memory of the previous 12 hours, trying to claw his way out of the hospital bed.

Eventually he became pitiful. Mouth working but without sound, false teeth cresting his lips, feet working in a silent run and incapable of communicating except with his eyes. His eyes reflected sadness, defeat, perhaps a little embarrassment. And fear. As if some small part of his brain knew how close to the edge he was, hanging on by the narrowest of margins.

As I left the hospital I could feel hours and hours of forced composure fall away, like a suit of armour whose weight I couldn’t bear any more. I ugly cried all the way wondering how I could have left him in such a state when he was so helpless, but aware I had to work too. The masks we acquire for the journey of cancer are vast, interchangeable and so convincing we sometimes believe its projection ourselves.

For three weeks he stayed in hospital, surprising us as he always does with his fortitude. He began walking tentatively, eating small dinners, engaging in a conversation of sorts. But his memory was trapped in the past. To a time my brother and I were teenagers, when my Dad worked in London, beloved, long gone pets were still alive, and he was a fully functioning person.