Pedro Torres was in the ICU of Concord Hospital suffering from a severe respiratory infection when he noticed a coffin next to his bed.
Torres peered over his railing to get a closer look and was horrified: Inside the box was his own corpse – face gaunt, eyes closed and arms rigid at his sides.
Torres didn’t know if he was hallucinating, dreaming or something in between. He tried to scream, but no sound came out.
Meanwhile, nurses in dark blue hospital scrubs continued moving around him, seemingly unaware of his nightmare, attending to his oxygen and his vitals.
“I was trying to ask for help from people in the room, shouting ‘I’m still alive, I’m here,’ but for some reason I couldn’t,” he said. “It was like I was paralyzed mentally and physically.”
Torres, 43, was suffering from delirium, a change in brain function that doctors say can happen when a person is ill, injured or exposed to toxic drugs or medications. Concord Hospital officials estimate that their physicians treat around 350 patients with delirium per month – but it can be hard to diagnose.
Delirium manifests itself differently in every patient. Concord Hospital has been investing in training for its staff in recent years to identify delirium early and treat it.
“The majority of people look very sleepy and just can’t wake up. A minority of people become agitated, fearful, hallucinating,” said Lyn Lindpaintner, a Concord doctor who specializes in delirium care. “They may very well strike out; they think people are trying to kill them instead of help them.”
Some patients are able to come out of a delirious state on their own, but leaving delirium untreated can also result in PTSD or permanent cognitive dysfunction, Lindpaintner said.
Torres saw hallucinations of the coffin – both of looking at it from the outside and being physically trapped inside it – for a day and a half. He also remembers seeing a Christmas tree in his room that wasn’t there – and said he once mistook his nurse for a duck.
He said everything around him appeared distorted and hazy, like he was viewing slides on a slide projector that were all in the wrong order.
It was one of the most terrifying experiences of Torres’s life, he said.
“I don’t wish that upon nobody – not even my worst enemy,” Torres said from his room at Concord Hospital last month. “I’d rather be dead than be stuck with that.”
Torres went into the hospital in Lancaster on Dec. 4 after days of coughing and urinating blood.
Doctors soon realized his condition was serious: He had anemia, a serious respiratory infection and his kidneys were failing. He needed to be transferred to another hospital.
Torres doesn’t remember much of the ambulance ride to Concord, but said when he woke up there he felt lost and in a haze.
Torres could see nurses and doctors moving around him, but when he tried to call out to them for help, no words came out. Their movements were stiff and robotic, and he said it felt like everything around him was puzzle-like and disjointed.
“It was like I was stuck in between two worlds,” Torres said. “It was like a movie, but it bounced around; there were no certain steps to it. It was on play, but it re-winded, but it kept bouncing back and forth, back and forth.”
He also said sound was amplified; he could feel it like vibrations throughout his body. He had no sense of time – two minutes felt like four hours.
Torres said the only time he would feel grounded at all was when he would close his eyes. Then, the hallucinations and the sounds would fade.
But he was afraid to sleep. He thought he might not wake up.
“I was stuck in this bad nightmare, like Alfred Hitchcock,” he said.
Despite the immense fear he felt, Torres didn’t want to talk about his condition.
“I thought they were going to lock me up in a psych ward,” he said.
But nurses noticed the signs that something more serious was wrong with him.
“He was hyper-alert, in an excited state, anxious, nervous. He couldn’t concentrate, he couldn’t focus. He was scared and not able to pay attention,” said Dana Bisson, a delirium nurse specialist at Concord Hospital.
Bisson said she knew right away he was at risk.
Although delirium is most commonly seen in elderly patients, it can occur in younger people – even children – if the body experiences severe physiological stress, Bisson said.
Bisson took Torres’s hand and kneeled down so she could look him in the eyes.
“A lot of his fear was that he didn’t know what was going on with him,” Bisson said. “I’m not afraid to tell patients, ‘You have delirium. This is a real thing, and we can make it better – 100 percent.’ ”
Torres said he felt immediate relief.
“I didn’t know there was a word for how I was feeling,” he said.
The treatments for delirium are simple, but effective.
Most patients are not aware of time – and are either sleeping too much or too little. By correcting their sleep-wake cycle, making sure lights go off at 10 or 11 p.m., it helps their body get back into routine, Bisson said.
Another is face washing and mouth care, something that was effective with Torres. Bisson said many people don’t have an awareness of their face or body.
“The first thing you need to do is ground someone back into reality: ‘This is where my mouth is, this is where my face is, and this is where it isn’t,’ ” Bisson said.
Torres said this was one of the things that helped him the most. When he could do it on his own, he would sit with a stack of wash cloths.
Then, it’s important to make sure the patient is as mobile as they can be, whether that’s taking walks down the hallway a few times a day, or sitting up from resting at the edge of their hospital bed, Bisson said.
If a patient has glasses or hearing aids, nurses should make sure they are wearing them, Bisson said.
Other treatments that helped Torres were playing with cards and model magic clay.
Bisson said watching television can often make delirium worse, because the brain can’t keep up with what the patient is seeing on the screen or separate what they are seeing from what they are experiencing in reality.
Familiar music, provided by Concord Hospital’s Therapeutic Arts and Holistic Services Department, can often help.
Bisson said once hospital staff identify delirium in patients, it’s relatively easy to treat. But that can be difficult at times.
“It’s easy to recognize the hyper-active, agitated ones,” Bisson said. “But the ones that are more sleepy – it can be a lot harder.”
The hospital has created a Delirium Order Set for nurses to help them identify patients who might be at risk for developing delirium and a list of treatments once patients are diagnosed.
Most people who experience delirium are lethargic – around 87 percent, Bisson says – and she’s found they are less likely to remember the experience at all.
It is mainly scary for their loved ones, who watch them suffer.
But for those who do remember the experience – often the excited and agitated patients – it can be very traumatizing.
“For me, the fear is still there, so it’s not going away,” Torres said. “I’m still afraid of having procedures done, because I don’t want to experience what I experienced that day.”
He said one of the scariest parts of the experience was not knowing what was wrong with him.
“I wish I knew a phrase or a word or a coping technique that would have helped me at that point in time and know that I wasn’t losing my mind, and I wasn’t dead and I wasn’t crazy,” he said.
“People have got to be more informed and know that this happens, and it’s alright to speak about it and say something. You’re going through it, and it will get better.”