Abstract
When you are mad, mad like this, you don't know it. Reality is what you see.
Marya Hornbacher, Madness: A Bipolar Life, 2009
“H
Mr. Jones paused and studied his imagined friend. “His eyes are big and bulging…and…and they turn like machine guns on a tank.” He closed his eyes trying to hide. “His eyes follow my eyes. They…they follow me all the time. He knows, he knows…” His voice trailed off.
Then he opened his eyes and started swinging his arms and pulling at his clothes. “I gotta get out of here. He's making a web…see it, it's in the corner. See it? He wants to stab me right in the gut, and then drag me to his web and…and…he wants to suck out all of my insides. But first, first, he wants to tease me like a trapped fly.”
Mr. Jones was dying and his thoughts were distorted. He was unable to distinguish the real from the unreal—he was delirious and afraid.
“Where is he Mr. Jones?” I asked.
“There, there on the wall. My God man, can't you see that monster?”
“No I can't Mr. Jones. I'm…”
“Damn you, are you blind you idiot? Am I talking to an idiot? See him? See him? Don't you have eyes?”
“Yes, now I see him, there he is. Mr. Jones, he looks friendly.”
“Friendly? Ha! He's waiting, just waiting. He's so patient, there's no calendar for him…he'll wait until the end, he wants me that bad.” He paused, grabbed the handrail of his rented hospital bed, and shook it as hard as he could. “Look at him…look at him, he smells me. There won't even be a funeral.”
I leaned over and gently touched his shoulder, but he blindly swung his arm, hitting me in the chest. “Get away!” he yelled. “Get away!” His eyes were wide with terror. His wife and three children stood beside as tears welled in their eyes.
“Daddy, there's no spider. It's just a spot on the wall.”
“What? You imbecile! It's there, a spider, climbing on the wall. Who the hell are you?”
“This is Betty. I'm your daughter Daddy.”
“My daughter?” For a moment the madness retreated, and his voice calmed. “My daughter?”
“Yes Daddy, Betty.”
Then he swung at the air again. “See that? There he goes, running up the wall. Look, look, see him? He's trying to get close to my head, then he'll drop down and smother me. I'm a goner.”
I noticed a long dark crack in the wall behind Mr. Jones' head, and feared he would think it was a spindle of web that would bring the spider, and death, ever closer—and he did.
He pointed to the crack. “See, I told you, he's coming down. See him? See him?” He cowered against the bed rail as his eyes darted back and forth. “He's moving fast now, he's coming for me…he's coming for me. Someone help me!” He grabbed his daughter's arm and squeezed with such strength she was reddened and bruised. His sons had to pry his hand loose.
I opened the emergency hospice kit, drew up some haloperidol, and injected it into his right arm. I did this three times over 30 minutes. Finally, after the third shot, he rested.
(Backstory: Delirium is a mixture of chaos and fear. This brief story illustrates the turbulent nature of delirium, and the terror it can exact upon both the patient and the family. Although the particulars of the story have been altered to protect the identities of the participants, the words are verbatim, and were recorded with permission. It truly was 30 minutes of madness.)