HOSPITAL

This is the story of a stay in hospital that should have been routine, but which in fact went off the rails.

One morning in December 1998 I found myself labouring to breathe. By the time my daughter took me to Emergency my fingernails were turning blue. It was found that I had pneumonia. As my lung capacity is limited to 1.5 liters (my brother has six liters) this was deemed serious. And so I was admitted to the Vancouver General Hospital.

At the end of the day I was taken to a ward with three other patients. Things went wrong from that moment, and I don’t know why. It had nothing to do with the staff or the hospital, it had all to do with some hitherto unknown pottiness in my makeup. I became alienated, an old word but more accurate than ‘crazy.’ Memory of these days is dim but I do know that in the small hours of the first day I was conscious, and I felt abandoned. There must have been a call button, a nurse would have shown it to me, explained its use. But I had forgotten, or I couldn’t find it, or I don’t know what. I now gaze with disbelief at the memory of what I did next. I looked around for a signal I could send to the nursing station. I found only a urinal, a kind of urn with a handle, welded together of stainless steel. It was a formidable flask, massively over-engineered, I should have thought, for something to contain at most a pint of piddle. Any rational person would perhaps have tapped this urinal discreetly on the floor to attract attention. Instead I deliberately flung it to the ceiling so that it fell to the terrazzo floor with a clang to awaken the dead. Attention and cries of reproach rapidly forthcame. This was the beginning of me as problem patient.

The day after this exploit I entered the Intensive Care Unit.

The moment I was there I began to hallucinate. If I lay with open eyes I saw the ward as it was. When they closed I saw a room almost filled with old wooden furniture. There were variants. Once I saw a specific stretch of pasture on the farm where I grew up.

Some necessary medical detail: When the breathing muscles of a patient are so weakened by pneumonia that breathing is compromised, a ventilator is brought to bear. It takes over the breathing by pumping air into the patient’s chest. This rests the muscles while the patient recovers. In certain cases, as in mine, the only way to attach this ventilator to the patient is to punch a hole in the windpipe and insert a curved plastic tube called a ‘trachaometer’, and breathing is done through this device.

Since the vocal cords are above this ‘trake,’ speech is no longer possible. All communication is by nodding or shaking the head or writing. One becomes a non-person. A further complication is that phlegm collects in the trake, and this must be siphoned out periodically. A tube is inserted in the trake until the patient gags and coughs it up to the point where the suction tube can reach it. Having other people poking about inside my own body would be bearable if it had all been explained to me; if I had seen a trake I could have visualized what was going on, and had it been explained that I could catch my breath through the ordeal of suctioning . . . But nobody explained anything, it was terrifying, I thought I was strangling.

Still, terrifying or not, there was no reason to act irrationally. Yet, my behaviour became totally bizarre. They said, charitably, that I was confused. Confused? I was demented.

This was at night. During the day I seem to have been lucid. I wrote endless notes to visitors. The nurses and therapists were unendingly cheerful and seemed to like me. I like medical people, they are so intelligent. And they do real work in the real world.

But the nights! The nights were a mixture of dream and delusion and real event, so interwoven that I still can’t sort them out. I know I was a trial to the nurses. One morning a polite little Chinese nurse just before she went off her shift explained reproachfully that I had made things hard for them during the night. Apparently they had found I had climbed out of bed and was starting to use the urinal, an ordinary plastic one this time. I don’t know why this was so wrong, but apparently they remonstrated, then grappled with me, with the result that I urinated all over them, all over myself and all over my bed. Everything had to be washed down. “Mister Greenaway, you were very bad.”

Every evening I felt a peculiar tension growing, an apprehension without a base, just . . . apprehension. The skin around the skull tightening, the digestion turned sour.

There were two major dreams.

I ‘knew’ our civilization was collapsing. Unspecified people were turning the world to anarchy and wreckage. My room in the Intensive Care Unit was the last refuge of civilization: I was alone in this room with my bed, the life-support machinery and my servant, an elderly woman who managed the machinery. I was surprised that she hadn’t gone off to join the wreckers. But no, she stayed on faithfully in the face of death. The 120-volt current never faltered, the ventilator bubbled away, the iv-drip dripped. I was not frightened, only fatalistic. It would come, it was only a matter of time. Inbreakage of the door, the lopped tubes spouting blood . . .

Another hallucination deserves to be recorded. From miles high on a mountain ridge I saw across a stupendous valley a smooth black rock-face with many irregular caries. These cavities were being filled in quickly with gold as I watched, and I knew that I myself was in one of these caves, preserved in gold.

The more persistent dream was of being lost in a wilderness and trying to find my way back to my bed in the I.C. Unit. I kept trying to get out of my bed to go and find the bed on which I was actually sleeping. And the staff kept stopping me of course. Over and over I was awoken by the rhetorical and deeply humijliating questions, “What are you DOING, Mr Greenaway?” “Where do you think you’re GOING, Mr Greenaway?” Unanswerable questions, even if I could talk. Was this one night? Ten nights? I cannot reconstruct.

Out of the confusion of those nights, half memory, half out-and-out delusion, there is a narrative that I find hard to come to terms with. There are two more or less factual events. In one, a nurse was suctioning me, and I panicked. It seemed to take forever, I felt I was strangling and went into some kind of convulsion. I could see, even in my distorted view of things, that the violence of my reaction startled and alarmed her. This, or some version of it, actually happened.

Somehow, in the toxic atmosphere of my mindset at the time I managed retrospectively to concatenate several events. I saw (and I can still see) the following scene, looking up at her from my supine patient position as though with an extreme wide-angle lens I see the malevolent face of the head nurse. The suctioning has ended, I am trying to get my breath back and protesting her roughness, she turns malevolent. Her face has the bared teeth, the rage-eyebrows of comic-book art. As punishment she ties my left wrist to the bed-frame with wire, I am so enraged that I try to bring my right hand to bear to break her wrist, but my right arm is being held by one of her stooges, an impassive man dressed in black. It is a battle between us. She is out to destroy me, and I intend to destroy her.

The fact is, I had to be restrained, tied down with straps. I have since read that at least a third of all patients in intensive care have psychotic interludes. All the same, it is humiliating to think I should make up this grotesque comedy out of whole cloth, based on nothing but a tired nurse near the end of a twelve-hour shift, having to deal with a sudden inexplicable tantrum during a routine hospital procedure.

Every night, as the light faded, I found the tension building. One night it became nearly insupportable. My son was there in the evening, and already this tension was so high I could scarcely write to him. The sourness spread from my belly into my muscular tissues until they felt saturated with battery acid. I felt somatically and spiritually foul. And yet, the event itself toward which this anguish pointed turned out to be anticlimactic: it was merely a recurrence of my epic, grotesquely comic dream\hallucination of being lost, trying to get back to my bed.

I was in a thicket of dense shrubbery. I became aware of a man near me in this bush taking things out of shallow drawers among the branches of a shrub, putting other things back. I was wary of him, because I ‘knew’ he was a communist agent. When he spoke, though, I was surprised that he spoke english. He asked, “Would you like me to suction you?” as polite as you please. Which he did, quite competently, he then turned and vanished.

And that final semi-hallucination—he was clearly a therapist or a male nurse—was the end of my irrational behaviour in the Intensive Care Unit of the Vancouver General. When I awoke all tension had vanished, and for good. Goodbye the notorious Mr. Greenaway, hello affable Tod.

The rest of the hospital stay was serene. The nurses were kind and amusing. The trake was removed so I could talk. The feeding tube was pulled out so I could eat. The food was better than people lead you to believe. Particularly soup. The hospital served the most superb clear vegetable soups. There was the clear song of the stock to be savoured for itself, and counter to this the flavours and textures of the onions and other vegetables. A polyphonic soup.

Now I face the long road to recovery. My self-confidence has taken a severe dent. I wonder about the doubts that come to me now: are they merely transient moods, as I think, due to the recovery process itself? Or are they harbingers of the future?

Summer 2005
The sombre mood of this piece faded, as can be seen in Loitering.

This was seven years ago and I have become increasingly aware of the extraordinary nature of my behavior and how it shamed me in the eyes of the medical people for whom I have the greatest respect and gratitude. This incursion of unreason into my life has come to trouble me deeply. I see that I have not read my life closely. I have skipped the bad parts. Now I have to go back and read the text, word for word.